Hospice and Palliative Care Services Survey

By letter dated January 2, 2015 Horizon gave notice to its Managed Care and PPO networks of unilateral contract amendments. Members have called with questions about the amendments. All participating physicians are urged to carefully review these letters, to assess whether you are able to comply with the new terms, and to consult with counsel if you are unable or unwilling to do so. The amendments will become effective on April 15. If you do nothing, you are bound by the contract amendments. If you do not accept the amendments you must terminate within 30 days of the delivery of the notice according to Horizon. While the letter does not appear to invite any negotiation, we would urge physicians who cannot accept the amendments to seek to negotiate any term that is not acceptable. MSNJ believes that the regulatory right to terminate on 30 days' notice of a unilateral amendment is a hollow right. During rulemaking we urged the Department of Banking & Insurance to give greater protection to physicians to establish a more level playing field between physicians and insurers, but were unsuccessful. Read MSNJ comments on this issue. 

Aetna's Fee Lawsuits Against Physicians Fail
In January of 2011 MSNJ alerted members to a flurry of lawsuits filed by Aetna in Camden County Superior Court against out-of-network physicians for charging excessive fees, among other allegations. Members also consulted MSNJ because the lawsuits received significant negative media coverage.  MSNJ was not a party to the lawsuits, but took the position then, and continues to maintain the position, that physician fees should be transparent and reasonable.  Further, fees should reflect the qualifications, skill, and experience of the physician. 

Affordable Care Act Update:
Employer Mandate
Companies with 100 or more employees are now subject to the requirement that they provide affordable health insurance to their employees or pay fines. The requirement was delayed for a year, but is a requirement in 2015. Companies with 50 to 100 employees will become subject to the requirements in 2016.

NJBIZ Healthcare Predictions for 2015 

Larry Downs, MSNJ's CEO, predicts that the biggest trend will be the narrowing of patients' choice in health care services. "In this environment of downward pressure on health care costs, patients will be squeezed as their insurance benefits get paper thin. Insurers continue to design low premium, narrow network health plans that result in less physician and facility options for consumers. Also, more patients will be self-financing big chunks of their healthcare as increasingly high deductible plans are offered through the exchange and employer-sponsored options."

2015 HIPAA Forecast
Elizabeth Litten, Esq. forecasts three HIPAA hurdles in 2015:

1. More sophisticated and detailed (and more frequently negotiated) Business Associate Agreements.
2. More HIPAA complaints and investigations.
3. More PHI-Avoidance efforts.

ICD-10: 264 Days Away

October 1, 2015 is the deadline to transition to the ICD-10 code set. MSNJ encourages all physicians to begin preparing for implementation by working with software vendors and testing their systems. View resources on MSNJ's website.  

Volunteer for CMS ICD-10 End-to End Testing

Call for Candidates

MSNJ is accepting applications from candidates interested in positions on the Board of Trustees, AMA Delegation, Judicial Council and various positions. Please review the MSNJ Declared Candidates for 2015 as of January 9th (Please note: Not all Counties have Submitted Candidates) and read a brief synopsis of the positions and expectations. Your involvement is key to the Success of MSNJ.

If you are interested in running for a position or have questions about specific vacancies, please feel free to contact your County Executive or Sue Hoisington at 609-896-1766 x 207.

De Groote Award Nominations

MSNJ is accepting nominations for the De Groote Award which will be conferred at the MSNJ Inaugural Gala of the 223rd President, Steven Berkowitz, MD on May 9, 2015. The De Groote Award was established by resolution to honor the selfless work of Dr. Robert De Groote in service to the medical profession. The De Groote Award will be given to the individual whose selfless and idealistic work benefits humankind and not himself or herself.

Nominations should be made by submitting a brief narrative to info@msnj.org by close of business on Friday, February 20, 2015.

2015 Medicare Physician Fee Schedule

Policies in 2015 Medicare Physician Fee Schedule Final Rule

CMS provided a summary of the policies in the CY 2015 Medicare Physician Fee Schedule Final Rule and announced the Telehealth Originating Site Facility Fee payment amount. View the article.  

Medicare Payment for Second Dose of Pneumococcal Vaccine

The Advisory Committee for Immunization Practices (ACIP)recently updated its pneumococcal vaccines guidelines to recommend administering two different pneumococcal vaccinations that will be covered by Medicare. CMS is updating the Medicare coverage requirements to align with the updated ACIP recommendations. An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B. A different, second pneumococcal vaccine may now be administered 1 year after the first vaccine was administered. Read more.  

UPDATE: Enrollment Requirements for Writing Medicare Part D Prescriptions

Open Payments Data Updates

CMS recently added nearly 68,000 payment records to the Open Payments dataset. These records were not published in the initial release on September 30 because of one of the two following reasons:

• The record was still under dispute at the end of the review period; or
• Records attested to on the last day of the data submission period for the 2013 program year were inadvertently excluded from publication (however, they were still included in the full 45-day review and dispute process). 

CMS will update the Open Payments data at least once a year. The refreshed data will include updates to data disputes and other data corrections made since the initial publication of this data documenting payments or transfers of value to physicians and teaching hospitals and physician ownership and investment interests. CMS will publish the full calendar year of 2014 financial data by June 30, 2015. Read more. 

The Open Payments system will be unavailable beginning on January 1 through late January 2015, due to system enhancements and preparations for the 2014 program year. Stakeholders will still be able to view Open Payments data and use the data search tool on the CMS website. Read more. 

An archived recording from CMS' November 13th Removed Payment Records webinar is now available.   

View January's Practice Tip of the Month for information on the new modifiers for the New Year!

Cape Medical Billing - Bronze Level Partner    

Contact: Rich Papperman, President
Address: 5 Locust Lane, P.O. Box 670, Cape May Court House, NJ 08210
Phone: 888-633-2457
Fax: 609.463.8106
E-mail: info@CapeBilling.com
Website 

Gone are the days of "submit a bill and get paid". Insurers have deployed "armies" of people, using high end computers, with sophisticated software, in order to find ways to deny providers payment. This is "Revenue Leakage."  

At risk is the loss of tens of thousands of dollars in revenue to a practice.

Cape Medical Billing is the premier Medical Billing Service for Physicians, Surgeons, Physical & Occupational Therapists, and Ambulance companies.

Cape Medical Billing has a proven track record of reversing "Revenue Leakage" and maximizing revenue for clients. Our services and systems are designed to get you paid faster, (over 98.5% of CMB claims are paid on first submission), prevent rejections, track claims efficiently, and follow-up on unpaid claims and patient balances.  Please contact us for a free quote.

Giordano Halleran & Ciesla - Silver 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.com
Website
Blog  

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.