October 2, 2015 – Day Two ICD-10 – NGS Reports High Volume

 Dr. Joseph R. Maldonado
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October 2, 2015
Volume 15, Number 37

Dear Colleagues:

Now, we are at Day Two of the transition to ICD-10. This morning, we had a status call with staff at NGS Medicare, the plan with the highest claim volume for New York physicians.

They are happy to report that their systems are functioning well and are accepting claims from yesterday with the new ICD-10 codes. They have asked MSSNY to remind you of two important issues:

  • If there is a national coverage determination (NCD) or a local coverage determination (LCD) for a particular service, you must be sure to use the ICD-10 code listed in the policy in order to be paid. These LCDs and NCDs can be found by doing a search for the medical policy located on ngsmedicare.com
  • When using an ICD-10 code that contains the description of right side or left side, you still must use the RT or LT modifier after the procedure code since all claim processing edits for Medicare are still in effect. Failure to use the RT or LT may result in delayed processing or a denial.

Most importantly, when selecting an ICD-10 code, you must be sure that your medical documentation supports the diagnosis code selected. For example, if the diagnosis code indicates that the service reported pertained to the right eye, the left leg, etc., your medical record must state the same body part and” laterality.” If you need more information, please call or email Regina McNally at 516-488-6100 ext. 332 or email her at rmcnally@mssny.org.

Since MSSNY’s email is not HIPAA-secure, please do not include any patient identification (no PHI).

As we have been telling physicians, the best crosswalk is at http://www.aapc.com/icd-10/codes/

Also, as reported to us by NGS staff this morning, the volume of traffic caused the site to slow down yesterday, so patience may be required.

We are not the government and we are here to help.



Please send your comments to comments@mssny.org


DFS Orders Health Republic to Cease Offering New Health Insurance Policies; More Details About Claims Payment will be Forthcoming
As has been widely reported, the New York State Department of Financial Services has ordered Health Republic to cease writing new health insurance policies and the co-op will commence an orderly wind down after the expiration of its existing policies.  As was noted in the DFS’ 2015 Guide to Health Insurance, Health Republic was the subject of an overwhelming number of consumer and physician complaints and grievances for failure to timely pay claims and other coverage disputes.

MSSNY physician leadership and staff have been in close contact with top officials at the DFS to obtain necessary information that enables physicians to make informed decisions with regard to their practices, as well as to assist patients who may have questions about their coverage.  Please remain alert for further details as DFS together with federal officials complete a thorough examination of the financial wherewithal of Health Republic to pay out its claims.  After the DFS announced the wind-down of Health Republic, MSSNY President Dr. Joseph Maldonado stated the following: “MSSNY will work with the Department of Financial Services, the NYS Department of Health and Exchange officials to be sure patients insured by Health Republic are able to get the care they need and appropriately transitioned to new insurance coverage, as well as to assure that physicians and other providers are fairly and timely paid for the care they provide”.

While Health Republic individual market enrollee contracts will continue until the end of the year, they will not be permitted to offer coverage for 2016, meaning these patients will need to find coverage through other health insurance companies on the State’s Exchange.  Existing Health Republic small group plans – which, unlike individual plans, do not all have calendar-year policy terms – will remain in effect after the beginning of the year, though DFS will be analyzing the ability of Health Republic to continue these contracts. The DFS noted in its press release that “it will evaluate the best course of action with regard to small group plans based on Health Republic’s ongoing financial results. Any future determinations made on small group plans will be announced with appropriate notice to help provide a transition period to new coverage and protect policyholders.”

Anthony J. Albanese, Acting Superintendent of Financial Services, said: “Given Health Republic’s financial situation, commencing an orderly wind down process before the upcoming open enrollment period is the best course of action to protect consumers. Moving forward, we will work closely with New York State of Health and federal regulators to help ensure continuity of coverage for Health Republic’s customers.”

Extensive Insurer Complaint Data Contained in DFS’ 2015 Health Insurance Guide
The New York Department of Financial Services has released its 2015 Consumer Guide to Health Insurance Companies which contains comprehensive information regarding upheld consumer complaints, upheld prompt payment complaints, external appeal data and quality information for various types of health insurance plans offered in New York in 2014. 

Consumer/Provider Complaints

The report showed that Independent Health had the best (lowest) overall consumer complaint ratio among HMOs, PPOs and EPOs operating in New York State.  Independent Health also had the best (lowest) Prompt Payment complaint ratio for its HMO, PPO and EPO products.

Empire had the worst overall consumer complaint ratio and prompt payment complaint ratio among HMO products.   Health Republic had the worst overall consumer complaint ratio among EPO and PPO products, while HIP had the worst prompt payment complaint ratio among EPO/PPO products.

External Appeals

The report showed that there were 1,786 external appeals of health plan coverage denials in 2014, of which 714, or 40%, where reversed either entirely or in part.  The highest number of external appeals, 705, were taken against Empire, of which about 35% (242), were reversed entirely or in part.


Health Republic was the health insurer which overwhelmingly had the highest number of grievances (6,801) filed against it in 2014.  Of the 4,554 closed grievances, 2,405 were found for the patient or provider.   A grievance is a complaint by a member or provider to a health insurance company about a denial based on limitations or exclusions in the contract.  According to the report, common grievances include problems getting referrals to specialists and disagreements over benefit coverage.

Quality Rankings

CDPHP was the HMO that had the highest overall patient rating, and highest patient rating for ease in obtaining appointments with specialists and other needed care.  Oxford was the lowest among HMO products for patient rating, with HIP having the lowest patient rating for ease in obtaining appointments with specialists and other needed care.

United had the highest overall patient ranking among EPO and PPO products, with CDPHP, Empire and HIP close behind.  MVP had the lowest overall patient rating for EPO/PPO products.  CDPHP had the highest patient rating among EPOs/PPOs for ease in obtaining appointments with needed specialists and other needed care, with Excellus and Independent Health close behind.   Aetna was the lowest ranking EPO/PPO for ease in obtaining appointments with specialists and other needed care.

Dr. Joseph Maldonado, president of the Medical Society of the State of New York, said the most common complaints he hears from members are related to claim denials, preauthorization and failure to pay promptly. He said the poor ratings for the largest insurers are consistent with members’ gripes. “It will only get worse with these mergers, because the power insurers exert on physicians is essentially take it or leave it, particularly in the New York area,” he said. [Crain’s Health Pulse, 10/1]

From Socio-Med Division: Info re HITECH EHR Meaningful Use Audits
Not to be the bearer of more bad news, but you need to be aware that MSSNY has been contacted by medical practices who are currently going through a Medicare Meaningful Use audit by Figliozzi and Company.

First, any measure that was attested to with a “yes or no” answer must be corroborated with a screen print as supporting documentation confirming that your system did or did not complete the measure.  However, the screen print MUST have the EHR company logo printed somewhere on the document or it will not be accepted.  Secondly, the Security/Risk Analysis, the practice must provide an actual security risk analysis that was conducted including who conducted the test (i.e., IT Vendor) date of the test, time of the test and the result of the test in report format.  A check list is not enough and will not suffice or be accepted.  From what we understand this risk analysis report must have been done on each computer within the practice.

For more information about these audits, please refer to the following links:

http://www.figliozzi.com/index.htm and https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/ehr_supportingdocumentation_audits.pdf

NYCDOMH: Legionnaires Disease Cluster in Morris Park, Bronx (updated 9/30)
Cases: Reported individuals with Legionnaires: 13; Death associated with the Morris Park cluster: 1; Individuals hospitalized: 11; Discharged from hospital: 1; All patients have underlying health conditions
Highlights: On Sept. 21, when the first case was reported, the Health Department’s disease detectives began investigating immediately.

Since Saturday, environmental scientists visited all cooling towers and took samples. 

Download the Morris Park LD Fact Sheet (PDF)Other languages: [Español]
View the Legionellosis Cluster in Morris Park by Diagnosis Date (PDF)
View the Legionellosis Cluster in Morris Park by Onset Date (PDF) 

NGS Provider Outreach & Education Presents Live Events Part B Providers
The JK Provider Outreach and Education Department is offering live educational events specifically designed for and dedicated to educating our Part B providers. Join us and learn about many topics that will help you prepare compliant and accurate Medicare claims as well as prevent unnecessary claim rejections, returns and denials.

Identical training sessions will be held at various locations. Here is what will be covered:

  • Medicare Part B Updates
  • Common Modifiers
  • Medicare Secondary Payer
  • Global Surgery
  • How to Submit Medicare Claims Correctly and Avoid Costly Denials and Unprocessable Claims
  • Advance Beneficiary Notice of Noncoverage (ABN)
  • Fraud and Abuse/Compliance
  • Reopenings/Appeals

Cost: $100 per participant paid prior to the event; includes breakfast, lunch, and access to printable training materials and provider job aids.

Cancellation Policy: The cost of this session is $100 per attendee. This registration fee can be transferred to another attendee/location if a request is submitted prior to the date of the event. Please submit request for cancellation/refund at least 48 hours prior to the event start time.

Note: No new registrants will be accepted on the day of the session.

Intended Audience: New and established Medicare Part B providers and office staff members who submit claims to National Government Services.

Time: 8:00 a.m.–4:00 p.m. eastern time. Check-in will begin at 8:00 a.m. Schedule includes break for lunch (refreshments/meals provided).

Materials: Will not be provided at the session. A link will be sent with your confirmed registration to the materials that will be used. When printing the materials, we suggest using multiple slides per page to reduce paper.

Credits: Five Medicare University Credits and five Continuing Education Units

Questions about this event can be addressed to maria.petruzziello@anthem.com

Register at www.ngsmedicare.com under the education calendar.

  • East Syracuse- The Hilton Garden Inn, 6004 Fair Lakes Road, on Thursday, Oct. 29
  • East Elmhurst, December 3 @ LaGuardia Airport Marriott, 102-05 Ditmars Blvd., $10 parking

Dr. Michael Simon Appointed to AMA Joint Commission Board
MSSNY congratulates Michael B. Simon, MD, an anesthesiologist from of Wappingers Falls (Dutchess), who has been appointed to the AMA’s Joint Commission Board of Commissioners. Dr. Simon’s term begins on January 1, 2016; he will be eligible for two additional three-year terms. Dr. Simon is past president of the New York State Society of Anesthesiologists (NYSSA) and currently MSSNY’s serves as Chair of Member Benefits Committee.

“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.

A copy of the flyer can be access HERE.  Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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.

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.

MSSNY to Conduct Three E-Prescribing Webinars This Fall
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 13 at 12:30 pm. Registration is now.

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 am. 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 mhardin@mssny.org or Terri Holmes at tholmes@mssny.org.

E-Prescribing Of All Substances Required By March 27, 2016
Physicians and other prescribers are reminded that New York State’s e-prescribing requirements for non-controlled and controlled substances will go into effect on March 27, 2016. The NYS Department of Health’s Bureau of Narcotic Enforcement has provided information to physicians and other prescribers to assist them in their transition to electronic prescribing. Practitioners should continue their efforts to become compliant with the law, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances (EPCS), and registering their certified software applications with the Bureau of Narcotic Enforcement.  According to state officials, over 22,000 prescribers have registered their systems with DOH.

For physicians who prescribe controlled substances, there are additional steps to complete in order to electronically prescribe controlled substances. These include the following:

  1. The software you currently use must meet all the federal security requirements for EPCS, which can be found on the Drug Enforcement Agency’s (DEA) web page.

Note that federal security requirements include a third party audit or DEA certification of the software.

  1. You must complete the identity proofing process as defined in the federal requirements. Third, you must obtain a two-factor authentication as defined in the federal requirements. Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found HERE.

EPCS systems must be registered through the ROPES system. ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

  • Login to the Health Commerce System (HCS) at https://commerce.health.state.ny.us
  • Under “My Content” click on “All Applications”
  • Click on “R”
  • Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

EPCS became permissible in New York State and over 90% of the pharmacies can now accept e-prescribing for controlled substances, according to officials from BNE.

DrFirst and MSSNY have partnered to bring MSSNY members the industry’s leading e-prescribing solution at a special discounted price and information on this program can be found here.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so before January 1. The waiver process will be electronic.   Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance.  DOH has indicated that more information on the waiver process will be available shortly.

E-prescribing of non-controlled substances is also required under the law; however, registering of this system with the state is not necessary.   The 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.

Information regarding e-prescribing may be accessed at the following links:




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:
medicmiche@aol.com or hrld_weissman@yahoo.com 

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 wnyllc@aol.com.

3 exam rooms; one consulting room;  large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.