Administrative Simplification in its many forms is a defining purpose of MedicineLouisiana. We fight against the redundant and avoidable administrative requirements imposed upon physicians and their office staffs that do nothing to improve patient care. The unnecessary human and capital resources in which physicians must invest to be fairly compensated for their services only increases the cost of providing healthcare.

From streamlining Managed Care policy to closing credentialing loopholes, we strategically focus on simplifying the administrative and management processes that actually reduce cost and improve quality. MedicineLouisiana helps members navigate the administrative side of medicine, so physicians can fully focus on providing quality medical care.

Network Adequacy is an important consumer protection, which enhances transparency in the healthcare industry. A critical attribute of healthcare coverage is the network of contracted physicians, hospitals, and other healthcare providers. An adequate network is the only solution to ensure that patients have access to the healthcare services on an in-network basis that they reasonably expected when they purchased health insurance. Network adequacy is also a critical component in minimizing the financial ramification of both the patients’ and the providers’ out-of-network experience.

With the expansion of narrow networks, high deductible plans, and additional coverage thresholds by the state Medicaid program, adequate network information is critical for consumers of both public and private insurance. Unfortunately, network adequacy in Louisiana remains elusive for commercial carriers, as well as for the public insurance system.

States must have a mechanism to examine and evaluate the integrity of each health insurance issuer’s network in local markets to determine where the carriers are delivering the network promised to the consumer beneficiaries. MedicineLouisiana has played a leadership role in advocating for network transparency by the carriers, as well as the providers.  We continue to advocate for enhanced regulation and enforcement of current regulation at the state level to ensure accuracy and adequacy of public and private health insurance issuers and their contractors.

Balance billing occurs when a non-contracted healthcare provider sends a “bill” to a patient for services.  The situation typically occurs when the patient is unaware that their provider is not in their health plan’s network. While some consumer advocacy agencies tag this practice as “surprise billing” and move to limit or reduce the physician’s ability to be reimbursed for services, the reality is that health insurance issuers must take responsibility at the time of sale to explain their products and disclose to their members what services are included in the monthly premium payments and which providers are included in their networks.

To compound the problem, more and more carriers are sending reimbursement dollars directly to the patient and failing to compensate the out-of-network physician, against their members’ wishes.  As providers strive to maintain level contract negotiating platforms with carriers, whether a carrier honors the patient’s assignment of benefits to the provider becomes a critical question.  Patients specifically assign benefits to facilitate their role in the healthcare delivery process between their physicians and their health plan. When beneficiaries directly receive insurance payments it creates confusion and leaves them owing the doctor’s office compensation for healthcare services they received.

Each year, prohibitions against balance billing are introduced in the Louisiana legislature. MedicineLouisiana has been the leader in ensuring that physician service reimbursement rates are not set at government levels and that health insurance issuers are held accountable. We continue to reinforce the health insurer’s responsibility to educate their beneficiaries and to be transparent with their networks.

On July 1, 2016, Louisiana expanded eligibility criteria for Medicaid beneficiaries, projecting coverage for an additional 400,000 individuals in the program. This expansion along with the state’s move to Medicaid managed care in 2012 has further compounded the administrative burden for participating physicians. The state now contracts with five Medicaid managed care health insurance companies to provide services for the large majority of beneficiaries. Access to care and accurate and adequate provider networks and specialty care options remain concerns for patients, as well as providers.

Physicians face daily challenges on claims denials and utilization management protocols that increase their administrative overhead and leave less time to take care of patients. MedicineLouisiana remains abreast of changing policy and relentlessly lobbies the executive branch, including the Louisiana Department of Health, to advocate for rules that support physician participation and patient satisfaction. MedicineLouisiana also lobbies the legislative branch to enact laws that support physicians in the Medicaid program, including elevated reimbursement rates and appropriate reimbursement for legitimate medical services. The organization also supports member group practices in traversing the LDH/managed care system and obtaining payment for services.

During recent legislative sessions, MedicineLouisiana fought multiple instruments designed to significantly impact the Louisiana Medical Malpractice Act. In upcoming legislative sessions, physicians will continue to face increased exposure to liability as legislation is proposed attempting to carve out certain specialty types and create exemptions for types of procedures from protections of the current medical malpractice cap.

Physicians will also continue to see tactics such as requiring physicians to obtain additional accreditation and/or board certification in order to qualify for liability protection. MedicineLouisiana will continue to represent physicians’ interest in securing fair and equitable coverage while balancing premium and surcharge costs.

From 1997 until 2008, telemedicine legislation focused primarily on facilitating use of the then-emerging interactive technology to expand access to healthcare for Louisiana’s Medicaid, uninsured, and rural populations. Louisiana laws governing use of telemedicine were changed substantially in the 2016 Regular Legislative Session. A physician currently practicing telemedicine in the state is no longer required to maintain an office in Louisiana, nor have an arrangement with a physician who maintains an office within the state in cases where the physician determines that he or she is able to meet the same standard of care as if the care were provided in person.

Any licensed physician who practices telemedicine upon any patient being treated at a healthcare facility required to be licensed under Louisiana law and holding a current U.S. DEA registration must use the same standard of care as if the healthcare services were provided in person. The physician may prescribe any controlled dangerous substance without having to conduct “an appropriate in-person patient history or physical examination of the patient” as otherwise would be required by Louisiana law.

MedicineLouisiana embraces technology that supports access to quality patient care. The organization also works to shape rules proposed by the Louisiana Board of Medical Examiners that govern the practice of telemedicine, as well as any legislation policy related to telemedicine.