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.

Take Action Now: Repeal the SGR

Long-awaited and hard-fought legislation to permanently repeal the fatally flawed sustainable growth rate (SGR) formula now is before both chambers of Congress with last week's introduction of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/ S. 2000).

The three key congressional committees of jurisdiction came to this bipartisan, bicameral agreement in advance of the March 31 deadline to prevent Medicare cuts of 24.1 percent. The bill incorporates many AMA and MSNJ recommendations to reform the health care delivery and physician payment system and improve care for America's seniors.

This legislation would provide physicians with positive annual payment updates of 0.5 percent for five years. It also includes medical liability protections and significant funding for resources and tools to help physicians in small practices transition to new payment and delivery models.

Congress is now closer than ever before to enacting fiscally prudent legislation that would permanently repeal the SGR formula. Amplifying the physician voice on this issue now is critical.

• Read the sign-on letter 
• Read the AMA's release and visit fixmedicarenow.org
• View the AMA's bill comparison chart 
• Send an e-mail to lawmakers

MSNJ leadership is reviewing the joint legislation and its impact on physicians. 

Rescheduled: MSNJ's Policy & Strategy Panel Meeting  

MSNJ's next PSP Meeting will be held on Thursday, February 27, 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?

MSNJ Joins AMA Requesting a Remedy to Medicare Appeals Backlog

This week MSNJ joined AMA and organized medicine in an urgent request to the Chief Administrative Law Judge for Health & Human Services to address the backlog of Medicare appeals. Currently, assignments for hearings may be delayed for over two years. We urged a comprehensive solution to address the backlog expeditiously. This is particularly important because it impact appeals from overpayment determinations under the RAC program, where RAC findings are often overturned on appeal. It is expensive for physicians to pursue the often meritorious appeals and many simply cannot afford the extensive lag time to favorably resolve payment issues. Read the letter. 

NJ Department of Health Alert: 

Potential Exposure of NJ Residents to Measles Case at Palisades Center Mall

ICD-10 Implementation Delay Sought

From the American Medical Association

Citing new cost estimates that could reach nearly triple those of previous projections, the AMA on Wednesday issued a letter calling on U.S. Department of Health and Human Services Secretary Kathleen Sebelius to reconsider the mandated adoption of the new code set, currently scheduled for Oct. 1.

"Physicians are being asked to assume this burdensome requirement at the same time they are being required to adopt new technology, re-engineer workflow and reform the way they deliver care; all of which are interfering with their ability to care for patients and make investments to improve quality," the letter states.

The letter underscores that ICD-10 implementation will be "financially disastrous for physicians," pointing to an AMA study released Wednesday. The costs for a small physician practice could be more than $225,000, while a typical large physician practice could expect to spend as much as $8 million on implementation.

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

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). 

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. 

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

St. Francis Medical Center Grand Rounds Diabetes Event: February 28, 2014

Birth certificates

The Assembly Human Services Committee released A1259, sponsored by Speaker Prieto. The bill would allow adoptees access to birth certificates.  Though there have been "competing" versions of the bill over the past few years and though the bill is controversial, MSNJ supports the bill for medical reasons. Read MSNJ's support letter. As previously reported, MSNJ also supports a Senate version of the bill.

Statute of Limitations on Lawsuits

The Assembly Judiciary Committee heard testimony, but did not vote, on A-1254. Also sponsored by Speaker Prieto, this legislation requires certain civil actions against certain licensed persons to be brought within two years. MSNJ supports this bill. It is loudly opposed by the NJ Association for Justice, which represents trial lawyers.  The  New Jersey Bar Association supports the bill, stating that it will bring New Jersey in line with neighboring states that all have shorter statute of limitations than New Jersey and will make the state more competitive. The NJ  Consumers for Civil Justice and NJ Citizen Action say the bill will limit consumer access to civil justice. Many other health and professional groups support the bill.

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. 

Medicare Claims Processing Guidance for Implementing ICD-10

Medicare will no longer accept ICD-9 codes on claims with dates of service on or after October 1, 2014. Institutional claims, and professional and supplier claims containing ICD-9 codes for services on or after October 1, 2014, will be Returned to Provider (RTP) as unprocessable. You will be required to re-submit these claims with the appropriate ICD-10 code. ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most

Medicare EHR Attestation Deadline Extended to March 31

CMS has extended the deadline for eligible professionals (EPs) to attest to meaningful use for the 2013 reporting year for the Medicare EHR Incentive Program from February 28, 2014 to March 31, 2014. This delay will allow more time for EPs to submit their data and receive an incentive payment for the 2013 program year. Please note: This does not impact the deadlines for the Medicaid EHR Incentive Program or any other CMS program including the electronic submission for the PQRS EHR Incentive Program Pilot .

The following are helpful tips that will help to make the process easier:

• Ensure that your payment assignment and other relevant information is up to date in the Medicare payment system PECOS;
• Make sure to include a valid email address in your EHR program registration;
• Consider logging on to use the attestation system during non-peak hours such as evenings and weekends;
• Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2013 data;
• If you experience attestation problems, call the EHR Incentive Program Help Desk and report the problem;
• If your organization has more than 1,000 providers assigned to a proxy user, use the PECOS system to designate additional proxies to facilitate attestation.

2014 PQRS Participation and Program Changes

CMS has released a new fact sheet for eligible professionals (EP) and group practices participating in the 2014 PQRS reporting year that highlights program changes. Some 2014 program and reporting changes include:

• An EP or group practice participating in the GPRO must successfully report 2014 PQRS quality measures to avoid a 2 percent penalty in 2016.
• CMS added 37 new individual quality measures for the 2014 program year and voided 45 measures from 2013.
• EPs must report on 9 measures across 3 National Quality Strategy (NQS) domains via claims, qualified registry, and EHR-based reporting methods.
• Group practices of 25 or more eligible professionals now have the option to report PQRS data through the certified survey vendor reporting method.
• EPs and group practices can no longer use the administrative claims-based reporting method to avoid a 2016 payment adjustment.

2013 Open Payments Program Year Registration and Data Submission

On February 18, Open Payments registration and data submission for applicable manufacturers and applicable GPOs will open with a two-phased approach for this first reporting year of this new program. Phase 1 will begin February 18 through March 31 and includes user registration in CMS' Enterprise Portal and submission of corporate profile information and aggregate 2013 payment data. Phase 2 will begin in May 2014 and extends for no fewer than 30 days. This phase includes industry registration in the Open Payments system, submission of detailed 2013 payment data, and legal attestation to the accuracy of the data. Both phases of data submission will be complete by August 1, and at that time healthcare providers and manufacturers will have an opportunity to review and correct inaccuracies. No action is needed from covered recipients at this time. Click for Phase 1 instructions.

PPTN Annual Recertification

The Professional Provider Telecommunication Network (PPTN) is a service offered by Novitas Solutions to Medicare Part B providers who submit claims electronically. Providers who use the PPTN network have the capability to dial directly into the Multi-Carrier System (MCS) to receive information. A provider can avoid interruption to their PPTN access by recertifying the Security Point of Contact (SPOC) on an annual basis. The SPOC is also responsible for completing the Annual User Certification letter to verify the PPTN ID's assigned to the provider's office personnel. If you receive this letter, complete the form and fax the letter back to Novitas Solutions EDI department at 1-877-439-5479 within 45 days of the date of the letter. 

New Standards Can Help Physicians Streamline Payment

The AMA has released updated toolkits to help physicians take advantage of the new electronic funds transfers and electronic remittance advice operating rules that took effect January 1, 2014. The toolkits include informative sections on getting started with electronic transactions, key questions to ask vendors, guidance about information technology solutions, and an outline of the rules and standards for electronic transactions. View more toolkits.

CMS Rescinds Article on Improper Payments Identified for Psychiatry and Psychotherapy Services

Last week MSNJ reported on CMS' MLN Matters Article SE1407 on Psychiatry and Psychotherapy Services. This article mentioned that many improper payments have been identified by the CERT program's review of claims for Part B Psychiatry and Psychotherapy Services and that the main error found was the failure to document the time spent on the E&M service separately from the time spent on the add-on psychotherapy service. CMS has since rescinded the article to be revised. It will be reposted when the revisions are made.  

Solicitation by Medical Equipment Suppliers

Physicians have complained about marketing schemes from DME suppliers. The Durable Medical Equipment Medical Administrative Contractors (DME MACs) for CMS have issued a letter regarding solicitation by medical equipment suppliers. You are under no obligation to support or justify these supplier solicitations or to sign orders for items not initiated by you or that were provided by the DME supplier at a patient's request without prior consultation. Read the letter for advice from the DME MAC.

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.