Notice If a website link within this document does not direct you to the appropriate information or website location, please contact Provider Services by telephone. The Provider Services directory is located on the last page of this document.
STAT Newsletter Volume 15 Third Quarter, 2009 Inside This Issue Credentialing and Recredentialing Through CAQH... 1 Paperless Claims... 2 Friendly Reminders... 2 Billing Bilateral and Multiple-Unit Procedures... 3 Preauthorization Reminders... 4 Sacroiliac Joint Arthrography and Injection... 5 Medical Services Protocol Updates... 6 Clinical Practice Guidelines... 12 Federal Mental Health Parity... 12 Health Care Reform... 14 Provider Telephone and Web Site Reference Guide... 15 Credentialing and Recredentialing Through CAQH As a reminder, as of August 1, 2009, providers are now required to enter their credentialing information (free of charge) into a secure, state-of-the-art data center at www.caqh.org. The CAQH provider-data collection service streamlines the initial application and recredentialing processes, reducing provider administrative burdens and costs. It offers health plans and networks real-time access to reliable provider information for claims processing, quality assurance and member services, such as directories and referrals. Providers submit data through CAQH and authorize health plans, as well as other organizations, to access the information. Periodic provider updates help ensure that the information is always current. The CAQH application meets the credentialing needs of health plans, hospitals and other health care organizations, as well as meeting all related standards for: Utilization Review Accreditation Commission (URAC) National Committee for Quality Assurance (NCQA) Joint Commission CAQH is supported by: American Medical Association American Academy of Family Physicians American College of Physicians America s Health Insurance Plans Medical Group Management Association National Association of Medical Staff Services If you have any questions regarding CAQH, please contact the Provider Enrollment Department at 1-716-887-7500. Page 1 0807C R2027 HN CC 5510
Paperless Claims a great savings opportunity for your practice! Did you know? The average cost for an office to submit a paper claim is $6.63. The average cost to submit the same claim electronically is about $2.90. By submitting electronically, there is a potential savings of $3.73 per claim! Documentation Some claims do require supporting documentation in the form of claim attachments; however, the majority of claims do not. As a reminder, the following attachments are not required when submitting claims: Referrals/Preauthorizations Prescriptions for supplies and/or physician orders Surgical consents Progress reports Radiology reports WNYHealtheNet screen prints Medicare Secondary EOBs (these claims should be billed electronically) Operative reports (exceptions listed) Invoices (exceptions listed) Modifiers (exceptions listed) If you have been submitting claims on paper because you have been including the attachments listed above, please submit them electronically no attachments are required (other than the exceptions noted). Coordination of Benefits Payers can also receive coordination of benefits (COB) detail electronically. If a Medicare Secondary Claim indicates that it has been crossed-over, please do not submit the claim to the payer. If you are unfamiliar with how to set this up, please contact your practice management system vendor for assistance. Remember, going electronic saves paper, time and money! Exceptions Modifiers: The use of the following modifiers requires documentation to be submitted: 22 Unusual procedural services 23 Unusual anesthesia 52 Reduced services 53 Discontinued procedure 62 Two surgeons 73 Discontinued outpatient procedure prior to anesthesia administration 74 Discontinued outpatient procedure after anesthesia administration 76 Repeat procedure by same physician 77 Repeat procedure by another physician 99 Multiple modifiers Unlisted Procedure Codes: Description of service, applicable documentation and invoices are required when an unlisted procedure code is used. Friendly Reminders When sending your patient for laboratory work, please list the most appropriate diagnosis on the orders. As of August 1, 2009, we no longer provide paper vouchers. If you have not already done so, please register for online vouchers with Payspan at www.payspanhealth.com. Always bill your usual and customary charges. Your charge should not be based on our fee schedule allowance. Billing your standard fee for a service helps reduce billing errors. In addition, if more than one insurance company has liability for a claim, your standard charge eliminates confusion and helps ensure proper payment. Page 2
Billing Bilateral and Multiple-Unit Procedures In accordance with Current Procedural Terminology (CPT) guidelines, bilateral procedures should be billed on one line only, utilizing modifier 50; enter one as 01 in the units field and bill your total bilateral charge. Bilateral billing examples: Bilateral breast reconstruction report as code 19357 with modifier 50 on one claim line with 01 in the units field. Bilateral lower and upper blepharoplasties report as: o 15820 with modifier 50 on the first claim line with 01 units o 15822 with modifier 50 on the second claim line with 01 units Note: For bilateral services, do not bill modifier LT/RT or any other site-specific modifier other than 50. Multiple procedures Separate billing is allowed for multiple procedures performed on the same day that add significant time or complexity and are not incidental or an integral part of the primary procedure. The primary procedure is reimbursed at the fee schedule amount; eligible secondary procedures are reimbursed at 50 percent. Multiple procedures that involve the same service performed more than once (such as CPT code 26100, arthrotomy of each carpometacarpal joint of the left hand), should be billed as five separate lines on the claim form along with the modifier 59 or the HCPCS individual digit modifiers on lines two through five in order to clarify that the additional lines are definitely separate services. Note: We will not recognize more than one unit of service per line for multiple procedures. Procedure code descriptions including more than one unit of service provided (such as code 95117, professional services for allergy immunotherapy, two or more injections, or code 96406, intralesional injections, more than seven lesions), are reported on one line with only one (01) unit. Final reimbursement is also determined after applying usual edits such as (but not limited to) preauthorization, cosmetic coverage and bundling. In addition, the member s contract must be active at the time the service is rendered. Exceptions When the CPT code description includes each additional (for example, code 63048, laminectomy, each additional cervical, thoracic, or lumbar segment), report the code on one line with the number of additional segments indicated in the units field. When the CPT code states specify number of tests, doses (such as code 95024, intradermal tests with allergenic extracts), report the code on one line with the number of tests, doses, etc. indicated in the units field. Code and Comment The Code and Comment section on our secure provider web site at www.healthnowny.com is an extremely valuable tool that, among other things, can help you determine if a surgical code is bilateral. On the Provider Home page, go to Payment and Operations on the left side menu, click Code Resources, then Code and Comment. Enter a procedure code and detailed information will appear about the code, including if the procedure code is bilateral. Page 3
Preauthorization Reminders As previously communicated, the following procedures required preauthorization as of July 15, 2009: Epidural Injections: All epidural injection procedures beyond the standard treatment of three injections within 12 months. The appropriate course of epidural injection treatment for pain management is limited to a maximum of three injections per year, administered at a minimum of two-week intervals according to InterQual Criteria (a McKesson company product). All epidural injections must be administered by providers who have been credentialed to perform these procedures. Manipulation Under Anesthesia for Treatment of Chronic Spinal or Pelvic Pain: Current Procedural Terminology (CPT) code 22505 (manipulation of spine requiring anesthesia, any region). Note: Fractures, completely dislocated joints, adhesive capsulitis (frozen shoulder), and/or fibrosis of a joint that may occur following total joint replacement are excluded from this requirement and do not need preauthorization. All other forms of manipulation under anesthesia are considered experimental/investigational in accordance with national criteria and will require preauthorization. Implantable Cardioverter Defibrillators (ICD) and Resynchronization Pacemakers (biventricular pacemakers): The medical policy for ICD can be found on our provider web site. Established national criteria for biventricular pacemakers will also be posted to the web site; it s currently available upon request. These medical policies are based on a thorough and up-to-date review of medical literature and reflect current national standards. Elective Cardiac Catheterization Preauthorization: Licensed criteria from InterQual will be used for preauthorization for the Current Procedural Terminology (CPT) codes listed below. InterQual's criteria, based on a thorough and up-to-date review of medical literature, reflects current national standards. 93510 93511 93514 93539 93545 93555 93556 In addition, providers were notified that the following procedure requires preauthorization as of September 1, 2009: Anesthesia services or monitored anesthesia care (MAC) during gastrointestinal (GI) diagnostic or therapeutic endoscopy administered by an anesthesia provider. In general, GI endoscopy procedures are performed under moderate sedation given by, or under the supervision of, the physician performing the endoscopy. If the physician performing the endoscopy decides to engage an anesthesia provider for any patient age 12 through 69, he/she is required to provide documentation indicating that one of the following risk factors or significant medical conditions* is present: o o o o o Prolonged or therapeutic endoscopic procedure requiring deep sedation Increased risk for complications due to severe co-morbidity (American Society of Anesthesiologists/ASA class III or greater) History of, or anticipated intolerance to, standard sedatives Patient is pregnant Patients with active medical problems related to drug or alcohol abuse (continued on page 5) Page 4
(continued from page 4) o o Patient is acutely agitated, uncooperative Patients with increased risk for airway obstruction due to anatomic variation * These qualifying situations are based on a national standard criterion set. Note: Use of anesthesia or MAC is not considered medically necessary for standard GI endoscopic procedures in patients with average risk. If prior approval has not been obtained, the anesthesiologist s claims will be subject to a processing delay and a potential denial. To obtain prior authorization for these procedures: Please fax your request to our Use Management Department at 1-716-887-7913 and include the following information: Member s name, date of birth (DOB) and ID number Diagnosis code Current Procedural Terminology (CPT) code Date of service Facility name Requesting MD name Tax ID number Office phone number Office fax number Clinical documentation for medical necessity review In addition to the information listed, please include an InterQual Smart Sheet (available on our secure provider web site) for elective cardiac catheterization procedures. Sacroiliac Joint Arthrography and Injection As previously communicated, effective September 1, 2009, the following CPT and HCPCS procedure codes were classified Experimental/Investigational (EI) and are indicated as such in the Code and Comment section on our web site: 27096 Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid 73542 Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation G0259 Injection procedure for sacroiliac joint; arthrography (for hospital use only) G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography (for hospital use only) (continued on page 6) Page 5
(continued from page 5) If guidance is performed by means other than the service described by CPT code 73542, such as fluoroscopy or computed tomography, those services will also be considered investigational when performed with sacroiliac joint arthrography and injection. Prior approval is not required, but is recommended; supporting documentation to determine medical necessity must be submitted to Use Management when requesting approval. Please refer to the Technology Assessment Protocol on our provider web site for explanation as to how a service is determined to be Experimental/Investigational. For Medicare Advantage contracts, we follow the local Medicare Contractor s (National Government Services) Local Coverage Determination policy on Pain Management (L28529), which indicates medical necessity criteria for sacroiliac joint arthrography and injections. Medical Services Protocol Updates The following clinical protocol update includes information on protocols that have had an annual review recently resulting in a revision to the guidelines or no changes at all. Thirty-three new Protocols have been added and one existing Protocol has been deleted. Please note that some of this protocol update may not pertain to the members you provide care to, as it may relate to contracts that are not available in your geographic area. Protocol Revision Summary The effective date of these changes is October 1, 2009: Bariatric Surgery (previously titled Surgery for Morbid Obesity) Guideline statement updated to include: Bariatric surgery is investigational to treat diabetes in those with a BMI below 35 or to treat those with a BMI of 35-40 whose diabetes is controlled Biliopancreatic diversion with duodenal switch may be considered medically necessary Clarification on surgery in adolescents and definition of morbid obesity Cochlear Implant Statement about next generation devices and replacements relocated/added (respectively), in a policy guideline section Added additional information on hearing loss and post-cochlear rehab programs to the same section (continued on page 7) Page 6
(continued from page 6) Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy Will be considered not medically necessary rather than investigational For Medicare Advantage, these additions included: four additional clinical indications and clarification regarding repeat testing, the need for any results to be necessary for defining further treatment, and that if the service is provided in relation to a non-covered service, such as radial keratotomy, it is non-covered Cryoablation of Prostate Cancer (previously titled Cryoablation of Clinically Localized Cancer) Guideline statement changed to indicate potential medical necessity as initial treatment of clinically localized (organ-confined) primary prostate cancer or in the salvage treatment of recurrent (following radiation therapy) localized prostate cancer Added statement that subtotal cryoablation is investigational Diagnosis and Medical Management of Obstructive Sleep Apnea Added medically necessary criteria for portable monitoring Moved the continued PAP medically necessary documentation back to the Medicare Advantage section Added least costly alternative language in regards to auto adjusting CPAP vs. regular CPAP (affects contracts that have language in the medical necessity definition to exclude services that are more costly but not more beneficial) Dynamic Posturography Added limited medical necessity criteria for Medicare Advantage Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds For Medicare Advantage, changed unsupervised use from investigational, to not medically necessary Fetal Surgery for Prenatally Diagnosed Malformations Added policy guideline section to give additional clarification about candidates for the surgery Functional Neuromuscular Stimulation to Provide Ambulation Added that functional neuromuscular stimulation as an aid for ambulation in post-stroke patients is considered investigational Keratoprosthesis Removed the separate Medicare Advantage guideline section (it is the same policy as the main guideline) Mechanical Insufflation-Exsufflation as an Expiratory Muscle Aid Added a policy guideline section to further explain the medically necessary situations: Offered in lieu of suctioning in patients with a tracheostomy Impaired ability to cough has been defined as a peak cough expiratory flow of less than 2 3L per second Contraindications listed Temporary vs. chronic use explained (continued on page 8) Page 7
(continued from page 7) Outpatient Pulmonary Rehabilitation Preop conditioning for lung transplant added as a medically necessary indication Selective Internal Radiation Therapy for Primary and Metastatic Tumors of the Liver Added a medically necessary criteria section for Medicare Advantage, indicating medically necessary for: SIR-Spheres with adjuvant intra-hepatic artery chemotherapy (IHAC) of FUDR (Floxuridine) for patients with non-resectable metastatic colorectal cancer in the liver; or TheraSphere for the treatment of unresectable hepatocellular carcinoma in patients who can have appropriately positioned hepatic arterial catheters (humanitarian device exemption, which means a treatment protocol and Institutional Review Board oversight must be in place) Prior approval will be required for Medicare Advantage. Sensory Integration Therapy Reworded the Medicare Advantage guideline section, which did not result in a change to the medical necessity criteria Treatment of Hyperhidrosis Guideline format changed Guidelines included for treatment of secondary gustatory hyperhidrosis Medical complications that might warrant treating hyperhidrosis added Clarification included regarding conservative treatment before surgery Note: Botulinum Type A and Type B continue to be discussed separately in Pharmacy and Therapeutics Guideline Treatment of Plagiocephaly without Synostosis (previously titled Adjustable Banding as a Treatment of Plagiocephaly) Removed policy statement regarding use as adjunctive post-surgical therapy being investigational Wearable Cardioverter-Defibrillators as a Bridge to Implantable Cardioverter-Defibrillator Placement For Medicare Advantage added that indications not meeting Medicare Advantage criteria may be rejected not medically necessary; previously they were being rejected as investigational. New Protocols The effective dates of the following are October 1, 2009, unless otherwise indicated: Biomarker Genes for Detection of Lymph Node Metastases in Breast Cancer Closure Devices for Patent Foramen Ovale and Atrial Septal Defects Endoscopic Radiofrequency Ablation for Barrett s Esophagus Epidermal Growth Factor Receptor (EGFR) Mutation Analysis for Patients with Non-Small Cell Lung Cancer (NSCLC) (continued on page 9) Page 8
(continued from page 8) Extracorporeal Photopheresis as a Treatment of Graft-Versus-Host Disease, Autoimmune Disease and Cutaneous T-cell Lymphoma Genetic Testing for Congenital Long QT Syndrome Genetic Testing for Helicobacter pylori Treatment Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia 6/1/09 (formerly part of Blood or Marrow Transplantation) Hematopoietic Stem-Cell Transplantation for Non Hodgkin s Lymphomas 6/1/09 (formerly part of Blood or Marrow Transplantation) Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia 6/1/09 (formerly part of Blood or Marrow Transplantation) Hematopoietic Stem-Cell Transplantation for Breast Cancer 6/1/09 (formerly part of Blood or Marrow Transplantation) Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer 6/1/09 (formerly part of Blood or Marrow Transplantation) Hematopoietic Stem-Cell Transplantation in the Treatment of Germ-Cell Tumors 6/1/09 (formerly part of Blood or Marrow Transplantation) High-Sensitivity C-Reactive Protein Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain Islet Transplantation Isolated Limb Perfusion for Malignant Melanoma Kidney Transplant KRAS Mutation Analysis in Non-Small Cell Lung Cancer Laboratory Testing for HIV Tropism Laparoscopic and Percutaneous Techniques for the Myolysis of Uterine Fibroids Laser-Assisted Tonsillectomy Low-Density Lipid Apheresis Microarray-based Gene Expression Testing for Cancers of Unknown Primary Microwave Thermotherapy for Primary Breast Cancer MRI-Guided Focused Ultrasound (MRgFUS) for the Treatment of Uterine Fibroids and Other Tumors 7/1/04 Myoelectric Prosthesis for the Upper Limb 3/1/09 Percutaneous Electrical Nerve Stimulation (PENS) or Percutaneous Neuromodulation Therapy (PNT) Radiofrequency Catheter Ablation of the Pulmonary Veins as Treatment for Atrial Fibrillation Small Bowel/Liver and Multivisceral Transplant Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea (continued on page 10) Page 9
(continued from page 9) Transanal Radiofrequency Treatment of Fecal Incontinence Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders 7/1/06 Clinical Protocols Reviewed Without Change Previous effective dates indicated remain accurate: Artificial Intervertebral Disc: Cervical Spine Artificial Intervertebral Disc: Lumbar Spine Balloon Sinuplasty for the Treatment of Chronic Sinusitis Cardiac Rehabilitation Clinical Trials Cognitive Rehabilitation Cosmetic vs. Reconstructive Services Genetic Testing for Familial Alzheimer s Disease Implantable Bone-Conduction and Bone-Anchored Hearing Aids Implantation of Intrastromal Corneal Ring Segments Low Level Laser Therapy as a Treatment of Carpal Tunnel Syndrome Lysis of Epidural Adhesions Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders Minimally Invasive Surgery for Snoring, Obstructive Sleep Apnea Syndrome/Upper Airway Resistance Syndrome Nerve Graft in Association with Radical Prostatectomy Pharmacogenic and Metabolite Markers for Patients Treated with Azathioprine (6-MP) Plasma Exchange (Plasmapheresis) Salivary Estriol as Risk Predictor for Preterm Labor Semi-Implantable Middle Ear Hearing Aid for Moderate to Severe Sensorineural Hearing Loss Serum Antibodies for the Diagnosis of Inflammatory Bowel Disease Surgical Management of Obstructive Sleep Apnea Syndrome/Upper Airway Resistance Syndrome Surgical Ventricular Restoration Thermography Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease T-Wave Alternans Vertebral Fracture Assessment with Densitometry Videofluoroscopic Evaluation of Velopharyngeal Dysfunction (continued on page 11) Page 10
(continued from page 10) Deleted Protocols Effective immediately, the following Protocol is archived: Debridement of Mycotic Nails This Protocol is archived and not replaced due to a national criteria set that is followed with possible reissue of a corporate medical protocol in the future. The above are brief summaries. Please refer to the Protocols, posted on the Provider web site, for the details of the updated Protocols and the new Protocols that affect your practice. If you need assistance obtaining specific protocol updates, please contact Provider Service. Related Policy and Code Information Medical Necessity Definition Most of our members have a medically necessary definition in their contracts which excludes services that are more costly than what is necessary for the proper treatment of their condition. In other words, the service may provide acceptable care and treat the condition, but there is no data to support that it is more beneficial. We are aware that there are situations where this contract language may not have been enforced for some members in the past. As of October 1, 2009, we will apply this contract language in the protocols where we have identified it as relative. Examples of Protocols that will be affected are: Diagnosis and Medical Management of Obstructive Sleep Apnea (as noted above) and Charged-Particle (Proton or Helium Ion) Radiation Therapy. Watch for this language in the Protocols. Computer-Aided Evaluation of Lesions with Breast Magnetic Resonance Imaging (MRI) Computer-aided evaluation (CAE), also called computer-aided detection (CAD) of a breast MRI does not meet the criteria of our Technology Assessment Protocol because scientific data is lacking to definitively show it improves health outcomes. For that reason, we will continue to not pay separately for it if you elect to provide this service in conjunction with a breast MRI. Be aware that procurement of a prior approval for a breast MRI from National Imaging Associates (NIA) does not include prior approval for CAE or CAD to be performed or reimbursed. The CPT procedure code is: 0159T Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI. Page 11
Clinical Practice Guidelines We continually strive to support our practitioners by providing the most current, evidence-based clinical practice guidelines. The guidelines support our Disease Management programs, HEDIS and Physician Incentive Program. All clinical practice guidelines are reviewed by our internal medical staff, local physicians who specialize in the guideline topics and our Corporate Quality Management Committee. Attention-Deficit Hyperactivity Disorder (ADHD) Management Guideline and Program Description Asthma Management Guideline and Program Description Cardiac Wellness: Primary and Secondary Prevention of Cardiac Disease Guideline Chronic Kidney Disease Guideline Chronic Obstructive Pulmonary Disease (COPD) Guideline and Program Description Congestive Heart Failure Management Guideline and Program Description Depression Management Guideline and Program Description Diabetes Management Guideline and Program Description These clinical practice guidelines can be located at www.healthnowny.com. On the Provider Home page, click Tools & Resources, then Policies & Guidelines, then Practice Guidelines. Paper copies can be requested for your practice at 1-877-878-8785. Federal Mental Health Parity A new federal law that affects coverage of mental health and substance abuse services will become effective upon a group s contract renewal after October 3, 2009. The Federal Mental Health Parity law applies to group health plans sponsored by employers with 51 or more employees. What does the new federal law require? The law requires that mental health and substance abuse/chemical dependency benefits, if they are provided, be in parity (or equal to) medical benefits, including: member cost-sharing apply the same copays, coinsurance and deductibles to mental health and substance abuse treatment as medical/surgical benefits treatment limitations apply the same inpatient and outpatient visit limits to mental health and substance abuse as medical/surgical benefits out-of-network coverage when out-of-network benefits are provided for medical/surgical services, mental health and substance abuse benefits must be provided (continued on page 13) Page 12
(continued from page 12) Who does this law apply to? The law applies to most large groups upon their next renewal after October 3, 2009. Small groups will keep their current benefit as defined by Timothy s Law. Small groups will have the option to purchase the federal parity benefit as a rider at renewal time. Are there any limits on Mental Health/Substance Abuse benefits? Yes. All Mental Health/Substance Abuse benefits are subject to medical necessity. Health Integrated, our delegated utilization management vendor, will continue to provide medical necessity and preauthorization services for our members. Exclusions This mandate excludes groups with 50 or less employees. These members will maintain their current level of mental health and substance abuse/chemical dependency benefits. Please keep in mind mental health and substance abuse benefits and member cost-sharing may change with future contract renewals. It is extremely important that providers verify member eligibility and benefits online at www.wnyhealthenet.org or by calling Provider Services at: 1-800-856-0480 (Syracuse area) 1-866-638-9011, option 2 (Rochester area) 1-888-995-3095 (for Cornell University members) 1-800-945-0556 (Mid-Hudson area) Page 13
Health Care Reform Health care reform is at the forefront of American domestic policy debate, and it s important that you know where HealthNow New York stands. We believe that everyone should have access to high quality, affordable health care and support the enactment of reform this year. However, we are concerned about the impact of a potential, new government health plan option on the employer-based system that is already working for 160 million Americans. A recently released bill by three committees of the U.S. House of Representatives includes a government-run plan that would pay providers based on Medicare rates (plus five percent for physicians and certain other providers). According to the consulting organization Lewin Group, a new government plan would result in significant losses in membership for private insurers from several million to as many as 114 million people because private insurers could not fairly compete on cost. Why this matters to you: As a provider, this has important implications for you, too. Medicare currently underpays doctors by 20 percent and hospitals by 30 percent. Even if the government plan initially reimburses at rates higher than Medicare, budgetary pressures would eventually force the rates down. According to estimates by the Lewin Group, the proposed House bill would cause hospital net income to drop by more than 60 percent and physician income to fall by over $11.5 billion within three years. The loss of revenue may make it difficult for physicians to accept government plan patients: Today, nearly one-in-three Medicare beneficiaries surveyed have problems finding a doctor that will take Medicare patients. A government plan would jeopardize delivery system reforms critical to controlling costs: It took Medicare 30 years to cover preventive care and 40 years to cover outpatient drugs. If we are to make health care reform about quality as well as cost, we must reform and build on the current system and your voice is critical in this evolution. Congress is making important decisions about the government plan now, and we encourage you to write to your members of Congress to express your concerns. You ll find congressional contact information and suggested messages at http://www.gethealthreformright.org. Page 14
Provider Telephone and Web Site Reference Guide Provider Services 1-800-856-0480 (Syracuse area) 1-866-638-9011, option 2 (Rochester area) 1-888-995-3095 (for Cornell University members) 1-800-945-0556 (Mid-Hudson area) Provider Relations 1-315-431-3627 (Syracuse area) 1-585-241-0900 (Rochester area) 1-518-220-5601 (Mid-Hudson area) Use Management 1-800-422-7333 (Syracuse area) 1-866-638-9011, option 1 (Rochester area) 1-800-422-7333 (Mid-Hudson area) Web Site www.healthnowny.com Page 15