Regulatory/Legislative News

Over the past several months physicians nationwide have been receiving notices from insurers, terminating their participation as panel members. Generally, this means that patients who wish to continue to see these physicians must pay a higher out-of-network co-pay. In some cases, it may mean that the insurers will cover no amount whatsoever when a patient sees the physician. Often these letters state simply that the insurer no longer requires the number of physicians on its panel, and in order to be more efficient, it has decided to reduce the number of panel physicians. In one case of which we are aware, the insurer claimed that it had 93 physicians in a particular specialty but required only seven.

Starting in January, a new Category I Current Procedural Terminology code will be used with the Ex-Press glaucoma filtration device, according to a press release from Alcon.

Improvements to public databases are expected to increase and improve access to safety information on marketed medical devices, according to a press release from the U.S. Food and Drug Administration’s Center for Devices and Radiological Health.

The American Medical Association praised what it called “strong bipartisan votes” by two Congressional committees to replace the current Medicare Sustainable Growth Rate (SGR) formula and end the “annual cycle of draconian Medicare physician payment cuts and short-term patches” on physician reimbursement.

The US Senate Finance Committee has approved a draft bill to repeal Medicare's Sustained Growth Rate (SGR) formula for physician paments.

A federal audit released today concluded that a lack of tight controls over electronic health records makes it easier to commit fraud.

A federal judge has agreed to a request by two Connecticut medical associations to temporarily block UnitedHealthcare from terminating physicians from its Medicare Advantage plan network.

A RAND Corp. analysis concluded that several ongoing health care innovations could significantly reduce physician shortages projected to occur as the Affordable Care Act is implemented.

The National Institute for Health and Care Excellence in the United Kingdom has published final guidance for Iluvien, which will allow patient availability through the National Health Service, according to a press release from Alimera Sciences.

The US Senate Finance Committee has approved a draft bill to repeal Medicare’s Sustained Growth Rate (SGR) formula for physician payments.