MSSNY eNews: CMS Chucking 6 Visit Codes

Thomas J. Madejski, MD MSSNY President

Thomas J. Madejski, MD
MSSNY President

July 20, 2018
Volume 20  Number 26


Dear Colleagues:

Your calls to MSSNY demanding that CMS improve patient care are being heard!

CMS heard your stories of physicians looking at computer screens rather than looking at patients. They heard about our resident physicians spending more time on documentation than time spent listening to, examining, and caring for their patients.

CMS is proposing to reduce the hassle of medical record documentation.

Simplifying Documentation

Beginning January 1, 2019, CMS proposes to simplify documentation for the purposes of coding E/M visit levels.

CMS proposes to allow practitioners to choose, as an alternative to the current framework specified under the 1995 or 1997 guidelines, either Medical Decision Making (MDM) or time as a basis to determine the appropriate level of E/M visit. This would allow different practitioners in different specialties to choose to document the factor(s) that matter most given the nature of their clinical practice.

The proposed rule identifies that CMS acknowledges that the coding, payment, and documentation requirements for E/M visits are overly burdensome and no longer aligned with the current practice of medicine. CMS proposes to simplify the office-based and outpatient E/M payment rates and documentation requirements, and create new add-on codes to better capture the differential resources involved in furnishing certain types of E/M visits. CMS is proposing to simplify payment for E/M levels 2 through 5. CMS indicates that eliminating the distinction in payment between visit levels 2 through 5 will eliminate the need to audit against the visit levels, and therefore, will provide immediate relief from the burden of documentation. A single payment rate will also eliminate the increasingly outdated distinction between the kinds of visits that are reflected in the current CPT code levels in both the coding and the associated documentation rules.

The rule also outlines CMS’ proposals on the following and much more:

  • Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services
  • Eliminating Extra Documentation Requirements for Home Visits
  • Eliminating Prohibition on Billing Same-Day Visits by Practitioners of the Same Group and Specialty Physician Self-Referral Law
  • CY 2019 Updates to the Quality Payment Program

For more information about additional changes, please review the CY 2019 Physician Fee Schedule proposed rule (currently 1473 pages!)

MSSNY Will Keep You Posted

I have tasked our MSSNY staff and committees with reviewing the proposal further.  The devil is in the details. What will the effect of the proposed rule change be on physicians’ practice revenue?  Is CMS committed to further payment reform and funding to cover the cost of increasingly complicated patients in an aging society, and reduce other government generated documentation requirements? Will simplified documentation protect our physician members in our increasingly litigious society?  CMS is seeking our input on these proposals.  You may submit electronic comments on this regulation hereFollow the “Submit a comment” instructions.

Please share your thoughts with me as MSSNY crafts our response to this welcome overture from Seema Varma and CMS at

Welcome New Members!

On a lighter note, I would like to welcome our new members from Northwell and the General Physician PC, a large, multi-specialty group practicing in northwest New York.

Caveat Emptor!

Thomas J. Madejski, MD 
MSSNY President


All Employers Must Act By October 9, 2018 to Comply With the New York State Mandate Requiring Sexual Harassment Training
On April 12, 2018, New York State Governor Andrew Cuomo signed into law new measures aimed at preventing sexual harassment which require prompt action by all New York State employers, regardless of the number of employees they have. Notable highlights include:

  • Required Sexual Harassment Training. By October 9, 2018, all employers must comply with a requirement of conducting annual sexual harassment training. Training must be in-person and interactive, and computer training will no longer be deemed sufficient to meet the requirement.
  • Mandatory Sexual Harassment Policies. By October 9, 2018, employers must adopt a written sexual-harassment prevention policy and distribute it to employees. New York City will be mandating similar requirements that will be effective in April 2019.

We want to be sure you are aware of this requirement and that it applies to medical societies, hospitals, group practices and to every independent physician who has even one employee.

We have asked attorneys from Garfunkel Wild, P.C., MSSNY’s General Counsel, to be available to help members in meeting the requirement.  Garfunkel Wild has a history of providing clients with sexual harassment training, handling internal investigations, litigating sexual harassment cases as well as drafting and reviewing sexual harassment policies.

Call 516-393-2200 to help your practice meet the requirements. 

Med Marijuana: Prescribe for Any Condition Where an Opioid Could Be Used
The NYS Department of Health finalized its emergency regulation, effective immediately, authorizing prescriptions for medical marijuana for any condition for which an opioid could be prescribed. Permanent regulations will be published Aug. 1 and will be subject to a 60-day comment period.

MSSNYPAC has golf opportunities for physicians available on July 30 and July 31 in the Albany area.  If you are interested in representing MSSNYPAC on either date and can travel to Albany, please inquire by calling 518-465-8085 and ask for Jennifer Wilks.  

We have SIX remaining tickets available for race day in Saratoga Springs.  Please contact Jennifer Wilks at 518-465-8085 to reserve your seat.  Visit for details.

Garfunkel Wild: Free Webinar “Right to Try” on Tuesday, August 7

  • Complimentary Webinar “Right to Try” Act: What You Need to Know
  • When: Tuesday, August 7, 2018
  • Time: 12:00 PM – 1:00 PM EST
  • On May 30, 2018, a new Federal “right to try” act became effective which gives patients with life-threatening conditions the right to use experimental medications without the approval of the Food and Drug Administration. This new Federal law can have a dramatic impact on Physicians and Patients confronting physical illness.

Join us as we explore the consequences and questions of this new law. More information here.

This activity has been planned and implemented in accordance with the accreditation requirements and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Medical Society of the State of New York (MSSNY) and Garfunkel Wild, PC.  MSSNY is accredited by 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 Credit™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

New York State Drug Take-Back Bill Becomes Law
Governor Andrew Cuomo signed the Drug Take-Back Act, which requires pharmaceutical manufacturers to finance and manage the safe collection and disposal of unused medications. The law requires pharmacies with ten or more locations to participate as drug collection sites to help ensure convenient access for residents. The law takes effect in 180 days. Program implementation will begin in mid-2019.

Unused medications accumulate in the home, where they are accessible to potential abusers and a danger to seniors, children, and pets. When improperly disposed down the drain or in the trash, unused drugs contaminate New York waterways and harm aquatic organisms. New York is the fourth state to require manufacturers to fund and safely manage drug take-back, preceded by Massachusetts, Vermont, and Washington, along with 22 local governments throughout the U.S.

The new law designates the New York State Department of Health (DOH) to oversee the program. Notably, the legislation gives pharmacies and other collectors the option to use kiosks, mail-back, or “other” approved systems.

4th Columbia Psychosomatics Conference – Oct 20-21, 2018 NYC
“Healing Unexplainable Pain: Advances in Multidisciplinary Integrated Psychosomatic Care”

Conference: Healing Unexplainable Pain at Columbia Medical Center Oct 20-21
Columbia University Medical Center & Office of Mental Health of the State of New York presents:

4th Columbia Psychosomatics Conference – Healing Unexplainable Pain: Advances in Multidisciplinary Integrated Psychosomatic Care

Lectures and workshops by multidisciplinary world experts in research and treatment of psychosomatic disordersConference Chairs: Alla Landa, PhD, Harald Gündel, MD, Brian A. Fallon, MD, Philip R. Muskin, MD

When: October 20 – October 21, 2018
Where: New York State Psychiatric Institute at Columbia University Medical Center, 1051 Riverside Drive, NY, NY

Advanced registration is encouraged at the number of seats is limited!
For information on CME, complete program, and to register please go here.

Emergency Physicians, Georgia Medical Association Sue Anthem
The Medical Association of Georgia and the American College of Emergency Physicians sued Anthem for denying payment for some emergency department services, according to a Bloomberg report.

A few facts about the lawsuit:

  • The medical groups filed their suit July 17 in Atlanta’s U.S. District Court against Anthem subsidiary Blue Cross Blue Shield of Georgia. The physicians requested the court require Anthem to cover any denied ED claims and to stop its policy.
  • Anthem implemented a new ER policy in Georgia in 2017. Under the policy, Anthem reviews diagnoses after members’ emergency room visits. If the condition is determined to be non-emergent, Anthem may not cover the ER visit. The policy is effective in Kentucky, Missouri, Ohio, New Hampshire and Indiana, according to Bloomberg‘s reading of the lawsuit.
  • In their filing, the physicians claimed, “Providers and patients alike are operating in fear of denial of payment by defendants when patients seek emergency department care.”

FDA: Draft Guidelines That Aim To Make More Drugs Available Without Script
Bloomberg News (7/17) reports the Food and Drug Administration issued a draft guideline that aims to make it easier for patients to access certain common drugs without a prescription. The idea resurfaced in 2012 when the FDA evaluated whether to reclassify treatments for high blood pressure, cholesterol, migraines and asthma as nonprescription. The market for such medicines is vast: Global sales of cholesterol-lowering drugs totaled $7.33 billion last year, according to Bloomberg Intelligence. Slightly more than half of U.S. adults, or about 43 million people, who need cholesterol medication are taking it, according to the CDC. About 75 million Americans, or one out of every three adults, have high blood pressure, though only about half of them have the condition under control, according to the CDC..


Board Announces Technical Specifications for CMS-1500 Initiative
As announced on April 17, 2018, in Subject Number 046-1058 Proposals to Improve Medical Care for   Injured Workers, the New York State Workers’ Compensation Board (Board) will replace the current Board treatment forms: Doctor’s Initial Report (Form C-4), Doctor’s Progress Report (Form C-4.2), Occupational/Physical Therapist’s Report (Form OT/PT-4), Psychologist’s Report (Form PS-4), and Ancillary Medical Report (Form C-AMR) with the CMS-1500 to help reduce paperwork and lower provider administrative burdens. This initiative will leverage providers’ current medical billing software and medical records while promoting a more efficient workers’ compensation system. It is expected that the initiative will roll out in three phases, as follows:

Phase 1: Commencing January 1, 2019:

  • Providers may voluntarily transmit CMS-1500 medical bills (and required medical narratives, and/or attachments as applicable) through an approved XML Submission Partner (“clearinghouse”) to workers’ compensation insurers/payers. Guidance on required medical narratives and attachments is available on the Board’s website. As previously conveyed in Subject Number 046-785, if a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A listing of approved clearinghouses for the CMS-1500 will be posted on the XML Forms Submission section of the Board’s website after each entity successfully completes testing and executes an XML Submission Partner agreement with the Board.
  • Workers’ compensation insurers/payers will accept CMS-1500 medical billing files from clearinghouses and electronically return acknowledgments of receipt of CMS-1500 files. Such acknowledgements (including receipt date) will be forwarded from the clearinghouses back to providers and the Board.
  • The Board will receive CMS-1500 files, narrative attachments and acknowledgements of receipt from clearinghouses in a designated XML format. The CMS-1500 forms and narrative attachments will be combined and displayed in the applicable claimants WCB case folders

Phase 2: On or about July 1, 2019:

  • Workers’ compensation insurers/payers will electronically transmit Explanations of Benefits (EOB) to their clearinghouses upon adjudication of the associated electronic CMS-1500 medical bills. Such EOB data will be forwarded from the clearinghouses back to providers and the Board.
  • The Board will receive EOB data from clearinghouses in a designated XML format.
  • The Board plans to eliminate the requirement for the insurer/payer to file Form C-8.1B or C-8.4 form (to object to full or partial payment of a medical bill) when an EOB for the medical bill was transmitted through the clearinghouse and the Provider may file Health Provider’s Request for Decision on Unpaid Medical Billing (Form HP-1) (based on receipt of EOB).

Phase 3: On or about January 1, 2020:

  • Providers will be required to submit electronic CMS-1500 medical bills (and required medical narratives, as applicable) through their clearinghouses to workers’ compensation insurers/payers and to receive EOBs back through their clearinghouse.
  • Providers will be required to electronically transmit any disputes for unpaid medical bills to their clearinghouse using the Board-prescribed form. The clearinghouses will electronically transmit medical disputes to the Board in a designated XML format. The Board will eliminate Forms C-4, EC-4, C-4.2, EC-4.2, C-4.1, PS-4, C-4AMR, EC-4AMR, OT/PT-4, EOT/PT4 and EC-4NARR forms. Web submission and XML submission of these forms will no longer be available.
  • The Board will establish a hardship exception process for providers who are unable to meet the mandatory electronic reporting requirements.

Visit the CMS-1500 Initiative section of the website to access technical specifications for the CMS-1500 medical billing and associated acknowledgement data and to find periodic updates.

Please direct questions to


NRMP Publishes New Interactive Data Tools for Main Residency Match Applicants
The National Resident Matching Program (NRMP®) is pleased to announce the availability of two new data tools for applicants participating in the Main Residency Match®. The Interactive Charting Outcomes in the Match allows applicants to compare their personal characteristics with those of prior year applicants who did and did not match to their preferred specialties (the specialty ranked first on the applicant’s rank order list).  The At-A-Glance Program Director Survey includes charts and data tables that capture specialty-specific program director feedback on the criteria used to select applicants to interview and rank.

The Interactive Charting Outcomes in the Match and At-A-Glance Program Director Survey can be accessed from the NRMP website.  Both tools complement the complete Charting Outcomes in the Match and Results of the 2018 Program Director Survey published earlier this month. Copies of the complete PDF reports are housed on the Main Residency Match Data and Reports page.


NY Medicaid EHR Incentive Program: Now accepting 2017 Attestations
Effective July 16, 2018, eligible professionals (EPs) may attest 2017 Meaningful Use in MEIPASS at EPs have the option to report on either Modified Stage 2 or Stage 3 measures.

2017 attestations shall be submitted completely online via MEIPASS. EPs do not have to mail hard copies of their 2017 Meaningful Use attestations to the NY Medicaid EHR Incentive Program.

The deadline to attest 2017 Meaningful Use is October 15, 2018. Accommodations will be granted to EPs whose 2016 attestations are still pending review.

MEIPASS video tutorials and reference materials are available at For additional assistance, please contact program support at 1-877-646-5410 or


The Deadline for Submitting MIPS Targeted Review Request Is Now October 1
If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is now available for review on the Quality Payment Program website. The payment adjustment you will receive in 2019 is based on this final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including those who are subject to the APM scoring standard may request for CMS to review their performance feedback and final score through a process called targeted review.

When to Request a Targeted Review

If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00pm (EDT). The following are examples of circumstances in which you may wish to request a targeted review:

  • Errors or data quality issues on the measures and activities you submitted
  • Eligibility issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)
  • Being erroneously excluded from the APM participation list and not being scored under APM scoring standard
  • Not being automatically reweighted even though you qualify for automatic reweighting due to the 2017 extreme and uncontrollable circumstances policy

Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by:

  • Going to the Quality Payment Program website
  • Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data. Please refer to the EIDM User Guide for additional details.

When evaluating a targeted review request, we will generally require additional documentation to support the request. If your targeted review request is approved, CMS will update your final score and associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine the amount of the upward payment adjustments after the conclusion of the targeted review submission period. Please note that targeted review decisions are final and not eligible for further review.

For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.



Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with

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:

For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed built 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


Practice Monitor Sought
Physician licensed in New York practicing Internal Medicine wanted for position as practice monitor for physician actively engaged in the private practice of Internal Medicine in New York State. Generous salary package offered. A total of eight quarterly very brief reports to be made by the practice monitor over a period of 24 months to The New York State Department of Education,

Office of the Professions, Albany, New York 12234. Contact

Paging Primary Care Doctors Who Love Technology
98point6 is a healthcare technology startup that needs your input.  We’re seeking practicing physicians to join our Primary Care Council to help shape the future of primary care.  If the fusion of healthcare and technology inspires you, please join us and apply today. Visit:

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.