Managed Health Care Legislation Passed

The NYS Governor signed legislation which is a major first step in addressing several problems that physicians have had in dealing with reimbursement delays and credentialing. Provisions of this new law:

• Prohibit HMOs and other insurers from demanding refunds from a physician more than two years after the claim was initially paid. This provision does not include situations involving fraud or abusive billing. Some health plans have been known to demand refunds for claims that were paid up to six years back.
• Require 30 days notice to providers when the insurer is seeking a refund. Some HMOs have been known to merely offset the amount demanded against future payment owed to a physician with little or no notice.
• Require insurers to accept and initiate the processing of claims that are consistent with the AMA’s CPT codes, guidelines and conventions
• Require some “transparency” in how insurers determine reimbursement amount. Health plans will be required to provide the name of the commercially-available coding software they use.
• Require health plans to complete a provider’s application to join a panel within 90 days, except in cases where a third party has not provided the necessary documentation

National Melanoma/Skin Cancer Detection and Prevention Month

May is National Melanoma/Skin Cancer Detection and Prevention Month. The month is dedicated to increasing public awareness of the importance of skin cancer prevention, early detection, and treatment, including basal cell, squamous cell, and melanoma. According to the United States Cancer Statistics: 1999–2002 Incidence and Mortality Report, 44,582 new cases of malignant melanoma were diagnosed in this country in 2002, the most recent year for which statistics are currently available. That same year, melanomas of the skin claimed the lives of 7,513 Americans. Although death rates from basal cell and squamous cell carcinomas are low, these cancers can cause considerable damage and disfigurement if they are untreated. However, when detected early, approximately 95 percent of these carcinomas can be cured.

Exposure to the sun's ultraviolet (UV) rays appears to be the most important environmental factor involved in the development of skin cancer. When used consistently, sun-protective practices can prevent skin cancer. UV rays from artificial sources of light, such as tanning beds and sunlamps, are as dangerous as those from the sun and should also be avoided. Although both tanning and burning can increase a person's risk for skin cancer, most Americans do not consistently protect themselves from UV rays. A survey sponsored by the Centers for Disease Control and Prevention (CDC) found that approximately 43% of white children under age 12 had at least one sunburn during the past year.

Use the following link to locate a Skin Cancer Screening Facility near you:
www.aad.org/public/SkinCancerScreenings/skincancerscreen.htm

The Risks when getting a tattoo or a body piercing

Certain risks do exist if instruments contaminated with blood are either not sterilized or disinfected or are used inappropriately between clients. It is recommended that instruments that are intended to penetrate the skin be used once, then disposed of or thoroughly cleaned and sterilized between clients.

Personal service workers who do tattooing or body piercing should be educated about how to prevent transmission of blood-borne infections (e.g., HBV, HCV, or HIV) are transmitted and take precautions in their settings.

If you are considering getting a tattoo or having your body pierced, ask staff at the establishment what procedures they use to prevent the spread of blood-borne infections, such as the hepatitis B virus.