MSNJ and Cooper University Health Care will host a Medical Practice Management Seminar on Friday, November 1, 2013 from 7:30 A.M. to noon. Listen to presentations on HIPAA, Sunshine Laws, ICD-10, Communication Skills, and a Legislative Update. To register call 1.800.8.COOPER (1.800.826.6737). For more information view the agenda.

Last Live Training for 2013!

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.  

University Medical Center of Princeton at Plainsboro (UMCPP) presents the First Annual Snider Symposium:

"Updates in Medicine for the Older Adult"
November 22, 2013
8:30 A.M. - 4:30 P.M.

UMCPP Education Center, Conference Rooms A-E
One Plainsboro Road, Plainsboro, NJ 08536

This activity has been approved for AMA PRA Category 1 Credit™.
This symposium is free of charge. Seats are limited.
Click for details and registration.  

CMS Responds to MSNJ & NJHA Objection to Qualified Heath Plan (QHP) Regulations 

MSNJ and the New Jersey Hospital Association (NJHA)  wrote to CMS in August, asking for a reconsideration of some of the regulations regarding Federal Exchange Plans. MSNJ and NJHA objected to the 90-day grace period for nonpayment of premiums which could result in physicians not being paid for services rendered during that time.

In a recent letter, CMS Administrator, Marilyn Tavenner acknowledged our concerns about uncompensated care and indicated that QHPs will be required to notify physicians of the possibility of claim denials when a patient is in the second and third month of the grace period. CMS plans to issue guidance to the QHPs on notification requirements.

MSNJ has continued concerns regarding the possibility of claim denials during the 90 day grace period and will continue to engage on the issue. 

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

Do No Harm: Keeping it Legal and Safe in the Medical Community

MSNJ has partnered with the DEA to educate physicians on best practices for opioid prescribing and the epidemic of prescription drug abuse. 

Register online. 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; However, seating is limited to the first 200 registrants.

LOCATION:
Hackensack University Medical Center
John Theurer Cancer Center
92 Second Street
Hackensack, New Jersey
Croonquist Conference Rooms 1 & 2

SAVE THE DATE:
October 30, 2013
Registration 7am - 8am
Program 8am - 1pm

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. 

Medicare Payments Continue During Shutdown

The Medicare Administrative Contractors (MACs) will continue to perform all functions related to Medicare fee-for-service claims processing and payment during the partial government shutdown.

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.

Did you know that the MSNJ has a Medical Practice Managers Section (MPMS)?

At MSNJ, we know that managing a medical practice is a daily challenge. We are here to help. Practice Managers and Office Staff can join MPMS to stay up to date on important information through e-News, participate in educational events, get complicated questions answered through our Member Resource Center, and take advantage of our many member benefits. In addition, MSNJ advocates on behalf of all the practice managers in the state of New Jersey. Have your office staff join today! 

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.

NJMGMA Payor and ICD-10 Update

NJMGMA will host a half-day educational Payor and ICD-10 Update on Friday, October 18 from 7:45 A.M. to 12:30 P.M. at the Holiday Inn East Windsor. Listen to a presentation on ICD-10 that focuses on what physician practices should be doing to ensure that they are prepared for the ICD-10 implementation on October 1, 2014. End-to-end testing, clinical documentation improvement as well as training requirements will be discussed in detail so that organizations can access where they are in their preparations. Updates from Novitas, Aetna, United Healthcare, and Horizon BCBSNJ will also be presented. Register online!

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. 

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 a free forum 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. 

• 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.