New York's highest court of appeals has held that no-fault insurers cannot deny no-fault benefits where they unilaterally determine that a provider has committed misconduct based upon alleged fraudulent conduct. The Court held that this authority belongs solely to state regulators, specifically New York's Board of Regents, which oversees professional licensing and discipline. This follows a similar recent ruling in Florida reported in this publication.
An Extra Year to Get Ready for ICD-10
Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS), has announced a proposed rule that would delay the compliance deadline for implementation / use of International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes for a full year, from Oct. 1, 2013 to Oct. 1, 2014. The compliance delay is part of a larger proposed rule that also "simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems," according to the HHS. For additional information regarding the ICD-10 and compliance specifics, visit www.cms.gov and enter "ICD-10" in the search field.