Maine's Universal Health Care Plan Could Burden Physicians: Electronic Claims Required

Article excerpt

A universal health care plan that promises to cover Maine's uninsured in 5 years could bring added hassles to that state's physicians.

They'll have to be more prudent about their medical records, disclosing charges to patients, and submitting claims under this ambitious program, Gordon Smith, executive vice president of the Maine Medical Association, told this newspaper.

The Maine legislature in June approved the nation's first universal health plan with a goal to cover the state's 180,000 uninsured citizens by 2009. The public-private insurance program, known as "Dirigo Health," will offer low-cost health plans to individuals, small businesses, and the self-employed through private insurance carriers. "Dirigo," part of Maine's motto, means "I direct" in Latin.

MaineCare, the state's Medicaid program, will be expanded to cover more low-income adults and children. Those with incomes below 300% of the federal poverty level are eligible for health care subsidies on a sliding scale based on ability to pay. The program would be supplemented by federal grants, federal Medicaid funds, and payments by subscribers and participating businesses. The state also expects to save $80 million annually by eliminating unreimbursed care for the uninsured.

While the new plan isn't without its perks--it includes $500,000 to increase the physician incentive program within MaineCare--some provisions of the law have physicians worried, Mr. Smith said.

One provision requires physicians to submit claims electronically through the use of standardized forms. It also allows carriers to reject claims that are not submitted electronically.

This isn't comforting news for physicians who operate one-person offices, live in remote, rural areas, or have no computer, Mr. Smith said. These requirements "could put them out of practice." However, the law does contain waivers and exceptions for offices with fewer than 10 staff, something that could soften the blow for rural offices that don't have ready access.

Physicians are especially nervous about a provision that allows the Maine Health Data Organization to collect quality data from their offices--something that's never been permitted before. There are concerns about the onerous administrative burdens and potential costs that are associated with this audit.

"Doctors' offices that don't have electronic records may have to hire a new person to pull out each record and assess what the data organization is looking for," Mr. …

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