195.000 MEDICARE

POSITION STATEMENTS

195.000 MEDICARE

195.000 MEDICARE

195.905 MSSNY Supports the AMA Work to Improve Medicare

The Medical Society of the State of New York supports the American Medical Association in its work to eliminate Medical Advantage plans and use the savings to better pay healthcare providers and provide better benefits to patients. (HOD 2024 – 68)

195.906 Medicare “Dis” Advantage

The Medical Society of the State of New York work with the American Medical Association to urge that CMS continue to investigate and prevent misleading information in the marketing of Medicare Advantage plans; and that the Medical Society of the State of New York work with the American Medical Association to urge that CMS and other relevant federal agencies investigate “shared savings” programs used by Medicare Advantage plans to determine if such programs create inappropriate incentives that result in reduced necessary testing, services, and medications for Medicare enrollees, or whether such MA plans are engaging in other impermissible or illegal activities. (HOD 2024 – 67)

195.907 Medicare Coverage for Non-Par Physicians

The Medical Society of the State of New York will work with the AMA to support federal legislation that would provide Medicare enrollees with the ability to receive partial reimbursement towards the cost of receiving treatment from the physician of their choice, regardless of whether that physician participates in Medicare; and that the New York delegation to the AMA advance a similar resolution at the next AMA Annual meeting. (HOD 2024 – 65)

195.908 Payment by Medicare Secondary or Supplemental Plans

MSSNY will advocate that New York State enact legislation that would mandate that all health plans, compliant with the Rutledge ruling Rutledge v. PCMA, cover Medicare secondary claims regardless of the provider participating in the secondary health plan.

MSSNY will advocate that the AMA advocates national legislation that would mandate that all health plans cover Medicare secondary claims regardless of the provider participating in the secondary health plan.

The AMA will report on the status of this resolution and policies H-390.839 and D-390.984 at the 2025 Annual Meeting. (HOD 2024 – 263)

195.909 Lack Of Access To Standard Of Care, Opioid Sparing, Evidenced Based Interventional Treatments For Chronic Pain In Medicaid Beneficiaries

MSSNY will develop a policy stating that managed Medicaid administrative reform which requires private administrators to follow Medicare NCD (National Coverage Determinants)/LCD (Local Coverage Determinants) guidelines for coverage determinations among Medicaid beneficiaries and prohibits them to alter/misinterpret these published guidelines. (HOD 2023-256)

195.910 Medicare Advantage Plan Transparency

The Medical Society of New York advocates that the AMA supports legislation and administrative rulemaking that would prohibit the use of the term “Medicare” for a private insurance entity for health care and support legislation such as the “Save Medicare Act” and similar legislative efforts.

The Medical Society of New York also advocates that the AMA supports legislation and administrative rulemaking that would educate consumers about the restrictions of hospitals, doctors, long–term care, and medications in these plans, often limiting continued care with their existing physicians or other health care providers.

The Medical Society of New York also urges the AMA to advocate for legislation and regulatory rules that require all such plans to provide corrective advertising to show that they are restricting and limiting healthcare choices, including hospitals and long–term care and rehabilitation facilities, and physicians and limiting medications, in the interest of corporate profit. (HOD 2023-250)

195.911 Care Management and Social Workers

MSSNY will advocate for legislation that requires private insurers, Medicaid Managed Care Plans, and Medicare Advantage Plans to have both care managers and social workers assigned to provide services to all patients enrolled in their plans. MSSNY will also advocate for legislation that requires private insurers, Medicaid Managed Care Plans, and Medicare Advantage Plans to compensate physicians whose practices administer care management and/or social workers services to patients enrolled in their plans. A copy of this resolution will be sent to the American Medical Association for consideration at its next House of Delegates. (HOD 2022-111; referred to Council; substitute adopted by Council 3/13/23).

195.912 CMS Innovation Projects

MSSNY will work with the AMA to continue to advocate against mandatory participation in Centers for Medicare and Medicaid Innovation (CMMI) demonstration projects, and advocate for CMMI instead to focus on the development of voluntary pilot projects. MSSNY and the AMA will advocate to ensure that any CMMI project that requires physician and/or patient participation be required to be approved by Congress. (HOD 2022-256)

195.913 Medicare Advantage Plan Mandates

MSSNY will pursue advocacy by the AMA for federal legislation which ensures that no person should be mandated to change from traditional Medicare to Medicare Advantage (MA) plans. (HOD 2021-106)

195.914 Stark Law Revision

MSSNY will continue to work with the American Medical Association and the federation of medicine in support of legislation or regulation to relax Stark Anti-referral prohibitions that negatively impact upon the ability of physicians to improve care accessibility and quality for patients. (HOD 2019-74)

195.915 Reimbursement for Care of Practice Partner Relatives

MSSNY will support changes in the Medicare guidelines to allow a physician, who is a partner in the practice, to care for and receive appropriate reimbursement for immediate relatives of one of the other partners in their practice. MSSNY will urge and partner with the AMA to amend the current Medicare guidelines, to allow a physician, who is a partner in the practice, to care for and receive appropriate reimbursement for immediate relatives of one of the other partners in their practice. (HOD 2019-269)

195.916 Raising Medicare Rates for Physicians

MSSNY will advocate strongly for raising the Medicare Fee Schedules for physicians and will also ask the AMA to advocate for raising the Medicare Fee Schedules. (HOD 2019-268)

195.917 Value Based Payment System

The Medical Society of the State of New York will continue to advocate state and federal policymakers for a reduction in the administrative burdens of complying with value-based programs as well as ensuring that these programs comply with evidence-based standards of care. (HOD 2018-52)

195.918 Ensuring Medicare Coverage for Long Term Care

The Medical Society of the State of New York supports increasing the existing 20-day limit of full Medicare coverage for a patient’s skilled nursing facility stay and will work with the American Medical Association to identify mechanisms by which the additional costs for this care can be fairly covered. This resolution will be sent to the AMA. (HOD 2018-51)

195.919 Reduce Physician Practice Administrative Burden

The Medical Society of the State of New York will work with the AMA and the federation of medicine to repeal the law that conditions a portion of a physician’s Medicare payment on compliance with the Medicare Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM) programs. Should full repeal not be achievable, the Medical Society of the State of New York will work with the AMA and the federation of medicine to advocate for legislation and/or regulation which would significantly reduce the administrative burdens and penalties associated with compliance with the MIPS and APM programs. The New York delegation will introduce a resolution at the June AMA House of Delegates meeting calling for similar action.

The New York delegation to the American Medical Association will introduce a resolution at the next AMA Annual House of Delegates meeting advocating for the repeal of the Medicare Merit-Based Incentive Payment System (MIPS) and replacement with 1) a practicing physician-designed program that has far less administrative burdens and 2) only adopts measures that have been shown to measurably improve patient outcomes. (HOD 2017-54; reaffirmed HOD 2018-52; Amended and reaffirmed HOD 2024-66)

195.920 Elimination of the Medicare Face-to-Face Requirement

The Medical Society of the State of New York will work with the AMA to advocate simplification of the Medicare requirements for a “Face to Face” visit by a physician with a patient as a precondition for Medicare home health coverage, including advocating for alternatives for such “face to face” visits such as by telehealth. This resolution will be forwarded to the 2017 AMA House of Delegates. (HOD 2017-50)

195.921 Discrimination Against Patients in Medicare Advantage Organizations

The Medical Society of the State of New York, on behalf of the patients of New York, objects to the behavior of Medicare Advantage Plans that disregard the law (42 CFR 422.101 (a)) which requires all Medicare Advantage Plans meet or exceed the benefits covered by Medicare Part B in the geographic area. MSSNY will request that CMS enforce this law and hold Medicare Advantage Plans financially responsible for the required coverage. (HOD 2017-262)

195.922 Seamless Conversion and Medicare Advantage Plans

The Medical Society of the State of New York will prepare a simple, easy to read modifiable model letter for physician members to provide their Medicare enrollees and a poster which can be downloaded for printing by physicians for their offices. MSSNY will work with appropriate stakeholders to collaborate with senior groups, including the AARP, to raise awareness among physicians and seniors on the implications of the practice of seamless conversion and to advocate with legislators and CMS to implement an immediate moratorium on the practice of seamless conversion. This resolution will also be submitted to the AMA for its consideration. (Adopted Council 9/15/16)

195.923 CMS Revalidation of Medicare Billing Privileges

The Medical Society of the State of New York (MSSNY) will advocate that the Centers for Medicare and Medicaid Services (CMS) adopt the practice of sending revalidation notices to physicians using certified mail with return receipt, thus ensuring that such notices are actually sent by CMS and received by the physician; and that the New York delegation to the American Medical Association submit this resolution to the AMA House of Delegates Annual 2016 Meeting urging similar advocacy by the American Medical Association. (HOD 2016-269)

195.924 Statute of Limitations for Medicare and RAC “Lookbacks”

The Medical Society of the State of New York (MSSNY) will ask the AMA to work with Medicare to reduce the “Lookback” period to be no longer than the length of time allowed to submit a claim for consideration. (HOD 2016-267)

195.925 Medicare Advantage Plans and Delayed Claim Payments ue to System Issues

The Medical Society of the State of New York (MSSNY) will urge the Centers for Medicare and Medicaid Services (CMS) to create specific, concrete guidelines applicable to any Medicare Advantage Plan (MAP) which has a “transition” of its system, or update of its claims processing system that could harm physician practices financially.

Any such guidelines from the Centers for Medicare and Medicaid Services (CMS) will impose punitive penalties (including payment of interest on delayed claim payments, and additional corrective actions), when an insurer’s “transition” of its system, and/or update of its claims-processing system, has led to (A) significantly delayed claim payments beyond the 30 days required by most contracts with Medicare Advantage Plans (MAPs); (B) improper adjudication of previously paid claims; and/or (C) improper denials followed by overpayment recoveries

As part of CMS’s punitive penalties and corrective actions, The Centers for Medicare and Medicaid Services (CMS), will require that any Medicare Advantage Plan (MAP) which has modified its system or updated its claim processing system should establish special service units, dedicated to resolving disputes and paying properly whenever the MAP’s system changes have led to (A) significantly delayed claim payments; (B) improper adjudication of previously paid claims; and/or (C) improper denials and then subsequent overpayment recoveries. (HOD 2016-266)

195.926 Inclusion of Disclaimer with Advertised Products

The Medical Society of the State of New York will seek legislation requiring inclusion of a clearly defined “disclaimer” identifying Medicare’s policy about “Reasonable Useful Lifetime” (RUL), (which ranges from 5 years to a lifetime benefit), in television and print commercial advertisements which claim to provide Durable Medical Equipment (DME) (e.g., back braces) with minimal or no out-of-pocket costs to Medicare beneficiaries, so that beneficiaries may make an informed and intelligent decision prior to ordering any “free” products. (HOD 2016-210)

195.927 Support Tax Policies That Encourage Work by Older Americans

The Medical Society of the State of New York will request that the American Medical Association seek legislation to stop the practice by the federal government of deducting Medicare Part B coverage costs from the Social Security checks of retirees, as well as from salaries individuals may earn after they draw on social security benefits. (HOD 2016-207 adopted with title change)

195.928 Point of Care Availability for Blood Glucose Testing

The Medical Society of the State of New York will call on the AMA to work with Centers for Medicare and Medicaid in order to maintain the CLIA exempt status of point of care glucose testing. (HOD 2014-252; Reaffirmed HOD 2024)

195.929 CMS “Two Midnight” Policy

The Medical Society of the State of New York will ask the AMA to demand that the Centers for Medicare and Medicaid educate the public and produce documents that outline the potential negative financial consequences of the “two midnight” policy. (HOD 2014-255; Reaffirmed HOD 2024)

195.930 Medicare Advantage Terminations Due to the Affordable Healthcare Act (ACA)

The Medical Society of the State of New York supports the information contained in the proposed rule by CMS, and supported by Congress, which states that Medicare Advantage Organizations notify their respective CMS Regional Account Managers no less than 90 (ninety) days prior to the effective date of planned termination(s) and MSSNY also supports CMS’ belief that their approach and expectations described in the proposed rule will promote a more structured, efficient process that will minimize confusion and disruption for Medicare Advantage Organizations, enrollee care, providers and CMS. (HOD 2014-256; Reaffirmed HOD 2024)

195.931 Application of Debt Collection Improvement Act of 1996

The Medical Society of New York will urge the American Medical Association to advocate for changes to the Debt Collection Improvement Act of 1996 so that CMS will be exempt from having to report to the Department of Treasury an outstanding debt arising from a Medicare/Medicaid overpayment when such original overpayment is $25 or less. (HOD 2014-63; Reaffirmed HOD 2024)

195.932: Medicare’s Non-Existent Relationship to Usual and Customary

MSSNY takes the position that there is no relationship between the Medicare fee schedule and Usual & Customary Fees, and requests that the MSSNY delegation to the AMA introduce a similar resolution at the next meeting of the AMA House of Delegates. (HOD 2013-253; Reaffirmed HOD 2023)

195.933: Extrapolation by Medicare Recovery Audit Contractors (RACs)

MSSNY will urge the American Medical Association to petition the Centers for Medicare and Medicaid Services (CMS) to amend CMS’s rules governing the use of extrapolation in the Recovery Audit Contractor (RAC) audit process, so that the amended CMS rules conform to Section 1893 of the Social Security Act – Subsection (f) (3) – Limitation on Use of Extrapolation. MSSNY will insist that the amended rules state that when a RAC initially contacts a physician, the RAC is not permitted to use extrapolation to determine overpayment amounts to be recovered from that physician by recoupment, offset, or otherwise, unless (as per Section 1893 of the Social Security Act) the Secretary of Health and Human Services has already determined, before the RAC audit, either that (a) previous, routine pre– or post–payment audits of the physician’s claims by the Medicare Administrative Contractor have found a sustained or high level of previous payment errors; or that (b) documented educational intervention has failed to correct those payment errors. (HOD 2013-251; Reaffirmed HOD 2023)

195.934: Unfunded Mandates Under the Medicare Program

MSSNY will 1) petition the New York Congressional delegation to urge the Centers for Medicare and Medicaid Services (CMS) to include in its proposed and final rule process, a cost–benefit analysis – using accepted actuarial and accounting standards – for any proposed or final mandate that would require physicians to incur costs; and will urge CMS to allow physicians and/or physician groups to claim an exemption if the cost–benefit analysis shows that compliance would cause significant financial hardship, or if the analysis shows that compliance would not be cost effective for the practice. (HOD 2013-250; Reaffirmed HOD 2023)

195.935 Prevention of Access to Care Crisis—SGR Fix: SUNSET HOD 2022

195.936 Medicare Denial of Diagnosis Pre-Op for Testing

The Medical Society of the State of New York will work with National Government Services (NGS) Medicare to clarify the local coverage determination with regard to Medicare coverage of diagnostic services required in advance of any operative procedure. (HOD 2012-262; Reaffirmed HOD 2022)

195.937 Medicare Re-Determination Online: SUNSET HOD 2022

195.938 Abuse of Medicare as Secondary Payer

The Medical Society of the State of New York will educate its membership regarding proper billing protocols for other liability matters in Medicare Secondary Payer situations. (HOD 2012-264; Reaffirmed HOD 2022)

195.939 Primary/Secondary Insurance Billing Training Manual

The Medical Society of the State of New York will expand its “Medicare as Secondary Payer” member training manual to reflect the many new complexities of the third–party insurance billing environment, including:
• new governmental and/or contractually determined billing rules,
• new physician participation options,
• broader overview of primary/secondary payment and billing policy (both governmental and contractually determined), and
• a specific focus on the rights that physicians enjoy, and the limits with which they must comply, with regard to (1) the submission of claims to governmental and private insurers and (2) the balance billing of private or managed care patients. (HOD 2012-265; Reaffirmed HOD 2022)

195.941 Opposition to CMS 10-Year Overpayment Lookback: SUNSET HOD 2022

195.942 Procedures Where MACs Notify Physicians:

MSSNY will petition the Centers for Medicare & Medicaid Services to allow and appropriately budget Medicare Administrative Contractors (MACs) to expand their electronic mail notification procedures to include personalized e-mail alerts to physician practices that are candidates for Revalidation of their Enrollment information, so as to substantially decrease the volume of telephone calls and correspondence to the MAC service areas and help preclude the unnecessary revocation of physicians’ Medicare billing privileges. (HOD 2011-258; Reaffirmed HOD 2021)

195.943 The Need for a Resource Explaining Medicare Remittance Denials:

MSSNY will work with National Government Services (NGS) Medicare to compile a user friendly document that will aid physicians in rectifying disputed claims. (HOD 2011-257; Reaffirmed HOD 2021)

195.944 Reprocessing Claims Affected by the Patient Protection and Affordable Care Act and by 2010 Medicare Physician Fee Schedule Changes: SUNSET HOD 2021

195.945 NGS Systems Issues:

MSSNY should warn the Centers for Medicare & Medicaid Services (CMS) that in increasing instances, claims processed by the Multi-Carrier System are being denied, suspended or otherwise not paid due to technical errors by the System (e.g., the System may fail to properly read appropriate ICD-10 diagnosis codes, or may fail to calculate appropriate time frames for frequency screens), which have nothing to do with the way the physician submitted the claim. Also, MSSNY will petition CMS to set up a dedicated unit or contact at the Multi-Carrier System site, to respond to reports from the county and state medical societies and the specialty societies about erroneous claim denials due to technical errors by the System, and to quickly resolve these error reports. (HOD 2011-255; Amended and Reaffirmed HOD 2021)

195.946 Provider Enrollment Chain Ownership System (PECOS) Penalty Phase:

MSSNY will continue to urge the Centers for Medicare and Medicaid Services (CMS) to postpone the initiation of any penalty phase regarding PECOS enrollment until such time as the Medicare contractors no longer have a backlog in their processing of the enrollment applications. (HOD 2011-254; Reaffirmed HOD 2021)

195.947 National Government Services Should Re-Open Its Local Coverage Determinations Web Page: SUNSET HOD 2020

195.948 Reform of the Medicare Geographic Practice Cost Index (GPCI) System:

MSSNY will:

(1) advocate with the Centers for Medicare and Medicaid Services (CMS) and with the New York State Congressional Delegation for increases in physician fees in the Upstate New York Medicare Physician GPCI system that will benefit the communities and physicians of Upstate New York without adversely impacting other areas of the state;

(2) have its President appoint a committee to study and report on reform options for the Medicare Physician GPCI system that will not have an adverse impact on other areas of the state; and

(3) continue advocating to the New York Congressional Delegation for a meaningful increase in Medicare reimbursement that is consistent with increases in practice cost. (HOD 2010-50; Amended and reaffirmed HOD 2020)

195.949 National Government Services: SUNSET HOD 2019

195.950 National Government Services: SUNSET HOD 2019

195.951 Medicare Claims Processing Problems Under National Government Services:

MSSNY will educate its members about Medicare’s Advance Payment process, including submission requirements, restrictions and offset procedures that will affect future Medicare payments made when all corrections have been addressed and will work with the Centers for Medicare & Medicaid Services to improve patient access problems created for Medicare beneficiaries by reducing this and many other operational problems created for Medicare physicians. (HOD 2009-254; Reaffirmed HOD 2019)

195.952 Medicare Physician Payments:

MSSNY will ask the American Medical Association to interact with the Centers for Medicare & Medicaid Services (CMS) to ensure that any plan that CMS contracts with to provide a Medicare Advantage product be mandated to adhere to Medicare’s National Coverage Determinations (NCDs) and Local Coverage Determinations for their service areas. (HOD 2009-253; Reaffirmed HOD 2019)

195.953 Internet-Based Instant Messaging Program for Medicare Customer Care Contact Centers:

MSSNY will:

-urge the Centers for Medicare & Medicaid Services (CMS) to allocate a budget item allowing National Government Services (NGS – the Medicare Administrative Contractor for New York) to provide, through the NGS Customer Care Contact Center, an Internet-based instant messaging or live chat feature that would enable physicians to communicate with NGS in real time;

-stress to CMS that such a service would help physicians discuss and resolve critical questions related to claims processing, education, and other pressing issues;

-alert CMS and NGS to the existing precedent, namely, the “Live Chat” system now used by Empire Blue Cross Blue Shield/Wellpoint; and

-urge NGS to work with Empire to implement a similar system.

(HOD 2009-252; Reaffirmed HOD 2019)

195.954 On-Site PC-ACE and Electronic Claims Training for Physicians: SUNSET HOD 2019

195.955 Issues Handled by Medicare Telephone Reopening Units: SUNSET HOD 2019

195.956 Medicare Contractor-Based PQRI:

MSSNY urge the Centers for Medicare & Medicaid Services (CMS) to (a) intensify its Physician Quality Reporting Initiative (PQRI) training efforts via sessions at the Medicare Administrative Contractor (MAC) level, rather than via national conference calls at the CMS level; (b) require the MACs to set up specialty-specific seminars, addressing the PQRI measures that are unique to each specialty area; and (c) integrate a mechanism to provide timely feedback during the course of the reporting year to physicians. (HOD 2009-96; Reaffirmed HOD 2019)

195.957 Centers for Medicare and Medicaid Services’ Deadlines for Implementation of Changes, e.g. National Provider Identifier: (Council 3/03/08; SUNSET HOD 2018)

195.958 Support for Critical Opposition to the Impending Medicare Fee Reduction: (HOD 2008-266; SUNSET HOD 2018)

195.959 Home Infusion of Antibiotics: (HOD 2008-254; SUNSET HOD 2018)

195.960 Medicare Private Contracting Opt-Out Renewal Requirement: (HOD 2008-253; SUNSET HOD 2018)

195.961 Medicare Carrier Processing of Claims Involving Retired, Archived, or End Dated Local Coverage Determinations: (HOD 2008-252; SUNSET HOD 2018)

195.962 Undue and Burdensome Regulations Inflicted by Medicare Part D Pharmacy Benefit Plans:

MSSNY will work with the Medicare Part D pharmacy benefit plans to

(1) devise and expedite a process so that physicians may, in the proper practice of medicine, prescribe for doses and durations that are in the best interest of their patients and supported by the medical literature; and

(2) allow patients who demonstrate significant therapeutic benefit and stability on their current therapeutic regimes to continue such regimes as a covered benefit under their current Medicare Part D carrier without interference or interruption. (HOD 2008-251; Reaffirmed HOD 2018)

195.963 Difficulty Filing Medicare Claims: (HOD 2008-250; SUNSET HOD 2018)

195.964 Consumer Rights for Durable Medical Equipment: (HOD 2008-163; SUNSET HOD 2018)

195.965 Deadlines for Implementation of Changes:

MSSNY will submit a formal protest to the Centers for Medicare and Medicaid Services (CMS) urging CMS not to commit to hard deadlines for changes to be implemented; rather CMS should work toward a transition that does not adversely impact physician cash flow caused by systems problems that result in denied/rejected claims. (Council 3/3/08; Reaffirmed HOD 2018)

195.966 Interaction by the Medicare Part D Carriers with the Physician Community re Drug Dosages:

MSSNY will:

(1) advise the Regional Office of the Centers for Medicare and Medicaid Services (CMS) that physicians are very concerned with the manner in which the Medicare Part D carriers are interacting with the physician community regarding drug dosages. Physicians find utilization review activities that demand the completion of cumbersome forms and submission of chart notes unwarranted and believe that these activities interfere with the practice of medicine; and

(2) urge the CMS Regional Office to re-evaluate the manner in which their Medicare Part D carriers interact with the physician community and instruct their Medicare Part D carriers that the dosage levels provided to the geriatric community for a variety of prescribed drugs often differ from the standard of FDA approved indications and/or therapeutic dosages. (Council 3/3/08; Reaffirmed HOD 2018)

195.967 Postponement of National Provider Identifier (NP195.966I) Implementation Date:
(Sunset HOD 2017)

195.968 Medicare Opt Out Physicians and Secondary Insurers:

In conjunction with the New York State Department of Financial Services, MSSNY will:

(1) draft legislation to develop and implement a mechanism to: a) require secondary insurers to identify Medicare opt out situations; b) allow physicians and patients who have executed a Medicare Opt Out agreement (yet still participate with the secondary private or managed care insurer) to have their claims processed correctly by making the secondary insurer primary as Medicare is no longer the primary insurer and no Medicare explanation of benefits exists; and

(2) draft legislation to: a) identify Medicare Opt Out situations; and b) include the requirement that the secondary insurer access the Medicare fee schedules posted on the carrier websites in order for the secondary insurer to calculate their payment responsibility in the event that present insurance law cannot be changed and the secondary insurer can reduce the benefit paid based on what Medicare would have covered. (HOD 2007-250; Amended and Reaffirmed HOD 2017)

195.969 Herpes Zoster Vaccine and Medicare Payment: (Sunset HOD 2017)

195.970 Sustainable Growth Rate (SGR): SUNSET HOD 2022

195.971 Holding Medicare Payments: (Sunset HOD 2016)

195.972 Recovery Audit Contractor: (Council 9/22/05; SUNSET HOD 2015)

195.973 Repeal of Section 306 of the Medicare Modernization Act: (Council 3/14/05; SUNSET HOD 2015)

195.974 Medicare MCO’s, CMS Operational Policy Letter #46, and the Proposed Handover of the Medicare Program to Private and Managed Care : SUNSET HOD 2014

195.975 Medicare and ‘Off-Label’ Uses of Drugs:

MSSNY opposes the imposition of any limitation, including under the new Medicare “Part D” drug benefit, on the “off-label” prescribing practices of physicians, whether by statute, regulation or operating practice of any private contractor administering such benefit. (HOD 2004-67; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

195.976 Low Molecular Weight Heparin: SUNSET HOD 2023

195.977 Empire Medicare Services: Physical Medicine and Rehabilitation SUNSET HOD 2020

195.978 Removal of Benign Skin Lesions: Sunset HOD 2011

195.979 The Treatment of Pain: Sunset HOD 2011

195.980 Prescription Drug Benefit for Seniors: Sunset HOD 2011

195.981 Expansion of Medicare Coverage for Preventive Services: SUNSET HOD 2021

195.982 Elimination of $75.00 Charge for Purchase of Medicare E.D.E.N. Relay/Gold Software for Electronic Billing: SUNSET HOD 2014

195.983 Medicare “Fraud and Abuse”:

MSSNY will urge the appropriate federal and state agencies to acknowledge that the characterization of any billing errors as “fraud” to be libelous and offensive.

MSSNY objects to the heavy handed techniques of search and seizure, with guns drawn and without formal charges levied, as tactics of a totalitarian police state;

MSSNY will demand that Congressional inquiry address these concerns, which give the perception that the physicians are “GUILTY UNTIL PROVEN INNOCENT,” with open public hearings at the earliest opportunity.

MSSNY objects to and rejects “statistical analysis” that attempt to claim that a physician’s billing or practice is aberrant by use of flawed methodologies, and will advocate to stop the use and extrapolation of this data as “fraud and abuse.

MSSNY will seek legislation, in concert with the AMA, directing the Health Care Financing Administration (HCFA) to remove the notations of fraud reporting announcements from all mailings to Medicare beneficiaries in order to prevent erosion of the physician/patient relationship. (HOD 2000-255; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

195.984 Proposed CAC Policies: SUNSET HOD 2014

195.985 Repealing Restrictions on Private Medicare Contracting: SUNSET HOD 2024

195.987 Opposition To Limitations on Medicare Contracts:

MSSNY will support corrective legislation concerning the Section 4507 of the Balanced Budget Act to allow Medicare beneficiaries to enter into private contracts for provision of medical care without any significant preconditions being imposed either on the patient or on those providing the care. MSSNY will specifically seek to abolish the requirement that the physicians providing care under a private contract must forego participating in the Medicare program for two years. (HOD 1998-261; Reaffirmed HOD 00-82; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

195.988 Comparative Performance Reports (CPRs): SUNSET HOD 2014

195.990 Patient’s Choice In Continuing a Physician/Patient Relationship: SUNSET HOD 2014

195.991 Mandatory Enrollment of Medicare – Medicaid Patients in Managed Care Plans

MSSNY strongly opposes mandatory enrollment of Medicare-Medicaid patients in managed care plans, and will actively use any available means to prevent forced enrollment and will bring this resolution before the next American Medical Association House of Delegates to be adopted as an official policy of the American Medical Association. (HOD 1997-103; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

195.992 Beneficiary Identification System SUNSET HOD 2014

195.994 Electronic Paper Claims: SUNSET HOD 2014

195.995 Extrapolation Methodology in Medicare and Medicaid Postpayment Review:

MSSNY is:

(1) Petitioning the AMA to urge HCFA to adopt a policy that Medicare carriers just provide data which justify the statistical validity of their findings when any extrapolation technique is used in a Medicare post-payment audit and review process prior to any request for return of monies paid to physicians;

(2) Seeking statutory changes in the Medicare and Medicaid laws to prevent the application of the extrapolation methodology in order to ensure due process for physicians whose medical records and billing procedures are under review;

(3) Educating physicians in concert with local county medical societies about the potential abuses by Medicare and Medicaid administrators in carrying out reviews, and identifying legal resources which can be called upon by individual physicians for legal assistance and/or defense in cases of alleged Medicare/Medicaid fraud and abuse or overpayment. (HOD 1992-5 & 1992-76; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

195.996 Medical Necessity Determinations:

MSSNY is urging the Centers for Medicare and Medicaid Services to require Medicare carriers to provide physicians with the name and phone number of the physician responsible for making a determination as to the medical necessity in the initial letter of inquiry sent by the carriers. (Council 9/13/90; Reaffirmed 2009-259; Reaffirmed HOD 2019)

195.997 Fair Hearing: SUNSET HOD 2013

195.998 Mandatory Acceptance of Medicare Assignment as a Condition of Licensure/Re-licensure: SUNSET HOD 2013

195.999 Mandatory Acceptance of Medicare Assignment: SUNSET HOD 2024

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