Medical Society of New Jersey e-Newsletter
 
January 17, 2014

   
In This Issue
WEBINARS
.
NEWS
-Aetna/UCR Class Action Settlement
-UHC Medicare Advantage
-2014 Medicare Physician Fee Schedule
LEGISLATIVE UPDATE
-Endocrinologist Certification Delay
-Policy & Strategy Panel
-MSNJ Nominating Committee
-County Events
.
PRACTICE MANAGEMENT
-Medicare Telehealth Services
-More
-ACA Practice Alert!
 

Download MSNJ's 2013/2014 
Meeting Calendar
Webinars

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.


Ready Set Code! ICD-10 Webinar Workshops

The compliance date for implementation of ICD-10 is October 1, 2014. Will you be ready? MSNJ and the New Jersey Hospital Association will host a series of specialty specific webinar workshops on ICD-10. These hands-on coding workshops will help you master ICD-10-CM and the documentation requirements associated with coding for your specialty-specific practice. Participants will gain an understanding of the code format and structure of ICD-10 and the ability to successfully assign diagnosis codes using ICD-10. Choose one workshop that best describes your practice. Each 2-hour Specialty Workshop will be repeated on two different dates/times for your convenience. All workshops are eligible for 2 AHIMA CEUs and approved for 2 AAPC CEUs. More information. 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 [email protected] 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 [email protected] 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.

CME/Events /Training

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.


Prescribers' Clinical Support System for Opioid Therapies (PCSS-O) is a three year grant funded by Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT).

The online modules are designed to increase your understanding of the current state of opioid-dependence treatment, increase your understanding of treatment issues for special populations, and lastly to increase your ability to assess and treat patients. Access the modules. 

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SAVE THE DATE:

MSNJ's 2014 Advocacy Conference and Annual Business Meeting  

May 2, 2014 at the East Brunswick Hilton

 

Inaugural Gala honoring Paul Carniol, MD, MSNJ's 222nd President

May 10, 2014 at the Parsippany Hilton 

 

Sponsorship information now online! 

NewsTOP

ALERT! Aetna/UCR Class Action Settlement-Consider your Options
Physicians recently received a notice in the mail that outlines the claims process for those who wish to participate in the above settlement. This action was filed by MSNJ and a number of state medical societies to address underpayments to physicians who treated Aetna patients out of network and it follows the premise of other cases: out of network fees based on the Ingenix data-base are not adequate and do not approximate usual customary and reasonable fees. Ingenix was discredited and replaced with a transparent, independent data base known as FairHealth as a condition of the settlement of an enforcement action by the New York Attorney General and litigation against United Health Group, the owner of Ingenix. Physicians who treated Aetna patients out of network must now decide whether to participate or to opt-out of the settlement. . More may also be found on the settlement web site

 

MSNJ has prepared a guide to assist physicians with the decision. Information, including Questions & Answers

Update on UHC Medicare Advantage Physician Terminations - MSNJ Facilitates Reinstatements

Since October 2013 when MSNJ first learned that UHC was narrowing its Medicare Advantage physician network, without any warning to the society of our members, we have been working to assist individual members be reinstated and to prevent such an initiative during the Medicare open enrollment period. In addition, we have discussed our concerns with the NJ congressional delegation and representatives of CMS. Our efforts include:

  • Requesting CMS to retest network adequacy on an individual or practice basis
  • Urging CMS to monitor and enforce the Medicare Advantage rules
  • Urging our congressional delegation to consider legislation to protect physicians and Medicare beneficiaries from network reductions during open enrollment
  • Working with the AMA to obtain policy or regulatory changes to the Medicare Advantage rules
  • Filing an amicus brief in support of the preliminary injunction obtained in litigation filed in Connecticut 

This week we spoke to Congressman Frank Pallone and representatives from CMS.

In response to cases that we have sent to CMS for network adequacy testing some of our member practices have been reinstated. The reinstated practices vary by specialty, size, and location including:

  • A five physician critical pulmonary care practice
  • A four physician allergist practice
  • A two physician ophthalmology practice

We are continuing efforts to assist members who did not receive notice of termination, but are being treated as terminated and other members with compelling facts that require reconsideration.

 

There will be a hearing on the preliminary injunction obtained in the Connecticut litigation on January 21. We will continue to monitor the lawsuit and consider all options to assist our members. It is important to note that the purpose of the injunction is to preserve the status quo to permit terminated physicians the rights under their contracts to arbitrate. It is not a decision on the merits of the case. The injunction only applies to physicians in the two Connecticut counties that brought the lawsuit.

We urge any physician who believes that he/she has a network adequacy issue or a contract issue to consider filing for arbitration. Please review your contract for details. We are interested in hearing from physicians who are considering arbitration. We will help you to evaluate your network adequacy position. Please write to [email protected]

2014 Medicare Physician Fee Schedule Issues: UPDATE
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, all fee schedules have been updated on the website.

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 now also available in Novitas' interactive fee calculator. 

Legislative Update

Lame Duck 2013 Gubernatorial Action - Two Successes for Physicians


APN Scope of Practice
Despite our protest, both houses have 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. MSNJ's opposition letter can be found here. We are hoping for a pocket veto by the Governor, as he did two years ago when the Legislature rushed the bill through in an identical manner.
 

Physician Loan Redemption

The Legislature passed S162, which establishes a Physician Loan Redemption Program. The bill awaits action by the Governor. MSNJ, along with NJ AFP and COTH worked expediently to improve the bill that was passed by the Senate in a skeletal, flawed form.  With our input, the bill now provides for redemption of eligible qualifying loan expenses for physicians who work for no less than four years at an approved site in the clinical practice of primary care or in the clinical practice of specialized care if the specialty is projected to experience a significant shortage.

 

Self-Referral Laws

The Governor signed a bill which allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met. MSNJ and New Jersey urologists support this bill, which is a "clean up" to the reforms made to self-referral laws (the Codey Act) in 2009. Lithotripsy was left out of the exemptions in 2009.

Read the full legislative report.

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.

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. Please contact your county executive or Sue Hoisington or 609-896-1766 x 207 for more information.

County Events

January 22, 2014
Topic: BME Issues: Board of Medical Examiners Investigations & Hearings:A Primer on what to expect if you become the target of an investigation or administrative complaint by the BME or AG�€™s office
Location: 2 Princess Road, Lawrenceville
Time: 6:30 P.M.-8:00 P.M.

January 23, 2014
Topic: 2014 Compliance Education Coding Updates & RAC 
Location: St. Peter's University Hospital 254 Easton Ave. New Brunswick, NJ
Time: 6:30 P.M.-8:00 P.M.

Practice Management

Medicare Telehealth Services for CY 2014

CMS has added two codes to the Medicare telehealth services list in the calendar year 2014 physician fee schedule final rule. Effective January 1, 2014, CMS has modified regulations describing eligible telehealth originating sites to include health professional shortage areas (HPSAs) located in rural census tracts of metropolitan statistical areas. CMS also modified regulations to establish geographic eligibility for Medicare telehealth originating sites for each calendar year based on the status of the area as of December 31 of the prior calendar year. Read more.

New Jersey Gender Equity Notice

Effective January 6, 2014, covered employers in New Jersey that have a total of 50 or more employees must post the gender equity notice in a place accessible to all employees in each of the employer's workplaces. Each employee of a covered employer who was hired on or before January 6, 2014 must be provided with a written copy of the gender equity notice no later than February 5, 2014. Any employee hired by a covered employer after January 6, 2014 must be provided with a written copy of the notice at the time of hiring. Effective January 6, 2014 covered employers must annually provide a written copy of the notice on or before December 31 of each year and must provide a written copy of the notice upon first request of the employee. View the poster.

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 FAQRead 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.

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.

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
Corporate Partners

 

MSNJ Magazine Subscription Service 

Subscription Services, Inc., does their very best to get you the lowest rates.  As a member, you are eligible for the very lowest prices on magazine subscriptions as well as personalized hands-on customer service. Click "Shop for Magazines" to place new subscriptions, renewals, as well as gift order subscriptions. You can also inquire about titles you may be interested in.  If you ever have a question regarding your order or your account, please call 1-800-603-5602, or use the contact page to communicate with a customer service representative.  And if you ever find a lower authorized price, they will match it! 

  

 

Member Resource Guide   

Check out the current MSNJ Member Resource GuideInside, you will find a complete listing of partners by service/product category, along with contact information. Also, be sure to check out the individual Corporate Partner pages on our website as some offer additional discounts to members!

 

It is important to note that MSNJ does not endorse any vendor, service, or product. However, we encourage members to please consider our Corporate Partners first as the financial support received from these organizations is vital to our association. It is our hope that their investment in MSNJ will help keep your membership dues and programming affordable.

 
Medical Society of New Jersey
2 Princess Road, Lawrenceville, NJ 08648
(o) 609-896-1766 e-mail:
 

About the Medical Society of New Jersey:

Founded in 1766, the Medical Society of New Jersey (MSNJ) is the oldest professional society in the United States. MSNJ promotes the betterment of the public health and the science and the art of medicine, to enlighten public opinion in regard to the problems of medicine, and to safeguard the rights of the practitioners of medicine.  The organization and its members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician-patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care.  For more information visit our website or send us an e-mail.

"Your Partner in Practice... Your Voice in Trenton"  

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