On the final day of HBMA’s 2017 Compliance Symposium, a few of us at The Valletta Group had the opportunity to meet with members of Congress to discuss various healthcare issues. It’s no secret that healthcare policy is currently in a state of volatility. In times of heated debate such as this, often only the most serious and divisive issues receive attention. Unfortunately, this can cause lesser-known, yet equally important issues to get overlooked.
Thus, the time is critical for RCM companies like ourselves to further relationships with our leaders and stand up for the policies that protect our clients and their patients. So when The Valletta Group and other HBMA members visited Capitol Hill, we spoke up for these lesser-known, bipartisan issues. These are the policies that help ensure a level playing field between insurance payers and physicians/patients.
Two of these issues are discussed below.
The Valletta Group’s Executive VP’s, Gilbert Johnston and Cal LaGroue, meet with United States Senator, Luther Strange.
The first issue concerns patient access to care. With the American Health Care Act (AHCA), insurance payers are lobbying to tightly control the network of physicians that patients will have access to under their selected insurance plans. With too strict of networks, access to certain specialists may not be possible for many patients.
The best way to combat this issue would be for the Centers for Medicare and Medicaid Services (CMS) to issue specific network adequacy standards, which insurance payers would have to abide by. These standards would require each network to include a reasonable number of both primary care physicians and specialists. To ensure that the number of physicians per network is adequate, a maximum patient wait-time standard could be introduced. Also, since physicians often change networks, it would be fair for insurance payers to give patients the option to openly change their health care plans in instances where their preferred physician leaves their network.
The second issue involves the administrative simplification regulations of HIPAA. Most individuals are familiar with the privacy regulations of Title II, but people often forget about the administrative simplification rules of Title I. The reason for this disparity comes down to who is tasked with enforcing these two sets of regulations. The privacy rules of Title II are enforced by the HHS Office of Civil Rights (OCR), while the administrative simplification regulations of Title I are enforced by the CMS. The problem is that the CMS is not actively enforcing Title I in the same manner as the OCR is with Title II.
The takeaway here is that physicians are being held to a very high standard when it comes to protecting the privacy of their patients. Meanwhile, insurance payers are not being held to the same standard when it comes to the administrative regulations of HIPAA Title I. No effective mechanism exists to ensure that payers perform the core aspects of their job in a manner that is reasonable and timely. Valletta and the HBMA argue that Congress should introduce mechanisms to ensure that the CMS properly enforces the regulations of HIPAA Title I going forward.
Beyond the issues discussed above, The Valletta Group understands the importance of building relationships with our elected officials. In an industry where policies change seemingly everyday, it’s important to partner with someone who can protect your interests and effectively prepare you for the future. Learn more about Valletta.
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