Dr. Malcolm Reid
|September 30, 2016
Volume 16, Number 34
MSSNY membership is not just about our hardworking Government Affairs Division. One of the many perks of being a MSSNY member is our Member Benefits program. The companies we have chosen are carefully vetted to enhance your practices and your lives. In addition to screening each firm for you, MSSNY monitors member satisfaction to ensure that you are receiving quality services.
I would like to highlight a few that might be of assistance to you and your practice:
- MLMIC- Medical liability insurer that offers superior protection with at-cost rates at www.MLMIC.com or call 888-782-3821
- Division of Socio-Economics Ombudsman Program- this program intervenes on behalf of the physician when an insurance claim is in dispute, is reduced or is denied. MSSNY staff has been often able to recoup payments or clarify policy to correct plan indiscretions. For information, call Regina McNally at 516-488-6100 ext. 332.
- Athenahealth– MSSNY members receive a 6% discount on an integrated suite of practice management services. Our ONLY approved EHR and billing company can be reached at www.athenahealth.com or call 866.927.2843
- Bank of America– cash reward credit cards at
- DrFirst– e-prescribing solutions at a discounted price for members at www.DrFirst.com
- Jerome Associates/Hilb Group-life insurance, long term care, primary healthcare for large and small employers, and disability insurance at http://www.eaijjj.com
- Kern Augustine Law Firm– attorneys specializing in health law matters offer a free consult and reduced hourly rates for practice- or employment-related matters. Take advantage of a FREE coding and documentation review under attorney-client privilege – avert compliance violations AND correct undercoding mistakes that leave money on the table http://www.drlaw.com/
- Liberty Mutual– Reduced insurance rates for auto and home exclusively for MSSNY physicians at www.libertymutual.com/mssny
- Mercer– Data breach insurance and Workers’ Compensation, to cover a wide range of risks that you face as a physician with a practice. Call 800-626-9063 or visit www.MSSNYMemberInsurance.com
- Merrill Lynch– Mortgage point discounts at http://www.merrillhomeloans.com/mlhl/pages/home.aspx?corpurl=mssny or email email@example.com
- NYrx Card– for your patients, a discounted prescription card for you to distribute to patients that have no insurance; it also can be used when insurance companies will not pay for a specific drug. Call Roseann Raia at 516-488-6100 ext 302 for cards to distribute to your patients.
This is just a sample of what MSSNY membership has to offer physicians.
If you have any ideas or suggestions for a member benefit that you think would enhance our current program, please contact Christina Southard at firstname.lastname@example.org 516-488-6100 ext 355.
Malcolm Reid, MD, MPP
President, Medical Society of the State of New York
Please send your comments to email@example.com
Governor Signs Bill to Reduce Reporting Burdens When A Physician Issues Paper Prescription
Governor Cuomo has signed legislation (S.6779, Hannon/A.9335,Gottfried) strongly supported by MSSNY which eliminates the requirement for a physician to report a litany of information to a DOH website when he/she issues a paper prescription. Instead, effective immediately, the physician must make a notation in the patient’s medical record that a paper/oral/fax prescription was issued. Upon learning that the bill was signed into law, MSSNY President, Malcolm Reid, MD issued the following statement: “We are pleased that Governor Cuomo has signed into law legislation to reduce the reporting burdens in those situations when a physician must issue a paper prescription. We thank Senator Hannon and Assemblyman Gottfried for championing this legislation. We look forward to working with the Governor and the Legislature to address other obstacles related to e-prescribing that interfere with patients timely receiving needed medications.”
At the same time, the Governor vetoed two other bills also designed to address burdens associated with e-prescribing:
- 9334/S.6778 – would have continued to permit oral prescriptions for nursing home residents. The Governor’s veto message noted that a waiver had previously been granted to permit such oral prescriptions, and that this waiver will now be extended until October 31, 2017.
- 9837/S.7334 – to permit sending of an e-prescription to a secure centralized site that can be downloaded by the pharmacy filling the prescription. The Governor’s veto message noted that the bill would “create significant risk of data breaches and unauthorized access to confidential information”. Instead, the Governor noted that he “is looking closely at a separate bill” (supported by MSSNY) that would permit a pharmacy to transfer an e-prescription to another pharmacy, which “would more directly and safely address the concern addressed by this bill”.
Healthcare Providers Required to Comply with “Non-Discrimination” Reporting Provisions by Mid-October
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which including most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.
To read a comprehensive summary prepared by Donald Moy, Esq. from the firm of MSSNY’s General Counsel, Kern Augustine P.C, to assist physicians with compliance, click here.
According to the AMA, the rule does not apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court.
Covered physicians must comply with the following requirements:
- Submit an assurance of compliance form to OCR
- Post a notice of nondiscrimination and taglines in multiple languages
- Develop and implement a language access plan
- Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)
To help reduce burden and costs, the HHS Office of Civil Rights (OCR) has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rule, factsheets on key provisions and a list of frequently asked questions.
Patients Fill Out MOLST Forms Incorrectly, Often Countermanding Wishes
University at Buffalo researchers, writing in the Journal of the American Medical Directors Association, say that end-of-life forms are too often ambiguous. Patients often leave forms, which are supposed to specify their requests, blank and that means they will receive the most aggressive form of treatment. Sixty-nine percent of forms reviewed had at least one section left blank. Inconsistencies were found in patient wishes among a subset (14%) of patients, wherein their desire for “comfort measures only” seemed contradicted by a desire to be sent to the hospital, receive IV fluids, and/or receive antibiotics. The conclusion was that patients and proxies may believe that making choices and documenting some, but not all, of their wishes on the MOLST form is sufficient for directing their end-of-life care. The result of making some, but not all, choices may result in patients receiving undesired, extraordinary, or invasive care. http://bit.ly/2dB37Lk
NY Medicaid Statewide Patient Centered Medical Home Program Incentive Payment Program Policy: Update on Retroactive Incentive Payments
The New York State Medicaid Statewide Patient Centered Medical Home (PCMH) Incentive Payment Program provides financial incentives to primary care practices who achieve PCMH recognition from the National Committee for Quality Assurance (NCQA). Payments are given as either per-member-per-month (PMPM) capitation payments for Medicaid Managed Care (MMC) members or as an add-on payment for eligible claims billed for services provided to Medicaid Fee-For-Service (FFS) members. Rates for both PMPM payments and add-ons depend on a provider’s NCQA recognition standard and level. For more information on the current established rates, please see the November 2015 Medicaid Update.
During the first week of each month, the New York State Department of Health’s Office of Health Insurance Programs (OHIP) posts the most recent list of PCMH-recognized practices and their providers to the Health Commerce System (HCS). The list contains the most recent PCMH recognition information the Department has on file from NCQA at that time. MMC plans to use this list to identify which practices and providers in their networks are eligible to receive the PCMH incentive payments and the rate they should receive.
Due to the monthly schedule of data transmissions from NCQA to the Department of Health and from the Department of Health to HCS, it takes approximately 60 to 90 days after recognition is awarded for health plans to be notified of a new or changed recognition status. This lag has historically caused a two to three month delay in practices receiving PCMH incentive payments.
Effective January 1, 2017, all MMC plans will be required to pay incentives for the New York State Medicaid Statewide PCMH Incentive Payment Program as of the month of PCMH recognition. This ensures incentives will be paid for every month of PCMH eligibility to practices and their providers. This may require plans to process retroactive payments to recognized practices and providers in their network when affected by this initial lag of information. Regardless of the NCQA recognition effective date, payments due to practices must account for the entire first month of their recognition, and should not be prorated.
MMC plans are required to distribute PCMH incentive payments to practices at least bi-annually, and MMC plans are encouraged to process on a more frequent basis if possible. Providers with questions regarding the frequency of payment for individual plans should contact their MMC plan representatives directly.
Finally, to ensure accurate incentive payments from both MMC plans and FFS Medicaid, providers must supply NCQA with the full address of the site’s physical location, not a billing site address. The National Provider Identifier (NPI) for the group and the individual NPIs of practitioners working at the practice should be provided to NCQA to ensure payments are made accurately.
Questions regarding this policy change may be directed to firstname.lastname@example.org. Questions regarding claim eligibility and/or billing guidance for Medicaid FFS claims should be directed to the eMedNY call center at 1-800-343-9000. For more information on how to achieve NCQA PCMH recognition, providers may contact NCQA at 1-888-275-7585 or visit the NCQA website at www.ncqa.org.
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
New Fact Sheet Details Physician Efforts to Address Nation’s Opioid Epidemic
The AMA Task Force to Reduce Opioid Abuse has released the attached fact sheet that details the extensive efforts that physicians across the country have taken recently to reverse the nation’s opioid epidemic. Specifically, the fact sheet notes the following:
. Every state in the nation saw a reduction in opioid prescribing in 2015—an overall 10.6 percent decrease nationally.
· State-based prescription drug monitoring programs (PDMPs) were checked nearly 85 million times in 2015—a 40 percent increase over 2014
· From 2012 to 2016 there has been an 81 percent increase in physicians certified to treat substance use disorders—more than 33,000 across all 50 states.
While not noted specifically in the fact sheet, here in New York State there have been over 50 million searches to New York’s PDMP, with a resulting 90% decrease in so-called “doctor shopping” (patients who visit multiple doctors and pharmacies to get multiple prescriptions for controlled substances)
MSSNY is one of the 25 state medical and national specialty associations represented on this AMA Task Force. MSSNY Assistant Treasurer Dr. Frank Dowling and MSSNY VP for Public Health Pat Clancy have made extensive efforts to support the work of this group.
Handwriting on Claims Submitted to Medicare
Beginning 10/1/2016, NGS will return to the provider any paper claim submitted with handwriting on the face of the claim that does not meet the criteria of being a signature field for Items 12, 13, or 31. You will receive a notice attached to the front of the claim when it is returned notating this as well. NGS continues to receive claims in which providers are inappropriately writing information on the claim by hand. Some claims are typed or computer generated, then revised with handwritten information prior to submission.
The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 26, Section 30, “Printing Standards and Print File Specifications Form CMS-1500” (596 KB) contains the printing specifications for the CMS-1500 claim form. These printing specifications do not provide instructions to submit handwritten claims.
The only fields on the CMS-1500 claim form that have space and allows for any type of handwriting for signatures of the beneficiary or provider are Items 12, 13, and 31. Other than the signatures, handwriting should not appear on any claim submitted to Medicare. Please refer to CMS IOM 100-04, Chapter 26, Section 30 (596 KB) to make sure you are completing paper claims correctly.
In last week’s Enews, it was incorrectly stated that MSSNY signed a letter along with the Pennsylvania Medical Society regarding “no confidence” in ABIM (American Board of Internal Medicine). The “no confidence” letter was referencing ABMS (American Board of Medical Specialties) NOT ABIM. Councilor Dr. Parag Mehta, who presented a comprehensive Power Point at the Council Meeting regarding ABMS, wrote to us about the error.
Physicians Foundation Results
The Physicians Foundation is pleased to reveal the results of its fifth Biennial Physician Survey. They received an overwhelming response with over 17,000 physicians providing a glimpse into their current practice environment and anticipated future of medicine.
The bottom line is that physicians are struggling to maintain morale levels, adapt to changing delivery and payment models, and to provide patients with reasonable access to care. While respondents agreed the most satisfying part of their job is the patient relationship, about two-thirds said third-party intrusions detract from the quality of care they can provide.
Even more striking, nearly half (49 percent) of survey respondents say they are either often or always feeling burnt out. This may lead to shifting practice patterns that could reduce the physician workforce by tens of thousands of full-time equivalents (FTEs).
For a deeper look at the findings, the entire report here.
Screening Colonoscopy Provides Little Benefit to Adults Aged 70–79
Screening colonoscopy appears to offer a modest benefit to adults aged 70–74 and little to no benefit to those aged 75–79, according to a study in the Annals of Internal Medicine. The U.S. Preventive Services Task Force recommends routine colorectal cancer screening for those aged 50–75, and screening on a case-by-case basis for those aged 76–85.
Researchers used Medicare data to follow a large group of older adults who hadn’t undergone colonoscopy in the 5 years before baseline. Among adults aged 70–74, the estimated 8-year risk for colorectal cancer was 2.19% among those who subsequently underwent screening colonoscopy, versus 2.62% among those who did not. Among those aged 75–79, this modest benefit was even smaller: 2.84% versus 2.97%.
Screening colonoscopy was associated with an excess 30-day risk for adverse events requiring hospitalization or an emergency department visit: 5.6 excess events per 1000 adults aged 70–74 and 10.3 per 1000 among those aged 75–79.
Annals of Internal Medicine article
Some Physicians Want to Make More House Calls
The New York Times (9/23) in its “Your Money” blog reported on the efforts of some physicians to revive house calls to care for the sick at home rather than in hospitals. The article points out that many practitioners work exclusively in hospitals, but also points out that house calls for Medicare patients increased from 1.5 million in 1995 to 2.6 million in 2014, according to the Centers for Medicare & Medicaid Services. The article also mentions the Independence at Home Act (S. 3130) http://bit.ly/2cR4SoN a bill with bipartisan support that “would expand a Medicare home care demonstration program.”
Elephant Tranquilizer Implicated in Recent Overdose Deaths
The Drug Enforcement Administration is blaming a spate of recent overdose deaths on carfentanil, a synthetic opioid that is roughly 100 times as potent as fentanyl. Just 2 mg of fentanyl can be fatal, while the lethal dose of carfentanil is unknown.
Carfentanil is estimated to be 5000 times as potent as heroin and 10,000 times as potent as morphine. A Schedule II substance, carfentanil is used to sedate large animals like elephants. It is often sold on the streets as heroin. Like with fentanyl, multiple doses of naloxone may be needed.
DEA news release https://www.dea.gov/divisions/hq/2016/hq092216.shtml
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to email@example.com
Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management. We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
Ideal for busy medical subspecialty. Exclusive use of consult, exam room. Stress test, echo available. Beautiful décor. Public transportation nearby. Available immediately. Please call 212-996-2900 or e-mail: firstname.lastname@example.org
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week. Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!
A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to email@example.com. No recruiters please.
A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).
If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to firstname.lastname@example.org. No recruiters please.
Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777