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

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.

Medical Chart 

Audit Webinar

Cigna's Audit Program

Wednesday, February 26 from 12:00 P.M.-1:00 P.M.

Ronald Menzin, MD, Cigna

Cigna will provide information on their program, and discuss tips for a successful audit.

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

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?

Joint Bill Repealing SGR Headed to Full Congress 

On Thursday, lawmakers revealed the bipartisan plan to repeal Medicare's SGR, replacing it with a stable payment model with five years of positive payment updates. The bill moves to the full Congress ahead of a March 31 deadline which would bring 24 percent payment cuts.

Read more. Read AMA's section-by-section summary of the bill and visit the advocacy page, Fix Medicare Now. 

MSNJ leadership is reviewing the joint legislation and its impact on physicians. Watch your e-mail for grassroots advocacy opportunities beginning next week.

Update on UHC Medicare Advantage Termination Litigation Pending in Connecticut -- Injunction Modified 

We previously reported on the litigation filed by two Connecticut counties against United Healthcare challenging its termination of Medicare Advantage physicians as part of a network narrowing. UHC's challenge of the preliminary injunction on its physician terminations to the 2d Circuit Court of Appeals ended in an order of mediation to settle by January 30. The parties were not able to settle.

Today, the 2d Circuit Court of Appeals modified the preliminary injunction based on certain concessions by counsel at oral argument. The modified injunction allows physicians from the Connecticut counties "a reasonable time, not exceeding 30 days from February 7, 2014, to challenge their removal by initiating arbitration proceedings in which they may seek emergency or injunctive relief from an arbitrator. After this period, the preliminary injunction shall expire." The onus is now on these physicians to arbitrate within 30 days and to seek any further emergent relief in the arbitration proceedings.

Physicians in New Jersey must file for arbitration within one year of their terminations.

MSNJ continues to advocate with Congress and federal regulators on the issue of network narrowing which occurs in virtually all plans. Recently, HHS decided to revisit the issue for products sold on the Exchanges. Starting next year HHS will take a closer look at the adequacy of networks in Exchange plans. [See February 2, 2014 letter to Issuers in the Federally-facilitated Marketplace from CMS at page 19 indicating that it will review for "reasonable access" and concentrate on historic network adequacy concerns such as hospitals and mental health providers.]  

We will continue our advocacy efforts at the administrative level. 

Are You the Subject of a Payer Audit?

Physicians, who are the subject of a payer audit, should check their professional liability policies for two reasons: there may be a reporting requirement; and your policy may provide some defense. Even if you are not the subject of an audit, you should review the terms of your policy and consider whether to obtain supplemental audit insurance. MSNJ has provided a variety of resources for our members on how to respond to audits. We are currently half way through a webinar series which included an introduction on the top legal issues, followed by separate webinars with speakers from each of the major payers. There is still time to register for the Cigna webinar on February 26 and the Aetna webinar on February 27. Both run from 12:00pm to 1:00 pm and registration is $25 for MSNJ members. The archived version of our opening audit webinar on the "Top Ten Tips for Physicians Facing RAC and Private Payer Audits" can be purchased on our website. The series will end with a presentation on audit insurance products (more information to come). 

Idaho Hospital & Physician Practice Merger Violates Anti-trust Laws-Court Orders Divestiture

On January 24, 2014, the U.S. District Court in the District of Idaho ordered a divestiture of the affiliation between St. Luke's and the Saltzer Medical Group because the arrangement violated antitrust laws. The decision will cause would-be merging parties to more carefully consider the efficiencies of such mergers and whether they will survive the scrutiny of the Federal Trade Commission which has shown increased interest in the anticompetitive impact of consolidation. 

In an effort to move toward an integrated patient care model, St. Luke's began purchasing independent physician groups where compensation depended on patient outcomes. In Nampa, Idaho St. Luke's acquired the Saltzer Medical Group; the combined group included 80% of the primary care physicians in Nampa.

While the court lauded the intent of the hospital and physician practice integration to improve patient outcomes, it predicted that the deal would have anticompetitive effects. The court found that it: 

In addition, the court noted in its findings that prior purchases of specialty practices by St. Luke's had resulted in dramatic increases in referrals to it and decreased referrals to other area hospitals.

The Court concluded that "while employing physicians is one way to put together a unified and committed team of physicians, it is not the only way. The same efficiencies have been demonstrated with groups of independent physicians." [p. 47]

The hospital will appeal. Read more.

CLIA Rule Allows Patients to Request Lab Results Directly

On February 6, 2014 in a Final Rule the Department of Health & Human Services published amendments to the Clinical Laboratory Improvement Amendments of 1988 (CLIA), allowing patients (or their personal representatives) to request their lab test results directly from labs subject to CLIA. This Final Rule also amends the HIPAA rule which generally gives patients the right to access test reports directly from labs subject to HIPAA. CLIA labs were previously exempt from this requirement, but the Final Rule eliminates this exemption. The Final Rule requires labs to provide the results to patients within 30 days of a request. HIPAA-covered labs will have 180 days from the effective date of the new rule to comply with the revised individual access requirements. Labs are able to charge reasonable, cost-based fees to patients requesting results. New Jersey regulations, N.J.A.C. 8:44-2.7(i), already provide that patients may request copies of laboratory test results directly from the lab. 

Journal Reprints Reportable under Sunshine Rule

MSNJ is disappointed that CMS has determined that the rule implementing the Sunshine Act requires the reporting of the transfer of value to physicians for reprints of medical journal articles and textbooks.  MSNJ, AMA, and other state medical societies urged CMS to exclude scientific peer-reviewed medical journals and textbooks from the reporting requirement. CMS cited transparency interests to provide this type of information from which consumers may evaluate the nature and extent of the relationship between physicians and those who provide such material. According to a letter dated December 23, 2013 to Congressman Phil Roe from CMS Administrator Marilyn Tavenner, the value of this material will be reported as "educational" or a "gift" depending on the circumstances. 

Resolutions

In preparation for MSNJ's House of Delegates meeting on May 2, all resolutions are due from the counties by March 14. The Reference Committee Hearing will meet via webinar on April 8 from 6:00 P.M.-9:00 P.M. Please review the resolution guidelines and the sample form.

Update on Nominating Committee

Following the recent snowstorm, the Nominating Committee has been rescheduled to Sunday, February 23 at 1:00 P.M. at MSNJ's offices in Lawrenceville. Please contact Sue Hoisington if you have any questions. 

Practice Checklist for ACA Exchange Implementation

The AMA and the MGMA have created a checklist for medical practices. This checklist provides hands-on advice for addressing issues that might come up with patients who purchased coverage through the new exchange health plans. View the checklist.

ACA: Additional Medicare Withholding Tax

Under the Affordable Care Act, the employee-paid portion of the Medicare FICA tax will increase for high-wage earners. The tax will increase by 0.9% from 1.45% to 2.35%. The extra tax applies to those making $250,000 for married taxpayers who file jointly, $125,000 for married taxpayers who file separately, and $200,000 for single and other tax payers. Go to the IRS website for details. 

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

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. Read the FAQ. 

Improper Medicare Payments Identified for Psychiatry and Psychotherapy Services

Many improper payments have been identified by the CERT program's review of claims for Part B Psychiatry and Psychotherapy Services. This is likely the result of the big changes to psychiatry billing in 2013. The main error found is the failure to document the time spent on the E&M service separately from the time spent on the add-on psychotherapy service. When a beneficiary receives an E&M service witha psychotherapeutic service on the same day, by the same provider, both services are payable if they are significant and separately identifiable and billed using the correct codes. New add-on codes designate psychotherapeutic services performed with E&M codes. Read more. 

Review New Jersey's Top Medicare Claim Submission Errors for December 2013!

View the errors and resolutions in order to avoid problems with future claim submissions.

Tips for Small Businesses Purchasing Insurance Coverage

The New Jersey Department of Banking and Insurance has provided basic tips to small businesses on purchasing or updating their insurance coverage. More information.

View February's Coding Tip of the Month on the Use of P 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.