NJPA Annual Meeting

Saturday, March 29, 2014 at the NJHA Conference and Event Center in Princeton

Register online.

View March's Coding Tip of the Month on the Use of O 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.

 

 

Medicare: SGR Repeal Update

In the House, Ways and Means Chairman David Camp (R-MI) introduced the anticipated amendment to offset the costs of H.R. 4015, the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014," with a five-year delay in implementation of the ACA's tax penalties for individuals who do not purchase health insurance.  Essentially, this is a poison pill, since Democrats support the individual mandate.

 

In the Senate, Majority Leader Harry Reid (D-NV) put a revised version of the Senate bill, now called the "Medicare SGR Repeal and Beneficiary Access Improvement Act" and bearing the number S. 2110, on the Senate calendar (the previous version was S. 2000, which was identical to H.R. 4015).  This bill contains the bipartisan, bicameral language of H.R. 4015/S. 2000, along with Medicare policy extenders (e.g., the floor on the geographic adjustment for physician work) and other provisions that were accepted as amendments during the Senate Finance Committee's consideration of an earlier bill, S. 1871.  That bill will likely be considered on the Senate floor during the last week of March, after Congress returns from a scheduled recess the week of March 17.

 

Neither of these proposals enjoys bipartisan support in their current form, risking a stalemate on SGR repeal and ultimately passage of a short-term payment patch to avoid the 24 percent Medicare cut that will take effect on April 1.  MSNJ opposes short-term patches and will continue to work closely with the AMA and urge our delegation to successfully reform SGR.  

Medicare Will Not Accept Claims with ICD-9 Codes After October 1

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 specific diagnosis codes based upon the information that is available at the time. Read more.  

Maintenance of Certification
The controversy over maintenance of certification (MOC) continues in the house of medicine.  In June 2013 the Medical Society of New Jersey engaged in a review of research and organizational requirements around Maintenance of Certification™ and certain proposals to mandate such certification as a condition of licensure (or re-licensure), network participation, hospital staff privileging or any other prerequisite to practice medicine. MSNJ remains steadfast in its commitment to continuous improvement in patient safety and healthcare quality. MSNJ has adopted policy statements with regard to the Maintenance of Certification™ process. We are concerned about its costliness, the onerous time commitment that it places on physicians, and the potential to disrupt the availability of physicians for patients care. Read about AMA efforts to reach consensus on MOC and to ensure that the process is not unduly burdensome or costly for physicians.  

Horizon Prior Authorization Hold Times

Several MSNJ members reported long wait times for Horizon BCBS prior authorization, some in excess of one hour. MSNJ advised Horizon of the issue. Horizon acknowledged that they have ongoing issues related to an upgrade of their prior authorization system and the usual volume increase associated with the beginning of the year. Horizon has advised MSNJ that they are working on the issue. While Horizon works to correct the issue, they are recommending that physicians fax prior authorization requests, instead of calling the hotline. In the meantime, Horizon has also asked MSNJ to collect specifics regarding these calls with long hold times. If you have experienced long wait times for Horizon prior authorization, please email the following to info@msnj.org: date and time of phone call; phone number used; and prompts used if any. Please include "Horizon Prior Authorization" in the subject line of your email. We will include this information in a report to Horizon and keep members apprised of developments in e-News. 

U.S. DOT FMCSA Certified Medical Examiner Training 

The National Registry of Certified Medical Examiners (National Registry) is a new Federal Motor Carrier Safety Administration (FMCSA) program. It requires all medical examiners* who wish to perform physical examinations for interstate commercial motor vehicle (CMV) drivers take this training and be certified in FMCSA physical qualification standards. Medical examiners who complete the training and successfully passed the test are included in an online directory on the National Registry website.  CMV drivers must have their required physical examinations performed by a Certified ME starting May 21, 2014.

 

This live activity is approved for AMA PRA Category 1 Credit™.

 

As a courtesy, NJOAPS is providing MSNJ members a $100 discount-off the registration fee  - MSNJ members pay the same as NJOAPS members!  MSNJ members, please click to obtain your promotional discount code and link to continue to further info and registration.

 

Non-MSNJ members and others interested attending this training, please click for further information and registration.

 

Note: This training is taking place as part of the  Annual Regional Osteopathic Conference (AROC).

 

*doctor of osteopathy, doctor of medicine, advanced practice nurse, doctor of chiropractic, physician assistant, or other medical professional authorized by applicable State laws and regulations to perform physical examinations.

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.

Congratulations to the Nominating Committee Candidates

The MSNJ Nominating Committee chaired by Dr. Mary Campagnolo met on Sunday, February 23, 2014. Congratulations to all the candidates.

Involuntary Outpatient Commitment

The Assembly Human Services Committee approved A865, which amends current law to give a short-term care facility, psychiatric facility, or special psychiatric hospital the option of initiating court proceedings for involuntary commitment to inpatient or outpatient treatment by submitting an electronically scanned clinical certificate completed by a psychiatrist and the screening certificate which authorized admission of the patient to the facility or hospital.  The bill provides for similar electronic filings of clinical and screening certificates in the case of a screening service or outpatient treatment provider initiating court proceedings for involuntary commitment to outpatient treatment.  NJPA supported this bill.

 

Emergency Generators

The Assembly Homeland Security and Preparedness Committee unanimously passed A1341, which requires that certain health care facilities be generator ready and allows health care facilities to qualify for NJEDA loans for cost of generators.

Submit Your Questions for MSNJ's Upcoming Modifier Webinar

Many members expressed interest in a webinar dedicated to modifiers. In response, we are planning a webinar for April and we need your help with questions. Please submit your questions to info@msnj.org with "Modifier Webinar" in the subject line and we will do our best to address them during the webinar. Thank you in advance for your input! 

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.

CMS orders MACs to Re-Review Two-Midnight Audits

CMS recently announced that MACs will re-review all claim denials under the two-midnight inpatient administration probe and education process to ensure that claim decisions and education are consistent with CMS' recent guidance.

A MAC may change its decision and issue payment outside of the appeals process if it determines that a claim is payable upon re-review. CMS also updated its physician Order and Certification guidance, including new information regarding patient transfer.

NJ DOBI Standard ICD-10 Readiness Survey - Respond by March 21 

The New Jersey Department of Banking and Insurance (DOBI) ICD-10 Implementation Task Force, which MSNJ participates in with NJHA and many New Jersey payors and hospitals, is conducting a standardized ICD-10 Readiness Survey to collect your practice's ICD-10 implementation project coordinator's contact information, as well as information regarding your ICD-10 readiness. The goal is to have all healthcare trading partners respond to one standard survey. Your survey responses will be shared. Everyone who participates in the survey will receive the results in Excel format. Trading partners, including participating payors, may use this information to follow your progress and schedule a time to begin end-to-end testing with you. This survey will be reissued periodically over the next eight months so you can continue to update information as you continue to make progress. Only one person should register and submit a response on behalf of your organization. Once you have done so, you will have access to all other trading partners that have submitted survey responses. Please keep in mind that registered users will also have access to your information. We urge members to participate in this survey and begin communicating with payors about transitioning to ICD-10. Submit your first survey response by March 21, 2014.

Sign Up for End-to-End ICD-10 Testing by March 24

CMS will offer end-to-end testing to a small sample group of providers starting July 21 through July 25, 2014. The sample group will be selected from providers and suppliers who volunteer to participate. Complete the Volunteer Testing Form by March 24. More information will be sent out to those selected after all forms are reviewed. Read more.

CMS ICD-10 Training Webinar Series

CMS is hosting a two-part series of ICD-10 Training Webinars that will cover the ICD-10 basics, key preparation steps for a successful transition, billing, and clinical documentation concepts.

• ICD-10 Clinical Documentation - March 18 from 12:00 P.M. to 1:00 P.M. Register.

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.

 

MSNJ continues to support a delay due to our concerns about feasibility. Read more in AMA Wire™ about the new cost study and 5 steps to prepare for ICD-10 and the AMA's letter to Secretary Sebelius.

CMS' eHealth University ICD-10 Resources

CMS launched eHealth University as a resource to the healthcare community to successfully participate in CMS eHealth programs. Use the following educational modules to help you prepare for the October 1 ICD-10 compliance deadline:

• Introduction to ICD-10- A fact sheet that explains the key steps for switching to ICD-10.
• Transition Checklist: Large Practicesand Transition Checklist: Small and Medium Practices - Checklists that outline tasks and estimated timeframes for important ICD-10 transition activities.
• Basics for Small and Rural Practices- A fact sheet that provides basics about the ICD-10 transition.
• Introduction to ICD-10 for Providers- A guide that explains the background behind ICD-10, why the transition is important, how providers can prepare for ICD-10, and important resources to help transition.

Intermediate and advanced resources are also available on the eHealth University website.

 

Contact: Frank Ciesla
Phone: Office: (732) 219-5485, Toll-Free: (800) 842-1LAW
E-mail:  fciesla@ghclaw.com
Website