Save the Date: MSNJ Policy & Strategy Panel Meeting

Thursday, July 18, 2013 at 5:30 P.M.

MSNJ Conference Room

This will be a working meeting. Council on Legislation reports will be considered for approval. At the direction of MSNJ Board of Trustees, we will be working on maintenance of certification policy development.   

Applications 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.

If you are taking advantage of this discount, you may be receiving an email or letter from Verizon asking you to validate your information. We are working with Verizon Wireless to streamline this process. To validate, please click here. Log into our website and follow the instructions listed. For assistance, please e-mail info@msnj.org. 

Phase II of the rollback on New Jersey's tax for cosmetic procedures will begin on July 1, 2013, as the tax drops from 4 to 2 percent.  

In January 2012, the Cosmetic Tax Rollback was signed into law by Governor Christie.  This rollback countered the 2004 legislation that explicitly taxed cosmetic surgical procedures by 6%, a measure that never produced the anticipated revenue expected by the government.  This action is very significant as New Jersey was one of the first states to institute the tax, which drove business out of New Jersey and prompted patients to go to other states for these procedures.  The first phase out of the cosmetic rollback began in July 2012, when the tax was reduced from 6 to 4 percent.

MSNJ fought hard to eliminate the tax. MSNJ opposes all taxes on medical treatment and facilities.

License Renewal Applications due July 15

The license renewal application is comprised of several parts: mailing address, address of record, additional information, education, employment, questions, additional renewal information, and the workforce survey. While the workforce survey is optional, the remaining portions of the application are mandatory. MSNJ asks that physicians complete the workforce survey. 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. Read more for tips and information needed to complete the application.

"HIPAA Minutes" - New Educational Tool
In response to the iHealthBeat article, which explains how medical societies should pursue new ways of sharing HIPAA guidance, MSNJ worked with Helen Oscislawski, Esq. to produce two-minute videos on the HIPAA changes due to the Final Omnibus Rule. It is our hope that these short videos will provide valuable information within a shorter timeframe that is convenient for our members. Our Part 2: HITECH Omnibus video on "What is 'HITECH' and 'Omnibus'?" is now available for viewing.

Part 2: HITECH Omnibus

About the Speaker:  

• Helen's Bio
• Website
• Blog
• "Health Law Diagnosis" - newsletter which summarizes the nuts-and-bolts of the changes.

A message from the American Medical Association's Grassroots Network:

WE NEED YOU! Contact Congress about medicine's priority issues 

Congress has now reached the halfway point of the 2013 legislative calendar, yet a significant legislative agenda awaits lawmakers this summer including priority issues for physicians and their patients. Priority issues requiring action by Congress include: SGR repeal, the passage of H.R. 1701/S.972, the Cutting Costly Codes Act of 2013, passage of H.R. 1310 and S. 236, the Medicare Patient Empowerment Act.

Physicians are strongly encouraged to contact and schedule meetings with their Representative and Senators during the upcoming July 4 Congressional recess period (July 1 -5). Talking points on these priority issues are now available at the AMA’s Grassroots Advocacy page to assist in district meetings with lawmakers.   

Read this week's full legislative update online.    

Medicaid Expansion

A bill that expands Medicaid eligibility pursuant to federal "Patient Protection and Affordable Care Act, codifying the Governor's expansion plan, has passed both houses and heads to the Governor's desk.

Prescription Drug Monitoring Program Reform

Assemblywoman Mary Pat Angelini has introduced legislation revamping the State Prescription Drug Monitoring Program. Assemblywoman Angelini is an advocate for drug abuse reduction and attended our March PSP on the topic. Read more.

Medical Marijuana for Minors

Both houses have passed a bill that changes the "New Jersey Compassionate Use Medical Marijuana Act" to: promote easier access to medical marijuana by minor patients; prohibit limitations on the number of strains of medical marijuana cultivated by alternative treatment centers; and expand the available means by which such marijuana is packaged and distributed to qualifying patients. Read more. 

MSNJ and Three Specialty Societies Comment on Acupuncture Rules 

This week, MSNJ joined together with three specialty societies, New Jersey Society of Physical Medicine and Rehabilitation, New Jersey Society of Interventional Pain Physicians, and the New Jersey Academy of Family Physicians, filing comments with the State Acupuncture Examining Board in which we objected to a proposed expansion in their scope of practice. We objected to what appears to be an open-ended, automatic, approval of adjunctive therapies based on the curricula of ACAOM-approved schools and continuing education courses. We also asked that the stream-lined statutory path that allows physicians to practice acupuncture be included in the Board's rules.

Health Insurance Marketplace & Increased Medicaid Enrollment

This week the US Department of Health & Human Services launched a consumer focused web site  to educate individuals about their choices for coverage in the Health Insurance market place. Open enrollment in the exchange will begin on October 1. In New Jersey, the state Medicaid program has decided to allow the federal health insurance exchange to determine if applicants are Medicaid eligible and then they will be enrolled. According to the state program, the federal government will be responsible for errors and appeals.

The impact of the marketplace publicity may be significant. According to a new study, just published by Health Affairs, Massachusetts experienced an uptick in enrollment among those previously eligible for Medicaid, but not enrolled. The study analyzes the "welcome mat" effect.

Medicaid Agrees to Retroactive Payment to January 1

Medicaid has agreed to pay certain resubmitted claims retroactive to January 1 in response to an MSNJ request. In January 2013, the Medicaid program required that all physicians who order, refer, or attend Medicaid beneficiaries, but do not bill for their services, enroll in the program as non-billing providers. The program confirmed to MSNJ that enrolling will not cause a physician to become a participating provider, but it will allow participating providers to be paid and will bring the program into compliance with the Affordable Care Act.

Medicaid Pediatric Vaccine Administration Issue: Victory

MSNJ previously reported on United Healthcare Community Plan's (UHC CP) new policy to no longer pay for CPT codes 90460 and 90461 (vaccine administration with counseling for children). In a letter to participating physicians, UHC CP explained that physicians should now use CPT code 90471 to report vaccine administration for children. MSNJ wrote to UHC CP expressing our concerns regarding correct coding, financial impact on physician practices, and patient access to care. We asked UHC CP to reconsider its policy and made the Medicaid program aware of our position.  In response to our concern, the Medicaid program had indicated that it is looking into the issue.  

The American Academy of Pediatrics, NJ Chapter (AAPNJ) met with the program to discuss our mutual concerns. As a result the program reached out to CMS and filed a revised State Plan Amendment (SPA) to include a Medicaid enhanced payment for CPT code 90640, as part of the ACA primary care incentive payments. The SPA has already been approved by CMS and primary care providers who meet the eligibility criteria for the Medicaid incentive payments should expect enhanced rates for CPT 90640. This is a great victory for pediatricians in the state. MSNJ thanks AAPNJ for their leadership and collaboration on this issue.

Insurers will Pay More Than $10 million in Rebates to Policy Holders

Insurance companies in New Jersey will be giving rebates to more than 200,000 policy holders in August. According to the Department of Health and Human Services, 220,010 policy holders are expected to receive $10.7 million in medical loss ratio (MLR) rebates, averaging to about $104 per policy holder, which is slightly higher than the $98 U.S. average. Out of the $10.7 million that insurance companies are expected to pay, around $6.6 million will be in small group market rebates and $4.1 million will be in large group market rebates. No individual market rebates were owed.

Under the Affordable Care Act, all health insurance companies must report how much they spend on health care and how much they spend on administrative costs such as overhead, salaries, marketing, etc. Insurance companies must spend at least 80% of premium on medical care and efforts to improve the quality of medical care.

View a table showing the rebate amounts and averages by state. More information about MLR rebates.

MSNJ Urges Members to Learn about New Medicare Payment Models

AMA is hosting a webinar on July 18 at 7:00 p.m. on "Building New Payment Models and Getting Paid." We expect Congress to introduce a bill in August that will repeal the SGR and sanction new payment models for the Medicare program. While we expect that the legislation will allow for a period of time during which FFS fees will be updated, there will be carrots and sticks to move Medicare providers into new payment models. We urge members to participate in this webinar to learn more about value-based payments. Register now.

This webinar conflicts with MSNJ's Policy & Strategy Meeting. It will be archived for physicians who are unable to participate in the live webinar.  

CDC Updated Outbreak Recommendations

1. Middle East Respiratory Syndrome (MERS - CoV) Update

Based on investigations CDC has EXTENDED THE SUGGESTED INCUBATION PERIOD for MERS- CoV from 10 days to within 14 days of travel. The novel coronavirus (MERS-CoV) originating in the areas of the Arabian Peninsula has been occurring since April 2012 and has primarily affected France, Italy, Jordan, Qatar, Saudi Arabia, Tunisia, United Kingdom and the United Arab Emirates. As of June 7, 2013, CDC is reporting a total of 55 cases including 31 deaths. NO CASES have occurred in the United States.

2. Avian influenza A (H7N9) Update

The new recommendation suggests TESTING ONLY patients with an appropriate exposure history AND severe respiratory illness requiring hospitalization. As of June 7, 2013, CDC is reporting a total of 132 patients, laboratory-confirmed with influenza A (H7N9) virus, including 37 deaths. No cases of H7N9 outside of China have been reported. No cases have been detected in people or birds in the United States.

Any patients suspected of having H7N9 or MERS-CoV should be reported IMMEDIATELY to the local health department (LHD) where the patient resides. If patient residence is unknown, report to your own local health department.  

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.  

June 30th Deadline to Avoid the 2014 eRx Penalty!

CMS has re-opened the Quality Reporting Communications Support Page until June 30, 2013, allowing physicians to request a hardship exemption for 2014. In order to avoid the 2 percent penalty in 2014, physicians must meet the requirements of the Medicare e-prescribing (eRx) program; meet one of the limited exemption categories, or obtain approval for a hardship exemption. Individual physicians who do not meet one of the exemption or hardship categories must report the eRx measure 10 times via claims between January 1, 2013 and June 30, 2013.

Groups using the group reporting option must report at least 75 times (2-24 Eligible Professionals), at least 625 times (25-99 EPs), and at least 2,500 times for groups of 100 plus. Physicians can also avoid the penalty by registering for the EHR Incentive Program by June 30, 2013, or achieving meaningful use under the EHR Incentive Program during the January 1, 2013 to June 30, 2013 reporting period. For a complete list of hardship exemptions and more information, view CMS' Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet.

Event Recap: ICD-10 Workshop 

MSNJ hosted an ICD-10 Workshop on "ICD-10 and Coding for Difficult Diagnosis" on Friday, June 21 at MSNJ Headquarters. The audience learned: 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. MSNJ would like to thank our speaker 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 for all the great information!

We thank our sponsors and vendors for their continued support

• QualCare, Inc.
• athenahealth, Inc.
• MD Success Consulting
• NJ-HITEC

MSNJ Practice Management Community

Take advantage of your in-store, Macy*s Business Smart Pass until July 31, 2013. As an MSNJ Member, save 15% all day, as many times as you want. See Pass for further details. Save on designer brands, such as Calvin Klein, Lauren Ralph Lauren, Jones New York, DKNY, Michael Kors, Ann Klein, Polo Ralph Lauren, Tommy Hilfiger, etc. Download your pass today. 

Rutgers Football is offering discount tickets for some of the 2013 home games at Rutgers Stadium in Piscataway. Health Professionals Day is September 14. For more information, contact Rutgers Athletics at 866-445-4678 or tickets@scarletknights.com.