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

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

Part 1: The Changing Medical Practice Landscape in a High Deductible World.
Speaker: Rich Papperman, MBA, CHBME of Cape Medical Billing

Part 2: The Cost of Collections and Practice Solutions for Automation.  
Speaker: Dr. Jon P. Neal, Vice President, InstaMed

Part 3: The Legal Aspects of Collecting High Deductibles.

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.  

Qualcare/Republic Presents:

Providing a New Choice in Healthcare: A Healthier Kind of Health Plan

Thursday, February 20 from 12:00 P.M.-1:00 P.M.

Tom Daniels; Director of Broker Relations at Health Republic Insurance of New Jersey

 

Health Republic Insurance of New Jersey (HRINJ) is a non-profit, Consumer Operated and Oriented Plan (CO-OP) established through the Affordable Care Act. HRINJ provides cost-effective and comprehensive healthcare coverage to the people of New Jersey and is a new entrant into the health insurance marketplace in New Jersey. This webinar will explain who we are, what our mission is as a new, innovative health plan, and provide information about our product highlights and partners. It will also offer some information about the Affordable Care Act (ACA) and provide a listing of resources, as well as answer questions. Please submit all questions to info@msnj.org with "Qualcare/Republic 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.

 

 

2014 Medicare Physician Fee Schedule Issues
After MSNJ was alerted by members that the 2014 conversion factor for anesthesia was posted incorrectly on the Novitas website, we contacted Novitas and asked about the timeline for posting the corrected fee schedules. We also discovered that the ambulatory surgery center (ASC) and vaccine fee schedules are not up to date. Since our communication with Novitas, the anesthesia conversion factor has been updated on the website. We are still waiting for the ASC and vaccine fee schedules to be updated. Novitas advised that physicians will be able to determine that the ASC and vaccine fee schedules are up to date based on a message at the top of the page referencing the 12/26/13 signing of the Pathway for SGR Reform Act. We have asked that Novitas also included a "last updated" date to decrease any confusion.

Novitas also advised MSNJ that it has loaded the regular 2014 fee schedule into their system and is prepared to accept 2014 claims. Novitas recently posted the 2014 physician fee schedule in PDF and Excel file formats, that may be imported into billing software. These fees are not yet available in Novitas' interactive fee calculator.

We have confirmed with Novitas that if you bill Medicare less than the 2014 fee schedule amount, Medicare will pay the lesser amount. Likewise, Medicare will not reconsider claims that were paid at a billed amount that is less than the current Medicare fee schedule. To avoid this issue, physicians may want to consider billing Medicare at the practice's regular fee schedule to ensure that the amount billed is above the Medicare fee schedule amount. Another option is to hold claims until the correct information is posted on the Novitas website.

Please stay tuned to e-News for more information as it becomes available.  

Declared Candidate 2014 - 2015
MSNJ has received the declared candidates for open positions for 2014 - 2015. Read the list of the members who agreed to serve on the Nominating Committee meeting on Wednesday, January 23, 2014, 9:30 A.M. at MSNJ Conference Center. There is still time to submit your candidacy by January 13, 2014, please contact your county executive or Sue Hoisington or 609-896-1766 x 207. 

Horizon Agrees to Delay Certification Requirement for Endocrinologists
In response to a request by MSNJ and the affected specialty society, Horizon has agreed to delay the Endocrine Certification in Neck Ultrasound (ECNU) requirement until June 1, 2015. A new payment policy, denying payment for thyroid ultrasound and ultrasonic guidance for biopsy, was to have gone into effect on January 1, 2014. MSNJ asked Horizon to delay implementation of the policy because endocrinologists were not aware of the policy and, even those who were aware, would not have been able to obtain the certification in the time permitted. The delayed policy allows endocrinologists until June 1, 2014 to apply for the ECNU and until June 1, 2015 to have earned the certification. We appreciate Horizon's consideration of the issue and the delay in implementation. Read the payment notification. 

MSNJ's next Policy & Strategy Panel Meeting will be held on Thursday, February 13, 2014 from 5:30 P.M. - 7:30 P.M. at the MSNJ Conference Center at 2 Princess Road, Lawrenceville, NJ 08648. This is a free event. A light supper will be provided.

 Topic: MEDICAID: Improving Access to Care in a Post-ACA World

Invited Guest Speakers will include NJ Medicaid staff,
policy experts and trendsetters.

• What happens when the federal primary care incentive runs out?
• How can we help more specialists enroll?
• How can we reduce administrative burdens and fraud?
• How will new practice models, like medical homes, help?

Please register online.

The Center for Medicare and Medicaid Services announced that overall health expenditures grew at an annual rate of 3.7% in 2012. This marks the fourth consecutive year of low growth, slower than the economy as a whole for the second straight year, according to CMS. More information can be found online. 

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.

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 Monday, January 13, 2014.

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.

Pain Medicine Restrictions

The Senate Budget Committee approved a bill that would limit insurers from using step therapy protocols for pain medication. Read MSNJ's support letter and our coalition's support letter. Though the bill has already passed the full Assembly, the Senate is having trouble passing the bill. We hope they will vote on it this Monday. Time is of the essence, so please call your senators to support this bill.

 

APN Scope of Practice

The Assembly Budget Committee passed a bill that would which would permit Advanced Practice Nurses to certify cause of death.  MSNJ opposes this bill because cause of death is in fact a medical diagnosis and should be provided only by a physician. Read MSNJ's opposition letter. The Assembly is scheduled to pass this bill on Monday. The Senate has already passed the bill, unfortunately. Please call your assemblypersons to oppose this bill.  

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. 

Medicare's Electronic Submission of Medical Documentation System

CMS uses many types of review contractors to prevent and correct improper payments or identify potential fraud. Review contractors find improper payments and potential fraud by reviewing a sample of claims. Review contractors request medical documentation from the provider or supplier and physically review the claims against the medical documentation to verify that the provider is in compliance with Medicare's rules. Providers are now able to respond to these requests for medical documentation electronically using the Electronic Submission of Medical Documentation (esMD) via Medicare's esMD Gateway. Medicare's esMD system provides an alternative mechanism for submitting medical documentation, PMD PA requests, and PMD result code responses to review contractors. New Jersey's Medicare contractor, Novitas Solutions, accepts responses to medical documentation requests through esMD system. Read more.

Enhancements to Open Payments Mobile Apps

Enhancements have been made to CMS' mobile apps: Open Payments Mobile for Industry and Open Payments Mobile for Physicians. Changes include:

 

• Streamlining the menu on the Welcome screen,
• Adding the ability to export allprofile data associated with a payment into CSV format, and
• Developing a new function to view reports of payments in bar and pie charts.

 

If you have already downloaded the apps, you will need to run an update in your app store on your mobile device to take advantage of the new app functionality. Note: You will not lose any data that you may have entered into the old version of the app. All data will be transferred. Search for Open Payments in your app store if you have not yet downloaded the app. View the updated mobile app FAQ. Read more.

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.