Humana’s 2006 Settlement Agreement with thousands of physicians officially terminated on October 19, 2009. Nonetheless, Humana has voluntarily agreed to continue to follow many of the key terms from the Settlement Agreement, including the following:
- 90 days’ advance written notice prior to implementing material adverse changes, including fee schedule reductions.
- Application of the clinical definition of “medical necessity” as defined in the Settlement Agreement
- Application of the coding rules required by the Settlement Agreement
- 18 month limit on seeking overpayment recovery
- Posting significant coding edits and the list of code combinations not appropriately reported with modifiers 25 and 59 on its Provider Website
Of course, this also means that other important terms will no longer remain in effect. Here are some examples of expiring provisions that will not be followed:
- Humana will no longer pay interest on late-paid self-funded claims. (Although Humana must still pay interest on late-paid claims as required by state law.)
- Humana will no longer be bound to recognize assignment of benefits, except as state law requires.
- Although Humana has no current plans to revise its fee schedules more than once a year, it will not agree to be bound by this limit.
- Humana will create a new Physicians’ Advisory Committee, while the Committee established by the Settlement Agreement will be disbanded.
For more details on this announcement and background on the Humana Settlement Agreement, visit http://www.hmosettlements.com/.
