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Welcome

Celebrating 80 Years Of Service!

The American Academy of Otolaryngic Allergy (AAOA) represents over 2,700 Board-certified otolaryngologists and health care providers. Otolaryngology, frequently referred to as Ear, Nose, and Throat (ENT), uniquely combines medical and surgical expertise to care for patients with a variety of conditions affecting the ears, nose, and throat, as well as commonly related conditions. AAOA members devote part of their practice to the diagnosis and treatment of allergic disease. The AAOA actively supports its membership through education, research, and advocacy in the care of allergic patients.

"Advance the comprehensive management of allergy and inflammatory disease in Otolaryngology-Head and Neck Surgery through training, education, and advocacy."

ADVOCACY UPDATES

CY 2022 Physician Fee Schedule Proposed Rule Summary

On July 13, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician…

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Congress Considers Extension of Telehealth Flexibilities Post-Pandemic

The COVID-19 pandemic forced Congress and the Centers for Medicare & Medicaid Services (CMS) to…

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Changes To E/M Codes Beginning On January 1st

Effective January 1, 2021, the Centers for Medicare & Medicaid (CMS) finalized significant changes to…

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Changes in MACRA

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Before the close of 2017, all physicians must take action to avoid the 4 percent cut that will be assessed in 2019 for not participating in the new Quality Payment Program (QPP) authorized by the Medicare Access and CHIP Reauthorization Act (MACRA).  Read More

CMS Announces Changes in MACRA Implementation Timeline. The Centers for Medicare and Medicaid Services (CMS) announced major changes to the implementation of the Medicare Access and CHIP Re-authorization (MACRA).
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Upcoming Dates

12/01/21: Research Grant Cycle
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02/22/22: Deadline For Call For Proposals
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04/01/22: Fellow Exam Application Deadline
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06/01/22: Research Grant Cycle
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06/26/22: Membership Application Deadline to be eligible for AAOA Member rate for the 2022 Basic Course

08/01/22: Scientific Abstract Submission Deadline

09/01/22: Membership Application Deadline to be voted in at the 2022 Annual Meeting

EDUCATION

The live stream of the 2021 AAOA Annual Meeting concluded on October 21st, but you can still register and earn CME/MOC credits. 4 hours of Pre-Work On-Demand content will be accessible until November 15, 2021. If you missed a lecture during our live-streamed content, do not worry. Most of the lectures will be available within the next week until November 15, 2021. Learn More

IFAR

Available Now

IFAR Impact Factor: 2.454

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IFAR Featured Content: COVID-19 - Free Access
Endonasal instrumentation and aerosolization risk in the era of COVID‐19: simulation, literature review, and proposed mitigation strategies . Read More

Changes in Managing Practices

Working together with AAOA staff, volunteer leadership and members will enable us to have a positive impact on our members’ practices.

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Live and Online CME

2021 AAOA Annual Meeting
Pre-launch Mid-September
On-Demand Access Closes on November 15
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2022 AAOA Advanced Course
In-Person!!! Santa Fe, NM
January 13-15, 2022
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2022 AAOA Basic Course
The Diptomat Beach Resort, Hollywood, FL
June 30-July 2, 2022

USP 797 Online Module
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News and Updates

A Message From The AAOA President Michael Platt, MD, FAAOA

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United Agrees To Give Physicians ERISA Rights in Connection with Repayment Demands

Bottom line Recent class action settlement gives all out-of-network (“ONET”) physicians important – and often overlooked –…

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College Allergy Symptoms Treatment Back to Shcool

PRACTICE RESOURCES

AAOA Practice Resource Tool Kit

The American Academy of Otolaryngic Allergy (AAOA) Practice Resource Tool Kit is intended as a guide to help AAOA members integrate allergy into their otolaryngology practice and to continually improve on this integration as new information, regulations, and resources become available.

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PARTNER RESOURCE CENTER

AAOA has launched a Partner Resource Center to bring you partner resources that can assist your practice and patient care.

Visit the New Center>

PATIENT CORNER

United Agrees To Give Physicians ERISA Rights in Connection with Repayment Demands

Bottom line Recent class action settlement gives all out-of-network (“ONET”) physicians important – and often overlooked – rights under the Employee Retirement Income Security Act of 1974 (“ERISA”) in connection with repayment demands.[1]

What is this case about? After paying claims submitted by ONET physicians, United sometimes determined that it overpaid a claim and sent the physician a repayment demand (“Repayment Demand”). Plaintiffs alleged that United failed to provide notice and appeal rights required by ERISA in connection with Repayment Demands. The class did not seek the payment of any money, but sought to require United to provide ERISA notice and appeal rights to ONET physicians (and allied health care professionals) in connection with past and future Repayment Demands. 

Who makes up the class? The class, made up of about 50,000 ONET physicians, includes those that: (1) received a Repayment Demand any time after January 24, 2005; and (2) where one such Repayment Demand was not fully resolved by payment, offset, or otherwise, as of June 2, 2021. 

How does the settlement benefit Federation of Medicine members?

  • For Repayment Demands issued in the 12 months prior to June 2, 2021, United is required to: (a) provide a spreadsheet to each class member containing information about each of those demands; and (b) automatically treat such class member as their patients’ Authorized Representative under ERISA for purposes of those demands.
  • For New Repayment Demands issued by United’s UNET claim processing system, United is required to treat an ONET provider as an Authorized Representative under ERISA so long as the provider gives United: (a) an executed Authorized Representative Designation form (United’s website contains such a form) or (b) an executed Assignment of Benefits form thatpurports to “assign,” “convey,” or “transfer” to a provider any “right,” “claim,” “cause of action,” or “chose in action” with respect to the plan beneficiary’s or plan participants’ plan or insurance policy (regardless of whether that form is an effective assignment of benefits).
  • If an ONET provider submits either of these forms to United in connection with a New Repayment Demand issued by the UNET system, United must give that provider ERISA rights as an Authorized Representative.

Why is this important to Federation of Medicine members? ERISA provides insured patients with a powerful set of legal rights to protect them from errors and other misconduct by those that administer their healthcare plan (in this case, United). What is often overlooked is that a physician can also take advantage of many of these rights if the physician is designated as their patient’s Authorized Representative under ERISA. An Authorized Representative is a person entitled to act on behalf of a plan participant for purposes of ERISA. This settlement makes it much easier for a physician who receives a Repayment Demand to be deemed by United to be an Authorized Representative, which means that the physician can “step into the shoes” of the patient and exercise the patient’s legal rights under ERISA. This includes the right to obtain detailed information about the written plan terms that purportedly support the Repayment Demand and United’s rationale, as well as the right to pursue an appeal to further understand and challenge that determination. These rights are designed to put the burden on United to show why, under the written terms of the patient’s plan, a Repayment Demand is reasonable. Although United allows ONET providers to file “Claim Reconsideration Requests” or “Appeals,” those procedures are not subject to ERISA’s requirements. As a result, even physicians who take these steps often lack the information necessary to determine if a Repayment Demand is reasonable. With this settlement, physicians have a much clearer path to obtaining the substantive information that ERISA promises, which will make their appeals more informed and effective. In other words, if one of your members wants to know what to do if United sends them a New Repayment Demand, and the member’s patient executed an Authorized Representative Designation or an assignment, the member has the option of responding in effect – “I dispute your claim. If you intend to pursue this further, I insist that you give me all of my patient’s rights ERISA and prove it in an ERISA hearing.” 

Have questions or looking for more information? For more information or questions related to the above, please contact Diana Huang (diana.huang@ama-assn.org).[2]

[1] Integrated Orthopedics v. UnitedHealth Group, No. 11-425 (D.N.J) 2 The information provided above does not, and is not intended to, constitute legal advice; instead, all information and content provided above is for general purposes only. 

[2] The information provided above does not, and is not intended to, constitute legal advice; instead, all information and content provided above is for general purposes only.

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