Managing Exchange Plan Patients: Is Your Practice Prepared to Collect High Deductibles?

Wednesday, January 15 from 12:00 P.M.-1:00 P.M.

Speaker: Michael J. Schoppmann, Esq., Kern Augustine Conroy & Schoppmann, P.C.

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

 Register online.

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.

January 1, 2014 marks the first day that many of the healthcare reforms under the Affordable Care Act come to fruition: individuals may no longer be denied coverage based on pre-existing medical conditions; annual and life-time benefit limits have been removed. Many will obtain insurance coverage for the first time through the Marketplace or expanded Medicaid. While the reforms are welcome, practices will be challenged in the early days to determine coverage status. For details on determining coverage status for individuals with Marketplace plans read the news article. For details on determining Medicaid eligibility, read the article on Medicaid expansion below. In addition to the challenge of determining coverage is the financial risk of not receiving payment for treatments rendered to Exchange plan participants who do not pay their premiums, but remained covered between days 31 and 90 after non-payment. MSNJ joined the New Jersey Hospital Association in a second letter urging CMS to address this issue as soon as possible. Finally, January will be an even more challenging time for cash-flow due to more plans with high deductibles. Plan to participate in MSNJ's webinar on how to handle high deductible plans on January 15. Read the new report just issued by Kaiser, "How Will the Uninsured in New Jersey Fare Under the Affordable Care Act?" about the impact of the ACA in New Jersey.     

2014 Medicare Physician Fee Schedule Posted

Novitas advised MSNJ that it has loaded the 2014 fee schedule and is prepared to accept 2014 claims. However, they are still 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. It is important that you not bill for less than the 2014 fee schedule amount. If you bill for less, you will be paid the lesser amount. 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.

HIPAA: Practice Penalized for Lack of Breach Notification Policy - Thumb Drive Loss
A dermatological practice in Massachusetts is the first practice to settle a HIPAA enforcement action for failure to have policies and procedures in place to address the breach notification requirements of the HITECH Act.The HHS Office of Civil Rights began the investigation when it received a report that an unencrypted thumb drive, containing protected health information, had been stolen from the car of one of the practice's staff members. The practice had not conducted an analysis of the risks to the confidentiality of PHI as part of its security management process. The practice will pay $150,000 and has entered into a corrective action plan. Read the press release and the enforcement order. 

UHC Injunction Hearing Scheduled for January 21-Appellate Court Accepts Amicus Brief
The preliminary injunction obtained in the pending suit against United Healthcare for terminations of physicians in its Connecticut Medicare Advantage plans has weathered opposition by United Healthcare. Late last year MSNJ, many state medical societies and specialty organizations, the AMA and other national specialty organizations joined in a motion for leave to file an amicus brief to support the continuation of the injunction. On December 26, 2013, the 2nd Circuit Court of Appeals granted the motion permitting the brief to be filed and setting oral argument for January 21. MSNJ and a long list of interested parties argued that the terminated physicians would be irreparably harmed without an injunction to preserve the status quo status quo which would allow them to utilize their full appeal and arbitration rights under their participation agreements. Read the brief in its entirety.

MSNJ filed comments on January 3 in support of the Food & Drug Administration's (FDA) rule proposal to implement the Food & Drug Administration Safety & Innovation Act, the law passed in 2012 to address national drug shortages. MSNJ was a leading proponent of the legislation that requires drug manufacturers to give six-months notice of drug manufacturing cessation and earlier notice of manufacturing interruptions. It is meant to help the FDA predict and minimize drug shortages. Of particular note is the FDA's exercise of its discretionary authority to cover all biologics, including vaccines, blood and gene therapy products. MSNJ supports the inclusion of biologic products as a shortage of these products can cause serious negative health consequences to those who rely upon them.

Medicaid Expansion Update - Enrollment Glitches  
In November, the NJ Medicaid program advised that for individuals applying through the federal Marketplace there would be a lag time between federal and New Jersey approval. It further advised that it was able to handle the lag and that New Jersey had the second highest number of Medicaid enrollments of states using the federal Marketplace.   

On December 20th, a story broke indicating that State officials said that those who applied for health coverage using the federal government's website are actually unable to be enrolled because the State cannot process the eligibility information from the federal web site.  Per the article, "New Jersey Medicaid said in­formation it received from the federal insurance marketplace for about 25,000 residents who qualify for free health coverage from New Jersey's program for the poor is 'unusable.'  Their applications can't be pro­cessed, and they can't yet be enrolled for coverage that is supposed to begin on January 1." Read the news article. 

But, MSNJ was recently informed that though,

"the flat file sent to NJ Medicaid by the federal Marketplace still is unusable...individuals who applied to the Marketplace between October 1 and December 31, who are verified as Medicaid eligible, will have their coverage backdated to January 1."

MSNJ immediately asked the Division for guidance - read more on MSNJ's blog.

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.  

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 registration form. More information.

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 January's Coding Tip of the Month on the Use of S and T 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.