Prescription Eye Drops

The Governor has signed a bill that requires health insurers that provide coverage for prescription eye drops, to provide health benefits coverage for expenses incurred for a refill of prescription eye drops in accordance with Guidance for Early Refill Edits on Topical Ophthalmic Products provided to Medicare Part D plan sponsors by the Centers for Medicare and Medicaid Services.   

The requirement to provide this coverage is conditioned on two factors:  

1. the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; and  
2. the refill requested does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner.   

The bill will take effect on the 90th day after enactment. MSNJ supported this bill throughout the legislative process in concert with the New Jersey Academy of Ophthalmologists.

Learn about: ICD-10-CM and guidelines, key coding conventions for the ICD-10-CM, differences between ICD-9 and ICD-10, and diagnosis coding in ICD-10 by body part.

Target Audience: Small Practices  

Register online

License Renewal-MSNJ Asks that Physicians Complete the Workforce Survey

Last week, the NJ Board of Medical Examiners mailed and posted notices for license renewal. Participation in the accompanying workforce survey is voluntary.  MSNJ is urging our members and all physicians in the state to participate.  

The information will assist the state in its evaluation of physician demographics and access to care. Applications are due on or before July 15, 2013. Please see the MSNJ FAQ and BME Guide  for more information.

On May 28 the Energy & Commerce Committee released draft legislation that would repeal and replace the sustainable growth rate (SGR). The draft legislation shows the most promise for a repeal and new payment methodologies for Medicare in the last decade. MSNJ commented on the concept last week. The Committee will accept comments on the draft legislation through June 10.

Horizon Recruiting Practices to Join Medical Home Program

Horizon Blue Cross Blue Shield of New Jersey is recruiting primary care practices to join their Patient-Centered Medical Home (PCMH) Program. For a brief overview of the program, Horizon has prepared a three-minute video to introduce the program to practices that may be interested. For more information, you can also contact Horizon via e-mail.  

Following on the heels of the favorable opinion in Nicholas v. Mynster, a medical liability case that required plaintiff's expert to share the same specialty and board certification of the defendant, MSNJ asked the New Jersey Supreme Court to consider amendments to its rules of evidence. Many states and the federal government have adopted rules that curb the use of "junk science" to prove cases. MSNJ believes that it is important for the New Jersey Supreme Court to modify its rules because new models of practice, evidence-based protocols, and team-based care under the Affordable Care Act may spawn new, innovative causes of action.  

Advantage plans (MAs) providing notice of payment reductions as a result of the sequestration. So far, members have received notice from

Aetna and United Healthcare. CMS published a guidance document for MAs to advise how the sequestration affects the plans.  

In the document, CMS explains that MAs, "are not permitted to modify the currently-approved benefit or cost sharing structure in any way;  [. . .] includ[ing] increases in premiums or cost sharing, or reductions in benefits in an attempt to offset the lower payments due to sequestration."  Likewise, MAs may only make changes to contracted physician payments in accordance with the terms of the contract.  

MSNJ is currently investigating whether the MAs are abiding by contract terms, when making these changes. If you believe that the change in fee schedule violates your contract with the MA, please email us at info@msnj.org with "MA Sequester Reduction" in the subject line and provide a copy of your contract.

Pharmacies Refusing to Fill Prescriptions for CDS

LCDs Posted for Comment

Novitas Solutions has posted the J12 MAC Draft Local Coverage Determinations (LCDs) for comment. MSNJ urges members to comment on: Biomarkers Overview, Hemophilia Factor Products, Molecular Diagnostics: Genitourinary Infectious Disease Testing and Other Applications for Amplified Probe Testing, Oral Maxillofacial Prosthesis, Prostate Mapping Biopsy, Vertebroplasty, Vertebral Augmentation; Percutaneous, and Wound Care and Bioengineered Skin Substitutes. The comment period ends on July 18, 2013.

AMA Advocacy on Electronic Prior Authorization

AMA has been working with the National Council for Prescription Drug Programs (NCPDP) in search of ways to streamline Prior Authorization for physicians. NCPDP maintains the electronic transaction standards associated with several e-prescribing functions. AMA attended a meeting with NCPDP where draft electronic Prior Authorizations (ePA) changes to the NCPDP Script standard were approved. The AMA will continue to advocate for standardization of the ePA process.

National Physician Payment Transparency Program

On February 8, 2013, CMS published a final rule to increase awareness of financial relationships between manufacturers of drugs, devices, biologicals and medical supplies and physicians and teaching hospitals. The "National Physician Payment Transparency Program: Open Payments" is part of the Affordable Care Act and is intended to create greater transparency in the healthcare market. View a summary of the final rule, implementation timelines, and requirements in MLN Matters Article #SE1303. 

Use of Rubber Stamps for Signature

CMS requires that services that are ordered or provided be authenticated by a handwritten signature or an electronic signature. Stamped signatures are not acceptable under most circumstances. CMS will permit the use of a rubber stamp for signature, in the case of an author with a physical disability, who can provide proof to the CMS contractor of his/her inability to sign.. View CMS' MLN Matters Article MM8219. 

Applications Still Accepted for Hurricane Sandy Relief Grant 
The Physicians Foundation announced a grant in the amount of $350,000 each to the Medical Society of New Jersey and the Medical Society of the State of New York. Grantees do not have to be MSNJ Members. Download the application today.

• Read the NJBIZ article about the fund. 
• Read more in the Hudson Reporter. 

MSNJ Practice Management Community

CMS Webinar on Transitioning to ICD-10

CMS will host an informative webinar on "Transitioning to ICD-10" on Thursday, June 20, from 10:00 A.M. to 11:00 A.M. Learn about: the background and Impact of ICD-10; CMS Internal ICD-10 implementation; how CMS is working with the States and partnering with Industry; and best practices. Registration coming soon.

ICD-10 Tip:

When submitting claims on or after the October 14, 2014 ICD-10 deadline, if the date of service was before the deadline, the ICD-9 code must be used. If the date of service is on or after October 14, 2014, ICD-10 must be used. For more information about ICD-10, join MSNJ for an informational workshop. See details below.

"ICD-10 and Coding for Difficult Diagnosis."  

Friday, June 21 from 9:00 A.M. to 12:00 P.M. at MSNJ Headquarters, Lawrenceville, NJ.

Join MSNJ for an ICD-10 workshop on "ICD-10 and Coding for Difficult Diagnosis."

Presented by: Tina Cressman, MALS, CPC, CPC-H, CPC-P, CEMC, CPMA, CPEDC, CPC-I, CCS-P, MCS-P, MCS-I, CPAT, CCAT, CCT, CMC, Assistant Director, Health Information Management, Cooper University Hospital.

Learn about: ICD-10-CM and guidelines, key coding conventions for the ICD-10-CM, differences between ICD-9 and ICD-10, and diagnosis coding in ICD-10 by body part.

Target Audience: Small Practices  

Register online

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