AAP Private Sector Advocacy

 

The Academy recently established a permanent advisory group to develop strategies and tools to help pediatricians tackle the tough issues they face in getting timely and appropriate pay for pediatric services from private payers. 

 

The AAP Private Sector Advocacy Advisory Committee (PSAAC) knows how difficult it is for individual pediatricians to educate private payers when it comes to making sure their payment policies are appropriate for pediatric services.  That’s because most plans are set up for adult patients.  It takes constant attention and focused effort to make sure the pediatric services are not undervalued.

 

Through the AAP Private Sector Advocacy, assistance and resources are available to assist members and chapters in addressing private sector issues.  

 

·        The Hassle Factor Form for pediatricians to report problems with payers is now available online on the Members Center homepage (under More Resources).  Summary reports will be used to track problems and generate national and regional reports on specific problems. Summaries will be used to identify issues chapters need to discuss with carriers.

·        Chapter Pediatric Councils  are forums whereby pediatricians meet with health plan medical directors to discuss carrier policies and administrative practices impacting on access, quality, coverage and compensation for pediatric services. Pediatric Council Start-up Kits are available to chapters considering forming a pediatric council as well as a letter from the AAP to carriers for chapters to use.

·        Online resources are available on the AAP Web site, Members Center, under the Private Sector Advocacy rubric with links to resources on coding, sample appeal letters to carrier denials, consultants, managed care litigation, and updates on AAP private sector advocacy activities, including letters to carriers.

·        Staff consultation from the AAP Division of Health Care Finance and Practice is available on coding, coverage and contract issues, including assistance in preparing appeal letters to carriers.  Contact staff via the National AAP Coding Hotline at aapcodinghotlne@aap.org or 800/433-9016 ext 4022 (a free services to AAP members and their office staff).

·        AAP Coding, Documentation, and Reimbursement in Pediatric Practice Workshops: Introductory:  November 12-13, 2005 Newark, NJ 

Advanced:  December 14-15, 2005 San Antonio, TX

      Additional information available on www.pedialink.org/cmefinder

 

For information on the AAP private sector advocacy, contact Lou Terranova, Sr. Health Policy Analyst at lterranova@aap.org or 800/433-9016 ext 7633.