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."

This event is $25 for MSNJ members, $50 for PAHCOM & NJMGMA members, and $100 for non-members.

Register online.

Horizon Advance/Advantage EPO

Wednesday, December 11 from 12:00 P.M.-1:00 P.M.

Speaker: Kevin Jennings from Horizon BCBSNJ 

Join MSNJ for a webinar on "Horizon Advance/Advantage EPO." Learn Horizon's new product offerings for 2014 that will comply with the Affordable Care Act. Horizon will review and compare the network structure, key features, benefits, and reimbursement for these plans. Please submit all questions to info@msnj.org with "Horizon EPO Webinar" in the subject line. General questions will be addressed during the webinar and practice specific questions will be addressed individually.

This event is free for MSNJ members, $25 for PAHCOM & NJMGMA members, and $75 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. 

Congressional Sign-on Letter Sent to House Leadership: Repeal SGR 

Last week, Representatives Dan Maffei (D-NY) and Bill Flores (R-TX) sent a support letter to House leadership, urging the repeal of the SGR this year. The letter was signed by 259 Congress members, including 141 Republicans and 118 Democrats. Read the letter. 

MSNJ Urges Congress to Address Medicare's Outdated Physician Payment Regions

Last week MSNJ joined six other states in a letter to the House Ways & Means and Senate Finance Committees urging Congress to address the out-dated, county-based physician payment regions in its Medicare payment reform legislation. While hospital metropolitan statistical area payment regions are updated annually, the county-based physician payment regions have not been updated for almost two decades. Failure to keep pace with regional changes has led to payment discrepancies to states that have become more urban and experience greater practice costs. This, alone, costs New Jersey an almost 3% reduction in physician fees. 

Alert! Terminations of Physicians from UHC's Medicare Advantage Networks

We have learned that some physicians have not been successful on their appeals from UHC's terminations from the Medicare Advantage networks. Some have sought reconsideration, but any physician who has lost his/her appeal should consult their agreement to determine the next step. Many physicians have a contract with UHC which requires that disputes be arbitrated within a year. Read more. 

Recently, MSNJ's delegation met with  Senator Menendez, Congressman Pascrell and Congressman Pallone to discuss various issues, including UHC's Medicare Advantage network terminations in which they expressed interest. MSNJ will keep members apprised of of the situation.

Sudden Cardiac Arrest Prevention

The Assembly Education committee passed A4415/S2367.  This bill, the "Sudden Cardiac Arrest Prevention Act", provides student-athletes, parents, and coaches with information on sudden cardiac arrest and establishes protocol concerning removal-from-play for athletes exhibiting symptoms of sudden cardiac arrest.  The following organizations were in support of the bill: NJ Chapter of American College Emergency Physicians, American Heart Association, NJ School Boards Association and the Athletic Trainers Association of NJ.  As previously reported, the Senate passed the bill in June.

Updates from the Medicaid Assistance Advisory Council (MAAC)

The MAAC met last week and provided updates on many items.

NJ Medicaid Program changes - The NJ program has new eligibility criteria and is going through rebranding.  Newly eligible populations:

* Parents and Caretaker Relatives up to 133% FPL

* Single Adults and Couples without dependent children aged 19 - 64 up to 133% FPL

ACA Exchanges - MAAC said that Medicaid enrollment has increased since the exchange website went live. New Jersey actually has the second highest number of post-exchange new Medicaid applications. Nonetheless, we are not yet seeing numbers of new enrollees as high as predicted by most observers. We will continue to analyze the numbers. The State is offering training for anyone who wants to help sign up new enrollees.

WellCare Health Plan - as previously reported, WellCare will be the newest Medicaid insurance contractor in New Jersey.  WellCare is absorbing Healthfirst, so there will remain 4 insurance companies contracting with the State for Medicaid.  MSNJ is meeting with WellCare on network matters.

Dual Special Needs Consumers - United Healthcare is ending its coverage in New Jersey. This will affect 10,300 consumers.

Move of Long Term Services to Managed Care - the implementation of this portion of Governor Christie's Medicaid waiver that moved most of Medicaid services to managed care is being delayed.  It will not take effect until July 2014.

Move of Behavioral Health to Managed Care - the creation of an Administrative Services Organization is still underway. *IMPORTANT NEWS FOR PROVIDERS: Medicaid will now have a new billable  telepsychiatry service for physicians and APNs designed to improve clinical access for clients (adults and children) in need of psychiatric services.

ACA Primary Care Payment Increase - $64 million has already been disbursed to NJ providers. The State has not yet decided if it will continue to fund the increased rates once federal funding runs out. MSNJ will push for sustained rates.

Accountable Care Organizations - Governor Christie signed a bill creating Medicaid ACO pilots in his first term. The implementation process has been frustratingly slow, but regulations are finally due out shortly. MSNJ will help members navigate this option.

Provider Credentialing Task Force - The task force is tasked with improving the process of credentialing. MSNJ is a task force participant. They are nearing the end of their process and will have recommendations soon.

More information on these items can be found in the presentation slides from the meeting.

Registration Open for NJ Medicinal Marijuana Program's Third Alternative Treatment Center

A third Alternative Treatment Center (ATC) called Garden State Dispensary began accepting registrations on November 18, 2013 for patients and caregivers enrolled in New Jersey's Medicinal Marijuana Program. Garden State Dispensary, formerly known as Compassionate Care Center of America is located in Woodbridge, New Jersey and expects to be open by the end of the year. There is no cost to change ATC registration and it does not require a new identification card. Patients can only be registered with one ATC at time. Currently, the two operating ATC's are Greenleaf Compassion Center of Montclair and Compassionate Care Foundation of Egg Harbor.

For questions relating to the new ATC, the Garden State Dispensary customer service department can be reached by calling (848) 999-2005 or visiting its website. Appointments with Garden State Dispensary can be scheduled via e-mail. 

Physician Resources on the Medicinal Marijuana Program include:

• Introductory webinar for physicians developed by the New Jersey Department of Health's Medicinal Marijuana Program.
• FAQ's on the Medicinal Marijuana Program.
• List of scholarly articles related to medicinal marijuana research.

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 info@msnj.org with "Medicaid Incentive" in the subject line. 

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.

Medical Chart Audit Webinar Series 

• Top Ten Tips for Physicians Facing RAC and Private Payer Audits - December 4 from 12:00 P.M. to 1:00 P.M. Register online.
• Horizon BCBSNJ - Physician Outlier Programs - December 18 from 12:00 P.M. to 1:00 P.M. Register online.

2012 eRx Incentive Program Feedback Reports Available

2012 eRx Incentive Program Feedback Reports are now available for Eligible Professionals (EPs) and group practices who submitted data for the 2012 eRx Incentive Program. Individual EPs or group practices can retrieve their feedback reports using one of the following options:

1. 1.     TIN-level Reports are available for download on the Physician and Other Health Care Professionals Quality Reporting Portal via QualityNet. ()

• o    Tin-level reports on the portal require an IACS account. View instructions on how to request an IACS account and access the portal. 

1. 2.     NPI-level Reports can be requested through the Communications Support Page by creating a NPI-level feedback report request. The report will be sent electronically within 2-4 weeks to the email address provided in the request.

eRx incentive payments to EPs and group practices who successfully participated in the program in 2012 is scheduled to be distributed in the fall of 2013. EPs and group practices can request an informal review of their 2012 eRx reporting performance beginning November 1, 2013 through February 28, 2014. View a fact sheet on how to request an informal review.

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.

Medicare Ordering and Referring Denial Edits Implemented on January 6, 2014

CMS will instruct contractors to turn on Phase 2 denial edits on January 6, 2014. These edits will check the following claims for a valid individual NPI and deny the claim when this information is invalid:

• Claims from clinical laboratories for ordered tests;
• Claims from imaging centers for ordered imaging procedures;
• Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS; and
• Claims from Part A Home Health Agencies (HHAs)

For more information, read the MLN Matters article.

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.

View November's Coding Tip of the Month on ICD-10 Signs and Symptoms 

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.

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.

EHR Incentive Programs Reporting Period Ends December 31

December 31, 2013 is the last day of the 2013 meaningful use program year for eligible professionals (EPs) participating in the EHR Incentive Program. If you are an EP participating in the Medicare EHR Incentive Program, you have until February 28, 2014 to attest to demonstrating meaningful use of the data collected during the reporting period for the 2013 calendar year. If you are participating in the Medicaid EHR Incentive Program, you should refer to your state's deadlines for attestation information.

January 1, 2014 marks many important milestones for EPs participating in the EHR Incentive Program, including:

• The start of Stage 2 for EPs who have already completed at least two years of Stage 1.
• The last year that Medicare EPs can begin participation and earn an incentive.
• A 3-month reporting period in 2013, regardless of the stage of meaningful use, to allow time to upgrade to 2014 certified EHR technology.
  • Medicare EPs beyond their first year of meaningful use must select a 3-month reporting period fixed to the quarter of the calendar year.
  • Medicare EPs in their first year of meaningful use may select any 90-day reporting period that falls within the 2014 calendar year.
  • Medicaid EPs can select any 90-day reporting period that falls within the 2014 calendar year.

Resources include:

• Meaningful Use Attestation Calculator 
• Attestation Worksheet for EPs 
• Attestation Guide for Medicare EPs

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.

2012 PQRS Feedback Reports Available

Feedback reports are now available for physicians who submitted PQRS data from Medicare Part B Physician Fee Schedule claims with dates of service between January 1, 2012 and December 31, 2012. Individual eligible professionals (EPs) who submitted 2012 PQRS data can retrieve their 2012 PQRS Feedback Reports using the following options:

• NPI-level reports can be requested through the Communications Support Page by creating an NPI-level feedback report request. (The report will be sent electronically and could take 2-4 weeks.)
• TIN-level reports, which contain NPI-level detail, are available for download on the Physician and Other Health Care Professionals Quality Reporting Portal via QualityNet. TIN-level reports on the portal require an IACS account. View step by step instructions on how to request an IACS account.

Group practices who participated in 2012 PQRS GPRO can access their feedback reports though the 2012 Quality and Resource Use Reports (QRURs). Authorized representatives of practices with 25 or more EPs can access the QRURs by clicking here using an IACS account with one of the following group-specific PV-PQRS Registration System roles:

• Primary PV-PQRS Group Security Official
• Backup PV-PQRS Group Security Official
• PV-PQRS Group Representative

For more information, read the 2012 PQRS Feedback Report User Guide.

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.