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A Machiavellian win for the NYS Early Intervention Program

Posted Aug 22 2011 5:38pm
Well I believe in equal opportunity blogging so when NYS does something correct with the early intervention program I have to herald the effort.

On August 17 Governor Cuomo signed a bill that facilitates payment of claims by health insurers to municipalities for early intervention services .

In a previous blog post I talked about the 85% denial rate that exists because the state government doesn't know how to collect from private insurance companies. This new law causes the IFSP to meet any precertification, preauthorization and medical necessity requirements imposed on benefits under any insurance policy.

There are additional new rules that prohibit insurers from denying claims based on the location where services are provided, the duration of the child's condition or that the child's condition is not likely to improve within a time specified in the policy, the absence of a referral by a primary care provider, or that the provider is a non-participating or non-network provider.

I would prefer that municipalities simply bill the same way that I do in my private practice. It would save a lot of time and hand-wringing about having to codify this into law and make excuses for government ineptitude.

Imagine if private practice billing could be made so easy with the stroke of a pen! Although this is ultimately good, it is also a lesson in how ridiculous it is that the government, being unable to play by the rules that everyone else on the planet are subject to, decides that the rules don't apply if they are playing. Hilarious.

Maybe I should try a letter like this:

Dear NY State:

The mean insurance company won't pay me because I don't like to follow the rules. I don't want to be a participating provider, I don't want to be subject to their timely filing requirements, and I don't want to answer to any of their demands. Therefore, please make them suspend all the rules for me - just like they did for you.


Do you think that would work?

Anyway, despite the hilarity of it all, it really is a good thing because the EIP will exist longer into the future if it is able to recoup money from insurance companies. This is NOT a new mandate - the insurance companies just got really good at denying EIP claims because no one in the EIP system knows about medical billing. Now the heavy handed government is going to make them pay whether they follow the rules of proper billing or not. I guess the Prince felt that he had to defend his State, blah blah blah. I know, I don't like the means either. Sigh.

Oddly, the United EI Providers Group made a little noise about this bill and lobbied people to try to stop it. As I mentioned before, I respect that they object to reforming EIP on the backs of providers but I think their analysis of this issue is as sharp as a marble. This law has nothing to do with direct access and it won't change all that much on the practice side of things and it is not a cleverly concealed stimulus program for primary care providers - so in total I just don't get the objections. Oh well.

So this was a good thing for the Early Intervention Program, even if it was a little Machiavellian.
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