Successful Legislative Year Concludes – June 26, 2015
 PRESIDENT’S MESSAGEDr. Joseph R.Maldonado |
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Dear Colleagues:
This week has seen a significant share of federal and state legislative news. The Supreme Court of the United States has ruled in King vs. Burwell by a vote of 6-3, that individuals in states that did not set up exchanges are eligible to receive tax subsidies. Various folks have asked us to weigh in on the decision. While enticing, dwelling on a discussion of the decision is purely a venting experience as it will contribute nothing other than creating greater divides. Instead, we should accept closure on this matter and focus our energies on fixing the flaws of the ACA. What good is a subsidized health plan that has a $6,000 deductible that encourages a patient to delay accessing care because of the out-of-pocket expense?
At the state level, we are pleased to announce that MSSNY has won two major victories—defeat of the mandated CME on pain management and change in commencement of the statute of limitations to the date of discovery. We thank the many of you who took the time to contact their legislators to express their concerns with these bills. These are victories only in so much as we were able to stop governmentally proscribed redress of these issues. We will NOT be able to walk away without addressing the core legitimate concerns raised by proponents of these now defunct pieces of legislation. Instead, we will need to work with our specialty societies to devise an appropriate way to address the need for better medical education on pain management as well as responsible tort reform which includes not only redress for those harmed in the course of care but other reforms that will reduce our premium burden.
RED ALERT!!! Girding Our Loins this Summer
As we approach the 4th of July week, I draw on an archaic term to draw attention to a need to be prepared for the threat of danger. This week, Rep. Devin Nunes, Chairman of the House Intelligence Committee stated that “the level of threat for a potential terrorist attack in the United States is at its highest.” It has been 14 years since 9/11 and two years since the Boston bombing. Within the past year, we dealt with an Ebola epidemic that reached our country and threatened our nation. Presently, we face a new danger with avian flu and MERS. MSSNY has a 50+ credit hour curriculum for Preparedness Planning which has been widely acclaimed. It is critical that we voluntarily prepare to meet the needs of our patients PRIOR to the next potential crisis or terror event. If we don’t volunteer, the next crisis will potentially bring a new mandate. More importantly, it may bring casualties as a result of an unprepared medical community. When was the last time you honed your preparedness skills and knowledge? I would highly encourage you to use the CME link on the MSSNY website to access the curriculum. New users will need to register with an email and password. Why not use the curriculum as part of your summer reading? It’s free to MSSNY members. The knowledge you gain may save your family, friends, neighbors and community.
Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org
Dear MSSNY and Alliance Members:
The 2015 legislative session conclude early this morning. Through your efforts guided by MSSNY leadership and the collective efforts of MSSNY staff, MSSNY has had a very successful legislative year.
As part of the budget, we: (1) secured $127.4M in funding for the Excess Medical Liability program; (2) defeated accreditation and onerous new regulatory requirements for urgent care practices and practices which offer after-hour care; (3) defeated the retail clinic bill; (4) defeated proposals which would have imposed additional registration and reporting requirements on physician OBS practices; and (5) secured the elimination of fees physicians currently have to pay to initiate a Workers Compensation arbitration proceeding.
As the session concluded, we have secured many more victories which demonstrate the tangible value of MSSNY to its physician members. These victories are discussed in further detail below but can be quickly listed: we (1) defeated the date-of-discovery statute of limitationss; (2) defeated a CME mandate for pain management, addiction and end- of-life care; (3) defeated scope-of-practice expansion by the podiatrists, dentists, optometrists and many other non-physician practitioners; (4) participated in a coalition which secured passage of legislation requiring school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade; and (5) again defeated a last ditch effort by CVS Health to secure enactment of legislation to secure approval to establish corporate owned retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law.
As we did when the budget negotiations concluded, your lobby team would again like to acknowledge each and every County and Specialty Medical Society, MSSNY leadership, and the many rank-and-file physicians who answered the call for grassroots action and met locally with their representatives or wrote a letter and/or took a day away from their practice to travel to Albany to personally meet with their elected representatives on issues of importance to all of medicine.
Sustained physician involvement can make a difference. Because of your efforts, we list the many successes that together we have achieved. It is our hope that you will share this newsletter with your colleagues so that we may continue to build membership in MSSNY to support even greater legislative accomplishments in the future.
Your Lobby Team,
Liz, Moe, Pat, and Barb
STATE SENATE LEAVES ALBANY WITHOUT PASSING UNSUSTAINABLE MALPRACTICE “DATE OF DISCOVERY” LEGISLATION
Despite a huge push from some media outlets and the trial lawyers, the State Legislature finished its 2015 session without enacting legislation to change the statute of limitations in medical liability actions. We thank the very significant number of physicians who weighed in with their local legislators to highlight the serious adverse consequences to our health care system that would ensue if this legislation were to have been passed without any corresponding provisions to bring down New York’s already exorbitant medical liability insurance costs that for many are among the highest in the nation. As previously reported, legislation (A.285, Weinstein) to change New York’s 2.5 year medical liability statute of limitation to a “date of discovery” rule had passed the Assembly two weeks ago. Substantially similar legislation (S.911-A, Libous) advanced to the Senate floor on the last day of Session, but the Senate did not bring it up for a vote. MLMIC estimates of similar legislation were that enactment of this legislation could trigger premium increases of 15%.
Conversations on this issue will continue however. During a press conference with the Governor and Assembly Speaker discussing end of Session agreements, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that immediately following the conclusion of Session a series of roundtables with parties on both sides of this issue will be convened so that the issues can be addressed “sooner rather than later”. This should present an opportunity for MSSNY and other allied hospital and health provider associations to raise issues with New York’s dysfunctional medical liability adjudication system with the goal of bringing down the cost of medical liability insurance.
MSSNY worked closely with many other provider associations also impacted by this legislation, including the Greater New York Hospital Association, Healthcare Association of NYS, the Health Care Facilities Association, other specialty medical societies, and the Lawsuit Reform Alliance of New York, in an effort to defeat this legislation. There were print ads in several newspapers across New York State, and in the Legislative Gazette, as well as radio ads on several Albany stations, urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care.
(AUSTER, DEARS)
PHYSICIAN ACTION CREDITED WITH THE NYS ASSEMBLY TAKING NO ACTION ON CME MANDATE REQUIRMENT
The New York State Assembly did not vote on legislation requiring physicians to take three house of continuing medical education every two years. Senate Bill 4348(Hannon) and Assembly Bill 355 (Rosenthal), would have required physicians to take three hours of continuing education on the following topics: I-STOP and drug enforcement administration requirements for prescribing controlled substances; pain management; appropriate prescribing; managing acute pain; palliative medicine; prevention, screening, and signs of addiction; responses to abuse and addiction; and end-of-life care. The measure had passed in the NY Senate. Thousands of physicians called or sent their legislators a letter through the Grassroots Action Center (GAC) about this legislation and urged its defeat. MSSNY staff would like to thank all who weighed in on this issue. Your grassroots advocacy made a real difference. We also thank the many members of the Assembly who expressed their concern about this legislation, as well as the AMA Advocacy Resource Center staff who provided us with critically important information regarding the significant drop in opioid use in New York State compared to other states in recent years.
(CLANCY, DEARS)
CVS HEALTH’s RETAIL CLINIC BILL FAILS
As reported last week, CVS HEALTH which operates CVS Pharmacies, a pharmacy benefit manager, mail order and specialty pharmacies, and retail-based health clinic subsidiary, MinuteClinic, attempted to secure passage of legislation (S. 5458, Hannon and a similar bill A. 1411, Paulin) which would allow the establishment of corporate owned retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law.
The Senate bill passed the Senate and was placed on a Committee agenda in the Assembly where it failed to garner the necessary votes. Later in the week additional efforts were advanced to have the bill placed back on the Committee agenda. MSSNY working closely with the Nurses Association and other specialty medical societies succeeded in beating back this effort defeating the bill for the second time this year.
‘Convenience care clinics’ or ‘retail clinics’ operate in states outside New York in big box stores such as Walgreens or CVS retail pharmacies. They are a growing phenomenon across the nation, particularly among upper class young adults who live within a one mile radius of the clinic. These clinics are usually staffed by nurse practitioners and focus on providing episodic treatment for uncomplicated illnesses such as sore throat, skin infections, bladder infections and flu. Physicians feel strongly that retail based clinics pose a threat to the quality of patient care and to the ability of physician practices to sustain financially and should not be allowed to propagate in New York.
Another significant concern is the potential conflict of interest posed by pharmacy chain ownership of retail clinics which provides implicit incentives for the nurse practitioner or physicians’ assistant in these settings to write more prescriptions or recommend greater use of over-the-counter products than would otherwise occur. The same self-referral prohibitions and anti-kickback protections which apply to physicians are not applicable to retail clinics, raising the concern for significant additional cost to the health care system. Rather than bend the cost continuum, we are concerned that costs will increase and quality of care will be negatively impacted.
(DEARS, AUSTER, CLANCY, ELLMAN)
LEGISLATURE PASSES BILL TO BETTER ASSURE AVAILABILITY OF PAIN MEDICATIONS THAT REDUCE RISK OF INAPPROPRIATE USE
The Senate and Assembly passed legislation (A.7427-A, Cusick/S.5170-A, Hannon) prior to the end of the Session to reduce barriers to patients receiving opioid medications containing abuse-dererrent technologies. The legislation would (1) prohibit the substitution of an opioid analgesic drug product, brand or generic, with abuse-deterrent technologies with an opioid analgesic drug product lacking abuse-deterrent technologies without obtaining a new prescription from the prescriber and (2) ensure that abuse-deterrent opioid products are covered by health insurance plans in New York at least the same prescription coverage tier as non-abuse-deterrent opioid products and ensure that a patient is not required to take a non-abuse-deterrent opioid before an abuse-deterrent version. (AUSTER, CLANCY)
LEGISLATURE PASSES BILL TO REDUCE MEDICAID MANAGED CARE PRESCRIBING HASSLES
Legislation (A.7208, Gottfried/S.4893, Hannon) to reduce hassles experienced by physicians when prescribing certain medications for their patients insured through Medicaid Managed Care plans was passed by the Senate and Assembly towards the end of the Session. MSSNY articulated its strong support for this legislation, and will urge the Governor to sign this legislation into law.
For many years, New York State has held to the important principle that patients covered under the Medicaid “fee for service” program are entitled to receive the prescription medications that are recommended by their treating physician, and such decisions may not be overruled by Medicaid administrative staff. After the Medicaid pharmacy benefit was included within Medicaid managed care, in 2012, the Legislature and Governor agreed to assure that these important “prescriber prevails” protections continued to be in effect for several classes of medications needed by patients affected with very serious health conditions, including medications in the anti-depressant, anti-retroviral, anti-rejection, seizure, epilepsy, endocrine, hematologic, immunologic and atypical antipsychotic therapeutic classes. Since that time, many physicians have reported situations where health insurers forced them to wait an unreasonably long time to receive approval to assure their patients could receive a needed medication from one of these drug classes, despite the “prescriber prevails” protections. This legislation would help to reduce these hassles, and assure that patients can receive needed medications more quickly.
(AUSTER, DEARS)
AS SESSION ENDS MSSNY IS SUCCESSFUL IN PREVENTING PASSAGE OF SCOPE OF PRACTICE BILLS
The following are among many scope-of-practice bills that MSSNY defeated this year as the Legislative Session for 2015 concludes:
- 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians. This bill remains in the Higher Education Committee in both the Senate and Assembly.
- 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand the scope of practice of podiatrists to diagnos, treat, operate or prescribe for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds. It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle. It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves. This bill remains in the Higher Education Committee in the Senate and Assembly.
- 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers and call themselves naturopathic doctors. Despite claims that they cannot do invasive procedures, it would allow them to immunize and perform cryotherapy. This bill remains in the Higher Education Committee in the Senate and Assembly.
- 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use. This bill remains in the Higher Education Committee in the Senate and Assembly.
- 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct. This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
- 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill remains in the Senate Higher Education Committee. There is no same-as bill in the Assembly.
The outcome of all of these bills is a resounding victory for TEAM MSSNY and all of our physicians who reached out to their Legislators to oppose them. (ELLMAN, DEARS)
COLLABORATIVE DRUG THERAPY MANAGEMENT BILL PASSES BOTH HOUSE OF THE LEGISLATURE- ISSUES RAISED BY MSSNY ADDRESSED.
Legislation (A. 5805-A, McDonald/S. 4857-A, LaValle) which would extend the authorization of pharmacists to perform collaborative drug therapy management (CDTM) in certain settings passed during the final days of session and will soon be sent to the Governor for his consideration. The final bill addressed many of the numerous issues raised by MSSNY with the initial version of this bill.
MSSNY was concerned that the bill removed protections which had been included when this demonstration program was first enacted which assured that the treating physician remained in control of the care provided to the patient. Specifically, the initial version of the bill would have allowed for the substitution of a drug which differed from that initially prescribed by the patient’s physician without authorization by the treating physician. The bill was modified to prohibit such substitutions or adjustments without authorization by the treating physician. Moreover, the initial version of the bill would have eliminated language which required the patient to consent to the collaborative drug therapy management. This protection was restored at the request of MSSNY. The initial version of the bill had inserted the term “prescribing” when ordering an adjustment or managing a drug regimen. MSSNY noted that “prescribing” remains outside of the pharmacist’ scope of practice and this term was removed from the bill. The original version of the bill would have extended to NPs and PAs the ability to collaborative with a pharmacist in collaborative drug therapy management. The extension of such collaborative authority was removed at MSSNY’s request. Lastly, MSSNY was concerned by the extension of CDTM to a nursing home or residential health care facility setting primarily because these settings are not well staffed by physicians. The final bill allowed for the extension of CDTM to other hospital settings including a nursing home but only if it has an on-site pharmacy staffed by a licensed pharmacist. The bill did not extend CDTM however to dental clinics, dental dispensaries, residential health care facilities and rehabilitation centers.
The bill extended the collaborative drug therapy demonstration with this parameter for three ore years.
MSSNY is grateful to the sponsors of the bill and the Chairs of the Higher Education Committees for their consideration of our concerns in constructing this on-going demonstration.
(DEARS, ELLMAN)
NYS LEGISLATURE APPROVES BILL TO ALLOW PHARMACISTS TO PROVIDE ADULT IMMUNIZATIONS; BILL WILL NOW GO TO GOVERNOR FOR CONSIDERATION
Pharmacists will expand the list of immunizations that they can provide to adults under legislation that passed the New York State Legislature. A. 123B, Paulin/S. 4739A,Hannon would add Diphtheria, Tetanus and Pertussis (DPT) to the list of vaccines that can be administered by pharmacists. The bill now goes before Governor Andrew Cuomo for his consideration and action. The bill would allow physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines. The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script. The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis. Importantly, the bill requires the pharmacist to report the administration of the vaccine to the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry. Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner. The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide. The bill also contains a three year sunset. The Medical Society of the State of New York opposed this measure, because of its belief that this policy would further fracture the medical home.
(CLANCY, DEARS, ELLMAN)
HOUSE PASSES IPAB REPEAL LEGISLATION
This week the US House of Representatives passed legislation (HR 1190) to repeal the Independent Payment Advisory Board (IPAB) by a vote of 244-154 (Roll call here). Eleven Democrats, including New York Representative Sean Patrick Maloney, joined 233 Republicans in voting in favor of passage (including New York Representatives Chris Collins, Dan Donovan, Chris Gibson, Richard Hanna, John Katko, Peter King, Elise Stefanik and Lee Zeldin). As H.R. 1190 was offset with funding from the ACA’s Public Health and Prevention Fund, several lawmakers commented that the number of Democrats voting for IPAB repeal would have increased had the bill been offset differently.
The IPAB is charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level that can only be overturned by a supermajority of Congress. MSSNY recently signed on to a patient and provider advocacy letter in support of repeal of the IPAB. The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decisionmaking responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”
(AUSTER)
MSSNY JOINS OTHER STATE MEDICAL SOCIETIES TO URGE 2-YEAR ICD-10 TRANSITION PERIOD
MSSNY continued working with the medical associations of California, Florida and Texas, as well as with the AMA, in support of activities to assure a more fair transition to the ICD-10 coding set. This week the CMA, FMA and TMA together with MSSNY wrote to the US Senate and House of Representatives leadership to urge a two-year ICD-10 “grace period” when physicians and other health care providers are required to use ICD-10 codes starting October 1, 2015. MSSNY also joined a similar federation sign-on letter initiated by the AMA. Moreover, MSSNY President Dr. Joseph Maldonado and Vice-President Dr. Charles Rothberg joined physician leaders and staff from the four state medical associations in a conference call meeting with CMS staff as a follow-up to a similar letter sent to Acting CMS Administrator Andy Slavitt last week. While the “Big 4” letter to Congress notes that the groups’ first request is to pass legislation such as HR 2126 (Poe), to stop the implementation of ICD-10 altogether, it also urges that “for those physicians who have adopted ICD-10, we ask that the payers allow a dual coding system where physicians can bill using either ICD-9 or ICD-10… If these requests are not achievable, we strongly encourage you to pass legislation such as HR 2652, the Protecting Patients and Physicians Against Coding Act, by Congressman Gary Palmer (AL-06) and others, or simply join our call for CMS to implement a two-year ICD-10 grace period…We believe that two years of transition time, on-the-job learning by physicians — plus our continued ICD-10 educational activities — will result in a much less disastrous transition to this overwhelmingly complicated new coding system.”
Our group efforts have been noted in multiple media outlets, including here and here.
(AUSTER)
SENATE FAILS TO ACT ON INCLUING E-CIGARETTES UNDER CLEAN INDOOR AIR ACT
The NY Senate failed to act on in waning hours of the legislative session to prohibit e-cigarette use in all public places in accordance with the NYS Clean Indoor Air Act. A.5595B/S.2202B sponsored by Assemblywoman Linda Rosenthal, and Senator Kemp Hannon, passed in the NY State Assembly. In recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit. Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions. Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law. The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure. The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute. MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air. This will continue to be one of MSSNY’s public health legislative priorities.
(CLANCY, ELLMAN)
For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
| pschuh@mssny.org | ldears@mssny.org | mauster@mssny.org | |
| pclancy@mssny.org | bellman@mssny.org |
Changes to the Medicare Opt-Out Law for Physicians and Practitioners
Prior to enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physician/practitioner opt-out affidavits were only effective for two years. As a result of changes made by MACRA, valid opt-out affidavits signed on or after June 16, 2015, will automatically renew every two years. If physicians and practitioners that file affidavits effective on or after June 16, 2015 do not want their opt-out to automatically renew at the end of a two year opt-out period, they may cancel the renewal by notifying all Medicare Administrative Contractors with which they filed an affidavit in writing at least 30 days prior to the start of the next opt-out period. Valid opt-out affidavits signed before June 16, 2015, will expire two years after the effective date of the opt out. If physicians and practitioners that filed affidavits effective before June 16, 2015 want to extend their opt out, they must submit a renewal affidavit within 30 days after the current opt-out period expires to all Medicare Administrative Contractors with which they would have filed claims absent the opt-out.(Updated on 06/18/2015)
Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.
The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.
To file a hardship exception, you must:
- Show proof of a circumstance beyond your control.
- Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.
Please note: The application includes specific instructions for documentation requirements for each category, please check the instructions and form carefully for the documentation for the category for which you are applying. While supporting documentation must be provided for certain hardship exception categories, CMS does not require additional documentation for 2014 Edition certified EHR technology issues. You should, however, retain documentation for your own records. CMS will independently review each application and any supporting documentation.
You do not need to submit a hardship application if you:
- are a newly practicing eligible professional
- are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22 ; or
- Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)
CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.
Need Guidance for ICD-10? Come to MSSNY Website!
Most physicians won’t need to know ALL the new ICD-10 CM diagnosis codes. However,
if you haven’t done so already, you should pick your top 10 or 20 ICD-9 Codes for your practice/specialty and “crosswalk” them to the new ICD-10 CM codes.
Please visit the following websites, for assistance:
http://www.icd10data.com/Convert
http://www.icd10data.com/ICD10CM/Codes
http://www.icd10charts.com/
Reminder: Medicare Does Not Preauthorize Coverage for Items or Services
National Government Services has seen an increase in calls to their Provider Contact Center (PCC), asking if Medicare preauthorizes coverage for provided items and services. As a reminder, Medicare does not preauthorize coverage for items or services that will receive payment under Part A or Part B, except for custom wheelchairs.
Additional information is available in the MLN Matters article SE0916 Revised, “Medicare Parts A and B Coverage and Prior Authorization.” Refer to this MLN and update any applicable internal procedures and policies with this information and share with internal staff.
Related Content
SE0916 Revised: Medicare Parts A and B Coverage and Prior Authorization
NY Medicaid Management Information System (NYMMIS) Project Website
The New York State Department of Health and Xerox State Healthcare, LLC are working diligently on the design and development of the new Medicaid Management Information System, called NYMMIS.
NYMMIS has an interim website online that was created to serve as an ‘information billboard.’ It will be used as a main source for communicating information by providing updates and email bulletins regarding the implementation of the new system. Updates will be provided on a regular basis in an effort to share relevant NYMMIS information that may potentially impact providers’ business processes. The interim website hosts a ListServ signup section. Those who sign up to the ListServ are able to receive timely emails that contain any updates on the project that might affect them.
The interim NYMMIS website will have no impact on eMedNY nor will it be used for provider billing or other transactions. Please visit: www.interimnymmis.com
Skinny Jeans Have Their Down Side
A report in the Journal of Neurology, Neurosurgery and Psychiatry, that tells of a case “of a 35-year-old woman who wound up lying prone on the pavement, unable to get up, after spending the day in skinny jeans while helping a relative move. By the time the doctors saw the patient, both her legs were so swollen below the knee that the medical team had to cut the jeans off her. She also had severe weakness in her feet and ankles and was not able to walk.”
Doctors without Borders Reception in Woodbury L.I.
On August 12 at 6:00pm at the Liquid Outdoor Lounge @ the Woodbury Country Club, 884 Jericho Turnpike, Woodbury NY 11797, Nikhil G. Jaiswal, age 13, is hosting a charity reception featuring hors d’oeuvres and raffles for Doctors without Borders. (Nikhil is the son of Arun Jaiswal, a member of Suffolk County Medical Society.) Tesla Motors will be showcasing their award-winning car, the Model S. All donations are tax deductible. If you would like to donate by check, please make it out to Doctors Without Borders and bring it to the event. To attend the event, the minimum donation is $75 per person. For more information contact Nikhil G. Jaiswal here.
Classifieds
Board Eligible Plastic Surgeon Seeks Full Time Position
Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355