March 9, 2018 – Making Lemonade Out of Snow
Charles Rothberg, MD
March 9, 2018
Making Lemonade Out of Snow
The 2018 Lobby Day scheduled for Wednesday, March 7, promised to be best attended showing in a decade. Top legislative leaders were all teed up to speak at the Egg for an informative program, and almost all Council members came for the Annual Albany Council Meeting. All hands were on deck.
Then, Mother Nature had an alternate plan— which was to dump at least a foot of snow on Albany and all points south on Tuesday night and Wednesday. Governor Cuomo put a Travel Ban in place and the Legislative Session for Wednesday was canceled— an extremely rare occurrence. Since the legislators left town to beat the storm, the Executive Committee agreed that there was no point in going ahead with the schedule and risking people’s safety.
The 2018 MSSNY Lobby Day was canceled. We definitely made the right decision. It snowed in Albany, beginning at 11:21PM on Tuesday and continued for 23 hours!
However, with many physician leaders already in Albany, there was still advocacy to be done!
On Wednesday morning, a contingent of physicians and staff consisting of Drs. Frank Dowling, President Elect Tom Madejski, Councilor Marie Basile, Suffolk County Executive Aaron Kumar and myself had the opportunity to have a lengthy meeting with Senate Majority Leader John J. Flanagan (2nd District Suffolk County) and his top staff that may have been cut short had we not had the “snow day.” It was a great opportunity to discuss the litany of concerns we have in the proposed State Budget (see below), as well as push for the collective negotiation bill.
MSSNY Councilors meet with NYS Senate Majority Leader John J. Flanagan (center). Dr. Frank Dowling;President Elect Dr. Tom Madejski; MSSNY President Charles Rothberg; Dr. Marie Basile; and Suffolk County Executive Aaron Kumar.
We also had a very good meeting with Senate Democratic Conference Leader Andrea Stewart Cousins (35th District Westchester), who was well versed in the issues that face New York’s physicians’ and their patients. And we had the opportunity to meet with one of the top advisors to Senate Independent Conference leader Jeff Klein.
I thank our hard working staff for all their work in pulling this day together. However, sometimes the best laid plans do not come to fruition.
Don’t worry, legislators, we will be back in full force for the 2019 Lobby Day! We also hope to identify a Tuesday in May when we may have another contingent of physicians come to Albany to press for our top priority bills as the Legislature makes its final push towards the end of the Legislative Session. We hope there will be no snow then!
In the meantime, please continue to contact your legislators on our key priority issues as the State will finalize its State Budget in three weeks. While our Albany staff will be meeting with all of our legislators regularly to keep them apprised of our positions and agendas for this session, legislators need to continue to hear directly from you – their constituents.
Charles Rothberg, MD
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Budget Negotiations Starting to Heat Up
Both houses of the legislature are expected to release their one-house budget proposals next week. This should give Physicians insight on where the Senate and Assembly stand on a number of Governor Cuomo’s budget proposals.
Budget negotiations will then begin to heat up and we must continue to apply pressure on the legislature to ensure that our voices are heard. It is important for physicians to continue to be engaged in the budget process all the way until the end. While the one house budget proposals are very important, the Governor has a significant amount of influence and power in the budget process.
The budget will be negotiated at all hours of the day and night. Additionally, MSSNY staff will usually be updated on various developments in negotiations. The final budget agreement is due by April 1.
MSSNY members are also urged to continue to contact their legislators, and make phone calls, Facebook and Twitter updates, e-mail blasts and other forms of activism. Among the many issue’s.
- Oppose Expanding scope of practice for certified nurse anesthetists (CRNAs)
This provision would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the supervision of a physician anesthesiologist. To urge your legislators to protect safe anesthesia care for patients please click here.
- Oppose Authorizing Health Services Offered In Big Box Stores
This provision authorizes the delivery of health services in a retail setting such as a pharmacy, grocery store, or shopping malls. Sponsors could include a business corporation.
With the recently announced proposal of drugstore chain giant and PBM operator CVS to purchase health insurance giant Aetna, this could result in an explosion of retail clinics at the expense of community physician practices. To urge your legislators to reject corporate owned retail clinics, please click here.
- Oppose Patient-Centered Medical Home cuts
This proposal would slash the Patient-Centered Medical Home (PCMH) add-on Medicaid payment that many primary care practices receive to help manage and coordinate needed patient care services. Moreover, it would potentially require all PCMH primary care practices to have a Level 1 Value-Based payment contract on July 1, 2018, or face further steep cuts in PMPM payments. Please send a letter here click here.
Additional budget items of great concern include:
- Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, forcing physicians to go through even more burdensome prior authorization requirements.
- Eliminating the Empire Clinical Research Investigator Program (ECRIP).
- Consolidating 30 public health appropriations into four pools, and reduce overall spending by 20 percent.
- Comprehensive Medication Management Protocols
This proposal allows nurse practitioners and pharmacists to provide comprehensive medication management to patients with a chronic disease or diseases who have not met clinical goals of therapy and are at risk for hospitalization. Urge your legislators to reject this inappropriate scope of practice expansion. Click here to send a letter to your legislator.
- Community Paramedicine
This proposal would allow emergency medical personnel to provide non-emergency care in residential settings. While a laudable goal, the bill language only includes general references to collaboration with the patient’s treating providers, rather than specific requirements to communicate with actively treating physicians and other care providers. To protect proper continuity and coordination of patient care with treating providers, please click here to send a letter to your legislator.
Additionally please click below to see the various joint letters with other organizations that MSSNY has been closely working with:
Sign-On letter to reject Governor’s Budget Bill regarding a nurse anesthetist to independently administer anesthesia
Sign-On letter rejecting the proposal to authorize retail clinics
Sign On Letter Comprehensive Medical Management (CMM)
Sign On Letter Prescriber Prevails click here (DIVISION OF GOVERNMENTAL AFFAIRS)
Legislation Introduced by Senate Health Committee Chair to Reduce Prior Authorization Hassles Based on AMA Prior Authorization Principles
As physicians and patients continue to raise concerns regarding the increasing burden of health insurer imposed pre-authorization requirements, legislation (S.7872/A.9588) has been introduced by Senate Health Committee Chair Kemp Hannon and Assembly Health Committee Chair Richard Gottfried to help reduce some of these administrative hassles. The legislation is consistent with elements of a recently released document entitled Prior Authorization and Utilization Management Reform Principles, developed by the American Medical Association, American Hospital Association, Medical Group Management Association, American Pharmacists Association, and Arthritis Foundation along with several other health and patient advocacy associations including MSSNY. Among the elements include:
- Requiring health plan utilization review criteria to be evidence-based and peer reviewed ;
- Reducing the time frame for reviewing prior authorization requests from 3 business days to 48 hours (and to 24 hours for urgent situations);
- Assuring that a prior authorization, once given, is enduring for the duration of the medication or treatment.
- Prohibiting mid-year prescription formulary changes; and
- Assuring that once a prior authorization is given, it cannot be withdrawn if eligibility is confirmed on the day of the service.
MSSNY together with NY Academy of Family Physicians & the NY Chapter of The American College of Physicians advocated for the introduction of this legislation. Legislation to reduce prior authorization hassles is more important than ever.
For example, a recent study by Milliman noted that insurers’ use of burdensome prior authorization and step therapy requirements for many prescription medications nearly doubled between 2010 and 2015. And a recent Annals of Internal Medicine study reported that physicians spend two hours on administrative work for every hour with a patient.
While legislation is one route to address these hassles, another route is direct discussion among representative organizations. For example, recently the AMA and the American Hospital Association joined with organizations representing health insurers (AHIP and the Blue Cross Blue Shield Association) in a consensus statement click here to work for “improvement in prior authorization programs”. And last week, the AMA and Anthem jointly announced collaborative efforts on a number of fronts, including working to “streamline and/or eliminate low-value prior authorization requirements” click here. (AUSTER)
Join MSSNY’s Physician Advocacy Liaison Network
One of the most frequent comments raised at MSSNY DGA staff’s various meetings with Legislatures and their staff is the importance of hearing their physician constituents’ experiences, stories, knowledge and expertise. This is why participating in MSSNY’s PAL program is so important. Please see the information below on how to sign up to become a PAL.
With so many changes occurring in our health care system, and other opposing interests seeking to marginalize the physician’s role as leader of the health care team, we must make up for it with an overwhelming presence in grassroots activity that will make it impossible for legislators to ignore.
Physicians must mobilize and become more active in the legislative and budget process to better ensure the enactment of favorable legislation and the defeat of proposals that will adversely impact the care that you provide to your patients. Click click here to sign up to be a PAL. Next week on March 15 there will be a special briefing for PAL members on the State Budget negotiations. (BELMONT)
Legislature Passes Bill to Restrict PBM Gag Clauses
Legislation (S.6940, Hannon) passed the Senate this week to prohibit Pharmaceutical Benefit Managers (PBMs) from prohibiting or penalizing pharmacists from disclosing to individuals the cost of a prescription medication and the availability of therapeutically equivalent alternatives or alternative payment methods, such as paying cash, that may be less expensive. The legislation would also prohibit the imposition of a copayment that exceeds the total submitted charge by the pharmacy and prohibits a PBM from redacting or recouping the adjudicated cost from the pharmacy.
Identical legislation (A.8781,Rosenthal) passed the Assembly earlier this Session. Earlier this week, the MSSNY Council passed a resolution calling for an end to such gag clauses in response to multiple media reports highlighting PBM practices that prohibited pharmacists from telling patients that they could save money by paying cash for prescription drugs rather than using their health insurance. (AUSTER)
AG Fines Emblem for Inappropriate Disclosures in Mailing
New York Attorney General Eric Schneiderman this week announced a settlement with EmblemHealth after the health insurance company admitted a mailing error that resulted in 81,122 social security numbers being disclosed on a mailing. In addition to paying a $575,000 penalty, EmblemHealth agreed to implement a Corrective Action Plan and conduct a comprehensive risk assessment.
The AG’s press release please click here notes that, in October 2016, Emblem discovered that it had mailed over 80,000 policyholders a paper copy of their Medicare Prescription Drug Plan Evidence of Coverage (“EOC Mailing”) that included a mailing label with the policyholder’s social security number on it. In addition to the financial penalty, Emblem is also required to implement a Corrective Action Plan that includes a thorough risk analysis of security risks associated with the mailing of policy documents to policyholders, and submit a report of those findings to the Attorney General’s office within 180 days of the settlement.
Tickborne Diseases: An update on trends, diagnostics, and emerging infections to be presented at the MSSNY House of Delegates on March 22nd
The New York State’s Department of Health Commissioner’s Grand Rounds session title Tickborne Diseases will be presented as a live seminar at the MSSNY House of Delegates on Thursday, March 22, 2018 from 3-4:30 p.m. at the Adam’s Mark Hotel, 120 Church Street, Buffalo, NY 14202. The purpose of this presentation is to describe the epidemiology of tickborne diseases in NYS, review diagnostic approaches to tickborne diseases, and provide an update on emerging tickborne infections.
Host for the afternoon session will be NYS Health Commissioner Howard A Zucker, MD, JD. Faculty will include C. Ben Beard, MS, PhD, Deputy Director Division of Vector-Borne Diseases. Centers for Disease Control and Prevention; Philip Molloy, MD, Rheumatologist, Nantucket Cottage Hospital, Medical Director for Tickborne Diseases, Imugen Inc.; Michael Ryan, PhD, Director, Division of Laboratory Quality Certification, Wadsworth Center, New York State Department of Health; P. Bryon Backenson, MS, Deputy Director, Bureau of Communicable Disease Control, New York State Department of Health, Assistant Professor, Department of Epidemiology and Biostatistics, University at Albany School of Public Health.
The Grand Rounds session is offered free to all health care providers and advance registration is required. For additional information and to register for this event please see the flyer here.
Continuing Medical Education Credits will be issued by The School of Public Health, University at Albany which is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians. The School of Public Health, University at Albany designates this live activity for a maximum of 1.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (CLANCY)
Register NOW for MSSNY House of Delegates Live CME Seminars on Thursday March 22nd and Friday March 23rd
The Medical Society of the State of New York will conduct three live seminars at its House of Delegates meeting on March 22nd and 23rd . The programs are opened to all physicians in the western New York area and will be held at the Adam’s Mark Hotel, 120 Church Street, Buffalo, NY 14202. Pre-registration is strongly suggested. The following programs will be offered:
Medical Matters: Disaster Medicine: Every Physician’s Second Specialty
Thursday, March 22nd, 1:00-2:00pm
Faculty: Lorraine Giordano, MD, FACEP, FAADM
* Must attend in person at the House of Delegates.
- Identify core preparedness competencies every physician should know
- Explore essential elements of preparedness plans for staff, patients, and family
- Describe available courses, resources and organizations to obtain disaster preparedness education and training
Bending the Diabetes Curve
Thursday, March 22nd, 2:00-3:00pm
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD
* Must attend in person at the House of Delegates.
- 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
Current Concepts in Concussion for Pediatric and Adult Patients
Friday, March 23rd, 1:00-2:00pm
Faculty: Deborah Light, MD & John Pugh, MD, PhD
* Must attend in person at the House of Delegates.
- 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 (HOFFMAN)
Dr. Kenneth Offit Makes Presentation to MSSNY Council on the BRCA Founder Outreach Study
Dr. Kenneth Offit, Chief of the Clinical Genetics Service at Memorial Sloan Kettering Cancer Center, presented information on the BRCA Founder Outreach (BFOR) Study at this week’s MSSNY Council meeting. The study is an innovative research initiative that will use an online platform and other novel approaches to health care delivery to address a longstanding, unmet need: access to screening for BRCA mutations. It has significant potential to save lives and advance progress in the emerging field of precision medicine. The BFOR study offers individuals no-cost BRCA testing for three mutations found in those of Ashkenazi ancestry. BRCA Mutations increase risk for breast, ovarian and prostate cancer.
Men and women at least 25 years old with at least 1 Ashkenazi Jewish grandparent are eligible. Participants register online and supply a DNA sample at a nearby lab. The study seeks to learn how many participants will choose to receive their BRCA results through their primary care provider (PCP) or from the study staff. If they choose their own provider, the PCP will have the option to disclose the genetic test results. If a PCP prefers not to disclose the results, the study staff will take this role. If a PCP chooses to disclose results, study staff will provide educational material to inform patient counseling and recommend additional testing if needed. Physicians and patients can learn more about eligibility for the study through the attached information sheet please click here or at www.bforstudy.com or by calling 1-833-600-BFOR. (CLANCY)
For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
Council Notes—March 6, 2018
- Kenneth Offit, MD, MPH presented an update on a NY cancer screening effort focused on physician involvement. The BRCA Founder Outreach Study (BFOR) is a research initiative that will use an online platform to address a longstanding, unmet need: access to screening for BRCA mutations. Dr. Offit is Chief of the Clinical Genetics Service and Vice Chairman, Academic Affairs, Department of Medicine at Memorial Sloan Kettering Cancer Center. Learn more at bforstudy.com
- Donald Moore, MD, MPH, Chair, MSSNY’s HIT Committee, presented a proposal regarding a program that will focus on the legal pitfalls of EHR Technology and how to mitigate the liability risks to physicians. MSSNY pledged support, along with the Medical Society of the County of Kings, to sponsor, promote and implement a statewide, 5 credit CME/HIT Symposium and Expo at the Brooklyn Borough Hall on Saturday, April 28, 2018.
- Council approved a new pilot project to facilitate recruitment of new members and former members who return after an absence of at least two years. The program will include a low introductory dues rate in participating counties and a schedule of gradually increasing dues over the course of four years.
- Council passed the following resolutions:
- MSSNY will support the creation of a state-wide clinical preceptorship tax credit for community based and hospital based health care practitioners and that any necessary documentation for the tax credit be contained in a simplified form to encourage participation in the program. The resolution will be sent to the AMA for consideration.
- MSSNY and the AMA and the American Osteopathic Association will communicate with US medical schools to study the inclusion of clinician-performed, point-of-care ultrasound instruction and training. The resolution will be sent to the AMA for consideration.
UHC’s Physician Advisory Council; Tell Us Now if You have Issues with United!
As part of the last legal settlement with United that was concluded in 2015, United agreed to the formation of a Committee referred to as the PAC – Physician’s Advisory Council. The Medical Society of the State of New York has four physician members who are on the UHC PAC. The Committee meets four times a year with similarly named physicians from United. One criteria for being on this group is that the physician must be participating with United.
The Committee is charged with addressing any issue of contention, either operational or administrative, that might be encountered in dealing with United. While issues are discussed at length, the agreement stipulates that UHC is there to listen and report back to the UHC leadership on items discussed. United does not present new policy matters to the PAC. However, the group could discuss United policy issues that cause concern and these concerns would then be taken back the leadership for their thoughts and/or action.
The spirit of the settlement agreement is that MSSNY could share subject matters at a high level to garner a better relationship with UHC. Our next meeting is Tuesday night, March 13th. In this spirit, MSSNY is asking members if they have specific issues with United that we can address and advocate for your behalf. If you have a concern, please send an email to Regina McNally, VP, Socio-Medical Economics. Please state the subject as UHC PAC Item and send your email to firstname.lastname@example.org MSSNY email is not HIPAA-secure, so please do NOT include any PHI!
RAND: Many NY Healthcare Providers Not Prepared to Care for Veterans
Fierce Healthcare (3/5) reports researchers concluded that New York healthcare providers are “almost manifestly incapable of caring for veterans, according to a new study by RAND Corp.
Researchers “surveyed 746 providers across the state of New York,” and found that “only 2% of civilian physicians and other medical providers are capable of providing quality care in a timely manner.”
UnitedHealth Tightens Reins on Emergency Department Reimbursement
The nation’s largest health insurer, UnitedHealth Group, is following rival Anthem’s footsteps with a new payment policy aimed at reducing its emergency department claims costs. (Modern Healthcare 03/07).
Under the policy, rolled out nationwide March 1, UnitedHealth is reviewing and adjusting facility claims for the most severe and costly ED visits for patients enrolled in the company’s commercial and Medicare Advantage plans. Hospitals that submit facility claims for ED visits with Level 4 or Level 5 evaluation and management codes—codes used for patients with complex, resource-intensive conditions—could see their claims adjusted downward or denied, depending on a hospital’s contract with the insurer, if UnitedHealth determines the claim didn’t justify a high-level code.
Minnetonka, Minn.-based UnitedHealth said the policy is meant to ensure accurate coding among providers. But hospitals fear the policy could squeeze reimbursement even further and lead to lower revenue.
UnitedHealth’s policy is different from Indianapolis-based Anthem’s, which has been denying coverage for ED visits that it decides were not emergencies after the fact. But both policies are aimed at lowering the insurers’ spending on ED claims.
Cigna Nears Deal to Buy Express Scripts
Health insurer Cigna is nearing a deal to buy Express Scripts, according to people familiar with the matter. A deal could be announced as soon as today, the people said. As of Wednesday, Express Scripts, a pharmacy-benefits manager, had a market value of $41 billion, meaning that with a typical premium the transaction could be worth $50 billion or more.
The combination would be the latest in a flurry of proposed tie-ups in the rapidly changing healthcare-services business. (WSJ, 3/8)
JAMA: Opioids No Better than Nonopioids for Easing Common Chronic Pain
Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
Opioids are not better than nonopioid drugs for relieving back pain or pain related to hip or knee osteoarthritis, a JAMA study finds.
Nearly 250 patients with moderate-to-severe chronic back pain or hip or knee osteoarthritis pain were randomized to receive either opioids or nonopioids. In the opioid group, patients began taking immediate-release opioids and could be stepped all the way up to fentanyl patches (maximum daily dosage, 100 morphine-equivalent mg). For nonopioids, patients began with acetaminophen or nonsteroidal anti-inflammatory drugs and could be stepped up to drugs requiring authorization from the clinic, including pregabalin.
The primary outcome — pain-related function — was similar between the groups over 12 months. Pain intensity, a secondary outcome, was significantly better with nonopioids (improvement of 0.5 on a 10-point scale). Opioid recipients had more medication-related symptoms.
The authors conclude that their findings do not support starting opioids in such patients.
JAMA article (Free abstract)
Trump Initiative: Provide Consumers with Greater Access to Their Medical Data
Bloomberg News (3/6) reports that the Trump Administration intends to provide consumers with “greater access to their medical data,” CMS Administrator Seema Verma said on Tuesday at a Las Vegas conference for health IT professionals. Verma is quoted as saying, “At a time when health-care data is being generated from so many sources, too often that data runs into the hard walls of closed systems that hold patients, and their information, hostage.” AP (3/6) reports that the Administration plans to launch a new initiative called MyHealthEData, which will “make electronic medical records easier for patients to use.” The effort “will be overseen by the White House Office of American Innovation, headed by presidential son-in-law Jared Kushner.”
The goal “is to reduce the time and costs associated with compliance, Verma said, but CMS will also be ‘laser focused’ on giving patients better access to their medical data.” Verma criticized the practice of “data blocking” which prevents “patients from sharing records outside of a particular hospital.”
|FDA, MIPS, Coding Tips|
FDA’s Gottlieb Criticizes Drug Supply Chain for Higher Costs
FDA administrator Scott Gottlieb criticized pharmaceutical companies, pharmacy benefit managers, and insurers for “Kabuki drug-pricing constructs” that he says unnecessarily raise drug costs. “Patients shouldn’t face exorbitant out-of-pocket costs, and pay money where the primary purpose is to help subsidize rebates paid to a long list of supply chain intermediaries,” Gottlieb told a conference attended by health insurers. “Sick people aren’t supposed to be subsidizing the healthy.”
Bloomberg News reported that Gottlieb placed most of the blame on the high levels of market consolidation among PBMs, distributors, and drug stores that stifle competition. He was particularly critical of how that system treats generic and biosimilar medication.
PAI’s QPP Tip of the Month
Physicians Have Until March 31, 2018 to Submit 2017 MIPS Performance Data and Avoid a -4% Payment Adjustment in 2019
Physicians have until March 31 to submit their 2017 MIPS performance data to avoid a negative payment adjustment in 2019. These data can be submitted through the CMS QPP submission portal. With the 2017 Merit-based Incentive Payment System (MIPS) reporting deadline fast approaching, you may be unsure of or need additional information on what steps you need to take to submit your 2017 MIPS participation data. PAI has gathered the most helpful CMS resources that provide you with step-by-step instructions on submitting your 2017 MIPS data:
- CMS MIPS Reporting Deadlines Fast Approaching: 10 Things to Do and Know – this CMS overview provides information on the top 10 things you need to do and know to submit using the CMS QPP submission portal and provides links to other helpful resources.
- CMS Tutorial for Individual and/or Group Data Submission – a video tutorial that provides a step-by-step demonstration of how to use CMS QPP Submission Portal and how to submit your data for each of the MIPS categories.
- CMS Submitting 2017 Transition Year Data to the QPP – this CMS fact sheet provides an overview of the submission requirements and outlines the different options for submitting MIPS data using other reporting mechanisms.
- Enterprise Identity Management (EIDM) Account User Guide – EIDM user accounts and credentials are required to log into the CMS QPP Submission Portal. This user guide provides step-by-step instructions on how to create an EIDM account for QPP submission purposes.
- 2017 Transition Year Flexibility Quality Category Options – this PAI resource provides you with information on the minimum you need to report for the quality category for the 2017 test participation option.
- 2017 Transition Year Flexibility Improvement Activities Category Options – this PAI resource provides you with the information on the minimum you need to report for the improvement activities category for the 2017 test participation.
Additional resources on the QPP, MIPS, and Advanced APMs are also available on PAI’s MACRA QPP Resource Center. Please note that resources for the 2017 performance year are still available to help you with your 2017 MIPS submission; updated materials for 2018 MIPS participation will be made available by PAI on March 15, 2018.
|Coding Tip of the Week|
When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out.
The omitted new codes are N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, and N63.42, which will replace the truncated ICD-10 diagnosis N63.
The Centers for Medicare & Medicaid Services (CMS) will correct the policies with its next update, which is scheduled for April 1. But CMS did not require its Medicare contractors to reprocess the denied claims.
CMS has instructed MACs to adjust any claims brought to their attention that were processed in error for any of the NCDs included in CR 10318. These adjustments will not take place until after April 2, 2018 unless otherwise noted.
National Government Services (NGS) has already updated their system and will reprocess claims upon the provider’s request.
Source: CMS Transmittal 2005 ICD-10-CM and other Coding Revisions to National Coverage Determinations (NCDs)
If you have a coding or compliance question you would like to have answered please send your question to MSSNY at email@example.com, and complete the subject line with Tip of the Week.
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