Practice Management Alert

Aetna is about to change the way it does business, thanks to a settlement the company recently reached in a national class action lawsuit.
 
Under the agreement, Aetna must heed the advice of a National Advisory Committee of Practicing Physicians to keep abreast of issues important to doctors and pay claims more quickly and with less headaches for medical offices, according to a company press release.
 
Additionally, Aetna has agreed to establish an efficient independent mechanism for doctors to appeal payment decisions with which they disagree, use generally accepted medical standards to determine medical necessity, agree on a nationally recognized and physician approved set of rules governing claims coding and grouping procedures, develop a more accurate claims editing software package, offer physicians offices increased electronic connectivity so they can track claims more easily, and make available a pharmacy discount program for physicians to offer patients.
 
Last but not least, Aetna must fork over $100 million to physicians it has wronged. However, itll likely take a while for Aetna to iron out the details of that, so dont wait by your mailbox just yet, notes consultant Michael Fleischman, CHC, CHCC, principal of Gates Moore & Co. in Atlanta.
 
All in all, this settlement comes as great news for billing offices that have had enough of wrangling with Aetna, Fleishman notes. This will make [Aetna] behave better.