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. 

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.  

County Event: 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

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.

Walgreen's Policy on Opioids Leaked to the Press; MSNJ Previously Sought Disclosure

This week a pharmacist employed by Walgreens in Indianapolis leaked the national drug store chain's policy on filling prescriptions for pain killers. Earlier this year when MSNJ members complained that their patients were being denied refills for pain medications, we sought the policy directly from Walgreens so that we could assist our members who specialize in pain management and other physicians who treat patients with chronic pain. Walgreens would not disclose it to us, or others, based on internal policy. Walgreens did, however, represent that it would reach out to local pharmacies that were refusing to refill prescriptions written by our members. Read more.

NJ Health Exchange Premiums Estimated to Be Higher than National Average

In a report released this week by the Department of Health & Human Services (HHS), New Jersey health insurance premiums under the Exchange are estimated to be higher than the national average. On October 1, 2013, an estimated two-thirds of New Jersey's 900,000 uninsured residents will be eligible for health insurance. 

HHS estimates NJ residents will have an average of 29 different health plans to choose from in the marketplace, at several levels of coverage. The national average of plans per state is 53. The report estimates that New Jersey's benchmark silver plan, covering 70% of a family's health expenses, will cost approximately $385 monthly, compared to $322 per month nationally. 

Subsidies will be available to low and moderate income families, significantly reducing the premium costs through tax credit discounts. HHS reports that more than half of the nation's uninsured will be able to find coverage for less than $100 per month after such discounts and coverage through Medicaid plans. Read the full report.

Marketplace Information for Patients

CMS has developed a number of guidance documents explaining the Marketplace for physicians to give their patients:

• Patient brochure about the health insurance marketplace
• How the marketplace works:: Simple steps for using the insurance marketplace
• Patient pocket card of websites and phone numbers

Marketplace Tools for Physicians

The AMA recently published new tools to help physicians assist their patients with navigating the marketplace. The tools include:

• FAQs regarding how to obtain coverage
• Fact sheet: Coverage under the ACA
• Flier to post in your office

Cocktail Reception to Support Nancy Pinkin, Candidate for Assembly, 18th District

• October 8th 2013 from 6:00-8:00 P.M. 
• Location: The Pines Manor, 2085 Lincoln Highway, Edison, NJ 08817
• Suggested Donation: $500

 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:

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"

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.

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.

ICD-10 Implementation Guide and Helpful Tools

To help prepare for ICD-10, CMS has created an online ICD-10 Implementation Guide. This web-based tool includes a basic overview of ICD-10 as well as a step by step guidance on how to transition to ICD-10 for small, medium and large practices, small hospitals, and payers. Links to other CMS ICD-10 resources are included in the online guide. (https://implementicd10.noblis.org/) Other helpful ICD-10 tools include:

• The ICD-10 Transition: An Introduction
• ICD-10 FAQs
• ICD-10 Basics for Medical Practices
• ICD-10 Basics for Small and Rural Practices
• Talking to Your Vendors About ICD-10: Tips for Medical Practices
• National ICD-10 Provider Education Teleconferences

CMS worked with Medscape to produce ICD-10 videos and articles, along with an opportunity for physicians to earn CME credits. CMS has recently released two new videos:

• ICD-10: A Roadmap for Small Clinical Practices
• ICD-10: Small Practice Guide to a Smooth Transition

EHR Incentive Programs: Stage 2 Guide Available

CMS has released a new resource, "An Eligible Professional's Guide to Stage 2 of the EHR Incentive Programs." The guide provides eligible professionals with a comprehensive overview of Stage 2 of the EHR Incentive Programs, including criteria for Stage 2 meaningful use, 2014 clinical quality measure reporting, and 2014 EHR certification. View the guide.

New CMS Interactive Tools for eHealth Programs

CMS has developed an interactive tool that allows eligible professionals to determine if they are subject to a future eHealth program penalty. This "eHealth Payment Adjustment Tool" shows what penalties to expect based on the eligible professionals' past, current, and expected future participation in eHealth programs. EPs will be asked a series of questions about their participation and eligibility status for the: eRx Incentive Program, Medicare EHR Incentive Program, and PQRS.

CMS also released a new resource that will help health care professionals determine their eligibility for eHealth programs. This tool outlines eligibility for eHealth programs based on your area of practice. View the eligibility tool. 

Fraud Protection in the Marketplace

In an effort to prevent and detect fraud in the Marketplace, the Health and Human Services (HHS), Department of Justice (DOJ), and Federal Trade Commission (FTC) have released a press release and other fact sheets explaining this important information. The fact sheets include:

• Protect Yourself from Fraud in the Health Insurance Marketplace
• Tips for Assisters to Help Consumers Navigate the Marketplace
• Securing the Health Insurance Marketplace

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.

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.