September 25, 2015 – ICD-10 Coming To You Next Thursday!

 Dr. Joseph R. Maldonado Twitter_logo_blue1
September 25, 2015
Volume 15, Number 36

Dear Colleagues:

October 1st and the ICD-10 compliance date is only 6 days away!

For better or worse, we have to deal with it. The biggest complaint is that ICD-10 contains lots more codes: 68,069 in the 10th edition compared with the 14,035 currently in use. It is here. And now— what we need to do is to identify problems early on so they can be addressed and resolved so that physicians will not experience cash flow problems.

As the transition date approaches, the regional office and CMS want to provide us with the best possible service. We may intensely dislike this change, but CMS has bombarded us in every possible media over the past two years to prepare us. MSSNY has done its due diligence in informing you of educational resources to ensure a smooth and successful transition.

CMS notified us yesterday that they will have real people available to answer your ICD-10 related questions or concerns. Anthony Jamrozy and Rebecca Birnbach will be our CMS New York Regional Office points of contact for ICD-10 related inquiries.  Anthony and Rebecca can be reached at and and will research and respond to any ICD-10 transition issues or concerns.

Also, as announced on the National Provider Call on August 27, the CMS ICD-10 Ombudsman is available to address ICD-10 related issues for individual physicians and stakeholders at Many resources are available to assist you with the transition, including the CMS ICD-10 website including Frequently Asked Questions the CMS ICD-10 Quick Start Guide and the Road to 10: CMS Online Tool for Small Practices.

Please check the website often, as content will be updated regularly. You can also keep up on breaking ICD-10 news by signing up for email update messages.

Just yesterday, a member sent this question to Regina McNally, VP of Socio-Medical Economics:

Question: What about resubmitting a previous claim which was ICD-9. Must it be resubmitted after Oct 1 with ICD -10 codes? 

Answer: This is Date of Service specific. For dates of service on or before September 30, 2015, you need to use ICD-9 diagnosis codes.  For dates of service on or after October 1, 2015, you must use ICD-10-CM diagnosis codes.

Regina is available to answer your questions. You can email her at This service is an excellent Members Only benefit!


Please send your comments to


Update: EmblemHealth Will Follow CMS’ Lead on Relaxed ICD-10-CM Rules
We asked EmblemHealth whetherthey will follow CMS’ leniency regarding ICD-10 coding specificity and whether they anticipated an impact to COB claims where Medicare is primary and CMS paid their portion of the claim based on a less specific code within the same family.  EmblemHealth’s ICD-10 experts reviewed the CMS FAQs we sent them and determined that their policies are aligned with CMS’. Providers must bill with valid ICD-10 codes with all of the expected digits accounted for. Specificity will not come into play as part of their claim systems’ adjudication processes as long as the code is valid. This holds true whether EmblemHealth is the primary or secondary payer. For more information on EmblemHealth’s ICD-10 approach, we recommend visiting their web site page “Getting Ready for ICD-10 Together” where you can find a robust set of useful resources:

                                                                        –Regina McNally, VP MSSNY Socio-Med

NYS Bureau of Narcotic Enforcement Fall Update On Electronic Prescribing
The NYS Department of Health’s Bureau of Narcotic Enforcement has released its Fall 2015 newsletter and it contains information on Electronic Prescribing of Controlled Substances (EPCS). Along with a general overview of EPCS, there is information on the registration process of EPCS with the NYS DOH, the electronic prescribing exceptions, out of state electronic prescription and electronic recordkeeping of controlled substances. A copy of the newsletter can be found HERE on the MSSNY website.  Further information on EPCS can also be found here.

Electronic prescribing of controlled and non-controlled substance will be required for all prescribers effective March 27, 2016.

MSSNY Hosts Three E-Prescribing Webinars During Fall; Sign Up Now!
The Medical Society of the State of New York will host three free continuing medical education webinars on E-prescribing. The first webinar will be held as part of MSSNY’s Advocacy Matters on Tuesday, October 13th at 12:30 p.m. Registration is now open to MSSNY physicians by clicking here.

Select training session and the upcoming tab.

A copy of the flyer can be found here.

Additional webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances.

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. 

Further information can be obtained by contacting Miriam Hardin at or Terri Holmes at

E-prescribing of all substances will be required in New York State by March 27, 2016. ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.   

New FCC Ruling Affects Medical Debt Collecting
Question: How does the new FCC ruling on medical debt collections affect my practice? Can I be held responsible and fined for my vendor’s violation of the new rule?

Answer: The Federal Communications Commission (“FCC”) issued an interpretive ruling this summer clarifying an area of much confusion under the Telephone Consumer Protection Act. Prior to the FCC’s ruling, there was little guidance regarding autodialing, consent to call and reaching wrong numbers, particularly for cellphones. The new FCC ruling, though, will present a challenge to medical-debt collectors seeking to contact patients on their cellphones.

Pursuant to the ruling, the onus is on debt collectors to confirm express consent before autodialing a cellphone. Debt collectors complain that the ruling provides no relief or viable alternative when a collection agency does not know they have the wrong number for someone.

The FCC’s ruling does provide some exceptions for appointment reminders and test results; however, the FCC was explicit that the exemptions did not extend to bill collection efforts. Industry wide, medical debt collectors are now working to implement this ruling and be in compliance with the new requirements. Under the rule, debt collection companies’ penalties start at $500 and can swell to $1,500 for willful violations.

Healthcare providers also need to be aware of the interpretive ruling since they too can be held liable even when it is their vendors who fail to comply with regulations. Healthcare providers must obtain express written consent to call patients on their cellphones about billing issues.

This issue must be addressed immediately by all practices, as a number of health systems are reporting an increase in bad debt due to the increase of patients coming in with high-deductible plans. Patients’ failure to pay their deductibles adds up to millions of calls from healthcare debt collectors each year.

If you have any questions, please contact Kern Augustine Conroy & Schoppmann, P.C. at

1-800-445-0954 or via email at 

“Cadillac Tax” Repeal Legislation Introduced in the US Senate
Senator Charles Schumer (D-NY) was among the several members of the US Senate this week to co-sponsor legislation introduced this week that would repeal the so-called “Cadillac Tax” on higher cost health insurance policies offered by employers.  Included as part of the ACA, the “Cadillac Tax” is a provision that would, beginning in 2018, impose a 40% excise tax on group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. It would undoubtedly have a greater impact in higher cost states such as New York, and would further discourage employers from offering comprehensive health insurance policies to their employees. MSSNY adopted policy at its 2013 House of Delegates meeting calling for legislation to repeal this tax.

The legislation was introduced by Senator Sherrod Brown (D-OH), and in addition to Senator Schumer, is co-sponsored by Senators: Patrick Leahy of Vermont; Mazie Hirono of Hawaii; Jeanne Shaheen of New Hampshire; Chris Murphy and Richard Blumenthal of Connecticut; Michael Bennet of Colorado and Bob Casey of Pennsylvania.  Senator Dean Heller (R-NV), and Martin Heinrich, D-NM, have also co-sponsored repeal legislation and Reps. Joe Courtney, D-CT, and Frank Guinta, R-NH, have both introduced separate repeal proposals.

To read more about this proposal, click here and here. 

Modules From The AMA Focus on Dealing With Physician Burnout
The problem of burnout and caregiver fatigue among physicians is real and immediate. In fact, research shows that the rates of overall burnout extend to about 40 percent of U.S. physicians, more than 10 percentage points higher than the general population. In response, the AMA has created an ambitious program aimed at successfully preventing burnout and promoting well-being by offering new online modules that help physicians learn their risk factors for burnout and adopt real-life strategies to reignite professional fulfillment and resilience.

“Physicians are professionals who at their core are called to self-sacrifice and inclined to always do what’s necessary to take care of patients,” said AMA President Steven J. Stack, M.D. “But modern medicine can take a toll over time, and the AMA wants physicians to know about the risks associated with burnout and the strategies to help combat it.”

Two new modules in the AMA STEPS Forward series offer key strategies for taking on burnout.

  • The first module,Improving Physician Resiliency, offers an internal approach to help physicians manage personal and professional stress. Physicians who are resilient are better equipped to manage the stress of relentless change in medical practice and less likely to experience burnout. The module provides simple, evidence-based solutions to help physicians foster resilience against stress and protect against burnout.
  • The second module,Preventing Physician Burnout, offers an external approach to help physicians make practice-level changes to improve workflow and reduce barriers to patient care. Increasing physician involvement in efforts to improve their practice environment results in better patient satisfaction, quality outcomes, and overall practice morale and productivity. The module provides assessment tools and targeted intervention strategies that reduce sources of stress and support professional well-being.

2016 PQRS Negative Payment Adjustment & The Informal Review Process
In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.

EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between September 9, 2015 and November 9, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 9, 2015 at 11:59 p.m. EST

Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment – Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website) for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. 

DOH/CMS Will Host Training for Fully Integrated Dual Eligibles
CMS and the New York State Department of Health (DOH) will host a training for providers on the Fully Integrated Duals Advantage (FIDA) program. The event will include:

  • Remarks by Jason Helgerson, State Medicaid Director.
  • Presentations by Menahem Dimant, Medical Director of AlphaCare Signature FIDA Plan, and Dr. Lisa George, Medical Director of VNSNY Choice FIDA Complete, on the benefits of FIDA and their best practices and experiences.
  • An overview of FIDA by Melissa Seeley, Technical Director from the CMS Medicare-Medicaid Coordination Office, and Joseph Shunk, Interim FIDA Project Director from DOH.

The event will be held on Wednesday, September 30, 2015 from 10:00 AM to 1:00 PM at:

CMS New York Regional Office

26 Federal Plaza on Broadway (between Duane and Worth Streets)

New York, NY 10278

Continuing Medical Education (CME) and Continuing Education Units (CEUs) are available for this training. Please see details, below.

RSVP by September 25, 2015 for the Wednesday, September 30 training here.

“Many Faces of Flu” CME Webinar On October 21; Registration Now Open
The Medical Society of the State of New York will begin its 2016 Medical Matters continuing medical education (CME) webinar series with “Many Faces of Flu 2015” on Wednesday, October 21, 2015 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.

Educational objectives are: 1) Recognize the distinction between seasonal, Avian and Pandemic flu; 2) Describe clinical and laboratory diagnostic features and treatment; 3) Identify recommended immunizations and antiviral medications for treatment. 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. 

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2016 and topics include: public health preparedness; immunizations and recommendations during a disaster; and radiological emergencies.  Program dates for Medical Matters will be announced shortly. 

Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days!  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide!

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans, and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately!

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay!  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact for your cards!


Full-time. Ideal for busy medical subspecialty. Exclusive use of consult, exam room.  Stress test, echo available. Beautiful  décor. Public  transportation nearby.                                            Available immediately. Please call 212-996-2900 or e-mail:


Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-SpecialtyGroup Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.

Job requirements:

  • Current Board Certification  / Recertification
  • Current & Unrestricted NYS license, DEA & NPI
  • Must be on panels of managed Medicaid and HMO plans
  • Working knowledge of EMR
  • Take detailed patient history
  • Do physical examinations
  • Order medically necessary tests, equipment, etc
  • Be able to make complex decisions
  • Write Prescriptions
  • Provide treatments
  • Venipuncture
  • Give injections
  • Follow-up – evaluation of test results and with patients
  • Provide referrals to specialists

NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to: or 



Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 /

OFFICE SPACE – 1185 Park Ave. (94th St.)
Full-time. Ideal for busy medical subspecialty. Exclusive use of consult, exam room.  Stress test, echo available. Beautiful décor. Public transportation nearby. Available immediately. Please call 212-996-2900 or e-mail:

Midtown Manhattan two blocks away from Grand Central
Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’

Asking $13,691/ month; Available April, 2016. Email at