Medical Chart Audit Webinar Series:

 

Novitas Solutions Medicare Part B Presents: MSNJ - Medical Review

Wednesday, January 22 from 12:00 P.M.-1:00 P.M.

Tanya Ickes, LPN, CPC, CEMC, HIA, HCAFA, Novitas Solutions, Inc.

 

Novitas will review the Program Integrity Department; Discuss what the Medical Review Department does and how they do it; Explain the different types of reviews; Discuss tips for a successful medical review; Review of Comprehensive Error Rate Testing (CERT) Program; Provide a clear understanding of the changes in Medicare and their impact to provider; and Discuss Contractor updates and initiatives as they correlate to the provider community.

 

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

Register online.

Amerihealth's Exchange Products

Wednesday, January 29 from 12:00 P.M.-1:00 P.M.

Michael Zollenberg, Amerihealth New Jersey

 

Join MSNJ for a webinar on "Amerihealth's Exchange Products" to learn about Amerihealth's products both on/off the Healthcare marketplace and the differences in their networks. Please submit all questions to info@msnj.org with "Amerihealth's Exchange Products" 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.  

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.

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.

 

 

Congress Passes Positive Medicare Fee Update for Three Months-Anticipates SGR Repeal

This week the Senate voted 64 to 36 on legislation that will avert the scheduled 24% Medicare fee cut on January 1 and provide a 0.5% payment update for three months.  This is the 15th such "patch" to avert payment cuts under the sustainable growth rate (SGR) formula over the past decade. It is the first positive update since 2010. The three month time period is in anticipation of comprehensive Medicare payment reform.  Read more and communicate with your representatives about the importance of repealing the SGR if you have not done so already.

  

MSNJ Urges Horizon to Delay Certification Requirement for Endocrinologists beyond January 1

On December 19 MSNJ requested in a letter that Horizon delay implementation of its policy that requires an Endocrine Certification in Neck Ultrasound (ECNU) for endocrinologists who perform thyroid ultrasound (CPT 76536) and ultrasonic guidance for biopsy (CPT 76942). The basis for our request was two-fold: many endocrinologists were not aware of the certification requirement; and, even if they had been, the period of time to obtain this certification is longer than the time-frame allowed. Horizon had indicated that it will consider the information submitted by MSNJ, AACE, and its New Jersey Chapter. We will keep members updated on Horizon's response. 

Affordable Care Act Updates

A 10-day grace period for consumers making their first health plan premiums under the ACA will go into effect for coverage beginning January 1. Participants must still select a plan by December 23 for coverage to take effect the first of the year. In New Jersey, the Health Republic Insurance of New Jersey (HRINJ), Horizon and AmeriHealth have all agreed to allow retroactive coverage for Exchange participants whose payments post by January 10.

 

Yesterday, DHHS announced the expansion of catastrophic plans under the ACA. Consumers may be eligible to purchase catastrophic coverage if their previous policy is canceled and they qualify for a hardship exemption. These consumers may also be exempt from all mandated coverage if they believe the cost to be more than their previous plan. Before this announcement, catastrophic coverage was only available to persons under the age of 30. Read more.

Due to inclement weather, the December 15 MSNJ Board of Trustees meeting was held virtually. Please read the summary of the meeting. 

MSNJ in the News: 

 

Check out MSNJ CEO Larry Downs' comments in "Latest ACA problem: New medicaid enrollees may find their coverage is limited," by Beth Fitzgerald, NJBIZ

Non-profit Physicians Foundation Releases Issue Watch List for Physicians

Earlier this month, the Phyisicans Foundation, of which MSNJ CEO Larry Downs is a board member, released its 2014 Watch List. The list includes five areas in healthcare which the Foundation predicts will most affect physicians' ability to practice and provide quality care to patients in the new year. View the list.

Horizon Managed Care Recoupment

Many MSNJ members have reported receipt of accounts receivable notices relating to a large overpayment recovery effort by Horizon. It is our understanding, based on member reports, that this effort is associated with managed care claims that were mistakenly paid at the traditional fee schedule. We are concerned that our members have not received advanced notice of the recoupment effort, other than EOB's that list an accounts receivable report. We asked Horizon to provide additional information regarding the effort, supply physicians with formal notice of the recoupment (including appeal rights), and delay automatic recovery until the 45 day appeal period ends or the appeals process is exhausted (whichever is later). Physicians who will face financial hardship due to the recoupment should contact their network specialists to discuss the matter.  We will update members through e-News and our website. In the meantime, members are encouraged to review our guidance document and FAQ on recoupment. Members with additional questions or concerns may contact us at info@msnj.org. Please put "Horizon Managed Care Recoupment" in the subject line. 

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.

Webinar: Hotspotting - Improving Care and Reducing Costs with Innovative Local Data Systems

Presented by the Affiliated Accountable Care Organizations and the Camden Coalition of Healthcare Providers (CCHP). 

This webinar will take place on January 9, 2014 at 10:00 A.M. CCHP, led by Dr. Jeffrey Brenner, has been using "Hotspotting," the process of identifying heavy users of the healthcare system and developing targeted interventions to address their needs. On this webinar, learn about their process and how a community can apply to have CCHP help map out better care. Register online.  

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.

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.

All Payer Claims Databases

The Assembly Health Committee took testimony on the concept of creating an all payer claim database, partly for the purpose of determining proper charges and reimbursement for certain services, particularly out of network services.  MSNJ has testified on existing legislation, stating that APCDs can be a good tool. MSNJ opposes legislation that would create artificial limits on out of network charges and supports improvements on in network issues first. See media coverage here. 

 

 

 

• Breast Density
• Self-Referral Laws
• Gender Changes on Birth Certificates
• Emergency Generators
• Reconstructive Breast Surgery
• Physician Loan Redemption
• Any Willing Provider
• Student Eye Injuries
• Latex Gloves
• Student Health
• Mental Health Screenings
• Declaration of Death
• Breast Milk
• Student Asthma
• Medical Marijuana

Request an Informal Review of the 2014 eRx Penalty

Eligible Professionals (EPs) and group practices who did not successfully e-prescribe under the 2012 or 2013 eRx Incentive Program will be subject to a 2 percent penalty in 2014. CMS will be notifying EPs and group practices who will be subject to the 2014 penalty.

 

CMS has implemented an informal review process for the 2014 eRx penalty. An informal review may be requested if the EP or group practice is notified from CMS confirming that they will be subject to the 2014 penalty or they did not meet the requirements to avoid the penalty. Requests for an informal review will be accepted through February 28, 2014 by email. View complete instructions. 

Register: CMS ICD-10 Testing Week

To help you prepare for the ICD-10 transition, CMS announced a national testing week for providers and clearinghouses from March 3 through March 7, 2014. The testing week will give trading partners access to the MACs and Common Electronic Data Interchange (CEDI) for testing with real-time help desk support. This event will be conducted virtually. Registration is required. Complete the below registration form. More information.

CMS Call on 2014 Physician Fee Schedule Final Rule

CMS hosted a National Provider Call on December 17 on the "2014 Physician Fee Schedule Final Rule: Quality Reporting in 2014." This call provided an overview of the 2014 Physician Fee Schedule Final Rule, program updates to the Physician Quality Reporting System (PQRS), details on how an eligible professional (EP) or group practice can meet the criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS penalty, criteria for satisfactory participation under the new qualified clinical data registry option, and program updates for EHR Incentive Program and Physician Compare. View the slideshow presentation. Transcripts will be available soon.

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.

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.