New Jersey - Volume XII, Number 11 - November, 2003

UNITED HEALTHCARE REDUX

It was gratifying to see that United Healthcare felt compelled to respond to our recent Special Issue in which we disclosed their reporting of audited physicians to the State Board of Medical Examiners. The company's CEO sent a letter to each of its participating physicians in the aftermath of the article in an attempt to put a more physician-friendly spin on its latest assault on physicians. Despite the spin, the fact remains that United was unable to deny that it has been reporting physicians to the State Board. Now, United has launched another attack on practicing physicians. Participating physicians who have more than one area of specialty or who hold multiple boards have been told that they will be listed in the company's provider book under one specialty and only one specialty. KACS will explore possible remedies to this seemingly arbitrary decision. In the interim, physicians dealing with United Healthcare should be guided accordingly.

KACS NAMED COUNSEL TO BERGEN COUNTY MEDICAL SOCIETY

Kern Augustine is pleased to announce that it has been named Counsel to the Bergen County Medical Society. We look forward to working with Bergen County’s physicians.

WARNINGS AGAINST HIPAA COMPLACENCY; COMPLAINT MECHANISM IN PLACE FOR VIOLATORS

The New Jersey Department of Banking & Insurance (DOBI) is urging health care providers to immediately move to come into compliance with the transactions and code sets provisions of the Health Insurance Portability & Accountability Act (HIPAA). Payors’ contingency plans allow them to accept both non-HIPAA compliant and compliant electronic transactions after October 16, 2003, but this accommodation is expected to end soon. Recent tests demonstrated that an alarmingly high number of claims would not be paid if the standards were enforced today. Many physicians are finding vendors and payors to be the barrier to achieving compliance. The Office of HIPAA Standards, the enforcement component for HIPAA electronic transaction standards, is accepting complaints against entities whose actions impact the ability of a transaction to be accepted or processed. An electronic system, called ASET, at https://htct.hhs.gov, provides for on-line submission of complaints, or a written complaint form may be obtained at http://www.cms.hhs.gov/hipaa/hipaa2.

COMMUNICABLE DISEASE REPORTING RULES REVISED

The New Jersey Department of Health and Senior Services (DHSS) has simplified its communicable disease reporting rules by promulgating one complete list of diseases that all health care providers and institutional heads must report. Multiple, overlapping lists of reportable organisms or diseases had led to confusion, including physicians not providing patient information on cases where the laboratory reported a positive test result. DHSS also found that laboratory compliance with reporting requirements was lacking, especially in light of increased concern about bio-terrorism events and the advent of new emerging pathogens/infectious diseases. Information regarding the new requirements should soon be available at www.state.nj.us/health/cd/mdrepdis.pdf. Physicians are required to report their findings for diseases and conditions listed in the regulations. DHSS can take action against chronic violators, including referral to the State Board of Medical Examiners.   

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