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

Register online.

Mercer and Middlesex County Medical Societies present a CME program on Accountable Care Organizations

Wednesday, April 2, 2014 at 6:00 P.M.

Steakhouse 85, 85 Church St., New Brunswick, NJ

More information

RSVP to Nancy Pinkin, MCMS Executive Director at: npinkin@mcmsnj.org or 732-257-6800

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.

MSNJ Continues Advocacy Efforts on Exchange Plans' 90-Day Grace Period
On March 5, MSNJ joined AMA and virtually all of organized medicine in a letter urging CMS to strengthen the requirements for how and when carriers notify physicians that a patient who has purchased a subsidized plan on the Exchange has entered the 90-day grace period for non-payment of the premium. MSNJ continues to object to the "pending" of claims during the second and third months of the 90-day grace period during which carriers are not required to pay physicians. CMS has unfairly shifted the burden and risk of non-payment to physicians. Read more.

Horizon Managed Care Recoupment  

In December 2013, many MSNJ members reported receipt of accounts receivable notices relating to a large overpayment recovery effort by Horizon. Some of our members recently reported continuing issues related to this recoupment effort. In a conference call this week, we reconfirmed with Horizon that this effort was associated with managed care claims that were mistakenly paid at the traditional fee schedule. All the adjustments related to this effort were made to Horizon's system in December 2013.  For those who did not appeal or pay by check, offsets should have begun by the end of February, beginning of March. Horizon acknowledged that there were several recoupment efforts at the end of 2013 that may have added to confusion.  Members are encouraged to review our updated guidance document and FAQ on recoupment. Members with ongoing concerns may contact us at info@msnj.org. Please put "Horizon Managed Care Recoupment" in the subject line.  

Medical Volunteers for Trenton Free Clinic

In the first quarter in 2013, the city of Trenton along with the Trenton Health Team received "free clinic status" from HRSA and reopened the Pediatric and Adolescent Treatment Center which had been closed since 2008. The Trenton Health Team invite you to be a part of the volunteer team staffing the Trenton's Pediatric and Adolescent Treatment Center for as many hours as you are able. Initially they are focusing on providing immunizations for school children, Pre-Kindergarten through Twelfth Grade. Other services for children to be offered include well-baby examinations, physical exams for children and teens and preventive and sick childcare. Read more. 

NJ Turnpike Authority Request for Proposal for Physician Services

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.

Consider the Conversation 2

Scheduled for release in summer 2014, Consider the Conversation 2: Stories about Cure, Relief, and Comfort has begun. It will contain the perspectives of patients at various stages of disease as well as the physicians who care for them. Read more. 

The Senate Commerce Committee passed S562, a bill that would require health insurance companies to encrypt patient data on their computers. Horizon recently suffered a computer breach, with PHI information released. MSNJ strongly supports this bill.

Explanation of Benefits

The Assembly Financial Institutions and Insurance Committee passed A1447, a bill that requires health insurance carriers to use standard explanation of benefits form. The bill passed along party lines, with Democrats voting in favor. MSNJ supports this bill.

APN Scope of Practice

The Senate Health Committee passed a bill that would permit attending advanced practice nurse to determine cause of death and execute death certification of patient if nurse is patient's primary caregiver. MSNJ opposes this bill and the Governor has vetoed this bill two legislative sessions in a row. Our letter can be found here.  

Doctor's Day

Practices Must Start Using the New CMS 1500 Claim Form by April 1  

The CMS-1500 Claim Form  has been revised to more adequately support the use of the ICD-10 diagnosis code set. The form will now give physicians the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes. ICD-9 codes must be used for services provided before October 1, 2014, and ICD-10 codes should be used for services provided on or after October 1, 2014. Medicare will only accept the revised version of the form starting April 1, 2014, as will many other payors. Use the free AMA resource to walk you through the form changes. Read more. 

CMS ICD-10 Resource for Small Practices: Road to 10

CMS released the Road to 10, a free online resource that is intended to help small medical practices jumpstart their ICD-10 transition. The Road to 10 allows providers to build ICD-10 action plans tailored for their practice needs. The customized action plans are broken down into the following steps:

• Plan your Journey - Look at the codes you use, prepare a budget, and build a team
• Train your Team - Find options and resources to help your team get ready for the transition
• Update your Processes - Check your clinical documentation and update policies, procedures, systems, and forms
• Engage your Partners - Talk to your software vendors, clearinghouses and billing services
• Test your Systems and Processes - Test within your practice and with your partners.

ICD-10 Implementation Delay Sought

Grace Period Toolkit Available to Physicians

AMA has created a toolkit for physicians caring for patients who have entered the grace period for nonpayment of premiums for coverage purchased through health insurance exchanges. This toolkit includes the following:

• "Step-by-step guide to the ACA 'grace period'" 
• "Grace period collections policy checklist"
• "Model financial agreement language for patients receiving Advance Premium Tax Credits
• "Sample letter: Grace period notice to patients"

The grace period toolkit includes two additional resources:

• Model legislation titled "Physician Notification of Patients in Health Insurance Exchange Grace Period Act"
• A technical document, "Health insurance exchange premium payment grace period: Best practice for electronic notifications"

Submit Your Questions for MSNJ's Upcoming Modifier Webinar

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.

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

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.

Contact: Michaelesha Godfrey
Address: 80 Grasslands Road, Elmsford, NY 10523
Phone: 914.785.0180 ext. 60626
E-mail:  Michaelesha.Godfrey@LibertyMutual.com
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