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• Increase in coinsurance percentages; • Increase in deductibles or out-of pocket maximums more than 15 percent, plus an inflation adjustment;

• Increase in copays more than inflation, plus $5 or 15 percent;

• Elimination of benefits for a specific condition; • Decrease in the employer contribution by more than 5 percent below the rate on March 23, 2010; and

• New annual limits on benefits or reduction in existing ones.

As long as a plan retains its grandfathered status, it may

impose patient cost-sharing for preventive health services. Additionally, the Centers for Medicare & Medicaid Services

(CMS) removed cost sharing for some preventive services and provides for an annual personalized preventive care plan for Medicare patients. For more information, consult the CMS Preventive Services Quick Reference Chart online, www.cms .gov/Medicare/Prevention/PrevntionGenInfo/Downloads/ MPS_QuickReferenceChart_1.pdf. From a practice management perspective, Ms. Kinney rec- ommends physicians examine how the insurance plans they contract with and plans they’re considering contracting with address and pay for the new preventive care benefits. She says plans may not have to provide the coverage or may apply pa- tient cost sharing for preventive services delivered in a setting or by a physician that the plan considers out-of-network for particular services. She says physicians should find out wheth- er the plans they contract with consider them to be in network for some or all of the preventive care services. “It would be a good idea for physicians to start contract ne- gotiations with health plans two to three months before the plan renewal date,” she said. “Is That Health Plan Con-

tract Good for Your Practice?” is an on-demand webinar pre- sented by Ms. Kinney. The we- binar helps practices assess a plan contract’s effect on their bottom line and the impact of their contracting choices. It also features information about contract negotiation and poten- tial problems in managed care contracts. Ms. Kinney explains the im-

portance of examining contract profitability and payer mix as part of informed contract de- cision making in a medical practice. To access the webinar, visit https://texmed.inreachce .com. Look under Browse by, then On DemandWebinar.

24 TEXAS MEDICINE September 2012

Additionally, the American Medical Association launched

an online community to help physicians improve their con- tracting strategies. The Cutting-edge Contracting Group allows physicians, practice staff, and contract experts to connect and share tips, know-how, and resources about contracting with managed care organizations. To register to join the online com- munity, visit Ms. Kinney encourages TMA members to take advantage

of the association’s contract evaluation service. For $150, at- torney and accountant Michael Z. Stern will review a new or existing managed care contract for legal pitfalls and provisions that may alter or affect a medical practice. Physicians will re- ceive a written evaluation. For more information, contact Mr. Stern at (512) 469-9006

or, or the TMA Knowledge Center at (800) 880-7955 or “Out-of-network physicians would be wise to ask the plans

how they’re going to pay for preventive services,” Mr. Stern said. “When a physician is out of network, there’s generally no contractual agreement regarding fees or copays and deduct- ibles. Managed care companies could strong-arm physicians, and they could potentially be providing services under a plan for which they don’t know how they will be paid.” He cautions that with changes to the law under PPACA, physicians shouldn’t assume their managed care contracts will be the same when they come up for renewal. “Insurance companies may start implementing a lot of changes in their contracts with physicians. It’s probably a good idea for physicians to have their contracts reviewed by an at- torney when they renew,” Mr. Stern said. n


To help medical practices implement and enforce their own policies and procedures, TMA offers Policies & Procedures: A Guide for Medical Practices. A hard copy of the guide with customizable CD is $295 for members and $395 for nonmembers. The customizable CD alone is $255 for members and $355 for nonmembers. To order the guide, call the TMA Knowledge Center at (800) 880-7955 or e-mail Regina Williams, an Austin human resources attorney who consulted with TMA in developing the human resources portion of the guide, says a practice’s office manager or other human resources professional should obtain written proof that new employees received the guide and were told to read it, and conduct an orientation session. The same training and notification procedures should be required when the manual is updated, she says. Keep a written record of atten- dance and written proof employees received the revised policies.

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