techTuesday
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Sept. 17, 2013
The Mobile Movement: Technology on the Go
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Nov. 19, 2013
Patients, Physicians, and the Internet
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“Doctors will now have more transparency in their contracts.”
panies looking to buy or sell those rates must not only spell out each line of busi- ness in physicians’ contracts, but also get physicians’ line-item approval. “If you don’t have all of those ele- ments, you have not received express authority from the physician to sell a contract rate,” TMA Vice President for Medical Economics Lee Spangler said. Third parties wanting to access phy- sician rates also must comply with all of the other terms of that contract. He says the provision was an important pro- tection for physicians because “a lot of downstream entities were just taking the benefit of the contract rate without any of the obligations,” such as promises that physicians will receive a flow of patients within that network.
While the new law adds a significant level of transparency, it also requires some homework by physicians. New notice provisions in the law pro- vide timelines for transitioning to the new regulations without erasing exist- ing contracts. For new contracts created after Sept. 1, doctors must agree line by line to the arrangements offered and sign off on each one for the contract to be valid. For contracts in place before Sept. 1, physicians will begin receiving renewal letters detailing the various networks and fee schedules they originally signed up for and giving them a chance to ob- ject and opt out if they choose. Not all of those notices will show up in the mail- box on Sept. 1. The timing for the notice
44 TEXAS MEDICINE September 2013
for older contracts depends on the re- newal dates contained in those contracts. Physicians must respond to the no- tices within 60 days. If they don’t, they will have given their permission without saying anything, Mr. Spangler cautions. That means physicians must scruti- nize network contracts and pay atten- tion to which networks they are join- ing, he says. For instance, one contract may include a dozen lines of business. Although the new law requires some products to have separate signature lines, other coverage, such as workers’ compensation or discount card programs, does not have to be singled out, so phy- sicians should carefully review contract offers to make sure they exclude insur- ance products they don’t want. Mr. Reynolds adds that physician practices should be diligent about orga- nizing and maintaining those contracts and corresponding fee schedules and making that information easily avail- able to billing staff. Practices also should keep an account of which networks they contract with, not just where they send claims — often two different entities. Despite the legislative win, TMA’s work will continue as TDI develops rules on the registration process. The law is al- ready in effect, however, and companies must comply regardless of when those regulations materialize. Ms. Kolodzey says TMA will work with newly appointed TDI Commissioner Julia Rathgeber to ensure the rules es- tablish an effective registration process.
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