Registration NOW OPEN!

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

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.  

OCR Delays Enforcement of HIPAA Privacy Update for Some CLIA Laboratories

This week the Office for Civil Rights (OCR) announced that it will delay enforcement of the requirement that certain HIPAA-covered laboratories revise their notices of privacy practices to comply with the Omnibus Rule adopted in January. OCR delayed enforcement because of its anticipated amendment to the HIPAA Privacy Rule and the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations regarding the right of individuals to receive their test reports directly from CLIA and CLIA-exempt laboratories. The proposed amendment was published in the Federal Register on September 14, 2011. The delay avoids the possibility that these entities would have to modify their privacy practices twice in a short period of time.

Practice Alert!  October 1 Notice Requirement under the Affordable Care Act

Employers covered by the Fair Labor Standards Act are required to provide notice to employees of the existence of the Health Insurance Marketplace (previously Exchange) by October 1. Any business with gross revenue of $500,000 or more is covered, so virtually all medical practices will be required to give the notice. Read the Department of Labor's (DOL) FAQ. The DOL has two recommended forms, one for employers who provide health insurance and one for employers who do not provide health insurance. While some advisors have warned of a per day penalty for failure to report, there is no penalty. This notice is required by the labor laws even though other employer obligations to report and make payments under the Affordable Care Act have been delayed for a year.

Read the DOL guidance document. The purpose of the notice is to inform all employees  of the Health Insurance Marketplace; indicate if the employer plan's share of the costs of benefits is less than 60% then the employee may be eligible for a premium tax credit; and that if the employee purchases a plan in the Marketplace that he/she may lose the employer's contribution to the plan offered by it.

MSNJ Advocates for Repeal of Medicare's SGR in Coaltion Letter

This week, MSNJ joined a coalition of more than 20 state medical and specialty societies in signing a letter to the Ways and Means Committee, advocating eliminating the SGR and replacing it with a sustainable Medicare physician payment system. Read the letter. Earlier this month a new grassroots advocacy action website, fixmedicarenow.org, was launched, calling upon physicians, patients and policymakers to target their efforts in the SGR repeal. We urge you to visit the site and reach out to all your contacts for their participation.

Physicians Foundation Webinar on Practice Innovation

MSNJ CEO and Physicians Foundation board member, Larry Downs encourages members to participate in the Foundation's webinar on "Practice Innovation: New Models for the 21st Century" on Wednesday, October 2, 2013 from 1:00 P.M. to 2:00 P.M. Learn about new practice models being tested and used around the country. Register online. 

Study Released by AMA Suggests that Over Half of Physicians are Self-Employed

The AMA has just released a Policy Research Perspective that demonstrates that the private practice of medicine is strong, despite an increase in hospital employment. According to the AMA: 

The analysis is based on the AMA's first nationally representative study of physician practice arrangements in five years. Data from the survey show that while there has been an increase in hospital employment, more than half of physicians (53.2 percent) were self-employed in 2012, and 60 percent worked in practices wholly owned by physicians. The survey found that 29 percent of physicians worked either directly for a hospital (5.6 percent) or for a practice that was at least partially owned by a hospital (23.4 percent).

Healthcare Spending Projection Report Released

A report from the CMS Office of the Actuary found that over the next decade, the U.S. healthcare system will see only a modest growth in spending, due to better access to care and more affordable options available. Notably, health care should see a drop in both Medicare and prescription drug spending. "National Health Expenditure Projections, 2012-22" is available in the October edition of Health Affairs. For more information, including historical data on national health expenditures, visit CMS' website. 

Clinical Competency Portal Launched for Medical Residents

Last month, the Committee of Interns & Resident launched a website,QIGateway.org, designed to give residents access to resources promoting patient safety, quality care and other tools. Teaching hospitals are facing the 2015 Accreditation Council for Graduate Medical Education deadline requiring all residents to demonstrate these competencies. The portal is now available to all committee members and residents. http://qigateway.org/

This event will be held on September 24th 2013 from 6: 30-8:30 P.M. in honor of Nancy Pinkin, Candidate for Assembly 18th District.  

Location: The home of Dr. Robert and Diane Kasper, 26 Sparenberg Ln., Somerset, N.J. 08873

Suggested Donation: $150. Please R.S.V.P. to Scott Snyder at 732-245-1287 or Scott@SJSConsultingNJ.com

Please mail contributions to: Pinkin for Assembly, 3 Crommellin Ct. East Brunswick, NJ 08816

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

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. 

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.

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"

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.
• Model Notices of Privacy Practices: The ONC and HHS office released model Notices of Privacy Practices for health care providers and health plans to use to communicate with patients. The model notices are offered in three different styles and are customizable by users. These can be printed for distribution and posted on the practice 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

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.

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.

Free Forum on Healthcare Management

MSNJ's corporate partner, Weber Gallagher will host 2 free forums on Healthcare Management. They will address the best practices when it comes to the hiring, firing and discipline of employees, touch upon the various employment laws that apply to New Jersey employees as well as tips for helping avoid litigation. Dinner will be provided. The two available dates are:

• Wednesday, October 2, 2013 at Artisans Brewery and Italian Grill, Toms River, NJ
• Tuesday, October 15, 2013 at MSNJ Headquarters, Lawrenceville, NJ

Click for more information and registration.

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.