The Weekly Dose
Bexar County Medical Society
take another unfair financial risk
Through the Affordable Care Act
(ACA), health insurance exchanges are being developed for those
patients who need health insurance at an "affordable" rate.
Those patients participating in the exchange program starting Jan. 1,
2014, have been given a 90-day grace period to pay their premiums by
the Centers for Medicare and Medicaid Services (CMS). According to
CMS, health plans will take the first 30-day financial risk, but
physicians are to bear the remaining 60-day financial risk.
The controversy arose when
regulations written to implement the major sections of the ACA in
2014 created a 90-day grace period before insurers can drop patients
who fall behind on premiums. Insurers were unwilling to accept full
financial burden so the Obama administration changed the rules so
that the financial burden for the first 30 days fell on insurers,
while physicians and other providers would carry the financial
default risk for care provided in the remaining 60 days.
The ACA does mandate that the
health plan inform a physician of the unpaid premium; therefore, if a
physician decides to sign these contracts he/she should ask that
question when verifying eligibility.
Other informational items about
exchange products in Texas will not be regulated by the
TexasDepartment of Insurance;
with any contract, physicians should review all insurance
exchange contract language, including the fee schedule, and make
a business decision regarding sustained financial stability; and
identification is mandated by law to inform physicians that the
patient is with an insurance exchange health plan.
The Bexar County Medical Society
encourages its members to contact their U.S. Congress representatives
and U.S. Senators to request a change in the law language to move the
90-day financial burden completely over to the health plans. This is
an issue between the health plan, the patient and the FEDERAL
Border Health Conference
participants attending the Welcome Reception in Laredo (standing
Manuel Acosta, MD, Border Health
Caucus Chairman; Mary Nava, BCMS Chief Governmental and Community
Relations Officer; Congressman Henry Cuellar (Texas Congressional
District 28); John Wisniewski, BCMS CEO/Executive Director; Luis
Benavides, MD, Border Health Caucus Vice-Chairman; Hilda Davila,
General Director of International Relations, Mexico Health
Secretariat, Mexico, D.F.; and Jake Fuller, Border Health Caucus
BCMS physician and staff representatives attend in
By Mary E. Nava, MBA
BCMS Chief Governmental and
Community Relations Officer
A little over a week ago, the
eighth annual Border Health Conference took place in Laredo at the
historic La Posada Hotel. This was the first time the annual
conference took place along the border in our state. Until now,
this conference occurred in Washington, DC. Moving forward,
the plans are to alternate the location of the conference between
DC (during even-numbered years) and Texas (during odd-numbered
years). More than 150 attendees participated, including physicians
and government and staff officials representing all levels of
government from the city and county levels to state and U.S. House
of Representatives and U.S. Senate; in addition to officials from
the Mexican Consulate and Mexico's Health Secretariat.
The conference was led by
Congressman Henry Cuellar, U.S. Representative for the 28th
District in Texas and Border Health Conference Congressional Chair;
along with co-chairs, Manuel Acosta, MD, and Luis Benavides, MD,
chairman and vice-chairman, respectively, of the Border Health
Caucus. Congressman Cuellar provided opening remarks during a
Welcome Reception on Aug. 22 to set the tone for the conference as
one of collaboration between representatives from both sides of the
border. The following morning, conference attendees boarded buses for
a tour of the area colonias.
To say the least, these impoverished areas, or colonias, were
quite an eye-opening experience for those witnessing such poverty
first-hand. In addition, we visited two community health
centers: Gateway Community Center, a FQHC that serves people from
and the Larga Vista Health Center in the town of El Cenizo, where
at the time of our visit, the town was in a serious health crisis
in the face of contaminated water.
Physicians and executive staff
representing BCMS included: John Nava, MD; John Holcomb, MD;
Raymond Osbourn, MD; BCMS CEO/Executive Director John Wisniewski,
and Mary Nava, BCMS Chief Governmental and Community Relations
Officer. Dr. John Nava also participated as a member of a
panel discussion entitled "Public Health Collaboration Between
the U.S. and Mexico." Other topics presented in panel
discussions included: Graduate Medical Education: The
Importance of Recruiting, Training and Retaining Physicians on the
Border; SGR (Adequate Provider Reimbursement) Fraud, Myths and
Reality; Immigration, Border Security and the Impact on Healthcare;
and the Affordable Care Act - Implementation and Impact on
For local discussion on this and other advocacy
topics, consider joining the BCMS Legislative and
Socioeconomics Committee by contacting Mary Nava at email@example.com.
The Future of Latino Healthcare
9 a.m.-11 a.m. Thursday, Sept. 5
UTSA Downtown Campus
501 W. Cesar E. Chavez Blvd., San Antonio 78207
Sponsored by the Texas Tribune and
Blue Cross Blue Shield of Texas
Reservations required by 3 p.m. Wednesday, Sept. 4
at firstname.lastname@example.org or
SAVE THE DATE
ICD-10 Implementation Success
Click here for
information and registration
Odds and ends
By John K. Wisniewski
BCMS CEO/Executive Director
Richard Perez, President/CEO of the
Greater San Antonio Chamber of Commerce is working on direct flights to
New York, JFK, and Boston, Logan International. If are a frequent
traveler to one of these destinations, please call him directly with
details at 210-229-2130.
Tom Tidwell, SAMGMA leader and
practice management consultant, wanted you to be reminded of property
damage clauses in your equipment leases. Often, these clauses
result in automatic surcharges if you fail to provide proof of general
liability coverage ... so check your equipment lease bills to avoid
BCMS President Dr. Gabriel Ortiz will
be making "rounds" at some of the area hospital physician
lounges and hopes to visit with as many of you as possible. Be on
the lookout for announcements of specific dates from your hospital
medical staff offices.
Best wishes for a safe and joyful
IN THE SPOTLIGHT
Are you ready for NIIT?
By Joe Davis.
David J. Bailey
& Co., PC
In 2010, when the Affordable Care Act
was being considered, Congress realized that they were going to need a
way to pay for the cost of this healthcare bill. One of the ways that
Congress devised to raise revenue and offset the costs of the ACA was
the creation of a new tax: the Net Investment Income Tax (NIIT).
Generally speaking, beginning with
the 2013 tax year, if your adjusted gross income is more than $250,000
and you file a joint federal income tax return, or more than $200,000
in most other filing situations (i.e., single, head of household) and
you have what is defined as "net investment income" (NII),
some or all of that NII will incur an additional tax, at the rate of
3.8 percent, on top of the regular income tax.
Net investment income has been
defined to include, among other items, income in the form of interest,
dividends, annuities, royalties, rents and net capital gain.
If you feel that you may be subject
to this new tax, contact your tax advisor for more information.
Contact Joe Davis,
CPA, at David J. Bailey & Co., PC, at 210-344-5000; www.djbcompany.com.
This information is sent on behalf of a valued BCMS Circle
of Friends sponsor at the Bronze level, but it is not an
endorsement. Donations from Circle of Friends sponsors help keep down
the cost of dues and allow BCMS to continue to provide quality service
to its members. The society continues its pledge to you and only will
involve itself in services and programs that benefit you, the member,
and your patients.
About The Weekly Dose
The Weekly Dose is a service of the Bexar
County Medical Society.
Some of the suggestions conveyed may not be applicable to
your practice today,
but the goal is to offer information over time that returns value
of the cost of your membership.
If you would like to recommend future topics to share with
please submit them to the BCMS executive director at email@example.com.
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Copyright © 2013
Bexar County Medical Society, San Antonio, Texas.