New Jersey - Volume VI, Number 10 - October, 1997

MOBILE DIAGNOSTIC TESTING SERVICES FOR CHIROPRACTIC PATIENTS GOVERNED BY MEDICAL BOARD'S RULE

As reported in our July 1997 Statlaw (Vol. VII, No. 7), a New Jersey Appellate Court recently ruled that Personal Injury Protection reimbursement is not available for medical diagnostic testing services that do not meet State Board of Medical Examiner's ("Medical Board") requirements. The State Supreme Court returned the case to the appeals court to review the provider's claim that, because the provider performed the majority of its services for chiropractors, its operations are governed by the State Board of Chiropractic Examiners rather than the Medical Board. The appeals court held that it is the nature of the health services performed rather than for whom the services are performed that determines which board's rules govern. Thus, for medical diagnostic testing, it is the Medical Board's rules which govern.

HMOs SIGN VOLUNTARY PROMPT PAYMENT AGREEMENT

At the urging of the Medical Society of New Jersey and others, ten New Jersey Health Maintenance Organizations (Aetna/US Healthcare; HMO Blue; CIGNA Health Care/CoMed HMO of NJ; HIP Health Plan of NJ; NYL Care Health Plans of New Jersey, Inc.; Oxford Health Plan; Physicians Health Services; Physicians Health Care Plan of New Jersey; Prudential Health Care and United Health Care of New Jersey, Inc ("HMOs") have signed a voluntary agreement requiring them to reimburse all "clean claims" submitted by a health care provider no later than 60 days from receiving the claim. "Clean claim" means a claim that has no defect or impropriety (including any lack of required substantiating documentation) or particular circumstance requiring special treatment that prevents timely payments from being made on the claim. Overdue payments will bear 10% interest and an HMO in breach of the agreement faces fines of up to $1,000 per violation. State regulations will soon make these requirements mandatory for all HMOs.

NJ MEDICAL BOARD ADDRESSES DELEGATION ISSUES AGAIN

The Medical Board is reviewing--and appears ready to support--legislation that would permit a physician assistant to prescribe in out-patient settings and to prescribe certain controlled dangerous substances. Regulations are also expected soon governing the tasks a physician can delegate to diagnostic radiation technologists and nuclear medicine technologists. The Medical Board also recently reviewed Aetna/U.S. Healthcare's policy on post-operative care of surgical patients between optometrists and ophthalmologists, and found the policy to be at odds with the Medical Board's policy that management of post-surgical care is the practice of medicine and, thus, the responsibility of the operating ophthalmologist, with only very limited involvement by optometrists in that aspect of patient care. Aetna/USHC has indicated that it will modify its policy accordingly.

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