Registration NOW OPEN!

Federal Motor Carrier Safety Administration (FMCSA) Certified Medical Examiner Training.   

 - Saturday, September 21 - Westin Mount Laurel, Mt. Laurel, NJ   

As a courtesy, NJAOPS is providing MSNJ members a $100 discount-off the registration fee - please click here to obtain your promotional discount code. Click here for further information and registration.

"Keeping it Legal and Safe in the Medical Community," a symposium with NJ's medical community on the epidemic of prescription drug abuse and your professional responsibilities will take place on October 30, 2013. Registration 7:00 A.M.-8:00 P.M., Program 8:00 A.M.-1:00 P.M. Location: Hackensack University Medical Center.  

This live activity has been approved for AMA PRA Category 1 Credit™.  This activity is jointly sponsored by the Partnership for a Drug-Free New Jersey and the American Academy of CME, Inc.® There is no cost to attend this symposium. Register online.  

AMA Launches "FixMedicareNow.org" to Target SGR Repeal

The AMA has embarked on a grassroots campaign that will ramp up this fall to put concerted pressure on members of Congress to once and for all repeal Medicare's Sustainable Growth Rate (SGR) formula for physician reimbursement.  An important component of this effort will be an interactive website - FixMedicareNow.org.  The site will engage both patients and physicians in the campaign to repeal the SGR, and also educate policymakers on Capitol Hill on the urgent need to do so.  Moreover, the site will function as a recruitment tool, enlisting Americans from all walks of life and all over the country to sign-up and join the campaign via social media channels and a variety of online marketing efforts; an advocacy platform that integrates grassroots alerts and calls to action for activists to email, call, and utilize social media to spur lawmakers to act; and an interactive information portal that will house videos, online info-graphics, and other resources that effectively make the case for SGR repeal.

MSNJ Files Comments on Medicare 2014 Fee Schedule Rule Proposal

Last week MSNJ filed two sets of comments on CMS' proposed rule governing 2014 Medicare fees. The most significant new issue this year is the proposal's addition of nurse practitioners and physician assistants into the "physician work" component of the geographical practice cost index (GPCI). To compound the negative impact of adding allied health professionals wages into the "physician work" component, the rule also took the costs of employing these non-physicians out of the "practice expense" component. This caused inaccurate weighting of these two components. These changes will result in a $20 million reduction in payments to physicians practicing in New Jersey. We argue that CMS exceeded its statutory authority by including non-physicians in the work component and not counting their expense in the practice expense component. Physicians and allied health professionals are defined and differentiated in the statute.

The GPCI rules are designed to adjust costs based on the expense of practicing medicine in different part of the country. These rules are meant to ensure that physicians practicing in high cost areas receive higher payments than physicians practicing in low cost areas. Since these changes disproportionately affect physicians in urban areas, we joined a coalition of six urban states that would be adversely impacted by the proposal in a separate sign-on letter. We commented on a variety of other payment issues in a separate letter.

NJ Medicaid Releases Long Awaited Balance Billing Guidance

The NJ Division of Medical Assistance and Health Services (DMAHS) has finally released balance billing guidance in its September 2013 Newsletter. This newsletter serves as an update to guidance, previously issued in 2001, regarding when it is appropriate to balance bill Medicaid beneficiaries. MSNJ has been providing DMAHS with input, based in part on our member issues, concerning  the guidance document over the last couple of years.DMAHS took many of our concerns regarding prior drafts into consideration, before releasing the final version. We thank DMAHS for the time and effort put into this guidance. We hope that it provides direction to physicians, who were uncertain about when it is acceptable to bill beneficiaries. Members with questions about the guidance should email MSNJ's Member Resource Center at info@msnj.org and put " Medicaid Balance Billing" in the subject line.

Save the Date:

On October 12, 2013, Holy Name Medical Center will hold its annual black-tie gala, The Founders Ball, at Pier Sixty in New York City.  At this year's Ball, Holy Name is honoring MSNJ Past President Robert S. Rigolosi, MD with the Spirit of Healing Award for his medical achievements and commitment to outstanding patient care. 

Register for this event. Contact Molly McGarry at 201-833-7143 or mcgarry@holyname.org for more information. 

Court Approves Class-Action Settlement Agreement on UCR

A New Jersey Federal District Court has given preliminary approval to a class-action settlement agreement brought by providers and patients concerning out-of-network payments from Aetna. A fairness hearing will be conducted on March 18, 2014 to consider final approval of the settlement. Claims for payment under the settlement must be filed by March 28, 2014. The total settlement fund is $120 million. Physicians may file claims against a general $60 million fund without providing proofs. $60 million is dedicated to member/patients and $20 million to providers who provide proofs. MSNJ will keep members apprised on developments with the settlement agreement.

National Suicide Prevention Week
National Suicide Prevention Week is the Sunday through Saturday surrounding World Suicide Prevention Day, September 10th. Suicide claims approximately 1 million lives worldwide each year, resulting in one suicide every 40 seconds. 

Suicide and suicidal behavior affects individuals of all ages, genders, races and religions across the planet. Please talk to your patients about suicide prevention! Read more. 

Update: Mumps Outbreak Investigation, Monmouth County, NJ

The New Jersey Department of Health (NJDOH), in conjunction with the Monmouth County Health Department and additional local and county health departments, continues to investigate an outbreak of mumps associated with Belmar, New Jersey. As of 09/12/2013, there are 22 outbreak-associated cases and 20 reports under investigation. Cases range in age from 16 to 43, with a median of 26 years of age. Illness onset dates range from 08/03/2013 through 09/07/2013. Learn more.  

Dense Breast Legislation

A bill which MSNJ has been working on in great detail requires insurance companies to cover certain screenings and requires physicians to provide information to  certain patients. The bill was amended this week. Read more.

Health Insurance Exchange

The Governor accepted a resolution in May that authorizes the creation of a Joint Legislative Task Force on Health Insurance Exchange Implementation. The Democratic members of the Legislature announced the members that they have appointed to the body today. Read more. 

Ambulatory Surgery Center Conference Recap 

At a large ASC conference this week, representatives from the NJ Department of Health clarified that one room surgical centers do not need to register if they are only performing endoscopies, cystoscopies and hysteroscopies, regardless of whether anesthesia is used or not. They had previously clarified that the use of local anesthesia does not trigger registration and that conscious sedation, if done by the treating physician, is also not a trigger.  Finally, they clarified that pain management injections do not trigger registration. Since DOH is reluctant to put such clarification in writing, we urge you to contact them if you have specific registration concerns. We are happy to help facilitate those conversations.

Horizon Exchange Product

Horizon notified MSNJ that participating physicians should expect to receive letters regarding participation in their exchange product, Horizon Advance EPO. Physicians should be on the lookout for a letter from Horizon that indicates whether the practice will be participating in the plan.  If you have questions or concerns regarding the letter your practice received, please write to us at info@msnj.org, put "Horizon Advance EPO" in the subject line, and we will ask a Horizon representative to get in touch with you.

Free Online Module: Prescription Drug Abuse 

MSNJ strongly encourages our members to take advantage of a free online module. We must be responsible partners in the fight against prescription drug abuse...before the policy makers make prescribing illegal or mandate CMEs, let's show them we care!

Screening, Brief Intervention, and Referral for Treatment: Evidence for Use in Clinical Settings 

By Elinore F. McCance-Katz, MD, PhD

Reference List

Module Description: Provides an overview of the development of and evidence for effectiveness of SBIRT in medical settings including emergency departments and primary care. Challenges to SBIRT implementation as well as innovative approaches are also briefly reviewed.

Is Your Practice Being Audited by a Payer? Take Heed!

Payers are auditing practices more frequently with an eye toward recovering overpayments, detecting fraudulent, wasteful or abusive billing practices, or simply correcting billing and coding errors. Services that are not documented are deemed to not have occurred and payers are monitoring for these deficiencies. All payers, government and private, have developed post- and pre-payment audits to detect coding errors, correct billing practices, and recover payments.  

MSNJ is concerned that many physicians may not be aware that they are in a post- or pre-payment review. When coding errors continue through a post-payment audit the practice will be placed

If you are currently in a payment review please write to info@msnj.org, put "Payment Review" in the subject line, and describe your situation. We have been working with payers in an effort to make these reviews more transparent and meaningful to physician practices. We plan a series of webinars in the fall to provide further information.

Sunshine Act Resources  

• MLN Matters article provides an Overview for Physicians and Teaching Hospitals.
• CMS' FAQs on Open Payments  

Free CME on Sunshine Act   

Certified CME activities for physicians to learn more about the Sunshine Act are now available online via Medscape:

• "Are You Ready for the National Physician Payment Transparency Program?"

• "The Physician Payment Transparency Program and Your Practice"

Save the Date:

Bergen County Medical Society is hosting a meeting at Hackensack Hospital (30 Prospect Ave, Hackensack, NJ) on Tuesday, October 1, 2013 from 5:00 P.M. - 6:30 P.M.  

Topics:

• Top 10 Issues for Employed Physicians
• Legislative Update
• ACA Implementation News

Take Action NOW to Avoid PQRS & Value-Based Modifier Penalties in 2015

The following penalties will be implemented in 2015 if certain measures are not taken by October 15 2013:

• PQRS: Individual eligible professionals (EPs) are subject to a 1.5 percent penalty in 2015 if they do not submit data on PQRS quality measures to CMS in 2013. Individual EPs can submit data through PQRS methods such as claims, registry and EHR to avoid the penalty and potentially earn a 2013 incentive payment of 0.5 percent. EPs can also request that CMS calculate their quality data from administrative claims by registering for this option by October 15, 2013.
• Value-Based Payment Modifier- Physicians in groups of 100 or more EPs are subject to a 1 percent penalty in 2015 if they submit claims to Medicare under a single TIN and fail to report under PQRS in 2013. Group practices should identify how many EPs they have billing Medicare under their TIN. If the number of EPs in the group is under 100, the group is not subject to the value modifier for 2015. Groups with 2-99 EPs may register to report under the PQRS Group Practice Reporting Option (GPRO) to avoid the 2015 PQRS penalty and potentially earn a 2013 PQRS incentive payment of 0.5%, but it is not required. Groups with 100 or more EPs must register to avoid the penalty. Reporting options include the web-interface GPRO and registry. Groups can also request that CMS calculate their quality data from administrative claims by registering for this option by October 15, 2013.

Visit CMS' website for more information on how to get started with PQRS. For specifics on what groups and individual EPs have to do to avoid the PQRS penalty, contact the Quality Net Help Desk by phone at (866) 288-8912 (TTY 1-877-715-6222), Monday - Friday: 8:00 A.M. to 8:00 P.M. EST, fax (888) 329-7377, or e-mail qnetsupport@sdps.org.

HIPAA Compliance: Is Your Practice Ready for Sept. 23?

The following resources are available to help your practice become compliant:

• Archived Webinar: If you missed MSNJ's August 28 webinar on "HIPAA Compliance Mandates on the Horizon - Be Prepared," you can now purchase the archived version. This webinar will help you to understand the upcoming mandates and how to be in compliance with them.The archive is $25 and is only available to MSNJ members.
• AMA Toolkit: A new toolkit released by the AMA can help physicians navigate sweeping new revisions to the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules. Physicians must comply with them by Sept. 23.
• HIPAA Minutes: MSNJ and Helen Oscislawski, Esq. present two-minute videos on the HIPAA changes due to the Final Omnibus Rule. All of the videos and FAQs are now posted on the MSNJ website.
• HIPAA Templates:MSNJ and Weber Gallagher Simpson Stapleton Fires & Newby LLP's HIPAA Business Associate Agreement and Notification of Privacy Practice templates are now available on MSNJ's website.
• Office of Civil Rights (OCR) Modules:
  • Patient Privacy: A Guide for Providers
  • HIPAA and You: Building a Culture of Compliance
  • Examining Compliance with the HIPAA Privacy Rule

Earn CEU's at Novitas Solutions' Medicare Fall Symposium

Novitas Solutions will host a free JL Medicare Fall Symposium at Cape May Regional Medical Center on October 23, 2013. This one day workshop consisting of four sessions will help you remain compliant with the Medicare program. The program will also be presented in Pennsylvania, Maryland, and Delaware. All sessions are approved for CEUs by the American Academy of Professional Coders (AAPC). For more information and registration, visit the Novitas Solutions website.

CMS 1500 Claim Form Revised

The CMS-1500 Claim Form has been revised () to more adequately support the use of the ICD-10 diagnosis code set. The form will now give physicians the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes. ICD-9 codes must be used for services provided before October 1, 2014, and ICD-10 codes should be used for services provided on or after October 1, 2014. Only physicians who qualify for exemptions from electronic submission may submit the CMS 1500 Claim Form to Medicare. Medicare will start accepting the revised form on January 6, 2014 and will only accept the revised version of the form starting April 1, 2014.

CMS Call: Program Year 2012 Quality and Resource Use Reports - Mapping a Route to Success for the 2015 Value-Based Payment Modifier

CMS will host a National Provider Call on "Program Year 2012 Quality and Resource Use Reports (QRUR) - Mapping a Route to Success for the 2015 Value-Based Payment Modifier" on Tuesday, September 24 from 3:00 P.M. to 4:30 P.M. On September 16, 2013 CMS will have the 2012 QRUR available to group practices with 25 or more eligible professionals. Authorized representatives of groups can access them using an IACS account. This call will go over how to understand and use the 2012 QRUR. It will be helpful to have your QRUR in front of you to follow along. Register online.

Prescription for a healthier practice: Increase practice efficiency with help from the 2013 National Health Insurer Report Card

For this month's practice checkup, take a look at the full results of the AMA's 2013 National Health Insurer Report Card (NHIRC) and see how health insurers measure up. The NHIRC provides metrics on the timeliness, transparency and accuracy of claims processing of participating payers in an effort to educate physicians and the public, and to reveal opportunities for improvement. Join the AMAAdministrative Simplification LinkedIn group for additional helpful resources. This tip is a part of the AMA's "Prescription for a healthier practice" series to help physicians and their staff examine how their practices are performing in key administrative processes.

View September's Coding Tip of the Month on Home Health Oversight. If you would like your questions addressed in an upcoming edition of e-News or you have a coding question specific to your practice, please email your questions. We will work with a certified professional coder to help answer them.