Webinar: MSNJ's MPMS Presents: Common Modifier Q&A 

Wednesday, July 9, 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.   

Please note: Those who already registered will be automatically signed up to participate in this webinar.     

 Register   

Webinar: Horizon Patient-Centered Advantage EPO Plans

Wednesday, July 16, 2014 from 12:00pm-1:00pm

Speaker: Kevin Jennings, Network Specialist, Horizon BCBSNJ 

This webinar will review Horizon's new product offerings for July 1, 2014. Horizon will review the key features, benefits, network, and reimbursement for the Horizon Patient-Centered Advantage EPO plans.  

This event is free for MSNJ members, $25 for PAHCOM & NJMGMA members, and $75 for non-members

Register 

More information  

• Both high-level and detailed information about key aspects of the Medicare program
• A half-day basic track for those who are new to Medicare or who want a refresher
• A "Current Topics" session to raise awareness of program changes
• An update on the new Health Insurance Marketplace
• Casework exercises
• Medicare training modules and workbooks
• Networking opportunities with CMS staff and other partners who share your commitment

View June's Coding Tip of the Month for information on the Use of M Codes 

Email us your coding questions! We will work with a certified professional coder to answer your question and may even address it in an upcoming coding tip.

Attention physicians! Please take our benefits survey to help us better serve you with discounted products essential to your medical practice.

MSNJ and New Jersey Dental Association (NJDA) proudly announce a joint effort to offer discounts to all of our members on prescription blanks. Participating vendors include:

POS® is a full-service print and electronic communication company that helps healthcare practices create and improve patient communication tools. POS® is your patient communication partner for everything from branded practice and patient education printed materials to patient statement processing and automated messaging services. Take advantage of our special offer available to members-

Nelson Press has been a manufacturer of quality printed materials for New Jersey Business since 1900. They were recently approved to print and sell the revised New Jersey Prescription Blanks for physicians. Special member pricing includes:

• 400 - Single Prescriptions - $60.00
  (Including Tax & Shipping)
• 800 - Single Prescriptions - $80.00
  (Including Tax & Shipping)
• 1200 - Single Prescriptions - $100.00
  (Including Tax & Shipping)

The Prudential Center is proud to offer MSNJ members a discount for their upcoming events. The following discounts are now available.

Professional Bull Riders  - Saturday, June 28, 2014 at 7:00 p.m.

Member Discount! 

Take advantage of your in-store, Macy*s Business Smart Pass from June 15 through July 14, 2014. As an MSNJ Member, save 15% all day, as many times as you want. See Pass for further details. Save on designer brands, such as Calvin Klein, Lauren Ralph Lauren, Jones New York, DKNY, Michael Kors, Ann Klein, Polo Ralph Lauren, Tommy Hilfiger, etc. Download your pass today. 

This week, Dr. Paul Carniol, MSNJ President, spoke at a quarterly meeting of the St. Peters medical staff. MSNJ thanks the physicians of St. Peters for their hospitality.

Kushyup Shah, student member of the MSNJ Board of Trustees, is spending the summer as a health policy intern with U.S. Senator Bob Menendez. We congratulate him on this post and wish him success!

The Sentinel Project:  Are Health Plans Providing Essential Health Benefits? 

The Seton Hall University School of Law and the New Jersey Appleseed Public Interest Law Center started working on the Sentinel Project, a two-year effort to determine whether individual and small business health insurance plans in New Jersey are providing the "essential health benefits" required under the Affordable Care Act. This project will gather and analyze information on individuals who enroll in individual or small business health insurance plans but are not able to get the health care they need. Members are urged to read the Sentinel Project summary, post the flyer in their offices, and refer patients who have been denied medically necessary services to complete the project's intake form. Attend the PSP meeting on July 24 to learn more. 

New Jersey Family Care Alternative Benefit Plan Medically Exempt Beneficiaries

The New Jersey Family Care Alternative Benefit Plan (ABP) was created to cover the expanded Medicaid population. The ABP does not include some benefits offered under traditional Medicaid, including long term care. Some beneficiaries may be considered "medically exempt" from participating in the ABP, under federal regulations. Medical exemptions include patients with: disabling mental disorders; chronic substance use disorders; serious and complex medical conditions; physical, intellectual or developmental disabilities that impair activities of daily living; and/or disability based on social security criteria.  If deemed exempt, NJ Medicaid must give the beneficiary the option to choose between the ABP or another Medicaid plan that includes all Medicaid covered benefits.  

Project Medicine Drop

Project Medicine Drop is intended to raise awareness of the prescription painkiller abuse problem in New Jersey and the proper disposal of these medications. Please post the appropriate county flyer in your office:

$800,000 HIPAA Settlement - Medical Records Dumping Case

Parkview Health System, Inc. has agreed to settle potential HIPAA violations with the U.S. Department of Health and Human Services Office for Civil Rights (OCR). OCR opened an investigation after receiving a complaint from a retiring physician alleging that Parkview had violated the HIPAA Privacy Rule. In September 2008, Parkview took custody of medical records pertaining to approximately 5,000 to 8,000 patients while assisting the retiring physician to transition her patients to new providers, and considering the possibility of purchasing some of the physician's practice. On June 4, 2009, Parkview employees, with notice that the physician was not at home, left 71 cardboard boxes of these medical records unattended and accessible to unauthorized persons on the driveway of the physician's home, within 20 feet of the public road and a short distance away from a heavily trafficked public shopping venue. Parkview will pay $800,000 and adopt a corrective action plan to address deficiencies in its HIPAA compliance program. The resolution agreement can be found here.  

Save the Date: Policy & Strategy Panel

Thursday, July 24, 2014 5:30 pm

At MSNJ Headquarters 

Topics Include:

• Learn how to protect your online reputation, with a presentation from a leading national website provider
• Share experiences of access to care issues for insured patients, including those with new exchange products as we join a new project to educate policy makers (see the related article on the Sentinel Project) 

Employment Contract Review Tips

At AMA's 2014 Annual Meeting, health care attorney Norman Jeddeloh shared seven helpful tips to consider before signing an employment contract. Read the tips and take advantage of MSNJ's new benefit:

Employment Contract Review Program
Due to the changing healthcare delivery landscape and the increasing number of physicians who wish to be employed, MSNJ has developed an employment contract review program for its members.

MSNJ's Corporate Partner Law Firms will offer an initial legal consultation for a discounted flat rate of $500.* Initial consultation includes:

• preliminary review of the employment contract;
• a written summary of terms of concern; and
• a phone consultation with an attorney regarding contract provisions that may require modification or further negotiation.

Click here for more information.

Listen to an update on state legislative activity presented via webinar to MSNJ's Medical Practice Managers Section by Mishael Azam Esq., MSNJ's COO & Senior Manager of Legislative Affairs.

APN Scope of Practice

Important EHR Incentive Program Deadline: July 1 

Paper Billers Submitting CMS 1500 Claim Forms

The following two items continue to be billed to Novitas Solutions incorrectly:

• Legacy Provider Identifier- Novitas continues to receive CMS 1500 claim forms that are reporting Legacy numbers including PIN, UPIN or National Clearinghouse Numbers in items: 17A (red shaded area) for the UPIN physician, 24J (red shaded area) for Rendering physician, and 33B for Billing or Group physician. These areas are to be left blank as of May 23, 2008. The NPI should be reported in the appropriate blocks that have been designated for referring, rendering and billing. Continued reporting in these fields will result in claims being returned.
• Diagnosis Codes reported in Item 21 and 24E- These are required fields
  • Item 21 - Enter the patient's diagnosis/condition. All physician and non-physician specialties should use diagnosis codes to the highest level of specificity for the date of service and enter the diagnoses in priority order.
  • Item 24E/Line Diagnosis - Enter the diagnosis code reference letter as shown in item 21 to relate the date of service and the procedures performed to the primary diagnosis. Enter the corresponding alpha diagnosis code pointer at the service line level. Enter only one reference letter per line item. When multiple services are performed, enter the primary reference letter for each service. If a situation arises where two or more diagnoses are required for a procedure code, the provider shall reference only one of the diagnoses in item 21.

CMS Registration Began June 1 for Physicians

ALERT: Dial-Up Customers

MSNJ congratulates the Affiliated Physicians and Employers MEWA on 10 years of service.  The Medical Society of New Jersey helped capitalize the MEWA to provide its member physicians with a self-funded health insurance option for their small businesses. 

QualCare, Inc. - Platinum Level Partner   

Contact: Jenny Martinez
Address: 30 Knightsbridge Road, Piscataway, NJ 08854
Phone: 888.670.8135, option 6
E-mail: mewasales@qualcareinc.com
Website 

QualCare, Inc., administers the MSNJ Affiliated Physicians and Employers - MEWA Health Plan, a multiple employer welfare arrangement (MEWA) which provides members with access to healthcare coverage options that might otherwise be too costly. Through this program, physicians may buy self-insured health plans at the equivalent of large-group rates.

QualCare, Inc. is New Jersey's largest, provider-sponsored Managed Care Organization that offers self-funded PPO, HMO network, point of service (POS) network, and open access health plans; third party administration (TPA) services, provider network access, wellness programs, care management services, and a workers' compensation product. QualCare also provides ACO consultative services and infrastructure.

Headquartered in Piscataway, New Jersey, QualCare services over 800,000 members and is owned by 16 non-profit hospitals and physician-hospital organizations, with a clientele that spans health systems, unions, local governments, school boards, and other commercial employers. QualCare's network covers over 100 acute, specialty and rehabilitation hospitals, as well as over 31,000 physicians and other ancillary providers across NJ, PA & NY.

Shiriak and Timins - Bronze Level Partner 

 

Contact: Arthur J. Timins, Esq
Address: 101 Gibraltar Drive, Suite 1E1, Morris Plains, NJ 07950
Phone: 973.740.1771
E-mail: atimins@timinsesq.com
Website
  

 

Shiriak and Timins routinely handles business-related litigation, arbitration, and administrative hearings, with a focus on health-care law and employment law, as well as matters before the State Board of Medical Examiners.

 

Arthur J. Timins, Esq. is a member of the American Society of Medical Association Counsel and has represented many practitioners as well as multiple medical staffs at area hospitals. Arthur J. Timins, Esq. is also a member of the End of Life Task Force of the New Jersey State Bar Association. And, he is a member of the Board of Directors of the Institute of Medicine and Public Health (IOMPH).

 

With over 65 years of combined legal experience, Shiriak and Timins have had the opportunity to represent professionals in a variety of settings. Assignments are handled personally by the partners and not delegated, and approached aggressively and responsively, while we remain sensitive to the billing concerns of our clients.

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.