PAYER RELATIONS
MSSNY 
How To Guide 

On behalf of MSSNY Members, the Division of Socio-Medical Economics has prepared this 
How To Guide for you and your office staff.  The MSSNY How To Guide is a collection of various articles that have been printed over the years in either MSSNY’s EVPgram or the News of New York.

Many of the articles were written with the advice that if additional information is needed on the specific subject you can feel free to contact the Division of Socio-Medical Economics at 1(516) 488-6100, ext. 332 or 334. This contact information has remained on each piece as it was originally written. The articles were written as “stand alone” items and can still be used in that manner, if you wish.

This compilation will not address every consequence that you will come across during the course of your business. However, the articles have been published, republished and updated through the years and appear to be relevant to today’s medical practice.

Reading through the various communiqués, might trigger your inclination for a point of clarification on additional subjects. If so, let us know and we will see what we can do for you. In the meantime, I hope you will find this current collection of material applicable to you and your staff.

The Division of Socio-Medical Economics is here to help you and your staff get through the myriad of insurance issues you deal with in your day-to-day practice and business. Give us a call, we’re at your service.

1-800-523-4405 / 516-488-6100, ext. 332 or 334.
The Division of Socio-Medical Economics is here to assist you with health insurance difficulties you or your staff may have on behalf of your patients.

The Division of Socio-Medical Economics offer members direct access to our Ombudsman Program through which we assist doctors who are having difficulties with health plans. The issues we handle could require a policy clarification or proper payment of a bill/claim. Questions we receive relate to Medicare, Medicaid, Workers' Compensation, No-Fault Auto programs, managed care, traditional indemnity plans, coding, billing, etc.

If the matters are more difficult or complex, we will ask the physician to provide us with documentation and write to a health plan on the physician's behalf, if necessary. 

For your information, we offer the following educational material to our members:
1. A flyer on the Medicare Managed Care Program
2. MSSNY's Medical Record Keeping Form

As you practice your profession, you should familiarize yourself with the following material that can be downloaded from the Centers for Medicare and Medicaid Services (CMS) website:
1. The CMS 1995 Evaluation/Management Guidelines at
www.cms.hhs.gov/medlearn/1995dg.pdf 
2. The CMS 1997 Evaluation/Management Guidelines at
www.cms.hhs.gov/medlearn/master1.pdf 
3. Medicare Secondary Payer Information at
www.cms.hhs.gov/medicare/cob/msp/msp_detail.asp 

Again, thank you for supporting our efforts on behalf of physicians throughout New York State. Please contact me or anyone on our staff if you have questions, suggestions, comments or complaints.

Sincerely,

Regina McNally, Vice President
Division of Socio-Medical Economics
516-488-6100, ext. 332
Fax 516-352-4093
rmcnally@mssny.org