• rss
  • facebook
  • twitter
  • linkedin

Practice Management Issues and Resources

State Issues and Developments

Local Coding & Reimbursement Issues

The AMA Private Sector Advocacy department has an online complaint form for logging in complaints about insurance companies.

United Health to "Unbundle" 99214 and 99215 - After years of blending CPT E/M codes 99214 and 99215, paying the same for both codes, UnitedHealthcare of New England is paying separate reimbursements for the two codes, effective March 2002. United announced this at a meeting with the Rhode Island Medical Society in April.

Recent Legislative/Regulatory Developments

HIPAA - The RI Medicare web site has a collection of articles on HIPAA.

Pain Assessment Regulations - the Department of Health has posted the final "Rules and Regulations Related to Pain Assessment." They became effective on May 29, 2003.

RI Health Department Reports on Health Plans - Several items on the state of health plans in Rhode Island are available at Rhode Island Department of Health Web site . They include performance reports on Rhode Island's commercial, Medicare, and Medicaid health plans.

Prompt Processing Law - the 2001 General Assembly passed a law that requires health plans to process insurance claims in a timely manner. Unlike "prompt payment" laws in other states, whose effectiveness have been hampered by disagreements over what constitutes a "clean claim," the Rhode Island law requires insurers to process a claim within thirty days. This means that the claim must be paid or denied with information on what additional data must be provided in order to make the claim "clean." Once the claim is "clean," the plan is required to pay providers within ten days following receipt of an electronic claim and twenty days following receipt of a written claim.

VA Shared Care Resources

The following resources are provided to assist physicians caring for patients who are also treated at the Veterans Administration Medical Center:

[PDF] Acrobat PDF format. Download Acrobat Reader software for free from Adobe. Problems with PDFs?