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Medical Society of New Jersey e-Newsletter
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Webinar: MSNJ's MPMS Presents: Common Modifier Q&A
Wednesday, April 30, 2014 from 12:00 P.M. to 1:00 P.M.
Our speaker will go over common modifiers, how they are used, and answer 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.
This event is $25 for MSNJ members, $50 for PAHCOM & NJMGMA members, and $100 for non-members
Register
More information
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CMS Open Payments Webinar
CMS will host an Open Payments Webinar on Tuesday, April 15, 2014 from 1:00 P.M. to 2:00 P.M. This webinar will provide an overview of the final rule, information on your role in the program, resources available to you as a health care provider, and key program dates.
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.
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Prescribers' Clinical Support System for Opioid Therapies (PCSS-O) is a three year grant funded by Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT).
The online modules are designed to increase your understanding of the current state of opioid-dependence treatment, increase your understanding of treatment issues for special populations, and lastly to increase your ability to assess and treat patients. Access the modules.
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Free Prescribers' Clinical Support System for Opioid (PCSS-O) Online Module on Assessing Safety, Efficacy & Misuse of Opioid Therapy for Chronic Pain. This online module focuses on prescription opioid safety, efficacy and misuse, monitoring practices that clinicians can employ in their practices. Click here to view the module.
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Diversity & Equity in Mental Health: A Special Cooper Psychiatry Grand Rounds Program
April 26, 2014 from 8:00 A.M to 12:30 P.M. at Cooper Medical School of Rowan University
Register
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The MDSuccess Spring Event: Building the Patient Driven Practice
May 1, 2014 at 8:00 A.M. at the Wyndham, Mount Laurel, NJ. More information.
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ICD-10 Training Session
BCMS will be hosting an ICD-10 Training Session on May 8, 2014 at Biagio's Ristorante in Paramus, NJ at 6:00pm. The event will be sponsored by the Constantine Consulting Group of Wells Fargo Advisors, LLC and will be presented by Kathleen Skolnick and Beverlyjean Jenkin of Priority Chart Review, LLC. Seating is limited to only 50 physician members. To register, contact Anjanette Sumala at 201-489-3140 or email bcmsnj@verizon.net
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8th ANNUAL AMERICAN CONFERENCE
FOR THE TREATMENT OF HIV (ACTHIV)
May 8 - 10, 2014
Sheraton Downtown Hotel
Denver, Colorado
Registration Now Open!
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Symposium on Tick-Borne Diseases
Saturday, May 17, 2014
Hyatt Regency Chesapeake Bay, Cambridge, Maryland
Join the Lyme Disease Association of Eastern Shore Maryland for a one-day medical conference designed to provide the most current information about the research, diagnosis, treatment and management of Lyme and other tick-borne diseases. More information.
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View April's Coding Tip of the Month for more information 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.
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May 2, 2014
Registration now available!Don't miss the keynote presentation by  The Honorable Chris Christie,
Governor of the State of New Jersey!
May 10, 2014
Inaugural Gala honoring Paul Carniol, MD, FACS, MSNJ's 222nd President
Parsippany Hilton
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News
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HHS Secretary Sebelius Resigns
Kathleen Sebelius, the Secretary of Health & Human Services, resigned her position yesterday. This comes after a five-year tenure most recently punctuated by the disastrous roll-out of the Administration's web site that hosts the Affordable Care Act's Insurance Exchange/Marketplace. Even still, enrollments in the exchanges have exceeded expectations with over seven million enrollees. President Obama is expected to nominate Sylvia Mathews Burell, current director of the Office of Management & Budget, to replace Sebelius. Read more.
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MSNJ Statement on CMS Release of Physician Payment Data
On April 9, CMS released 2012 Medicare payment data on virtually all physicians to the public. As recently as January CMS indicated that patient requests under the Freedom of Information Act would be reviewed and released on a case-by-case basis. This massive release is without precedent. The release was done without the opportunity for any opportunity to review the data for accuracy. MSNJ is disappointed that CMS did not allow time for this review which is conventional for other programs that report data. We are also disappointed that the raw data has been released without any context that would inform the public's evaluation of the data.
MSNJ is in favor of fee and payment transparency. We urge patients to become more familiar with the particular costs that may be included in the reported payments as well as the costs incurred by physicians to provide quality services. We urge patients not to jump to conclusions about total payments without giving consideration to the type and quantity of services provided. We believe that many patients will be surprised to see how little physicians are reimbursed for many of the services that they provide. Patients with specific questions or concerns about the payment data are encouraged to speak directly with their physician.
Members: Read MSNJ's Practical Pointers on How to Evaluate the Data & Respond to Questions.
Read nine reasons that the raw data released by CMS may be misleading.
Read how medications paid for and administered by some specialists upwardly skew payment amounts.
Read Wall Street Journal article, "Doctor-Pay Trove Shows Limits of Medicare Billing Data" (April 11, 2014)
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CMS Shows Interest in Medicare Advantage Physician Terminations
CMS has shown interest in the termination of physicians from Medicare Advantage plans, undoubtedly as a result of the attention brought to the issue when United Healthcare (UHC) significantly narrowed its network of participating physicians in New Jersey and across the nation. MSNJ has had numerous contacts with CMS over the issue beginning last fall when UHC initiated a significant network reduction by terminating physicians without cause. CMS has expressed concern over the impact of significant network reductions on network adequacy and will take a harder look at the impact on seniors. In its 2015 Medicare Advantage Final Call Letter, which sets forth best practices and operational guidance for carriers, CMS will require 90 days advance notice of a significant planned network reduction and demonstrated compliance with network adequacy rules for the remaining network. Patients who are negatively impacted by a network reduction may be entitled to change their plans to stay with their physicians, mid-year, but would be required to prove their need.
This is a step in the right direction and a marked improvement outside of rulemaking. We are heartened by CMS's recognition of the issues presented by a significant network reduction during open enrollment. We believe that more will be necessary to ensure network adequacy and to avoid the chaos and unfairness of "no-cause" physician terminations during Medicare's open enrollment period. We will continue to work with the AMA, state medical societies, and Congress to ensure that physicians who participate in Medicare Advantage plans, and patients who count on them to be in their selected plans, are not harmed by significant no-cause terminations of physicians during plan years. We appreciate the efforts of AMA and other state and specialty societies on this issue.
Read the CMS Fact Sheet on this issue.
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Health Insurance Coverage for Small Businesses
The Small Business Health Options Program (SHOP) Marketplace can provide small businesses (50 or fewer full-time equivalent employees) with health coverage to your employees at any time throughout the year. If you enroll by the 15th of the month, the coverage can begin on the first of the following month. Fewer than 25 employees may qualify for small business health care tax credits if you buy insurance though SHOP. To enroll in a SHOP plan in most states, you will use an agent, broker, or insurance company and fill out a SHOP eligibility application. Browse the health and dental plan information before you apply. Get started today! Questions regarding the SHOP Marketplace can call 1-800-706-7893 (TTY: 1-800-706-7915) Monday through Friday 9:00 A.M to 7:00 P.M.
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National Healthcare Decisions Day: April 16, 2014
National Healthcare Decisions Day is April 16. This is an initiative to educate and empower the public and providers about the importance of advanced directives. See below for the revised POLST form. Learn more.
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National Public Health Week: April 7-13
This week is National Public Health Week! New Jersey Health Commissioner Mary E. O'Dowd emphasized New Jersey's effort to build healthier communities. The Department is working with its partners to support residents in improving their health. Over the past year, a five-year plan has been developed by the Department and stakeholders to reduce chronic disease, such as heart disease, cancer, stroke and diabetes. The plan, Partnering for a Healthy New Jersey, outlines evidence-based prevention programs and strategies that support healthy lifestyles. Read more.
Come hear Governor Christie at MSNJ's Advocacy Conference on May 2! Register online!
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MSNJ would like to congratulate Dr. Donald Chervenak for receiving the 2013 OB-GYNPAC MVP!
Dr. Chervenak had 100 percent participation at the Tri-District Annual Meeting in Puerto Rico. This is his third time to receive this award in four years!
Congratulations to all MSNJ members who are being recognized at the Edward J. Ill Excellence in Medicine Awards Dinner on May 7, 2014:
- Donald M. Chervenak, MD - Peter W. Rodino, Jr., Citizens Award
- David E. Swee, MD - Outstanding Medical Educator Award
- Frederick F. Buechel, Sr., MD - Outstanding Medical Research Scientist Award for Clinical Research
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Click here to read the Summary of the Board of Trustees Meeting from March 16, 2014.
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Standardization of Explanation of Benefits
The Assembly Financial Institutions and Insurance Committee passed A1447, a bill that requires health insurance carriers issuing health benefits plans in this State to provide a standardized written explanation of benefits form (commonly referred to as an "EOB") to a covered person whenever a claim is generated under the covered person's health benefits plan. MSNJ supports this bill.
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Revisions were made to the New Jersey Practitioner Orders for Life-Sustaining Treatment (POLST) form. The POLST form now includes revised language in Section E to improve clarity. A line has also been added in Section F to allow for the practitioner's license number. Facilities should be using the new form, however both forms will be honored. View the POLST FAQs.
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Security Risk Assessment Tool
The Office of the National Coordinator (ONC) has released a tool that can help you understand the HIPAA Security Rule and can help make your security risk assessment easier. This tool shows each HIPAA standard that must be addressed and provides space for you to document how you meet or plan to meet the current standard.
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ICD-10 Delayed
Legislation was recently passed that prevents the DHS from implementing the new ICD-10 code set before October 1, 2015. Read AMA's article. See below for some helpful ICD-10 resources and toolkits to help you prepare.
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Provider Enrollment Status Inquiry Tool
Novitas Solutions enhanced the Provider Enrollment Status Inquiry Tool. This tool provides the status history of all Part A and Part B Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or paper-submitted CMS-855/588 (EFT) applications. The status of Phase 3 revalidation applications is now available. Status history information is available for all applications from receipt through completion. Processed and completed application history is maintained for six months. Access the tool.
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Updating Beneficiary Information
There has been substantial conversation about the accuracy of beneficiary Medicare Secondary Payer (MSP) information on the CWF and who is responsible for keeping that information updated. Providers have also stated that the update is not accepted when they attempt to update beneficiary information with the Benefits Coordinator and Recovery Center (BCRC) by phone. CMS and the BCRC are both undertaking initiatives to resolve the issue and maintain the most up-to-date and accurate beneficiary information with regard to MSP. Read more to view the steps that are in place to help providers update MSP records.
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Hold on Medicare Claims until April 14
CMS asked that Medicare Administrative Contractors (MACs) hold claims from April 1, 2014 through April 14, 2014, while waiting for Congress to prevent the fee cut. This only affects claims with dates of service of April 1, 2014 and later. All claims for services delivered on or before March 31, 2014 will be processed and paid under normal procedures. Read more.
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Penalty Information for Medicare Eligible Professionals
Eligible Professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to penalties beginning on January 1, 2015. The penalty is based on meaningful use data submitted prior to the 2015 calendar year. EPs must demonstrate meaningful use prior to 2015 to avoid the penalties.
The following will determine how your participation start year will affect the 2015 penalties:
- 2011 or 2012: If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015.
- 2013: If you first demonstrated meaningful use last year, you needed to demonstrate meaningful use for a 90-day reporting period to avoid the payment adjustment in 2015.
- Plan to begin in 2014: If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and eligible professionals must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment.
To avoid penalties in the future you must continue to demonstrate meaningful use every year. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you must demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these penalties.
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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.
The hardship application and information on the exceptions are available.
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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 with a psychotherapeutic service on the same day, by the same provider, both services are payable if they are significantly and separately identifiable and billed using the correct codes. New add-on codes designate psychotherapeutic services performed with E&M codes. Read more.
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Avoid the 2016 PQRS Penalty
Eligible professionals and group practices that fail to successfully report data on quality measures during 2014 will be subject to a two percent reduction on Medicare Fee Schedule amounts for services furnished by the eligible professional or group practice between January 1, 2016 and December 31, 2016.
To avoid the 2016 penalty, eligible professionals must meet one of the following criteria during the 2014 reporting period:
Individual Eligible Professional:
- Meets the criteria for satisfactory reporting adopted for the 2014 PQRS incentive, which are identified in the 2014 Medicare PFS Final Rule and in PQRS educational materials available on the PQRS website. Meeting the criteria will also ensure a PQRS incentive payment equal to 0.5 percent of estimated Medicare Part B allowed charges for covered professional services in 2014.
Or
- Participates in PQRS via qualified clinical data registry, qualified registry, or claims reporting and reports at least three measures covering one National Quality Strategy domain for at least 50 percent of the eligible professional's Medicare Part B FFS patients.
Group Practice:
- Meets the Group Practice Reporting Option (GPRO) requirements for satisfactory reporting (which are similar to the criteria for satisfactory reporting for the 2014 PQRS incentive), as identified in the 2014 Medicare PFS Final Rule and in PQRS educational materials available on the PQRS website.
Or
- Participates in PQRS via qualified registry reporting and reports at least three measures covering one NQS domain for at least 50 percent of the group practice's Medicare Part B FFS patients.
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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.
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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 2015 ICD-10 compliance deadline:
Intermediate and advanced resources are also available on the eHealth University website.
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Corporate Partners
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Two River Community Bank - Bronze Level Partner
Contacts: Ross Zimmerman, SVP/Managing Director; Maria Cianci, Private Banking Officer; Michael Schutsky, Private Banking Officer; Edward Wurzel, Private Banking Officer
Address: 766 Shrewsbury Avenue, Tinton Falls, NJ 07724
Phone: 732-671-6897
E-mails: rzimmerman@tworiverbank.com, mcianci@tworiverbank.com, mschutsky@tworiverbank.com, ewurzel@tworiverbank.com
Website
Private Banking for Medical Professionals
You can count on us the way your patients count on you.
With a tremendous amount of experience, our Private Bankers have assisted medical professionals in achieving their financial goals by providing favorable rates, impeccable service and state-of-the-art technology. We invite you to experience the benefits we provide...we're confident you'll be glad you did.
About The Bank
We are a New Jersey state-chartered financial institution with sixteen branches located throughout Eastern Monmouth County and the Union County area and two regional lending offices in Summit and New Brunswick, NJ. Since opening our doors in 2000, our focus has been on you, as we strive to make your banking experience the very best it can be, meet your financial needs and goals, and get to know you as a valued customer and friend, while providing you with the latest in technological advances. We are here to help you achieve your dreams.
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Giordano Halleran & Ciesla - Bronze Level Partner
Contact: Frank Ciesla Address: 125 Half Mile Road, Ste. 300, Red Bank, NJ 07701-6777 Phone: Office: (732) 219-5485, Toll-Free: (800) 842-1LAW, Trenton: (609) 695-3900 Fax: (732) 224-6599 E-mail: fciesla@ghclaw.comWebsite
The attorneys in the Giordano Halleran & Ciesla health care practice area have more than 100 years of cumulative experience in health care law. We counsel our clients on a broad range of problems, integrating traditional legal principles with the special body of federal and state law governing the health care field. We focus on developing personal relationships and gathering in-depth knowledge of our clients' practices to provide sound legal advice and effective strategies to resolve business issues ranging from everyday operational issues to major transactions.
Our services include reviews of issues arising under the anti-kickback law/Stark law/New Jersey self-referral ("Codey") law; professional practice formation and related agreements such as partnership, operating, and shareholder agreements; preparation and negotiation of contracts, such as management, employment, and managed care contracts ; purchase and sale of professional practices and practice divorces; regulatory compliance; HIPAA and confidentiality issues; leases; joint ventures; physician practice management issues; Medicare and other reimbursement issues; licensing issues; and litigation. As a multi-specialty firm, we draw on the expertise of attorneys in other practice areas of the firm when necessary to meet our health care clients' needs, such as labor and employment issues, estate planning, or land use issues. Our clients can be assured that their attorneys are working hard to find solutions in a resourceful and cost-effective manner.
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As an Affiliated QualCare Network Provider, your practice may be eligible for our "Health Services Safety Group" Read more.
MSNJ Magazine Subscription Service
Subscription Services, Inc., does their very best to get you the lowest rates. As a member, you are eligible for the very lowest prices on magazine subscriptions as well as personalized hands-on customer service. Click "Shop for Magazines" to place new subscriptions, renewals, as well as gift order subscriptions. You can also inquire about titles you may be interested in. If you ever have a question regarding your order or your account, please call 1-800-603-5602, or use the contact page to communicate with a customer service
representative. And if you ever find a lower authorized price, they will match it!
Don't Overpay for Payroll
Easy Online SurePayroll gives you incredible value on a small practice budget, so you can increase your bottom line and avoid overspending on payroll. And as a Featured Benefit for MSNJ members, you will save up to 50% compared to traditional payroll providers. Get a Free Quote today.
Member Resource Guide
Check out the current MSNJ Member Resource Guide! Inside, you will find a complete listing of partners by service/product category, along with contact information. Also, be sure to check out the individual Corporate Partner pages on our website as some offer additional discounts to members!
It is important to note that MSNJ does not endorse any vendor, service, or product. However, we encourage members to please consider our Corporate Partners first as the financial support received from these organizations is vital to our association. It is our hope that their investment in MSNJ will help keep your membership dues and programming affordable.
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Medical Society of New Jersey
2 Princess Road, Lawrenceville, NJ 08648
(o) 609-896-1766 e-mail:
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About the Medical Society of New Jersey:
Founded in 1766, the Medical Society of New Jersey (MSNJ) is the oldest professional society in the United States. MSNJ promotes the betterment of the public health and the science and the art of medicine, to enlighten public opinion in regard to the problems of medicine, and to safeguard the rights of the practitioners of medicine. The organization and its members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician-patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. For more information visit our website or send us an e-mail.
"Your Partner in Practice... Your Voice in Trenton"
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2014 © Medical Society of New Jersey. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the written permission of the Medical Society of New Jersey.
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