Final Audit Series Webinar

Webinar: Cyber and Regulatory Insurance: Are you Covered?

Wednesday, April 9, 2014 from 12:00 P.M. to 1:00 P.M.

Join MSNJ for a webinar on "Cyber and Regulatory Insurance: Are you Covered?" Bollinger Gallagher and Princeton Insurance will explain what these coverages are; who needs to be covered; when the policy is triggered; which carriers have these coverages built into their policies; the limits of these coverages; when the policyholder should buy higher limits from the carrier; and steps to follow when an insured believes they are going to be audited or named in a suit.

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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.

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 last 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.  MSNJ confirmed that the NJ Dept. of Banking and Insurance concluded an investigation into Horizon's recoupment effort and determined that they were acting within the parameters of NJ law. 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.  

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.

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.

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. 

Meaningful Use Hardship Exception Available

CMS announced that there will be an additional hardship exception available to physicians to avoid the penalty under the EHR Meaningful Use Incentive Program. This additional exception applies to those who have not received or were unable to implement updated 2014 certified software. Some physicians, such as those new to Medicare or those in certain specialties, are exempt from the penalty and do not need to apply for a hardship in 2014. Below is a list of the hardship exemptions that are now available.

• Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
• New eligible professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.
• Unforeseen circumstances: Examples may include a natural disaster or other unforeseeable barrier.
• Patient interaction:
  • Lack of face-to-face or telemedicine interaction with patient
  • Lack of follow-up need with patients
• Practice at multiple locations: Lack of control over availability of CEHRT for more than 50 percent of patient encounters
• 2014 EHR vendor issues: The eligible professional's EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.

Webinar link: 

https://webinar.cms.hhs.gov/openpaymentsro1-4/

Telephone dial-in number:  (877) 267-1577

Meeting ID number:  997 848 185

This meeting does not require a password

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"
• A technical document, "Health insurance exchange premium payment grace period: Best practice for electronic notifications"

Submit Your Questions for MSNJ's Upcoming Modifier Webinar

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' 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.

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