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.

 

 

President Obama Signs Positive Medicare Fee Update for Three Months

Yesterday, President Obama signed the Pathway for SGR Reform Act of 2013, which averts the 24% Medicare fee cut scheduled for January 1 and provides 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.

 

  

Listen to MSNJ's SGR toolkit webinar and read more online. 

MSNJ in the News: 

 

Check out MSNJ General Counsel Melinda Martinson's comments in "Seniors scrambling after United Healthcare drops doctors from Medicare Advantage," by Colleen Diskin, Bergen Record.

Recalcitrant Provider Procedures

CMS has heard from Medicare contractors that some providers are abusing the Medicare program.

The recalcitrant providers who refuse to comply with CMS requirements are being placed on prepay medical review for long periods of time, requiring the extensive use of contractor resources. CMS is encouraging contractors to take advantage of current sanctions to address this problem of recalcitrant providers. Note: Any provider referred as a potential recalcitrant provider case should be an "outlier," meaning a provider who has been the least receptive to changing and has a significant history of non-compliance. For any case submitted, it is important to remember that different mitigating or aggravating circumstances may need to be applied. Read more.  

Listen to MSNJ's archived webinar on "Top Ten Tips for Physicians Facing RAC and Private Payer Audits" and be sure to register for Novitas Solutions' Medical Review webinar hosted by MSNJ.

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.

State Trauma Plan

The Senate Health Committee has cleared a bill that provides for the establishment of a formal Statewide trauma care system plan, which will include all health care facilities in the State providing care to injured patients in the State, to the extent that their resources and capabilities allow.  

 

The Department of Health sought counsel with the American College of Surgeons Trauma System Evaluation and Planning Committee regarding the State's trauma system.  This bill incorporates the recommendations that resulted from that interaction.  The commissioner is required to appoint a State Trauma Medical Director to oversee the planning, development, ongoing maintenance, and enhancement of the formal trauma system in collaboration with a multidisciplinary advisory body called the State Trauma System Advisory Committee (STSAC).  

 

The STSAC is required to study the State's trauma care system, collect data, and provide a report on the development of a formal Statewide trauma system plan.  The STSAC's recommendations will provide the basis for the commissioner's development of regulations implementing the plan.  The STSAC's initial report, containing the formal Statewide trauma system plan, is due within one year.  

 

Thereafter, the STSAC will be required to systematically review strategies to maintain and improve the State trauma system, submit an annual report to the commissioner and the director on its activities, and provide recommendations it determines are necessary to improve the State trauma system.  Though the Assembly has not yet moved the bill, it is likely a lame duck priority that will reach the Governor's desk soon.

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

2014 Medicare Physician Fee Schedule Posted

Novitas is working on posting the 2014 physician fee schedule in the file formats that you are used to. For now, Novitas is posting the files in a basic text only format to give you an opportunity to review the 2014 fees. This text file is formatted for viewing only and is not formatted for importing into billing systems or other types of computer systems. These fees are not yet available in Novitas' interactive fee calculator. As soon as the 2014 fees are posted in formats appropriate for importing, Novitas will notify you on their website and by an e-mail message.

Update: Medicare Demand Letters and Medicare Claim Cancellations Associated with an Item or Service Provider to Incarcerated Beneficiaries

Starting in the first week in December, refund payments for the Incarcerated Beneficiary Claims have been issued. If you believe that an overpayment has been made due to the Incarcerated Beneficiary refund payment, you are encouraged to follow the 'Notifying Medicare of an Overpayment - Part A and Part B' in the Reference Manual under Chapter 24 Section 2 to return the duplicate payment.

 

For more information on Incarcerated Beneficiary Claims Denials, view CMS' FAQ.

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.

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.