Doing Right for Patients & Members


Thomas J. Madejski, MD MSSNY President
Thomas J. Madejski, MD
MSSNY President
MAY 4, 2018
Volume 18
Number 17

Doing Right by Our Patients and Our Members

Dear Colleagues:

I related to you last week my testimony before the Assembly Health Committee explaining MSSNY’s policy on physician assisted suicide/aid in dying. I testified to MSSNY’s existing policy, which was last reviewed and updated at our 2015 House of Delegates.  Our HOD explicitly indicated that physicians should not participate in physician assisted suicide or euthanasia.

Contentious Issue

I acknowledged that this is a difficult and contentious issue amongst our members, and that there are reasoned arguments on both sides.  My testimony indicated what MSSNY’s present policy is, and that there has not been any attempt to change that policy.

MSSNY was asked at the last House of Delegates to conduct a survey of our members’ attitudes toward physician assisted suicide/aid in dying.  Of note, the 2017 resolution DID NOT ask MSSNY to change its policy; just that a survey be conducted. I testified that the survey has been completed and that the results are being analyzed and reviewed by the MSSNY Bioethics Committee.

MSSNY routinely conducts surveys on many different issues throughout the course of the year.  We use various instruments and recognize that all surveys have inherent bias and methodological issues.  We consider the information and potential flaws of all the data that we use when we formulate policy.

Under Consideration Now in NY

The Medical Aid in Dying Act (S3151/ A2383) is currently under consideration during this legislative session.  Our Council and Bioethics Committee did not have an opportunity to discuss their work prior to the completion of public hearings. After discussion with MSSNY leadership and staff, I wanted to provide as much information as we could to aid the legislators in their deliberations, acknowledging that we had not completed our consideration of the information.

No good deed goes unpunished.

In response to my testimony, organizations that support aid in dying accused MSSNY of mishandling the survey. The organizations are: Compassion and Choices; End of Life Choices New York; Death with Dignity National Center; and Death with Dignity-Albany.

I testified at the hearing that MSSNY is committed to improving care for all of our patients, especially those near the end of their life.  One of the core principles of the practice of medicine is the easing of suffering, and I acknowledged in my testimony that sometimes physicians may hasten a patient’s death in an attempt to ease their pain.

My job as MSSNY President is to represent MSSNY policy— which I believe I did.


The organizations chose to attack us, rather than work with MSSNY to improve the care of our patients at end of life.  I think it is important to respond to some of the criticism in an attempt to clear the air, and hopefully move forward together:

  • The organizations indicated we released information “unexpectedly.” MSSNY members who are part of the Aid in Dying movement have been asking for information, and questioning why MSSNY wasn’t giving out results. Again, we continue to work on the analysis, but with time constraints and pending legislation, I felt it was important to try and give some information about the results, fully acknowledging that these were preliminary conclusions and will be reviewed further.
  • The organizations indicated that MSSNY did not produce an unbiased survey.  Our Bioethics Committee took great care in creating a survey instrument to minimize bias, and created an instrument that would help to inform leadership on the concerns of MSSNY members.
  • The organizations were concerned that non-MSSNY members participated in the survey.  MSSNY became aware of this early in the survey process.  In fact, Compassion and Choices interfered in the survey process only hours after MSSNY released the survey and several days later we learned that the Catholic Conference was also sending out the MSSNY survey. The organizations don’t indicate that MSSNY legal counsel had to have a discussion with organizations advocating for and against Aid in Dying to cease and desist redistributing the survey to their non-MSSNY members.
  • MSSNY shares Assemblymember Paulin’s concern about the participation of non-MSSNY members and will consider that in our evaluation of the data.
  • One of the difficulties in discussing physician assisted suicide/aid in dying is conflation of related issues. The organizations quoted a number of different studies, but does not seem to be concerned about sources of bias in their parsing of data favorable to their position.
  • Those organizations indicated that it defies logic that a majority of MSSNY physicians oppose medical aid in dying in the light of other national surveys. If that is truly the case, then why be concerned with our process? Then why are the organizations so vested in our process?    We have a very democratic and open process in determining policy through our House of Delegates.

I have already tasked some of our committees with reviewing the issues related to death and dying.  This issue will also be discussed at the MSSNY Council Meeting.

MSSNY has been advocating for the care of patients, the proper practice of medicine, and the betterment of public health since 1807. The last time the majority of MSSNY members spoke through our House of Delegates they opposed physician assisted suicide. That policy has not changed.

NY Is a Policy Leader 

New York State is a national leader in educating physicians and creating health care policy.  I think we can work together to create policy and systems of care that ease our patients’ suffering without creating additional disparities in care.

As President of MSSNY, I am committed to leading a discussion amongst all physicians on how best to care for patients at end of life.


I am interested in hearing your comments on this topic:

Thomas J. Madejski, MD 
MSSNY President

Dr. Donald Moore, host of the well-attended, all-day HIT Symposium at Brooklyn Boro Hall on Saturday, April 28. Dr. Sal Volpe, Dr. Parag Mehta were featured speakers.

MLMIC Insurance

Capital Update

MSSNY Joins Patient Groups to Advocate to Prevent Mid-Year Formulary Changes
This week MSSNY representatives participated with representatives of several other patient advocacy groups as well as the bill sponsors in a press conference and legislative meetings in support of legislation (A.2317-C, People-Stokes/S.5022-C, Serino) that would (in most cases) prohibit a health insurer from making a change to their prescription drug formulary or moving a prescription drug to a higher tier during a policy year.  The legislation passed the Assembly unanimously this week, and is before the Senate Insurance Committee.

The measure is supported by many patient and physician advocacy groups, including the Global Healthy Living Foundation, Lupus and Allied Diseases Association, NAACP, AARP, New Yorkers for Accessible Health Coverage, the Epilepsy Foundation, the Arthritis Foundation, the American Cancer Society, the National Association on Mental Illness-NY, the NY Chapter of the American College of Physicians, the NYS Osteopathic Medical Society, and the American College of Rheumatology.  This week’s event received significant media coverage, including through Newsday and Capital Tonight.

Also participating in the press conference and meetings were parents of children with chronic diseases who shared stories of the impact of these mid-year formulary changes.

The press release referenced a survey released by the Global Healthy Living Foundation found that 65% of New Yorkers reported that their insurance company switched their medication to a drug that was different from the one their physician prescribed; 86% reported paying more out-of-pocket for their prescription medications due to formulary changes; and 93% reported that the medication they were switched to worked worse than the original prescribed medication.

MSSNY President Dr. Thomas Madejski stated the following for the press release:Continuation of a medication regimen prescribed by a patient’s treating physician is critical to assuring a patient’s recovery from illness, maintaining their health, or preventing worsening of their condition. Unexpected changes to a medication formulary could result in significantly higher out-of-pocket costs for patients. This could seriously interfere with their continued ability to obtain these needed medications.  Insurance company formulary changes are not made with the intimate knowledge of the patient’s personal physician.  Additionally, this legislation would help to protect consumers from unforeseen higher cost-sharing requirements.  (AUSTER, BELMONT)

Update on the Patient-Centered Medical Home Program – Physicians Concerned that Some PMPM Cuts Going Forward
To respond to State Budget constraints, earlier this year the NYS Health Department announced its intent to implement a huge cut in Medicaid payments to physicians participating in the Patient-Centered Medical Home program. Specifically, DOH intended to slash the current $7.50 Per Member Per Month (PMPM) payment for each Medicaid patients to $2.00 for May and June.  The amount would increase to $5 or $5.50 PMPM in July but would also have required that each PCMH participant have a Level 1 Value-Based Payment (VBP) contract with a Medicaid Managed Care plan.

If permitted to go forward, these cuts and new requirements would likely have forced many physicians out of the Medicaid PCMH program, which in turn would have significantly impaired access to primary care services for many patients insured through Medicaid.   As a result of these concerns, MSSNY worked together with the New York Chapters of the American College of Physicians, Academy of Family Physicians and American Academy of Pediatrics, as well as the Community Healthcare Association of New York State (CHCANYS), to successfully advocate for the Legislature to include $20 million in the State Budget to prevent these Medicaid payment cuts from being implemented.

While a NYS Assembly summary of the final State Budget noted that these funds were intended to “reject a reduction in reimbursement rates for patient centered medical home services”, that point has been disputed by the NYSDOH.     This week DOH released a letter noting payment changes to the PCMH program starting in May.  We are pleased that, DOH has indicated that it was not going forward with its original proposal to require PCMH participants to have VBP contract by July 1.  However, of significant concern, the letter indicated that there are still going to be cuts to Medicaid PCMH payment, as follows:

  1. Effective May 1, 2018 – June 30, 2018, the MMC PCMH PMPM for providers recognized under NCQA 2014 Level 3, NCQA 2017, or NYS PCMH standards will be $5.75.
  1. Effective July 1, 2018 to the end of SFY 18-19, the MMC PCMH PMPM for providers recognized under NCQA 2014 Level 3, NCQA 2017, or NYS PCMH standards will be $6.00.
  1. Effective May 1, 2018, the PCMH incentive payments for providers recognized under NCQA’s 2014 Level 2 standards will be permanently eliminated for both MMC and FFS.

MSSNY continues to work with the ACP, AFP, AAP and CHCANYS to express significant concerns to the Legislature, DOH and Governor’s Office with these PCMH cuts, even at a reduced level, in spite of the action taken by the Legislature.  Physicians are urged to contact the Governor and their legislators to express their concerns here(AUSTER) 

MSSNY Urges for Extension of Committee for Physicians Health Program
This week the Senate Health Committee unanimously advanced legislation (S.8093, Hannon) to the Senate floor that would extend for an additional 5 years the continued operations of the MSSNY Committee for Physicians Health (CPH) program.  Authorization for several key components of the program expired on March 31, 2018.   Identical legislation (A.10221, Gottfried) is before the Assembly Health Committee.

The CPH is a program designed to confront and assist physicians thought to be suffering from alcoholism, substance abuse or mental illness.   Since the inception of this program, CPH has assisted thousands of physicians in returning healthy to medical practice.  The work of the CPH program is an important public service both to our health care system as well as the general public. As a result, the State Budget annually includes an appropriation of $990,000 for the program, which is generated from a $30 assessment on all physicians’ biennial registration fees.

The program has traditionally been extended by the Legislature in 3 or 5 year “demonstration programs” with the most recent extension in 2013.  The recently enacted State Budget included a provision to create another “demonstration program” until 2023.  However, it omitted other provisions historically extended at the same time that are essential to its functioning that could greatly impair its operations unless immediate action is taken.  These includes provisions that set forth the CPH program’s reporting requirements to the Office of Professional Medical Conduct (OPMC), provisions to ensure liability protections for the physician Committee members for work performed in the scope of CPH, and necessary confidentiality protections for the program given the sensitivity of the work they perform.   These protections are absolutely essential to the continued functioning of the program to ensure that physicians with the appropriate expertise are willing to serve on the Committee, as well as to assure that the program has the ability to report sensitive information to OPMC when warranted by the circumstances.

Physicians Encouraged to Take Survey; Bending the Diabetes Curve CME Course Available Online
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York.  MSSNY has developed a short survey to sample physician’s knowledge of the National Diabetes Prevention Program (DPP) and the Prevent Diabetes STAT program. The survey also serves as a platform to physicians to express what specific boundaries they have experienced or anticipate experiencing regarding the implementation of the DPP and/or Prevent Diabetes STAT. Participation in this survey is essential to the development of various educational components that will benefit both the physician and patient communities. Click here to take the one-minute survey.

Bending the Diabetes Curve webinar is now available to view online; click here. By educating physicians and connecting more patients to evidence-based lifestyle change programs, this diabetes initiative will help bridge the gap between clinical care settings and communities to reduce the incidence of type 2 diabetes.

Webinar: Bending the Diabetes Curve

Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Additional information or assistance with registration may be obtained by contacting Carrie Harring at  (HARRING)

Register now for the Medical Society of the State of New York’s May 2018 Medical Matters CME Webinar Program
The Medical Society of the State of New York is pleased to announce its free Continuing Medical Education (CME) webinar for May, 2018.  Participation in this webinar will earn physicians one CME credit free of charge.

May 16 at 7:30am – Medical Matters: Physically and Biologically Derived Chemical Agents: An Overview

Register for this webinar here.
Faculty: Arthur Cooper, MD

Educational Objectives:

  • Acquire a basic understanding of physically and biologically derived chemical agents
  • Identify types of physically and biologically derived chemical agents used as chemical weapons
  • Understand the indicators of each type of chemical agent
  • Describe the treatment of each type of chemical agent
  • Identify local and state resources

To view all of MSSNY’s scheduled programs, click here and select “Upcoming”.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at                                                               (HOFFMAN)

Medical Society of the State of New York Announces May and June CME Webinar Schedule
The Medical Society of the State of New York is pleased to announce its free Continuing Medical Education (CME) webinars for May and June.  Participation in the webinars will earn physicians one CME credit free of charge.   The webinar schedule for May and June is as follows: 

May 24th at 7:30amCurrent Concepts in Concussion for Pediatric and Adult Patients

Register for this webinar here.
Faculty: Deborah Light, MD & John Pugh, MD, PhD

Educational Objectives:

  • Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology;
  • Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol;
  • Describe methods for the primary and secondary prevention of concussion;
  • Identify patients who would benefit from referral to a concussion specialist

June 20th at 12:30pmMedical Matters: Children’s Mental Health After Disaster
Register for this webinar here.
Faculty: Linda Chokroverty, MD

Educational Objectives:

  • Enhance physicians’ understanding of the impact of disaster on children’s and family mental health
  • Improve physician skills to address potential psychiatric problems in children and families following a disaster

To view all of MSSNY’s scheduled programs, click here and select “Training Center” and “Upcoming”.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at                                                                  (HOFFMAN)

Warmer Weather Means More Disease
As the summer months and warmer weather draw near, there is the inevitable onslaught of pests that cause disease.  The New York Times reported on Tuesday, May 1st that the incidence of diseases transmitted by mosquito, tick and flea bites has more than tripled in the United States between 2004 and 2016, with nine such diseases newly discovered or introduced in the U.S. since 2004.

Prepare yourself for the season by going to for MSSNY’s free CME courses on Mosquito Borne diseases and Zika Virus.   If you do not already have an account, you will need to create one.  And while you’re there, check out all of MSSNY’s CME offerings. (Hoffman)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:  


Insys’ Controversial Opioid Sales Tactic Examined
In an 8,112-word feature, the New York Times (5/2) spotlights Insys Therapeutics’ controversial opioid sales practices and outreach to physicians to push its fentanyl drug, Subsys. “The Insys speaker program was central to Insys’ rapid rise as a Wall Street darling, and it was also central to the onslaught of legal troubles that now surround the company,” and seven former top executives “now await trial on racketeering charges in federal court in Boston.” The pieces profiles Insys founder John Kapoor who “flirted with legal trouble throughout his long career as a pharmaceutical entrepreneur” and “bankrolled Insys almost entirely on his own for over a decade” as he pursued the Food and Drug Administration’s approval for Subsys.

Three Nonprofit Insurers in Western New York Posted Higher Profits For 2017
The Buffalo (NY) News (4/30) reports, “Three of Western New York’s major nonprofit health insurers performed better in 2017, each of them helped by gains in investments and lower administrative expenses.” The article says Independent Health posted a surplus of $22.4 million for 2017, compared to $13 million in 2016, while HealthNow New York had “a $55 million surplus, up from $4.2 million in 2016, on revenue of $2.5 billion.” For its part, Univera Healthcare had net income “of $182.3 million last year, up from $99.5 million in 2016, on total premium revenue of $5.6 billion.”

Calling All IMGs! Symposium on May 23 at Jacobi Medical Center in the Bronx
Essen Health Care will host an IMG Symposium on May 23 from 5-8 pm at Jacobi Medical Center in the Bronx. Topics range from Navigating Residency: What to Expect to Residency Application and Interview Tips; and from Primary Care Pathway to IMG Onboarding and Training. IMGs are invited to participate in a pre-symposium networking from 5-6 pm. RSVP at or by calling 929.239.4160. Click here for more information on the symposium


Workers’ Comp: Schedule Loss of Use Informational Webinars
As part of the 2017 executive budget, Workers’ Compensation law §15(3)(x) required the Workers’ Compensation Board to implement new Permanency Impairment Guidelines for Schedule Loss of Use (SLU) evaluations. The new 2018 SLU Guidelines took effect January 1, 2018.

The Board’s Medical Director and Senior Policy Advisor, Elain Sobol Berger, MD, JD will provide training in the 2018 Guidelines’ approach to assessing SLU permanent impairment. Case studies will demonstrate how to apply the SLU principles and objective criteria in making an SLU determination.

There will be four webinars, so you can register for the time that works best for you. Each webinar will last approximately one hour and will include time for questions and answers. Space is limited, so please register early. When you click ‘register here’, you will be taken to a general information page. You must click ‘Register’ on the bottom of that page to sign up.


Wednesday, May 16, 8:30 a.m. – 9:45 a.m. Register here
Wednesday, May 16, 4:00 p.m. – 5:15 p.m. Register here
Wednesday, May 23, 8:30 a.m. – 9:45 a.m. Register here
Wednesday, May 23, 4:00 p.m. – 5:15 p.m. Register here 

More information

For more information on the Schedule Loss of Use Guidelines, please see Subject No. 046-1011. The enabling regulation is set forth at 12 NYCRR 325-1.6, and is also available at the Board’s website.


FDA Suggests Reexamination of Safe Harbor Protecting Drug Rebates
Bloomberg News (5/3) reports Food and Drug Administration Commissioner Scott Gottlieb, MD, asked whether the legality of drug-plan rebates should be reconsidered. Dr. Gottlieb asked if the federal government should reexamine the safe harbor provision that prevents such rebates from being considered kickbacks.

Reuters (5/3) reports that Dr. Gottlieb has repeatedly criticized the common industry practice of setting high list prices for drugs, which are then lowered for health insurers through large rebates. Dr. Gottlieb asked in remarks prepared for a Food and Drug Law Institute conference, “What if we took on this system directly, by having the federal government reexamine the current safe harbor for drug rebates under the Anti-Kickback Statute?”


New Yorkers Will Be Getting New Medicare Cards Soon
CMS has three ways for card recipients to find out when they should expect new Medicare card in the mail:

  • Check out the map on Remember, once card mailings begin in New York, it will take about a month from start to finish.
  • Keep an eye on email. CMS will send an email update when new Medicare cards start mailing in your state.
  • Log in to account to see if a new card has been mailedSign up now at —  it’s a free, secure, and easy way to access all your Medicare information in one place.

Brexit Starting to Drain U.K. Health Workforce
The National Health Service is bracing for an exodus of European doctors and nurses, POLITICO Europe reports. A new survey of 68 NHS hospitals and other care institutions found 1 in five have already altered recruitment plans, despite the U.K. not being scheduled to leave for another year. More than a third say the workforce impact of Brexit has been negative. The NHS relies heavily on non-British European doctors and nurses. Polls indicated one of the factors driving support for Brexit was improved funding for the U.K.’s taxpayer-funded health service. The Vote Leave campaign claimed free movement from the EU was creating unsustainable demands on health services. (Politico 5/1/18)

Uninsured Can Get Appointments but Cannot Pay Average Cost of $160
The US uninsurance rate has nearly been cut in half under the Affordable Care Act, and access to care has improved for the newly insured, but less is known about how the remaining uninsured have fared. In 2012–13 and again in 2016 Health Affairs conducted an experiment in which trained auditors called primary care offices, including federally qualified health centers, in ten states. The auditors portrayed uninsured patients seeking appointments and information on the cost of care and payment arrangements. In both time periods, about 80% of uninsured callers received appointments, provided they could pay the full cash amount. However, fewer than one in seven callers in both time periods received appointments for which they could make a payment arrangement to bring less than the full amount to the visit. Visit prices in both time periods averaged about $160. Trends were largely similar across states, despite their varying changes in the uninsurance rate. Federally qualified health centers provided the highest rates of primary care appointment availability and discounts for uninsured low-income patients. (Health Affairs April 2018)



Thriving  Internal Medicine Practice for Sale by the Physician.
Has been growing exponentially, with number of patients doubling over last two years.
Has the visits-volume and the potential space & hours to keep expanding
The physician will stay to overlap for at least one year to personally transition all the practice’s patients, to seamlessly transfer all insurance account and to assist with acquirement of hospital privileges

Well established location at street level, with dedicated handicap entrance, easy access to public transportation, a parking lot and within one mile from all three leading local hospitals.
Fully credentialed as a medical practice site with all health insurances in the market, and compliant with Americans with Disability Act requirements. Office space lease guaranteed for extended period of time. Call 917-596-8936

Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up:

Beautiful NYC Medical Office — Long-term Share
Bright, big consultation room and one or two exam rooms in large,  tastefully furnished office in first-rate building. 58th Street between Park and Lexington. Near transportation.  Smaller, windowed consultation room and exam room also available. Rent by the day or week, beginning June 1 or sooner. $180 per day or $5500 per months. Perfect for internist, rheumatologist, physical medicine, ob-gyn and others. Superb front desk and office management available, along with many amenities including internet, ultrasound, EMG, kitchen, optional C-arm. Call Carol: 917-856-6402.

For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed build out 4 exam rooms with sinks and wall cabinets
Waiting and reception areas, windows throughout.
Street and private entrances, two bathrooms and storage/lab/staff room.
One block to bus and two blocks to Presbyterian Medical Center and subway.
$1900-$7900/ month for one to 4 exam rooms. or 917.8618273

For Share – Plastic Surgeon’s Office Facing Central Park Ground Floor Lobby Entrance/Private exit
One to three exam rooms, consult/private office and procedure room for full or part time use.
Elegant, modern and spacious secretarial, waiting and two exam rooms.
Accredited operating rooms and recovery rooms on site.
One block to bus and 20 feet to subways.
$1275-$3750/day monthly for one to three exam rooms. or 917.861.8273

Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail:


Private Multidisciplinary Medical Group Seeking Full Time or Part Time Podiatrist and Full Time or Part Time Internal Medicine/Family Practice/Allergy & Immunology Physicians.
Midtown, Union Square & Lower Manhattan locations. Attractive base salary plus comprehensive benefits package. E-mail CV to No recruiters please.

Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 

Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to href=””>



September 29, 2017 – Helping to Help Others

Charles Rothberg, MD
September 29, 2017
Volume 17
Number 37

Dear Colleagues:

Over the past few weeks our mainland has been devastated by hurricanes. Most recently, and most tragically, Puerto Rico has been overcome with loss of life and lack of available medical services due to flooding, isolation and downed communication lines. Hospitals, clinics and nursing homes have been destroyed beyond repair. The entire Puerto Rican medical system has been critically damaged. Local officials have called conditions “a humanitarian crisis.”

The Medical Educational and Scientific Foundation (MESF) is MSSNY’s not-for-profit subsidiary. As they have in other times of need, MESF is collecting funds to assist in the recovery efforts. One hundred percent of the funds raised will support the physicians affected practices in Puerto Rico. After Hurricane Sandy, due to your generosity, MESF was able to help many New York physicians rebuild their practices.  The program will help cover expenses (not covered by insurance or other funding) for relocating or rehabilitating a physician’s medical office. This may include replacing equipment, aiding needed staff, rebuilding patient records, and other similar needs all towards the goal of helping physicians once again treat patients.

I encourage you to join me in supporting the work of the Foundation with a generous contribution.

Donations can be made online here or by sending a check made payable to MESF with the designation “Hurricane Relief Fund” and mailed to MSSNY, 865 Merrick Avenue, Westbury NY 11590. All donations are tax deductible.

Thank you for helping us to help others.

Charles Rothberg, MD
MSSNY President

Please send your comments to

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Assembly Hearing: Labor Community Concern Re Impairment Guideline Proposed Changes
The New York State Assembly Labor Committee held a hearing this week to examine strong concerns expressed by organized labor, groups representing injured workers and trial attorneys with a proposal by the Workers Compensation Board to revise the permanency impairment guidelines.  To watch a re-broadcast of the hearing, click here The testimony and Q&A with the leadership of the New York Workers Compensation Board encompasses approximately the first 2 ½ hours of the hearing.

The labor community, including the NYS AFL-CIO, New York Committee on Occupational Health & Safety (NYCOSH) and the Injured Workers Bar Association expressed concerns with both the proposed changes to the impairment guidelines as well as the regulations implementing the use of these new guidelines.  They are very concerned that the schedule loss of use (SLU) awards will be reduced if the proposed guidelines are permitted to go into effect.  Moreover, they have strong concerns with proposals that would limit the ability of an injured worker to have an independent physician rather than the treating physician determine the degree of the injured worker’s impairment.  Moreover, there are concerns with provisions that would require injured workers to completely answer questionnaires and respond to written interrogatories from Independent medical examiners.

On the opposite side, the Business Council of New York State challenged the assertions that the regulations were unfair to injured workers.  However, they too raised concerns with the proposed guidelines due to “multiple instances where the guidelines fail to be reflective of advances in modern medicine in very key areas, are far too subjective in their determination processes and fail to give employers fair opportunities to cross-examine claimants.”

The proposed revised guidelines were originally drafted by the New York State Society of Orthopedic Surgeons (NYSSOS).  However, they were changed significantly following an August 15 meeting convened by the WCB that included representatives of the NYS AFL-CIO, the New York Business Council, the City of New York and several insurance companies, as well as physicians representing MSSNY and the New York State Osteopathic Medical Society.  NYSSOS President and MSSNY member Dr. John Olsewski as well as orthopedist Dr. Jeffrey Lozman testified at the Assembly hearing this week, expressing concerns with the significant changes to their original proposed guidelines.

To read the testimony of the New York Committee on Occupational Health & Safety, click here.

To read media coverage of the Assembly hearing, click here.

Governor Proposes Legislation to Combat Synthetic Fentanyl Use
Governor Andrew Cuomo announced this week a series of actions to combat the fentanyl crisis in communities across New York State. Specifically, the Governor is proposing legislation to add 11 fentanyl analogs to the state controlled substances schedule.  Moreover, the NY Department of Financial Services issued a circular letter to advise health insurers against placing arbitrary limits on the number of naloxone doses covered by an insurance plan.

The press release noted that, while overdose deaths involving opioids in New York increased nearly 35% between 2015 and 2016, fentanyl-related deaths increased nearly 160%   The release further noted that while Fentanyl proper is a Schedule II synthetic opiate, underground labs have tweaked the molecular structure of fentanyl to create new, unregulated chemicals referred to as fentanyl analogs. These deadly cousins are chemically similar to fentanyl—and often many times more potent—but are not listed on New York State’s schedule of controlled substances, and therefore not subject to the same criminal penalties.

In response,  the legislation proposes to add the following 11 fentanyl analogs to Schedule I of the controlled substance schedules of New York State Public Health Law §3306: AH-7921; Acetyl Fentanyl; Butyryl Fentanyl; Beta-Hydroxythiofentanyl; Furanyl Fentanyl; U-47700; and Acryl Fentanyl (or Acryloylfentanyl); N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide; Ortho-Fluorofentanyl; Tetrahydrofuranyl Fentanyl; Methoxyacetyl Fentanyl. The 11 substances are already listed on the federal schedule of controlled substances. The legislation will also give the New York State Health Commissioner the authority to add to the state controlled substances schedule any new drugs that have been added to the federal schedule.

Moreover, the new DFS circular letter advised that health insurers “should provide coverage for naloxone on an outpatient basis when prescribed to an insured by an authorized provider, as they would for any other prescribed drug, subject to the terms and conditions of the health insurance policy or contract. In addition, naloxone should also be covered on an inpatient basis when medically necessary.”

Among the many public officials quoted in the press release is Suffolk County legislator and Past-President of the Suffolk County Medical Society Dr. William Spencer who stated:  “Fentanyl represents a dangerous new front in the devastating opioid crisis, and I am grateful that Governor Cuomo recognizes this challenge and is stepping up to address it head on. The Governor’s multi-pronged effort to stop the spread of fentanyl will literally save lives. So I want to thank Governor Cuomo for spearheading this effort and making a difference here and all across the state.”

Continue to Urge Gov. Cuomo to Veto One-Sided Medical Malpractice Expansion Legislation
Physicians are urged to continue to send letters and call Governor Cuomo’s office to request that he veto legislation (S.6800/A.8516) passed in the waning hours of the Legislative Session that would significantly expand the time to bring a medical malpractice lawsuit, in circumstances based upon an “alleged negligent failure to diagnose a malignant tumor or cancer”.   You can send a letter here and call 518-474-8390.

This week MSSNY President Dr. Charles Rothberg had a letter published in the Albany Times Union calling for comprehensive, not piecemeal, reform of NY’s dysfunctional medical malpractice adjudication system.  Dr. Rothberg’s letter recommends that, “Cuomo must veto this well-intentioned, but one-sided, destructive legislation. Instead, he should empanel a blue ribbon commission to develop legislation that both assures the rights of patients to bring actions for negligence while preserving the availability of timely and quality medical care.”  The article referenced by Dr. Rothberg’s letter can be found here.

Last week, Orange County Medical Society President Dr. Stephanie Zeszutek had a letter published in the Middletown Times-Herald urging the Governor to veto this bill.   Dr. Zeszutek’s letter noted that “The state has a dangerous doctor shortage and future doctors are already being deterred from certain specialties or medicine altogether due to malpractice liability concerns. This bill sets a dangerous precedent for liability across the country. We urge Gov. Cuomo to reject this bill in favor of more sensible legislation.”

Numerous other letters from regional physician leaders have appeared in papers across the State urging a veto including the following:  Buffalo NewsSyracuse Post-Standard, Rochester Business Journal, Poughkeepsie Journal, Albany Times Union

While many physicians have weighed in, we need an overwhelming demonstration from physicians regarding how this bill will harm access to care in their communities if this bill is signed into law without also providing needed tort reforms to bring down the exorbitant costs of medical liability insurance in New York.

Promo Code: MSSNY

MSSNY’s 2017 Legislative Summary Now Available Online
Many of you are aware that a statute of limitations expansion bill (S.6800/A.8516) passed over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.  However, working together with specialty societies and other health care advocacy groups, MSSNY was successful in advocating for several public health bills passed both houses.

Moreover, MSSNY’s advocacy together with its allies resulted in scores of adverse bills being rejected by the New York State Legislature included those that would have expanded the scope of practice for various professions and those that would have imposed unworkable mandates on physician delivery of patient care.

Please click here to see our 2017 legislative summary.

Sign Up To Become a Physician Advocacy Liaison Today
Your participation is essential to continue a strong grassroots effort to address all of the issues facing physicians.  We encourage you to remain active and reach out to your elected officials to make sure our voices and health care expertise are heard.

PAL responsibilities include:

    • Educating other members on issues facing physicians, such as at local county medical society or medical staff meetings
    • Working as appropriate with your county medical society, be available to meet with your members of the legislature at least twice a year
    • Being responsible for calling or writing letters to members of the legislature on issues that impact physicians
    • Attend training programs in regard to legislative issues
  • Enlisting other member to support our action plans and mobilize them to action
  • Joining and recruiting others to join MSSNYPAC

Please join the many other physicians who have signed up to become a Physician Advocacy Liaison.

Michael Dowling: The Issue of Ill-Conceived Regulation and How it Led to CareConnect’s Demise
Becker’s Hospital Review/Written by Michael J. Dowling, President & CEO, Northwell Health 

One of the greatest frustrations among many healthcare leaders today is the federal government’s increasing addiction to micro-management. Whether it’s a soccer match, or a football, hockey or basketball game, the referees set the rules and then allow the players to compete, stopping the game only when the rules are broken. Rather than let the players play, today’s federal regulators have set the rules and often enter the game themselves. On occasion, they’re even changing the rules during the middle of the game.

To continue reading the article, click here.

US Senate Decides to Shelf Cassidy-Graham Legislation
This week the United States Senate failed to garner the necessary support to bring the “Cassidy-Graham” ACA repeal and replace legislation to a vote of the full US Senate.  As reported last week, MSSNY joined with numerous other New York healthcare provider associations in a letter to New York’s Congressional delegation expressing its strong objections to the Cassidy-Graham proposal because of its potentially significant adverse consequences to New Yorkers’ insurance coverage as well as to our State finances.

As reported in Politico-NY, after Senate Majority Leader Mitch McConnell announced that the bill would not be considered, MSSNY President Dr. Charles Rothberg stated: “Once again, another unworkable ACA repeal bill failed to secure a majority of Senate votes. Now is the time for Republicans and Democrats to work together to find common ground to address the many pressing health care issues of anxious patients and their physicians.

These include continuation of the Child Health Insurance Program, continuation of essential cost-sharing subsidies and yes, addressing fundamental flaws of the ACA such as inadequate physician networks and exorbitant deductibles.” 

Constitutional Convention Debate
Every 20 years, New Yorkers have the chance to vote whether they want to hold a constitutional convention to amend or change the New York State Constitution.  As reported last week, while some advocacy groups support a Constitutional Convention, many groups oppose it.  Professor Gerry Benjamin moderated a recent NYS Constitutional Convention forum with former counsel to former Governor Mario Cuomo, Evan Davis and Chris Ludlow, Hudson Valley Legislative and Political Action Coordinator for the Civil Service Employees Association.

Click here to listen to the pros and cons of holding a NYS Constitutional Convention.  Voters will decide on whether they want to hold a convention on Election Day, November 7, 2017.

USPSTF: Vitamin D Not Recommended Fall Prevention in Seniors
The U.S. Preventive Services Task Force is recommending against vitamin D supplementation to prevent falls in community-dwelling adults aged 65 and older (grade D recommendation). The draft statement is a change from its 2012 recommendation in favor of supplementation.

In a new analysis, the group found evidence that vitamin D supplementation did not reduce fall risk in patients who were not vitamin D deficient.

The USPSTF continues to recommend exercise to reduce the risk for falls in community-dwelling elders (grade B), and multifactorial interventions may be offered to high-risk seniors (grade C).

In a separate draft recommendation statement, the task force maintained its 2013 position on vitamin D and calcium supplementation to prevent fractures in men and premenopausal women. There is still not enough evidence to recommend for or against the practice (grade I).

The group again recommends against postmenopausal women taking 400 IU or less of vitamin D and 1000 mg or less of calcium daily because there’s no effect on fracture prevention (grade D). There was less certainty about higher doses (grade I).

USPSTF recommendations on fall prevention for seniors

USPSTF draft recommendations on Vitamin D, calcium supplementation for fracture prevention.

Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!

Register Now for the Veterans Mental Health Training Initiative Conference
The Medical Society of the State of New York, the New York State Psychiatric Association, and the National Association of Social Workers – New York State Chapter are hosting a two day conference on Friday, 10/13 Saturday,10/14 at the Niagara Falls Conference Center, 101 Old Falls St, Niagara Falls, NY. Registration is now open for this free two-day conference here.

Please note registration for the conference is separate from the registration for the educational programs.

The conference will consist of interactive seminars and panel discussions focusing on the current and evolving healthcare needs of veterans. MSSNY and NYSPA will be conducting three CME accredited trainings for primary care physicians and specialists. The CME programs are: Invisible Wounds of War: PTSD, TBI & Combat-Related Mental Health Issues;  Recognition, Management and Prevention of Veteran Suicide; and Veterans Matters: Substance Use Disorders in Returning Veterans  (you can register for each seminar by clicking on the program title[s]).

Accreditation Statement
These activities have been planned and implemented in accordance with the Accreditation Requirements and Policies of the Medical Society of the State of New York (MSSNY) through the joint-providership of the Westchester Academy of Medicine (WAM) and the New York State Psychiatric Association, Inc. WAM is accredited by MSSNY to provide Continuing Medical Education for physicians. WAM designates this live activity for a maximum of 1.5 AMA PRA Category I Credits™. Physicians should claim only the credit commensurate with the extent of their participation in each activity. The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

“The Importance of Herd Immunity” CME Webinar October 18; Register Now!
MSSNY will begin its 2018 Medical Matters continuing medical education (CME) webinar series with “The Importance of Herd Immunity” on Wednesday, October 18, 2017 at 7:30 a.m.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

Educational objectives are:
Review the epidemiology of vaccine-preventable infectious disease and role of herd immunity.
Describe how herd immunity protects vulnerable populations such as newborns, the elderly and those who are too sick to be vaccinated.
Discuss the percentage(s) of a population who need to be vaccinated to allow herd immunity to be effective.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Are You Ready to Eliminate Hepatitis C?
Did you know that Hepatitis C is easy to treat and curable? Join us for an exciting free half day CME program that will review the recently released NYSDOH AI clinical guidelines on the treatment of chronic HCV! This program is sponsored by NYSDOH AI Clinical Education Initiative and Mount Sinai Institute for Advanced Medicine.

“From Screening to Treatment: The Clinician’s Role in Eliminating Hepatitis C in New York State”
Thursday, October 12, 2017
8:00am – 12:00pm
DoubleTree Syracuse
6301 State Rte. 298
East Syracuse, NY 13057

Space is limited, so register for this free training today –      

 Not near Syracuse? We’re coming to a city near you!

Questions? Contact Jessica Steinke at or 212-731-3789
View Flyer Here .

NYSDOH AIDS Institute Started Naloxone Co-payment Assistance Program (N-CAP) in August
For individuals with prescription coverage through their health insurance plans, this program will cover the cost of co-payments for naloxone up to $40 so there are no or lower out-of-pocket expenses when accessing naloxone at participating pharmacies.  All Medicaid Managed Care Plans cover at least one formulation of naloxone, and the vast majority of private insurance plans also cover naloxone.

Additional information as well as the ability to order promotional materials on N-CAP can be found at: There are 2,000 pharmacies throughout the State who dispense naloxone with a physician standing order.  Individuals getting naloxone at these pharmacies do not need a prescription. They simply need to ask for it at the pharmacy counter and present their insurance information as they do for any other medicine.  They do not need to enroll in N-CAP.  Maximizing pharmacy distribution will allow individuals increased access to naloxone.

Pharmacies are open evening hours and weekends, and have multiple locations. Refills can also be obtained from any of the 2,000 participating pharmacies.  A directory of pharmacies with standing orders can be found here.

Individuals who cannot access naloxone from pharmacies will continue to access naloxone through registered opioid overdose prevention programs including individuals using naloxone in the line of duty and people who are uninsured.  If you have questions, please contact Lyla Hunt at:

As you are aware, CMS has been working on our Handwritten Paper Claims Reduction Initiative since July.  As we move to the Downstate New York regions, I am once again asking if you can help us communicate this important update to your Members and colleagues.

Handwritten Paper Claims Reduction Initiative
On July 10, 2017, NGS began returning any paper claims that include handwriting in fields other than the allowed signature fields (Items 12, 13, or 31).

We are rolling this out on a State/Locality basis and by November, all handwritten claims will be returned to the provider.

The schedule is as follows:

November 13, 2017New York (Downstate: Localities 01, 02, and 04)New York Locality/Area and County Information

Date we will start to return handwritten paper claims State/Locality County listing
August 7, 2017 New York (Upstate: Localities 03 and 99) New York Locality/Area and County Information

The 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” (700 KB) contains the printing specifications for the CMS-1500 claim form. These printing specifications do not provide instructions to submit handwritten claims. Please use this CMS IOM reference to ensure you are completing paper claims correctly.

Alternatives to Handwritten Paper Claims
We understand this may require some substantial changes to your office practices and we at NGS have two alternatives to handwritten paper claims that would be of little cost to your practice.

  1. NGSConnex is our web-based self-service portal, free of charge, and available through Internet access. You can login to NGSConnex and submit claims to us. In addition to claims submission, NGSConnex has other useful functions like verifying Medicare entitlement, submitting appeals on claims, and viewing and downloading your remittance advice. Take this opportunity to get started on NGSConnex today!
  1. Electronic claim submission and other transactions submitted electronically process considerably faster than paper submission. The Electronic Data Interchange (EDI) page on our website, explains how to enroll and what capabilities your office needs to be able to submit electronic claims.  In addition, NGS can provide you with no cost claim submission software, PC-ACE.  Visit our web site at PC-ACE to learn more.

All providers with access to the Internet should have the capability to download this billing software free of charge. However, if that is not the case, this software will continue to be available on CD for a $25 nonrefundable fee.

To learn more about PC-ACE visit the Electronic Data Interchange software tab on our web site at  and choose Claims & Appeals

For assistance, please contact the EDI Help Desk or submit an EDI E-mail Inquiry Form for assistance. If it is determined that you are not capable of downloading the software, you will be provided with the appropriate form to request the PC-ACE software on CD.

Tip of the Week
By Jacqueline Thelian, CPC, CPC-I, CHCA, Medco Consultants, Inc. 

Due to HIPAA-HITECH requirements, please do not send any Protected Health Information (PHI) via email. Please contact Medco to obtain secure file transfer instructions.

Professional Healthcare Consulting Services that make a difference!

Certified Coding, Remote Coding, Coding education, Coding Certification Prep Course, and discounted coding products. If you have a coding or compliance question you would like to have answered please send your question to MSSNY at, and complete the subject line with Tip of the Week.

MIPS Milestone: Begin Data Collection by October 2nd for 90 Consecutive Days of Participation
It’s not too late to participate in the first year of the Merit-based Incentive Payment System (MIPS)—one of the two tracks in the Quality Payment Program. The transition year of MIPS has been underway since January 1, 2017 and runs until December 31, 2017.

Transition year (2017) Participation:

For 2017, you can participate in one of three ways:

  • Submit data covering a full year, or
  • Submit data covering at least a consecutive 90-day period, or
  • Submit a minimum amount of data (<90 days)

Remember: You should begin data collection no later than October 2, 2017, to report 90 consecutive days of data for the transition year. For example: If you are planning to submit 90 days or more of your quality data via your claims, you would need to begin adding the applicable quality data codes to your claims no later than October 2nd. If you submit data for at least 90 days, you avoid the negative payment adjustment, and may be eligible for a positive payment adjustment.

Are you planning to submit less than 90 days of data? If so, you can begin data collection as late as Dec 31st and still avoid the negative payment adjustment. However, more data increases your likelihood of earning a positive payment adjustment.

When is data submission? This listerv is a reminder to begin data collection. You will begin submitting your 2017 MIPS performance data on January 2 through March 31, 2018.  If you are eligible to participate but choose not to submit data, you’ll get a negative 4% payment adjustment which will go into effect on January 1, 2019.

Need Help Participating?

  • Contact the Quality Payment Program at or 1-866-288-8292 (TTY: 1-877-715-6222).

Targeted Probe and Educate
Effective 10/1/2017, the CMS is expanding the existing Targeted Probe and Educate (TPE) pilot to include all MACs. TPE will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the ZPIC, UPIC, RAC, etc. The goal of TPE is to reduce/prevent improper payments. The purpose of this expansion is to reduce appeals, decrease provider burden, and improve the medical review and education process.

Key Elements of TPE

  • All current NGS medical record reviews are replaced with three rounds of pre-payment or post-payment TPE. If the provider’s error rate remains high upon completion of the first round, then the provider is retained for the second and, potentially, a third round of review.
    • Automated reviews and prior authorization directed by CMS are outside of the TPE strategy.
    • Note that any reviews or pilots otherwise mandated by CMS are excluded from this change.
  • Providers with a continued high error rate after three rounds of TPE will be referred to CMS for additional action
  • NGS will select the topics for review based upon existing data analysis procedures.
  • The claim sample size for each round of probe review is limited to a minimum of 20 and a maximum of 40 claims
    • Note that the sample is per provider, per topic, and per round.
  • The TPE process includes provider specific education that will focus on improving specific issues without allowing other problems to develop along with an opportunity for the provider to ask questions. Education will be offered after each round of 20 to 40 claims reviewed.   We urge all to take advantage of the education.
    • In addition, there is an opportunity for intra-round education as well if the nurse reviewer identifies a common theme that can be easily corrected during the review phase.

Provider Tips

  • Providers targeted for TPE will receive a notification letter about the upcoming review and ADRs will be used for the specific claims selected for review.
  • Providers should ensure that medical records are submitted promptly upon request.
    • Reminder: ADRs must be responded to prior to the 45 day deadline (based on the date of the ADR) for each claim selected.
    • Providers are highly encouraged to respond to the ADR by sending all applicable medical records prior to day 45
  • Provider nonresponse to medical records requests will count as an error.
  • MACs may conduct a “related claim review” of services related to a denied claim and such reviews may be conducted outside of the TPE process.
  • The TPE process does not replace or change appeal rights.
    • The educational sessions are not an appeals forum nor do the result letters and/or the educational sessions extend the appeal period.

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