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Medical Society of New Jersey e-Newsletter
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NJ Devils One Day Only Sale - November 26
Save 30% on tickets. Read more.
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MSNJ Board Meeting
December 3, 2015 at 6:30pm
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PCSS-MAT Webinar: Enhancing Clinical Treatment Through Use of Prescription Drug Monitoring Programs
December 8, 2015; 12:00pm to 1:00pm
More information.
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Webinar: Harnessing Improvement to Reduce Diagnostic Errors and Delays
December 1, 2015; 2:00pm to 3:00pm
More information.
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Save the Date! MSNJ's 2016 Advocacy Conference and House of Delegates Meeting
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Save the Date! MSNJ's 250th Anniversary Celebration and Inaugural Gala honoring Dr. Joseph Costabile
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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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Legislative Update
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Out of Network Legislation
The Assembly Financial Institutions and Insurance Committee released A.4444, the "Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act." Three Republicans abstained and all of the Democrats voted yes. MSNJ continues to oppose this legislation, especially now that it essentially prohibits all billing by out of network physicians in a patient's in-network facility, with plans being allowed to opt in to the requirements to pay those claims. Read the letter from the coalition of physician and hospitals opposing the bill. See press coverage. More press coverage.
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Claim Database
The Assembly Financial Institutions and Insurance Committee also passed a bill creating an All Payer Claims Database. In the bill, the database is not used explicitly to create payment caps, but rather is meant to inform the public of "price" information.
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Pharmacy Benefit Managers
The Senate Commerce Committee unanimously passed a bill that would require better drug pricing transparency from PBMs. The pharmacies and MSNJ support this bill, while PBMs and health insurers, as well as business trade groups, oppose. See press coverage.
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News
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AMA Urges DOJ to Block Two Major Health Insurer Mergers In a letter to the US Department of Justice the AMA has requested that it block two announced mergers: the acquisition of Humana by Aetna; and the acquisition of Cigna by Anthem. It objects to the resulting high insurance market concentration and the anticompetitive effect that the combined companies will have through the exercise of market power. AMA lays out its analysis and concerns that the mergers will have a negative impact on consumers in terms of healthcare access, quality and affordability. Both the American Hospital Association and the AMA have testified to Congress that there is no evidence that the proposed mergers will result in any efficiencies. Read more.
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United Healthcare Considers Withdrawing from Exchange
Citing lower profit estimates, United Healthcare has indicated that it may discontinue offering health plans on the Exchange as early as 2017. Read more.
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Most Co-ops under the Affordable Care Act Have Failed
More than half of the Co-ops established under the Affordable Care Act have failed or are winding down operations. Co-ops were to have created more competition in the health insurance industry by lowering barriers to entry. Read more. While the Co-op in New York has failed, the New Jersey Co-op, Health Republic Insurance of New Jersey, is currently fully operational and has 59,000 members.
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Public Health
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Physicians are required to report administration of rabies post-exposure prophylaxis.
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Practice Management
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ICD-10: Clarifications about NCDs and LCDs
CMS provided additional clarification on NCDs. In most cases, claims are being automatically reprocessed, and no action is required. Starting January 4, 2016, a permanent systems update will be in place. Check your MAC website
for information about specific claim types and the reprocessing of claims.
Post implementation, MACs recognized that certain LCDs needed further refinements for ICD-10 diagnosis codes. Claims affected by these edits were temporarily suspended and automatically reprocessed. No action is required. Read the announcement.
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2016 Fee Schedules Now Available
The 2016 Medicare Physician's Fee Schedule is now available. 2016 procedure codes will also be individually searchable through Novitas Solutions Fee Lookup Tool starting on January 5, 2016.
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PQRS Informal Review Period Extended to December 16
CMS has extended the 2014 Informal Review period to December 16, 2015 for Individual eligible professionals, Comprehensive Primary Care practice sites, PQRS group practices, and Accountable Care Organizations (ACOs) that believe they have been incorrectly assessed for the 2016 PQRS negative payment adjustment. All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page.
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Value Modifier Informal Review Deadline Extended to December 16
CMS has extended the informal review period for the 2016 Value Modifier to December 16, 2015. The informal review process allows groups with 10 or more eligible professionals, as identified by their taxpayer identification number, that are subject to the 2016 Value Modifier to request a correction of a perceived error in their Value Modifier calculations.
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Submit 2015 PQRS data to avoid the 2017 penalty!
MSNJ is continuing its PQRS Reporting Benefit in 2015:
Have you started thinking about PQRS reporting to CMS for 2015? Start planning now to avoid the 2% penalty in 2017!
Through a partnership with PQRSwizard® we have made it easy for your practice to participate. PQRSwizard, like Turbo-Tax™ for PQRS reporting, will help guide you step-by-step to simplify the CMS PQRS reporting process.
Measures Groups, individual measures, and GPRO Lite options are now open for 2015 registration.
Visit www.msnj.org/benefits to access the preferred MSNJ price of $225 per provider (Regular Fee is $299).
The deadline for 2015 reporting through PQRSwizard, using the MSNJ discount, is February 26, 2016.
Note that ALL PROVIDERS WHO BILL MEDICARE FFS are responsible for reporting under the PQRS program.
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Novitas Releases Articles to Help You to "Increase Your Bottom Line"
Novitas Solutions has started to roll out a series of "Increasing Your Bottom Line" articles geared specifically to help Medicare Part B providers submit Medicare Part B claims accurately the first time. The next article, "Increasing Your Bottom Line: Using Modifier 79 Correctly to Indicate An Unrelated Procedure During the Post-Operative Period" is now available.
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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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2015 © 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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