WMR Writes:
If you wish to control your future this would be required reading. It is an example of why Medicos will be funding TMA membership for incoming fellows and faculty. We have never received this kind of support from the Tenn AAFP. But, we hope to change that beginning with the May 18 meeting..
You have previously received Medicos' analysis of medicaid underfunding for vaccines, IUD's, PCN, ESSURE, and office based ultrasound services. This now includes all office surgeries, injectable antibiotics and insulin. This is part of the reason patients are being driven to use the ER for their care.
Basically, the government is nationalizing these services by subsidizing them only in government clinics. Others cannot compete. This creates a monopoly. To survive, doctors need to develop these services bundled with other services to remain viable. Medicos is a health services research laboratory seekiing the antidote to taught helplessness. We are among the minority that pays taxes. A family medicine ACO may be one solution. To be discussed at the May 18 meeting.
The insurance regulations are so complex that private practice doctors lack tiime to read them and employee doctors never see the mail. Medicos is developing policies to counteract these disincentives.
WE will start with distribution of common fee schedules at the May 18, 2011 Memphis FP meeting.
UPDATE: BCBST Extends Deadline Until May 23 for Amendment Agreements
Update - The TMA has received word that BCBST has extended the deadline for your decision on the contract amendment referenced in a correspondence dated March 23.
The new deadline for reponse is May 23.
Organized medicine works! The change is a direct result of a meeting between the TMA board and Dr. Robert Mandel, BCBST Sr. VP, Health Care Services. TMA members should watch for more information from BlueCross BlueShield of Tennessee (BCBST).
The amendments affect your contracted fee schedule for Networks P and S and are time sensitive, with your response due by May 23.
Physicians have three options:
1. Accept the amendment in writing on or before May 23;
2. Take no action, in which case the amendments will be deemed accepted; or
3. Reject the amendments in writing, in which case BCBST has the option of terminating you from the networks
Background
The letter accompanying the amendments indicates that your current fee schedule is linked to CMS methodology for Medicare reimbursement. When CMS tinkers with its reimbursement formula, it affects your BCBST reimbursement. The letter outlines two previous years where CMS adjustments to RVU or GPCI factors have resulted in physician reimbursement increases for physicians. On April 1, 2011, another CMS adjustment resulted in a payment increase that averaged six percent for physicians. The letter states that BCBST cannot pass the six-percent increase on to its customers.
The effects of these amendments -- if you accept them -- will be:
You will receive, on average, a six-percent increase until June 23, 2011
On June 23, your reimbursement rate will revert to last year’s rate (the rate effective on March 31, 2011)
If CMS adjustments to its reimbursement methodology result in Medicare reimbursement increases or decreases in the future, your BCBST Network S and P reimbursement rate may remain at the rate in effect on March 31, 2011
TMA members should already have received the letter with contract amendments. If not, you should contact your BCBST provider representative or local BCBST office immediately. Again, this is time-sensitive material.
Read the letter and amendments.
The TMA cannot advise members as to whether to accept or reject the BCBST contract amendments. Each practice must carefully evaluate how the amendments would affect your bottom line and decide whether to accept the amendment or try to negotiate an alternative if you have leverage due to specialty or location.
For more information, contact the TMA Legal Department at 800-659-1862.
Index--Fellowship curriculum, practice management, funding the mission
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