Medical Society of New Jersey e-Newsletter
 
November 1, 2013

   
In This Issue
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CME/EVENTS/TRAINING
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FEATURES
-UHC Medicare Advantage Terminations
-Scope for APRNs
-Quick Links: Flu Shots
-HHS Penalty Exemption
-Sunshine Regulations
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LEGISLATIVE
-CME Event: Opioid Abuse
-Lame Duck
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NEWS
-Medicare Primary Care Incentives
-Marketplace Info for Patients
-Horizon Exchange Product
-Payer Audits
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PRACTICE MANAGEMENT
-2015 EHR Penalty
-Influenza Resources
-PQRS Webinar
-Sunshine Rule Webinar
-Public Comment on Potential CQMs
-Are you ready for ICD-10?
-Code-a-Thon
-More
-Webinars
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CORPORATE PARTNERS
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Download MSNJ's 2013/2014 
Meeting Calendar
Medical Audit Webinar Series

Top Ten Tips for Physicians Facing RAC and Private Payer Audits

Wednesday, December 4 from 12:00 P.M.-1:00 P.M.

Deborah Winegard, Whatley Kallas, LLP

 

Join us for a webinar on "Top Ten Tips for Physicians Facing RAC and Private Payer Audits."

 

Register by November 13 and receive a $10 discount! The early bird pricing is $15 for MSNJ members, $40 for PAHCOM & NJMGMA members, and $90 for non-members.

Register online.

 

 

Horizon BCBSNJ - Physician Outlier Programs

Wednesday, December 18 from 12:00 P.M.-1:00 P.M.

James A. Dell'Arena, Horizon BCBSNJ

 

Join us for a webinar on "Horizon BCBSNJ - Physician Outlier Programs."

 

Learn an overview of the post payment and pre-payment programs with a focus on high level evaluation and management codes as well as modifiers 25 and 59.

 

Register by November 27 and receive a $10 discount! The early bird pricing is $15 for MSNJ members, $40 for PAHCOM & NJMGMA members, and $90 for non-members.

Register online. 


SAVE THE DATE:

MSNJ's 2014 Annual Business Meeting  

May 2, 2014

East Brunswick Hilton

 

Inaugural Gala honoring Paul Carniol, MD, MSNJ's 222nd President

May 10, 2014

Parsippany Hilton 

CME/Events /Training


Essex County Medical Society will be honoring Satty Keswani, MD at their Founder's Day Dinner on Wednesday November 20, 2013 at Calabria's Italian Restaurant in Livingston, NJ. For more Information or to attend, contact Dr. Barry Prystwosky at 973-235-0101.


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 


Prescribers' Clinical Support System for Opioid Therapies (PCSS-O) is a three year grant funded by Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT).

The online modules are designed to increase your understanding of the current state of opioid-dependence treatment, increase your understanding of treatment issues for special populations, and lastly to increase your ability to assess and treat patients. Access the modules. 

New Jersey Chapter, American College of Surgeons 62nd Annual Clinical Meeting

Saturday, December 14, 2013 from 7:00 A.M.-5:30 P.M. at the Renaissance Woodbridge Hotel and Conference Center, Iselin, NJ. 

 

Clinical sessions in a variety of surgical specialties will be presented.

 

For additional information, please call the Chapter office at (973) 539-4000.


Applications for Hurricane Sandy  

Relief Grant 
The Physicians Foundation announced a grant in the amount of $350,000 to the Medical Society of New Jersey. Grantees do not have to be MSNJ Members. Download the application today.


Find Medical Society of New Jersey on Facebook

View our videos on YouTube
 
Follow Medical Society of New Jersey on Twitter
 
Connect with Medical Society of New Jersey on LinkedIn

Physicians: Have you been terminated from United HealthCare's (UHC's) Medicare Advantage Plan? 
Read more below.

FeaturesTOP

UHC's Termination of Physicians in Medicare Advantage Plans

On Wednesday, October 30, MSNJ hosted a well-attended webinar open to the entire medical community to explain how we are addressing UHC's termination of physicians in their Medicare Advantage plans. We are concerned about:

  • the lack of transparency for patients who are in the open enrollment period who may not know that their physician will no longer be in their plan next year and have a limited time to switch their plans;
  • the patients' right to choose their physician;
  • continuity of care issues;
  • the reasons for the terminations;
  • whether the remaining network will be adequate
  • whether UHC satisfied its legal obligations to physicians and patients. 

Listen to the webinar for a full briefing of actions to date. 

 

If you have been terminated, go to our website for a full menu of resources which we are updating as the need arises. If you wish to stay in these plans you must appeal within 30 days. If you believe that your termination will result in a network adequacy issue, please let us know by writing to [email protected]. CMS has agreed to test the network adequacy of terminations that we send to them. We are asking that the entire state be tested for network adequacy. 

MSNJ Objects to Federal Expansion of Scope for APRNs
This week MSNJ joined the AMA and virtually all of organized medicine by objecting to the designation of advanced practice nurses (APRNs) as independent providers, without regard to state licensure laws. The issued surfaced in a draft Veterans Health Affairs (VHA) Nursing Handbook. This would effectively eliminate physician-led, team-based care within the VHA system. It would require APRNs to attain independent practice and prohibit those who do not from practicing as APRNs within the VHA system. Read the letter. MSNJ supports physician-led team-based care.

Quick Links:

 

Firing Employees Who Don't Get Flu Shots:  What Risks Do Hospitals Face? Read more.

 

LaborSphere Update: The Dos and Don'ts of Implementing a Mandatory Flu Vaccine Policy Read more. 

HHS Establishes Penalty Exemption for those Enrolling at the End of the Marketplace's Initial Open Enrollment

Individuals who enroll for healthcare insurance through the Marketplace toward the end of the initial open enrollment period may be subject to a penalty, or "shared responsibility payment," on their federal tax returns in 2015. HHS recognized that this might not have been clear to enrollees so it has established a hardship exemption. Read more

MSNJ Objects to Sunshine Regulations Reporting Requirement for Journal Reprints & TextBooks

MSNJ has joined the AMA's objection to the final rule adopted under the Sunshine Act that will require the reporting of the distribution of textbooks, scientific peer reviewed medical journal reprints, supplements, and abstracts. The Sunshine Act contains an exemption from reporting for "[e]ducational materials that directly benefit patients or are intended for patient use."  These materials provide a direct benefit to patients and should be excluded from reporting. Read the letter.

Legislative

CME on Prescription Drug abuse

MSNJ, in conjunction along with the Partnership for a Drug-Free New Jersey, DEA and NJ Department of Law and Public Safety and in joint sponsorship with the American Academy of CME, provided held a free CME for physicians this week focusing on prescription drug abuse. Topics included the prescription drug monitoring program, recognizing addiction and diversion and legal advice.  Well over 100 physicians attended. (photo attached). MSNJ will continue to sponsor this event in other areas of the State, and will also continue to work on other educational efforts on this important matter. MSNJ aims to be a part of the solution that strikes a balance between reducing abuse and maintaining proper access to medication. Read more.

Lame Duck

MSNJ held webinars this week with specialty societies to prepare for the lame duck session of the New Jersey legislature, which will begin after the November 5th election. MSNJ President, Dr. Ruth Schulze, led the discussions which aimed to form consensus around key lame duck priorities.

News

Medicaid Primary Care Incentive Payments Set to Begin

The New Jersey Division of Medical Assistance and Health Services (DMAHS) announced in its October newsletter that traditional Medicaid retroactive payments for the primary care incentive will be made in bulk payments and processed by mid-December 2013. Incentive payments will begin processing on a claim by claim basis as of November 4, 2013. Under Traditional Medicaid, physicians had until April 30, 2013 to file attestation forms in order to receive retroactive incentive payments going back to January 1, 2013. Physicians who submit the attestation after April 30th will receive incentive payments starting from the first day of the month the attestation was submitted. For example, if the attestation is submitted on October 17, 2013, then the incentive payments will apply to claims starting October 1st. Please note: the fee-for-service deadline does not apply to physicians in the Medicaid Managed Care Organizations (MCO); a deadline should be provided directly from the plan.

 

MSNJ has heard reports from members that some MCOs have already begun processing retroactive incentive payments. Once caught up with retroactive payments, the MCO incentive payments will be made in quarterly bulk payments and will not be claim specific. Please let us know if your practice encounters any issues with these incentive payments by writing to us at [email protected] with "Medicaid Incentive" in the subject line. 

Marketplace Information for Patients

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

Marketplace Tools for Physicians

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

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 [email protected], 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

in pre-payment review. When coding errors continue in pre-payment the practice is at risk for referral to the payer's fraud unit and the state's fraud office. Physicians are urged to ask their billing staff if claims are being routinely denied and if the practice is in a payment review.  

 

If you are currently in a payment review please write to [email protected], 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.

Practice Management

Avoiding the 2015 EHR Penalty

Beginning January 1, 2015 Eligible Professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to a penalty. The penalty will be determined by CMS based on meaningful use data submitted prior to the 2015 calendar year. EPs must demonstrate meaningful use prior to 2015 to avoid the penalty. Determine if you are subject to the penalty by your participation start year:

  • If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the penalty in 2015.
  • If you first demonstrated meaningful use in 2013, you must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid the penalty in 2015.
  • If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the penalty in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and EPs must attest to meaningful use no later than October 1, 2014 to avoid the penalty.

To avoid the penalties in the future, you must continue to demonstrate meaningful use each year. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you must demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these penalties. View the Payment Adjustments and Hardship Exemptions Tipsheet for EPs.

2013/2014 Influenza Resources for Health Care Professionals

The Medicare Learning Network� (MLN) has developed the following educational resources to help health care professionals understand Medicare guidelines for seasonal flu vaccines and their administration:

View the MLN Matters article for more resources.
PQRS Webinar
Covisint will host a webinar on 2013 PQRS compliance and preparation on Friday, November 8 at 12:30 P.M. Learn what is required for PQRS in 2013 and how to avoid the 1.5 percent penalty in 2015. Register online.

Open Payments Sunshine Rule Webinar

CMS will host a webinar on the "Open Payments Sunshine Rule" on Tuesday, November 19, 2013 from 12:00 P.M. to 1:00 P.M. This webinar will include an overview of the Physician Payments Sunshine Rule for CMS Regions 1, 2, 3, & 4. Registration is not required (NJ is in Region 2). Click here to join the webinar. The Dial-in telephone number is 1-877-267-1577; Meeting ID Number: 998 023 973 

Public Comment on Potential CQMs for Stage 3

CMS requests that the public provide input on new clinical quality measures (CQMs) for potential use by eligible professionals in the EHR Incentive Programs. Comments are now being accepted and must be received by Monday, November 25 at 5:00 P.M. In particular, CMS is interested in obtaining feedback on:

  • Relevance of the measures to the mission of public reporting under the EHR Incentive Programs for eligible professionals
  • Usefulness of the measures to improve quality of care for patients
  • Feasibility of data collection via EHRs for public reporting under the EHR Incentive Programs for eligible professionals

Click here to read the measure specifications and instructions on how to comment.

Are you Ready for ICD-10?

A study of 20,000 physician notes was released by the American Academy of Professional Coders (AAPC). Coders and practice managers are showing great concern that their physicians' documentation will not support the new code set. Accurate coding and proper payment will not be possible without improved clinical documentation. The following are steps to prepare your doctor:

 

  1. Share the results of the AAPC's 20,000-record study
  2. Show your physician an example of ICD-10 readiness documentation 
  3. Ask them to consider ICD-10 Documentation Training.
  4.  Watch the 2 minute video.

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:

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:

Photocopiers can be a HIPAA Violation

With the new HIPAA rules in place starting September 23, 2013, physicians and practice managers should be aware of the HIPAA Privacy and Security issues related to protected health information (PHI) maintained in a computer or transmitted over the internet. What some may not realize is that photocopiers can also contain PHI. Affinity Health Plan, Inc. has settled potential violations of the HIPAAA Privacy and Security Rules with HHS for $1,215,780. Affinity failed to incorporate the electronic PHI stored in the copiers' hard drives in its analysis of risks as required by the Security Rule and failed to implement policies and procedures when returning the hard drives to its leasing agents. 

 

Make sure your information security plans cover digital copiers. Use all of the copiers' security features and securely overwrite the entire hard drive at least once a month. Plan now for how you will dispose of the copier securely. Click here for more information.

Code-A-Thon: Professional Coder Volunteer Sign-Up and Survey

NJHA and the NJ DOBI have been hosting stakeholder ICD-10 planning meetings to help the industry prepare. From this group, a plan has been created to conduct a Code-A-Thon to provide them with valuable information prior to go-live. Coders who have been trained in ICD-10 are urged to help by volunteering and participating in a survey. Click here for more details.

November 30 Deadline for Hospitals to Attest to Receive Payment for 2013 EHR Incentive Program

Eligible hospitals and critical access hospitals (CAHs) have until November 30, 2013 to register and attest in fiscal year 2013 for the Medicare EHR Incentive Program. Hospitals must attest each year to receive an incentive and avoid a penalty, which will be applied beginning October 1, 2014 to Medicare eligible hospital that have not successfully demonstrated meaningful use. The penalty is determined by the hospital's reporting period in a prior year. Medicaid eligible hospitals should refer to their state deadlines for attestation. View more resources.

PQRS Reporting is Easier than you Think

The last day to submit to the PQRS data registry is February 28, 2014. There are four easy steps to submit your PQRS data.

  1. Use your current data
  2. Choose one Measures Group relevant to your practice
  3. Enter data for 20 patients
  4. Receive your incentive payment and avoid penalties. More information

OSHA Training Requirements

December 1, 2013 is the deadline for training staff on the new OSHA requirements. The new Hazard Communication Standard  requirement is applicable to medical practices and was updated in 2012 to make it uniform with the global chemical labeling system that manufacturers follow. The Hazard Communication Standard will be phased in through June 1, 2016. Training can be done in the office by using materials from OSHA. View OSHA's QuickCards on safety data sheets and labeling.

Archived Webinar: Obamacare for Employers

Last week, MSNJ hosted a webinar on Obamacare for Employers - In Detail and In Plain English. Even though there is a delay in employer reporting, the IRS is at work on regulations. Anthony Rainone from Brach Eichler LLC discussed the details of the recently proposed "Shared Responsibility" regulations including: Whether your company is an "applicable large employer"; What is a full time equivalent employee (FTE) for determining applicable large employer status; Whether your company has to pay an "assessable payment" penalty and, if so, how much; and other helpful tips for employers, including Obamacare's amendments to the Fair Labor Standards Act. This webinar is geared towards employers with 100 or more employees. Purchase the archived webinar. 

Webinar on Comparing ICD-9 to ICD-10

MentorHealth will host a webinar on Comparing ICD-9 to ICD-10 on Wednesday, November 20, 2013 at 1:00 P.M. This 90-minute webinar will provide an overview of the changes from ICD-9 to ICD-10 chapter specific guidelines, documentation requirements for ICD-10 in each chapter, and examples using the most frequently reported codes in each chapter. The cost to register is $175 for one participant (group pricing also available). Register online.

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.

NJ-HITEC Offers Meaningful Minutes

NJ-HITEC has changed their Meaningful Use hour-long webinars into Meaningful Minutes so they can still continue to provide updates, but in a more concise and shorter format. At the conclusion of each Webcast, participants will receive a one-page summary of the most important topics covered to share with the rest of their team. The "Meaningful Minutes" will be offered every Wednesday from noon to 12:30 p.m. and will continue to help physicians, nurses, and practice managers stay up-to-date on the important changes in Meaningful Use, CMS incentive programs, and related Health IT issues. These Webcasts are open to all physicians and their staff regardless of membership. View the list of upcoming topics.

Corporate Partners

 

QualCare, Inc. -

Platinum Level Partner 

 

Contact: Matthew Rutkin, MEWA Sales & Proposal Coordinator 

Phone: 888.670.8135, option 6
E-mail:  [email protected]
Website 

 

 

 

QualCare, Inc., administers the MSNJ Affiliated Physicians and Employers - MEWA Health Plan, a multiple employer welfare arrangement (MEWA) which provides members with access to healthcare coverage options that might otherwise be too costly. Through this program, physicians may buy self-insured health plans at the equivalent of large-group rates.

 

QualCare, Inc. is New Jersey's largest, provider-sponsored Managed Care Organization that offers self-funded PPO, HMO network, point of service (POS) network, and open access health plans; third party administration (TPA) services, provider network access, care management services, and a workers' compensation product. QualCare also provides ACO consultative services and infrastructure.

 

 

 

Needing magazines for your waiting room or for yourself? Magazine subscriptions also make wonderful gifts! Why not send someone a gift subscription this holiday season? Place all your orders or subscription renewals through the MSNJ Magazine Subscription Service to save you time, money and every purchase helps MSNJ!

 

Subscription Services, Inc., does their very best to get you the lowest rates.  As a member, you are eligible for the very lowest prices on magazine subscriptions as well as personalized hands-on customer service. Click "Shop for Magazines" to place new subscriptions, renewals, as well as gift order subscriptions. You can also inquire about titles you may be interested in.  If you ever have a question regarding your order or your account, please call 1-800-603-5602, or use the contact page to communicate with a customer service representative.  And if you ever find a lower authorized price, they will match it! 

  

 

Member Resource Guide   

Check out the current MSNJ Member Resource GuideInside, you will find a complete listing of partners by service/product category, along with contact information. Also, be sure to check out the individual Corporate Partner pages on our website as some offer additional discounts to members!

 

It is important to note that MSNJ does not endorse any vendor, service, or product. However, we encourage members to please consider our Corporate Partners first as the financial support received from these organizations is vital to our association. It is our hope that their investment in MSNJ will help keep your membership dues and programming affordable.

 
Medical Society of New Jersey
2 Princess Road, Lawrenceville, NJ 08648
(o) 609-896-1766 e-mail:
 

About the Medical Society of New Jersey:

Founded in 1766, the Medical Society of New Jersey (MSNJ) is the oldest professional society in the United States. MSNJ promotes the betterment of the public health and the science and the art of medicine, to enlighten public opinion in regard to the problems of medicine, and to safeguard the rights of the practitioners of medicine.  The organization and its members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician-patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care.  For more information visit our website or send us an e-mail.

"Your Partner in Practice... Your Voice in Trenton"  

2013 � Medical Society of New Jersey. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the written permission of the Medical Society of New Jersey.