Message from MSV president: Eagle eyes

27 January 2012

Dear colleagues,

Buried in Governor McDonnell’s 483 page budget were three lines of text that direct the Department of Medical Assistance Services (DMAS) to amend its regulations related to the provider appeals processes. These three lines (item 307 III.1.iii) would make it acceptable for DMAS to give a physician an incomplete case summary when it demands a retraction of payment from the physician. Legislators have also introduced two bills, HB 918 and SB 426 that would affect physicians’ due process rights to appeal adverse rulings by DMAS during its Medicaid audit process.

How do I know about all this? The eagle eyes of MSV staff read thousands of bills and hundreds of pages of budget documents with the practice of medicine in mind. They notice obscure provisions in bills that could cause big headaches for us.

If left in place, the language in the budget would eliminate the incentive for DMAS to provide a complete summary to physicians and other providers in retraction cases. Retractions are requests from DMAS for a physician to repay money to the agency for health care claims that through a DMAS audit were found to be improperly documented. Current regulations provide that DMAS’s failure to provide a complete case summary to a physician involved in an informal appeal will result in a decision in favor of the health care provider from whom the retraction was sought. It is essential in these situations that the physician be given all of the details and basis for the retraction so the physician can determine whether to agree to the retraction, contest it, or appeal it.

Thankfully, these proposed changes did not go unnoticed. Earlier this month, I sent letters to Sec. of Health and Human Resources William A. Hazel Jr., M.D. outlining physicians’ concerns about the budget provision and the administration-backed bills. On behalf of MSV, I requested that the budget language be deleted and the bills withdrawn. MSV has worked with Del. John O’Bannon, M.D. and Sen. John Watkins to have the budget language stricken to leave the current process and procedures related to provider appeals intact. MSV and representatives from the health law section of the Virginia Bar Association are working to oppose HB 918 and SB 426.

Without a great staff watching out for physicians, items like this would become law. Issues like this and MSV’s advocacy on our behalf again reminds me of the value of my membership in MSV.

Regards, 

Hugh M. Bryan III, M.D.
President