American College of Cardiology

Medicare, All Blues Plans to Accept Legacy Claims After Oct. 16
The Centers for Medicare and Medicaid Services (CMS) and all Blue Cross and Blue Shield plans will accept electronic transactions that are not compliant with the HIPAA transaction and code set standards regulations after the Oct. 16, 2003, compliance deadline. The ACC has been working closely with a number of physician specialty societies and other provider organizations to encourage the CMS and health plans to take this step. According to a CMS news release, the agency implemented its contingency plan after a review found that less than 15 percent of compliant claims were being submitted. According to a Blue Cross and Blue Shield Association news release, each of the 42 Blues plans across the country will determine how long after Oct. 16 they will continue to accept noncompliant claims. For more information on this issue, visit the HIPAA resource center on the ACC Web site.

Medicare Reform Debate Continues Down Rocky Path, At Risk of Failing
Members of the House-Senate conference committee debating Medicare reform legislation have set Oct. 17 as a deadline to produce a compromise bill. Numerous reports indicate, however, that a compromise may be impossible. Democrats and Republicans continue to be at odds over how the centerpiece of the package—a prescription drug benefit—should work, and rifts within the Republican ranks also are proving to be problematic. In fact, 13 House Republicans sent a letter to Speaker of the House Dennis Hastert, R-Ill., with a listing of provisions that any Medicare reform package must have if they are to vote for it. Some of those provisions, including one that would require the Medicare program to compete directly with private health plans by the end of the decade, have already been characterized by Democrats as nonstarters.

ACC Keeps Pressure on Legislators to Address Medicare Fees, Members Urged to Act
In related news, the College continues to work on its own and with the Alliance of Specialty Medicine, of which the College is a member, to pressure Congress to prevent 2004 Medicare fees from being cut. As previously reported, the House-passed Medicare reform bill contains provisions that would replace a 4.2 percent cut in 2004 Medicare fees with a 1.5 percent increase. As part of its lobbying efforts, the Alliance is publishing an advertisement this week in Roll Call, the most widely read daily publication on Capitol Hill, urging Congress to act. Also, on September 11, ACC President Carl J. Pepine, MD, issued an alert via email and fax to all College members asking them to contact their members of Congress on this issue.

FDA Could Regulate Tobacco Under Senate Bill
A bill being considered by the Senate Health, Education, Labor, and Pensions Committee would give the FDA the authority to regulate tobacco products—something for which the ACC has long advocated. The legislation is being championed by the committee’s chair, Judd Gregg, R-NH, and Mike DeWine, R-Ohio. According to an Associated Press report, under the bill, the FDA would have the authority to order a cigarette manufacture to completely remove nicotine from its products. “It’s ridiculous to have food products regulated, and the FDA has no authority over a very dangerous product,” Sen. DeWine said.

Health Insurance Trade Organizations to Merge
The boards of the American Association of Health Plans (AAHP) and Health Insurance Association of America (HIAA), the two biggest trade groups in the health insurance industry, have approved a merger. Combined, the organizations’ members represent 1,500 health plans that cover more than 200 million Americans. The new organization will be headed by AAHP CEO Karen Ignani. “On every piece of legislation one can make a strong case that having one voice representing our constituency is always better than having two voices,” Ignani told The Hill, a Capitol Hill publication.

CMS Weighing Tying Facility Reimbursement to Registry Participation
Under a plan being considered by the CMS, medical centers and other facilities would be required to participate in some post-market registries of new devices to receive reimbursement for procedures involving the devices. According to a Health News Daily report, CMS officials said that such a requirement would help to identify issues that arise with new technologies, especially as the CMS continues to receive requests to cover off-label indications for new devices, such as drug-eluting stents. “The agency is extremely interested in how we [could] become players, or stimulators, of collections of data,” Steve Phurrough, MD, director of the Coverage and Analysis Group at CMS, said during an FDA town hall at the recent TCT conference.

Aetna Launches New Web-Based Tool for Claims Processing
Aetna, one of the nation’s largest health insurers, has introduced a new Internet-based tool that allows providers to see how the billing codes submitted for payment will be handled by Aetna’s claims-processing system. The new tool—called Clear Claim Connection and developed by McKesson Information Solutions—is available to all physicians in Aetna’s network. “The claims-payment system has been a major source of tension between health plans and physicians for years, and this new tool should eliminate surprises in the way bills are processed,” William C. Popik, MD, Aetna’s chief medical officer, said in a news release. The new tool’s launch is part of a $170 million settlement of a class-action lawsuit between Aetna and 17 state medical societies.

Another Major Liability Carrier Exits the Market
The Farmers Insurance Group is getting out of the medical liability insurance market, the company has announced. Farmers has already stopped writing new medical liability policies, the insurer noted in a news release, “and will begin the process to nonrenew existing business beginning Jan. 1, 2004.” Farmers writes medical liability policies in 18 states. A spokesperson for the insurer told the Associated Press that “significant underwriting losses”—including a $100 million loss in 2002—were a primary driver of the decision.

Correction
In last week’s Advocacy Weekly, it was incorrectly reported that the Texas state legislature had recently passed a bill that caps noneconomic damages in medical liability cases at $750,000. The legislation actually provided for a $250,000 cap on noneconomic damages per provider named in a liability suit, with a total cap on noneconomic damages of $750,000 per suit.