Charles Rothberg, MD
|September 15, 2017
Finally, there is a user-friendly video that shows physicians, in a straight and forward manner, how to avoid 4% Medicare Payment Penalties in 2019. IT’S SURPRISINGLY QUICK. IT’S SURPRISINGLY EASY. AND it is available at: https://www.ama-assn.org/qpp-reporting
The Quality Payment Program (QPP) is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and is administered by CMS. Because the QPP is new this year, MSSNY and the AMA want to make sure physicians know what they have to do to participate and the QPP’s “Pick your Pace” options for reporting. This is especially important for those physicians who have not participated in past Medicare reporting and programs and may be less FAMILIAR WITH the steps they can take to avoid being penalized under the QPP.
This SHORT video developed by the AMA, titled “One Patient, One Measure, No Penalty: How to Avoid a Medicare Payment Penalty with Basic Reporting ,” offers step-by-step instructions on how to report so physicians can avoid a negative 4% payment adjustment in 2019. Under the “Pick-Your-Pace” mode, this is the TEST component. DESPITE CMS CHARACTERIZATION OF ” one-patient, one-measure” on one claim, our VP of MSSNY’s Socio-Medical Economics Division Regina McNally ADVISES PHYSICIANS THAT, “Just to be safe, file three or four measures on three or four patients just to makes sure the government gets it.”
The AMA and the Federation stressed to CMS the importance of establishing a transition period to QPP and, as a result, physicians need only to report on at least one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under the Merit-based Incentive Payment System (MIPS). On this website , there are also links to CMS’ quality measure tools and an example of what a completed 1500 billing form looks like.
Regina McNally, strongly urges our members who are “lost” and want no part of MIPS to view this video. “This is the first video I have seen that simplifies the process, explains the process clearly and succinctly, and could help physicians from paying penalties,” she said.
Please visit: https://www.ama-assn.org/qpp-reporting
Charles Rothberg, MD
Please send your comments to email@example.com
- MSSNY’s VP of Legislative and Regulatory Affairs John Belmont presented information on Physician Advocacy Network (PAL), an initiative aimed at getting MSSNY’s message out to legislators in an innovative new way. MSSNY recognizes that many physicians have relationships with various legislators and others activists. The goal would be to have at least two or three members assigned as a liaison to each state legislator and for these PALs to meet personally with their assigned legislator at least twice a year to develop or further solidify relationships with elected officials. MSSNY is currently in the process of updating and retooling our key contact list to assist in our legislative advocacy and is looking for assistance from members in reaching out and identifying physicians who have close relationships with legislators. For more information, contact John Belmont at firstname.lastname@example.org or 518-465-8085.
- Speaker Kira Geraci-Ciardullo, MD announced key information and deadlines for the House of Delegates meeting, which will begin on Friday, March 23, 2018 and will adjourn on Sunday, March 25, 2018. All activities will take place at the Adam’s Mark Hotel in Buffalo. The window for submitting Resolutions is January 22, 2018-February 9, 2018 at 5 pm.
- A letter was sent by 41 state medical societies (including MSSNY), and 33 National Medical Specialty Societies, to Dr. Nora of the American Board of Medical Specialties regarding the ongoing contentious issue of MOC. The letter informed ABMS about both a high-level summit that recently took place regarding MOC, and an upcoming meeting in December with the ABMS, the Council of American Specialty Societies and state medical societies to share physician views and seek agreement on how to reshape the MOC process. Dr. Madejski will represent MSSNY at the December meeting.
- Council reconsidered Resolution 2017-157: Development and Promotion of Evidence-based Ultrasound –First Radiation Mitigating Protocols, and voted to Not Adopt Resolution 157.
- MESF will present Physicians Leadership Seminar on October 20-21, 2017 at the Albany Hilton. Topics include Where the NYS Legislature is Leading Us in Health Care; Strategic Leadership of the Health Care Enterprise: Creating Value in Turbulent Times; and Blue Ocean Thinking: Focusing on Where the Fish are Swimming. Featured speakers include Jon Chilingerian, Ph.D, Carole Carlson, MBA.
New Law to Prohibit Medical Record Charges When Needed to Support a Patient’s Government Benefit Application
Governor Cuomo has signed into law legislation (S.6078, Valesky/A.7842, Gottfried) that prohibits health care providers and facilities from charging patients for copies of medical records when such records are needed “for the purpose of supporting an application, claim or appeal for any government benefit or program”. While existing law already prohibits charging for medical records when a patient is unable to pay, the purpose of the new law is to respond to numerous complaints lodged by patients where they were charged for medical records necessary to assist applications and appeals for government programs assisting lower income patients such as Social Security Disability Insurance (SSDI) and the Supplemental Nutritional Assistance Program (SNAP), or other government benefit program such as those for 9/11 first responders. While noting that it did not condone the actions of health care providers who were charging low-income patients for medical records, MSSNY did express concerns that the terminology “any government benefit or program” in the legislation was too broad, and suggested that the bill be amended to specifically enumerate in the law those low-income government benefit programs to which this fee charge prohibition should apply. However, that change was not made. S6078 letter to the Governor
Centene to Buy New York’s Fidelis Care For $3.75 Billion
The Wall Street Journal (9/12) reported that Centene Corp. announced Tuesday that it will buy nonprofit health insurer Fidelis Care in a $3.75 billion deal. The deal adds 1.6 million members in New York to Centene. Centene is a leader in Medicaid managed care business and Medicare, and is also active in Affordable Care Act exchange plans. The deal is expected to close in the first quarter, according to the Journal.
Unlike its competitors Aetna, Anthem, UnitedHealth Group, and Humana, Centene is expanding into new markets and “has been able to successfully manage the costs of sick uninsured Americans buying individual policies on the ACA’s public exchanges. Centene had nearly 1.1 million customers enrolled in ACA marketplaces as of June 30 this year, compared to 617,700 at this time last year. Fidelis, the article says, is “an established player in New York’s Obamacare, Medicaid and Medicare Advantage markets.” Forbes (9/12)
The Law: Pharmacy Providers Cannot Demand Copays from Those Who Cannot Pay
The NYS Medicaid Pharmacy Program has been notified that some pharmacies are refusing to dispense medications to patients for their inability to pay the copayment. Social Security Act §1916 specifies that no Medicaid enrolled provider may deny care or services to an individual eligible for such care or services on account of such individual’s inability to pay a deduction, cost sharing, or similar charge. The September 2011 Special Edition Medicaid Update cover-page and the March 2012 Medicaid Update page 15, confirm this Federal law applies to all Medicaid providers, both fee-for-service and managed care. Providers may attempt to collect outstanding copayments through methods such as requesting the co-payment each time the member is provided services or goods, sending bills or any other legal means
Dr. Rosenblatt: Desperately Seeking Physician Support for Proposed Office-Based Surgery Guidance Changes
The NYS Department of Health has an Office Based Surgery (OBS) Advisory Committee, of which I have been a member since 2006. In July of 2017, the NYS DOH decided it would conduct a voluntary pilot with OBS practices requiring them to report the number of cases they perform and the AMA-CPT codes of these cases via the Health Commerce System (HCS).
The first foray by the DOH to mine data was meant to be voluntary. However, starting January 2018, the DOH wants to make the provision of this information mandatory by all NYS OBS practices. They feel that they have the authority to require this because of the following wording in the OBS law:
Reference: PHL § 230-d, 4. (b): “The department may also require licensees to report additional data such as procedural information as needed for the interpretation of adverse events.” http://www.health.ny.gov/professionals/office-based_surgery/law/docs/230-d.pdf
As a plastic surgeon, and MSSNY’s representative on the OBS Advisory Committee, I am only one of a few practicing office-based physicians on the DOH Committee. We practicing OBS physicians are outnumbered by the significant number of state employees and full-time hospitalists on the Committee. I have been speaking against this requirement for the following reasons:
- Much of the data that the DOH is seeking and asking to be reported is publicly available. For example, AAAASF already provides the number of cases done per 6-month period to the DOH.The law already requires an OBS physician or center to report certain types of adverse events (AE).
- This kind of regular health record reporting requirement would be burdensome and not needed to develop policies to protect patients in office-based surgical facilities.
- This proposed requirement represents an unfunded time consuming mandate for practicing physicians
- I don’t agree that the law allows the DOH to require all OBS facilities to regularly report this information
For many plastic surgeons who provide OBS, the vast majority of our procedures are not reimbursed by insurance. Therefore, AMA-CPT codes are not used for recording those procedures.
In NYS there are over 990 OBS facilities. https://www.health.ny.gov/professionals/office-based_surgery/practices/. To locate a specific OBS site, click on Number of accredited practices by county and select the county of your choice.
Effective July 14, 2009, physician offices that perform surgical or invasive procedures using more than mild sedation or liposuction over 500cc under straight local must be accredited by one of these agencies:
- Accreditation Association for Ambulatory Health Care (AAAHC)
- American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF)
- The Joint Commission (TJC)
There are about 650 OBSs that are certified by AAAASF, which provides the NYS DOH with the number of cases done. Neither AAASF nor the Joint Commission ask their facilities for those numbers; and therefore, doesn’t supply that information to the NYS DOH. If the DOH wants the number of cases, they should ask the two other certifying agencies to provide them the data and not hassle the doctors.
So far during the voluntary reporting, only 179 of the over 900 OBS facilities in NYS have reported. When the DOH leaders were asked what will occur if facilities do not report in 2018, their answer was that the OBS sites would be reported to the OPMC. Can you imagine what the OPMC would do with the report of hundreds of non-reporting facilities? They are overburdened by their current workload.
MSSNY and I are looking for support from all the NYS OBS facilities. We need to mobilize the NYS Plastic Surgical Society, NY Regional Society of Plastic Surgery, Gastroenterology, invasive radiology and all other specialists who work in their own accredited office-based surgical facilities to urge the NYS DOH to obtain the data they seek from the OBS certifying agencies.
If you feel that the DOH is overstepping their charge, as I do, please call the DOH or Rosemarie Casale (518) 408-1219) (Rosemarie.Casale@health.ny.gov) and express your displeasure at having to fill out more forms.
If you have any more ideas, I will be glad to speak to any of you.
William Rosenblatt MD
Past President of MSSNY
Managed Care Network Physicians: Medicaid Provider Enrollment Requirement
Section 5005(b)(2) of the 21st Century Cures Act amended Section 1932(d) of the Social Security Act (SSA) and requires that effective January 1, 2018, all Medicaid Managed Care and Children’s Health Insurance Program providers must enroll with state Medicaid programs. The SSA requires that the enrollment include providing identifying information including name, specialty, date of birth, social security number, National Provider Identifier (NPI), federal taxpayer identification number, and the state license or certification number.
For example, if a physician currently participates in a network with a Medicaid managed care plan that provides services to, or orders, prescribes, or certifies eligibility for services for, individuals who are eligible for medical assistance, the physician must enroll with New York State Medicaid.
Common Enrollment Questions:
- To check on your enrollment status, please call CSRA at 1-800-343-9000. Practitioners may also check the Enrolled Practitioners Search function at: https://www.emedny.org/info/opra.aspx
- If you are already enrolled as a Medicaid fee-for-service (FFS) provider and are listed as active, you will not have to enroll again.
- If at one time you were a FFS provider, and your enrollment has lapsed (no longer actively enrolled), you may be able to keep your original Provider Identification Number (PID), also known as MMIS ID, by reinstating.
- Practitioners who do not wish to enroll as a Medicaid FFS billing provider may enroll as a non-billing, Ordering/Prescribing/Referring/Attending (OPRA) provider. The enrollment form for this function is attached.
- Enrollment in Medicaid FFS does not require providers to accept Medicaid FFS patients.
If you are not actively enrolled, please go to: https://www.emedny.org/info/ProviderEnrollment/index.aspx and navigate to your provider type. Print the Instructions and the Enrollment form. At this website, you will also find a Provider Enrollment Guide, a How Do I Do It? Resource Guide, FAQs, and all forms related to enrollment in New York State Medicaid.
As a point of information, under 42 CFR 455.104 defines the following providers as excluded from the definition of “disclosing entity”:
- Solo practitioners such as an individual physician, psychologist, or chiropractor.
- Group of individual practitioners, such as a group of cardiologists, or a group of radiologists.”
Therefore, physicians do not need to complete Section 5.
If you have questions, please call Regina McNally
Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!
Donate to AMA’s Physician Disaster Fund
MSSNY Councilor Josh Cohen, MD, MPH is also President, AMA Foundation Board sent a letter providing information as to how New York physicians can aid fellow physicians affected by the recent storms.
The physician community rallied together to help our peers in Texas who were adversely affected by Hurricane Harvey. Now, as a result of the havoc caused by Hurricane Irma, more of our colleagues are experiencing the same devastation in Florida and need our support. It is vital for doctors to quickly rebuild their medical practices to continue serving their communities. The AMA Foundation created the Physician Disaster Recovery Fund to offer relief to doctors in this time of great need.
Your gift today to the AMAF’s Physician Disaster Recovery Fund will directly support Texas and Florida to help to reestablish delivery of patient care by physician practices impacted by Hurricane Harvey and Hurricane Irma.
Join us and please make a gift to the AMAF’s Physician Disaster Recovery Fund. Let’s work together to enable our fellow physicians to get back to the vital work of caring for their patients.
Q: I have been denied by many insurance carriers for invalid radiology orders. What am I doing wrong?
A: Diagnostic tests are currently under scrutiny from many insurers. To be sure your orders are in good order make sure they include the following:
- The patient’s name
- The test requested
- Clinical indications for the test (diagnosis)
- The legible name, signature and date of the ordering provider
- Signature stamps are not acceptable
- The Medicare Claims Processing Manual (Chapter 23, Section 10.1.2) states that the ordering physician must provide the diagnostic information at the time the study is ordered.
Also keep in mind insurance carriers are also verifying the orders with the ordering provider to make sure the medical necessity for ordering the test is documented. In some cases, the insurance carrier is leaving that responsibility up to the servicing provider.
The source document frequently referenced by the carriers is the DOH Medicaid Update May 2006 Vol.21, No 5, Documentation Requirements for Ordered Services. Check it out https://www.health.ny.gov/health_care/medicaid/program/update/2006/may2006.htm
If you have a coding or compliance question you would like to have answered please send your question to MSSNY at email@example.com, and complete the subject line with “Tip of the Week.”
Feds: NY Paid $1.4B to Providers with Medicaid Compliance Problem
The AP (9/12) reports that New York State paid $1.4 billion in Medicaid funds in 2014 to long-term care providers who did not comply with state rules for the program, according to federal Office of the Inspector General report published Tuesday. The report “revealed a large number of providers who failed to document patient assessments, provide community-based services or provide written care plans to patients, all requirements spelled out in their contracts with the state.” New York Medicaid Director Jason Helgerson disagreed with the report’s conclusions, stating that many are “simple paperwork problems” and “wouldn’t be sufficient reason to demand full refunds from the providers.”
Many of the deficiencies outlined in the report amount to simple paperwork problems, he said, and wouldn’t be sufficient reason to demand full refunds from the providers, a move he likened to the “death penalty.” He said the report’s conclusion that $1.4 billion could have been saved is “a complete mischaracterization.”
“They’re suggesting that if any (provider) plan has any clerical error – if they have any deficiencies – we should recoup entire years of reimbursement,” he said. “If we were to basically ding them for a full year’s reimbursement, no one would ever sign that contract.”
He said the agency is looking at using fines as a way to ensure providers are complying with the rules.
“We want full compliance,” he said, “but at the same time we have to have a measured response.”
MSSNY President to Be Honored at Harvest Moon Ball in Glen Cove
MSSNY President Charles N. Rothberg is being honored at the Brookhaven Hospital Harvest Moon Ball at the Nassau Country Club in Glen Cove (Long Island) on Saturday, October 14, 2017 from 6PM to 10PM. Dr. Rothberg will be receiving the Dr. Jacob Dranitzke Award. For tickets, to donate or be a sponsor, please go here.
Monroe County Joins ABMS Multi-Specialty Portfolio Program
The Monroe County Medical Society (MCMS) has joined the American Board of Medical Specialties’ (ABMS) Multi-specialty Portfolio Program. The program, functioning in the quality collaborative segment of the Society, will assist the organization in providing basic guidelines for clinical care across the region.
Based in Rochester, the Monroe County Medical Society covers Livingston, Monroe, Ontario, Steuben, Seneca, Wayne and Yates counties, advocating for betterment of health care in the region.
“As an ABMS Portfolio Program Sponsor, MCMS will ensure that we provide meaningful QI [quality improvement] project opportunities to the physicians in our region, bringing expertise of the Quality Collaborative and physician leadership oversight to the program,” said Christopher Bell, executive director of MCMS, in a statement. “We will encourage physicians to be innovative in their project designs or participate in projects developed within the Quality Collaborative and will welcome their feedback during the process to ensure they have input throughout it.”
In the early hours of the program, the MCMS expects 250 primary care physicians to participate. The result, as Bell stated, is intended to be a push for better quality control for health care in the region.
“MCMS’ participation in the Portfolio Program provides additional recognition of the valuable efforts these physicians and their teams are undertaking to improve the care of not only their current patient population, but through their various collaborations, even more patients and families throughout the state,” said David Price, executive director of the Portfolio Program.
Utilized nationwide, the Portfolio Program, to date, has initiated over 2,000 improvement efforts to health care systems.
Great Neck – Medical Zoned Condo
2690 Sqft – $699,000 – quick easy access to North Shore University Hospital, Long Island Expressway and Long Island Rail Road. 10 Exam rooms plus waiting room & large secretary area http://bit.ly/2wXCbkQ . Call Chris Pappas, LAB 516-659-6508
Beautiful, Fully-Equipped Medical Suite for Rent or Share – Glen Oaks, NY
For Rent or Share – Glen Oaks, NY
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Available for full or half-days.
Beautiful, recently renovated office
available for part-time share
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Centrally located /Close to expressways.
The practice is 5 minutes from LIJ/Northwell Hospital.
8 exam rooms/procedure rooms. Waiting room, break room and
personal office with private bathroom.
(~2500 sqft) Free WIFI.
6 parking spots for patients and 2 for doctor.
The previous tenant, a full-time primary care
physician with a part-time cardiologist coming
in turned it over to an associate a year ago
but has been here for about 10 years. He needed more space
and bought a building about 20 minutes away. Our building gets a lot of drive-by traffic and pedestrian traffic from the mall across the street. Weekly we have patients walk in inquiring about the practice.
The dental practice next door sees over 2500 patients per year and refers actively to the medical suite.
Follow the link for a video of the space (all furnishings, exam tables, chairs, oxygen, orthoscope included in lease – about $500k in value): https://youtu.be/f9gr62fKaVs
Contact Haresh at firstname.lastname@example.org or 516-220-3297
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house. Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800
Beautiful recently renovated Plastic Surgery
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Contact Patricia at email@example.com
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Child and Adolescent Psychiatrist – Lockport, New York, Eastern Niagara Hospital
Eastern Niagara Hospital is seeking a Full Time Medical Director for its 12 bed Child and Adolescent Psychiatric Unit. Responsibilities include inpatient care, shared on-call responsibilities and Medical Director duties. Competitive compensation package. For more information, please contact David DiBacco at 716-514-5501 or email to firstname.lastname@example.org.