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.

Overview of Aetna's Claim Review Program

Thursday, February 27 from 12:00 P.M.-1:00 P.M.

Robert Refowitz, MD, CMO, OrthoNet

Aetna will describe the program, review general operations and offer suggestions, in general, about documentation.

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

Governor's Action at the End of the 2013-2014 Legislative Term   

BILLS SIGNED: 

• 2012:S792 / 2012:A2022 (Weinberg, Singleton, Benson, Johnson, Lampitt, Quijano, Vainieri Huttle) - Requires insurers to cover breast evaluations and other additional medically necessary testing under certain circumstances and requires certain mammogram reports to contain information on breast density
• 2012:A3251 / 2012:S2567 (Ramos, O'Scanlon, Jimenez, Vitale, Singer) - Permits pharmacists to administer influenza vaccines to children seven years of age or older 

BILLS THAT EXPIRED WITHOUT GUBERNATORIAL ACTION (POCKET VETOED): 

• 2012:S162 / ACS for 2012:A1269 / 2012:A4507 (Singer, Vitale, Greenwald, Coughlin, Prieto, Riley, Lampitt, Casagrande, Wimberly, Conaway) - Provides loan redemption for certain physicians who work in State four years
• 2012:S1598 / 2012:A1097 (Weinberg, Vitale, Quijano, Wimberly, Munoz, Jasey) - Permits attending advanced practice nurse to determine cause of death and execute death certification of patient if nurse is patient's primary caregiver  

Read the full listing. 

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. Review the agenda. 

Court Ruling on Injunction Against UHC for Medicare Advantage Terminations
On January 21 the 2nd Circuit Court of Appeals heard arguments on the injunction against UHC to preserve the status quo concerning its termination of physicians in two Connecticut counties from its Medicare Advantage plans. MSNJ, AMA, and many state and national specialty societies filed an amicus brief in support of the continuation of the injunction. At the end of oral argument, the court, based on statements made by the physicians' counsel, suggested that the parties attempt to reach a settlement regarding the timing of the arbitrations. Consequently, the Court of Appeals ordered the parties to mediation on January 30 and to report back to the court. However, the court did not make a specific ruling on the propriety the injunction.

Are you an Attractive Target for Merger/Acquisition/Employment?  

The trend of solo and small physician practices merging with other practices is undeniable; the trend to hospital employment of physicians continues. But are you an attractive target for a merged practice or hospital employee?  If you have not been participating in PQRS and keeping up with Medicare's Value Based Modifier program you may not be. Penalties under the value based modifier program kick-in two years after the reporting obligations. These penalties ("downward payment adjustments") will follow the physician. Listen to CMS' webinar on the Value Based Modifier payment adjustments. This is yet another reason to begin participation in the PQRS program if you have not done so already.  

Appellate Court Denies MSNJ's Motion to File Amicus Brief on the State Health Benefits Plan-At Issue: Standing and Calculation of UCR
In October of 2013 MSNJ and the AMA filed an amicus brief in the Matter of Montvale Surgical Center's Request for a Declaratory Ruling from the State Health Benefits Commission (SHBC). The case is on appeal and pending in the New Jersey Appellate Division. It raises important questions of whether physicians have standing to challenge reimbursement under the State Health Benefits Plans and whether the plans' use of 160% of Medicare to reimburse for certain fees meets the statutory standard for reimbursement of out-of network fees. MSNJ's brief was filed to provide information to the court on why the SHBC and its third-party administrator's conclusion that 160% of Medicare was an appropriate measure for usual and customary facility fees fails to satisfy the statutory standard.  We are disappointed that the appellate court denied our motion for permission to file the brief and that it will not have the benefit of the information and legal arguments. We appreciate the support of the AMA on these important issues for our members and all physicians.   

MSNJ Joins ACOG and its NJ Chapter in Brief on Methadone Treatment of Pregnant Women  

MSNJ has joined a roster of specialty societies and medical experts in an amicus brief filed with the New Jersey Supreme Court. The state's high court granted certification to hear a case initiated by the NJ Division of Youth & Family Services (DYFS) against a mother who used methadone pursuant to a drug addiction treatment program during her pregnancy. She was found by DYFS to have committed child abuse and neglect solely on the ground that she obtained medically-supervised methadone treatment during her pregnancy which resulted in treatable, transitory, and known side-effects to the child. The brief argued that a judicial finding on the impact of methadone treatment should be informed by the medical and scientific evidence, including the benefits of medically supervised methadone treatment. 

CMS Rule Proposal Would Require Medicare Enrollment for Prescribers of Part D Drugs & Permit Revocation of Billing Privileges for Abusive Prescribing Patterns  In an effort to fight drug fraud and abuse CMS initiated rulemaking on January 6  that it claims will ferret out problematic prescribers and pharmacies that write or fill prescriptions for Medicare beneficiaries under Part D. Among other things, the proposal would require that prescribers of Part D drugs enroll in Medicare. In addition, the proposal would add authority allowing Medicare to revoke the prescribers enrollment for a pattern or practice of prescribing Part D drugs that is abusive and that represents a threat to Medicare beneficiaries. Read the CMS fact sheet. AMA and MSNJ are studying the proposal and will file comments.
 

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. 

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

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

Last week, MSNJ hosted a webinar on collecting high deductibles. This three part panel series included presentations on:

• "The Changing Medical Practice Landscape in a High Deductible World" presented by Rich Papperman, MBA, CHBME of Cape Medical Billing;
• "The Cost of Collections and Practice Solutions for Automation" presented by Dr. Jon P. Neal, Vice President, InstaMed; and
• "The Legal Aspects of Collecting High Deductibles" presented by Michael J. Schoppmann, Esq., Kern Augustine Conroy & Schoppmann, P.C.

Purchase the archived webinar.

CMS' 2014 PQRS Webinar Recording

A recording of The Philadelphia Regional Office of CMS' 2014 PQRS webinar from January 9th is now available. Learn the program requirements for the 2014 PQRS program. Listen to the webinar. 

CMS Philadelphia is planning a webinar in February to merge information from all programs. More details to come.

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.