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.

 

Read MSNJ's FAQs on what to do if Horizon has excluded your practice from the Horizon Advance EPO network. If you received notice that you have not been selected as a participating physician for this product, all services rendered to patients on these plans will be out of pocket. Members are encouraged to post signs in office waiting areas to alert and educate patients regarding the practices' participation status.   

 

Horizon BCBSNJ - Physician Outlier Programs

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

James A. Dell'Arena, Horizon BCBSNJ

 

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. This webinar will not be archived.

 

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

 

Register online. 

Valley Hospital Grand Rounds and the Dermatological Society of New Jersey - North Region will present, "Unusual Genital Presentations/BCE Too" by Ted Rosen, MD. This event will take place on Thursday, December 19, 2013 at the Stony Hill Inn in Hackensack.

Cocktails:  6:30 P.M.; Dinner: 7:30PM. RSVP - Dr. Marcus (201) 891-4373

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.

 

 

Positive Developments on Medicare SGR Repeal Legislation
On December 5 the House Ways & means and Senate Finance Committees released a document with modifications to their draft discussion document on how to repeal Medicare's sustainable growth rate (SGR) formula and replace it with new value-based payment models. This activity precedes the Senate Finance Committee's December 12 scheduled mark-up session and the anticipated mark-up by the House Ways & Means Committee. 

The modifications are positive and consistent with suggestions made by the AMA and MSNJ. AMA reports that Congress may move legislation to address the looming 24% Medicare physician pay cut before January 1 as a "bridge" so that Congress will be able to complete work after its holiday recess to achieve a permanent repeal of the SGR together with comprehensive payment reform. While these modifications do not include positive payment updates, something on which MSNJ and organized medicine continue to advocate, positive changes include:

• A single, consolidated incentive program
• Less payment performance than under current law through 2019
• Greater opportunity for clinical practice improvement activities
• Reduced target for misvalued services from 1% to 0.5%
• Increased funding for technical assistance for small practices from $10m to $25m
• Increased disclaimer language  on the Physician Compare website

Read the December 5 modification to the October 30th discussion draft for details.
 

Physicians Should Evaluate Medicare Participation Options Now 

Medicare fees will be cut by an average of 24% due to the SGR. However, changes were made in the weights assigned to the three fee schedule components (physician work, practice expense, and malpractice expense) to more closely match their assigned weights in the Medicare Economic Index. A positive 4.72% adjustment was made to the fee schedule conversion factor to offset the aggregate impact of this "rescaling" of the three fee schedule components. The net impact of these changes produced a conversion factor that is 20.1% lower than the 2013 conversion factor.

 

All physicians should carefully consider their participation options now. These include "participation," "non-participation," and "opt-out." Each status has specific requirements. Due to the regulations being issued nearly four weeks late, CMS has agreed to extend the Medicare participation status deadline to the end of January 2014. Physicians should study the options, calculate the differences in fees, and make a thoughtful decision before the deadline. AMA has developed an FAQ to help physicians make this important decision.

MSNJ will host a lame duck update via conference call on Monday, December 16th at 6:30 P.M.  This will be an informal forum during which MSNJ President Ruth Schulze, MD, will be available to hear any concerns or priorities for the house of medicine as we finish this legislative session and enter the next one.

 

Call in information:

866-740-1260

Code: 8961209

Candidates for Open Positions
We are accepting applications for interested candidates for positions on the Board of Trustees, Judicial Councilor, AMA Delegates and various positions. Please review the Offices to be Filled by Election Report and read a brief synopsis of the committees and its expectations.

If you are interested in running for a positions or have questions about specific vacancies, please feel to contact your county executive or Sue Hoisington at 609-896-1766 X 207.

The deadline to submit a request is Wednesday, January 13, 2014.

New Data on Medicare Part D Prescription Drug Donut Hole Savings

CMS has released new data on Medicare prescription drug plan coverage. The Affordable Care Act has saved seniors and people with disabilities $8.9 billion to date on their prescription drugs. In New Jersey, 156,868 seniors and people with disabilities saved $165,019,270, or an average of $1,052 per beneficiary, from January 2013 through October 2013. Read the press release.

2013 WEDI Report Released

The annual Workgroup for Electronic Data Interchange (WEDI) report was released this week. It recommends ten changes to Health Information Technology regarding patient engagement, innovative encounter models, data harmonization & exchange, and payment models. Read the 2013 report.

Brach Eichler LLC, in conjunction with New Jersey Monthly, will host a free seminar on "The Private Practice of Medicine in an Obamacare World: Strategic Approaches" on Thursday, March 6, 2014 from 12:00 P.M. to 1:30 P.M. at the offices of Brach Eichler LLC, 101 Eisenhower Parkway, 2nd Floor, Roseland, NJ 07068. Learn how the Health Insurance Exchange impacts your practice. Lunch will be served. RSVP to Lauren Lynch by February 24, 2014 by e-mail or by phone at 973-364-8389.

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 

MSNJ will host a series of webinars on Medical Chart Audits:

• 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 December's Coding Tip of the Month on the Use of Z Codes

 

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.

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.