MSSNY Pulse: August 19, 2022
Message from MSSNY President Parag Mehta, MD:
MSSNY Helps Our Members Get What They Deserve
Physicians and practices are frustrated with insurance companies denying their claims, reducing reimbursements, and demanding charts. MSSNY is here to help. You can count on us to be your voice in dealing with the insurance companies.
As an example, a member recently reached out to MSSNY after a year’s worth of insurance claims were reimbursed at a significantly reduced rate and the insurance provider was unwilling to rectify the situation. The member physician contacted our Director of Payment and Practice, who negotiated with the insurance provider and helped the practice receive a settlement of $64,000.
This is one of many victories that have led to financial relief for physicians in all types of practice environments, and it is a vital service that we provide at MSSNY. Heather Lopez, MSSNY’s Director of Physician Payment & Practice, is essential in delivering these victories for our physicians. She comes to MSSNY after a long career in the St. Mary’s Healthcare system, where she honed her practice management, billing, reimbursement, and administration skills. If your practice needs help, don’t hesitate to contact Heather for her assistance in practice management, CPT/ICD10 coding, contract negotiation, billing, insurance barriers, and reimbursement methodology. Following are a few examples of the help Heather has provided to MSSNY members over the past few months:
- 9 million takeback from insurance worked down to zero dollars taken back from the doctor
- Contract negotiated from 105/visit to 125
- 64,000 recovery on claims processed significantly under rate
- Multiple claims with multiple insurances that have exhausted appeal process overturned due to processed incorrectly once escalated by me
- Assist in getting offices that are closing storage options for their medical records to ensure HIPAA compliance
- Provide clarity and suggestions for coding questions to multiple members
- Assisted with IPA issue and insurance not paying for over a year on claims, recovered payments
MSSNY is here to help you and your practice. Heather’s expertise is included in the cost of membership and is available to any MSSNY member.
Wellness Corner. “To combat hopelessness and despair, let’s start with hope. We think of hope as being a warm and fuzzy emotion. But that’s actually not true. In fact, being hopeful is a skill that you can learn. Being hopeful comes from being able to set realistic goals, figure out how to meet the goals and believe in your own abilities. Hope comes from encountering adversity and discovering that you can be resilient in the face of it. To learn hopefulness, you need to practice setting goals that you can actually meet.” — Brene Brown, Atlas of the Heart
Read MSSNY Pulse on the App: Look for “MSSNY Pulse” in the App store or Google Play and share your experience. Please email me your comments and suggestions at MSSNYpresident@mssny.org.
Parag Mehta, MD
Learn How to Write the Best Personal Statement for Your Residency Application:
Join MSSNY IMG & EMAS Seminar August 27
The first seminar hosted by MSSNY’s IMG and Ethnic Medical Association Sections launches on August 27, 2022, at 8:30 am. Please join us to learn how to write the best personal statement for your residency application. Leaders in the medical field will teach you how to ensure your statement stands out. View flyer. Register now.
Longitudinal Assessments of Neurocognitive Performance and Brain Structure Associated with Initiation of Tobacco Use in Children, 2016 to 2021
The use of e-cigarettes has surpassed the use of cigarettes and has become the most prevalent tobacco product used by US youths since 2014. In 2020, 19.6% of high school students and 4.7% of middle school students reported using e-cigarettes in the past 30 days.
The landscape of tobacco use has substantially changed in the last decade. E-cigarette products have sleek designs and come in various flavors from candy, mint, fruit, and more. This JAMA study of 11,729 participants sheds light on the association of health effects with early initiation of tobacco use, including e-cigarettes, cigarettes, and other tobacco products.
The results suggest that late childhood tobacco use is associated with inferior cognitive performance and reduced brain structure. These effects were sustained at a 2-year follow-up. Based on these findings, tobacco prevention in youths should be treated as a priority.
Comparison of Radiation Exposure Among Interventional Echocardiographers, Interventional Cardiologists, and Sonographers During Percutaneous Structural Heart Interventions
This recent JAMA study compares head-level radiation doses for interventional echocardiographers with those of interventional cardiologists and sonographer controls during left atrial appendage occlusion (LAOO) and transcatheter edge-to-edge mitral valve repair (TEER) procedures.
Due to the need for intermittent manipulation of the transesophageal echocardiography (TEE) probe during LAAO and TEER, the interventional echocardiographer must stand near the patient, which is the principal source of scatter radiation during fluoroscopically guided procedures. Given the nearness of interventional echocardiographers to the radiation emission source, the authors hypothesize that interventional echocardiographers have increased exposure to higher radiation doses than interventional cardiologists and sonographers.
These comparatively increased radiation doses could reveal a previously underrecognized occupational radiation exposure risk. Long-term exposure to scatter radiation has multiple adverse health effects, including premature cataract formation, early carotid atherosclerosis, and possibly left-sided brain malignant tumors. These adverse health effects could significantly impact the rapidly expanding field of interventional echocardiography.
Comparison of Radiation Exposure Among Interventional Echocardiographers, Interventional Cardiologists, and Sonographers During Percutaneous Structural Heart Interventions (JAMA, 7/7, McNamara, Chopra, Decker).
Digital Healthcare: The Future
Digital healthcare is the future, but will technology help close the healthcare gap? In the Royal College of Physicians’ latest “Future Healthcare Journal,” the author explores the many routes in which healthcare and technology intertwine, predicting changes to the traditional paradigm of clinical history, examination, and differential diagnosis. As technology advances, more data will be collected, improving treatment through machine learning, mobile applications and sensors, wearables, and telehealth.
Advances in technology will lead to better healthcare for some but will it equal the playing field? Patients with poor digital literacy should not be excluded from accessing high-quality healthcare. It is up to the clinician to use technology to deliver the best care for patients, not let it be a factor that separates physicians from patients.
Digital healthcare: the future (RCP, 7/1, Butcher).
New Law Will Require Certain Information to be Provided to Patients with Epilepsy
This week Governor Hochul signed into law a bill (S.67-A, Hoylman/A.3298-A, Epstein) that will require physicians treating a patient for their epilepsy and at elevated risk of sudden unexpected death due to epilepsy (SUDEP) to provide the patient with written materials about the risk of SUDEP. While we continue to have strong concerns with requirements on medical practice, MSSNY and the New York State Neurological Society (NYSNS) worked with the sponsors to greatly improve the final version legislation over earlier versions. These important changes: exempt those providing emergency care from the requirement; narrow the cohort of patients for whom the requirement would apply to only those who truly are at elevated risk for SUDEP; ensure the materials to be distributed would be developed by non-profit organizations with expertise in neurology and epilepsy; and ensure that there are no penalties for an initial non-willful violation of the requirement.
The law will be applicable on or about October 15. MSSNY will be working with the NYSNS to work with the NYS Department of Health to help develop the materials that will be required to share with these patients.
Please Contact Your Members of Congress to Prevent Steep Cuts for 2023
Physicians are urged to contact their Respective Congressional representative and Senators Schumer and Gillibrand (Stop Cuts to Medicare Payments (p2a.co) to urge that they act prevent an 8.5% cut to their Medicare payments in 2023.
Late last year, MSSNY worked together with the AMA and state and specialty societies across the country to successfully persuade Congress to delay a “perfect storm” of Medicare payment cuts totaling 10% that, if permitted to be implemented, would have severely impeded patient access to care. However, these provisions expire at the end of 2022.
MSSNY is again working with the federation of medicine as part of a group effort to prevent the cut. Before the end of the year, we are asking Congress to:
- Extend the Congressionally enacted 3% temporary increase in the Medicare physician fee schedule
- Provide relief for an additional 1.5% budget neutrality cut that is planned for 2023
- End the statutory annual freeze and provide an inflation-based update for the coming year
- Waive the 4% PAYGO sequester necessitated by passage of legislation unrelated to Medicare
If these changes were not going cause enough damage to community physician practices, MSSNY is raising the alarm to CMS regarding a provision in the 2023 Medicare payment rule that would further reduce Medicare payments to New York physicians by decreasing the regional adjustments to Medicare payments arising from New York’s excessively high rents costs and liability insurance costs. MSSNY has been working with the AMA and the Physicians’ Advocacy Institute to ensure that this concern is reflected in their comments to CMS about the Medicare payment rule
Again, you can send a letter from here: Stop Cuts to Medicare Payments (p2a.co)
DFS Announces 2023 Health Insurance Premium Rates, Significantly Reducing What Insurers Requested
New York Department of Financial Services (DFS) Superintendent Adrienne A. Harris, announced this week that the DFS has approved health insurers’ premium rates for 2023. Specifically, DFS took a number of steps to reduce the premiums requested by health insurers for the 1.1 million New Yorkers enrolled in individual and small group plans, including:
- Reducing the average rate increase in the individual market, from 18.7% to 9.7%, which DFS estimates will save New Yorkers $167.1 million.
- Reducing Small Group rates by 52% from insurers’ requested rates, which DFS estimates will save small businesses $632.4 million.
- DFS also noted that it held insurers’ profit provisions to a historical low of 0.5%.
DFS noted that last year, over 60% of individuals enrolled in a Qualified Health Plan through New York State of Health received the federal premium tax credits to lower the costs of premiums and approximately 262,000 New Yorkers are currently enrolled in individual commercial plans.
These rate decisions do not include the Essential Plan, which is available through New York State of Health. As of June 1, 2021, beneficiaries of the Essential Plan, who qualified, were not charged premiums. More than one million New Yorkers were enrolled in the Essential Plan.
You can learn more details about the new rates by visiting go the DFS website.
MSSNY Continues to Urge Governor Hochul to Sign Legislation Requiring Qualified Health Insurer Physician Reviewers
A.879 (Gottfried)/S.8113 (Cleare), would ensure that those who make “medical necessity” determinations on behalf of a health insurance company are appropriately qualified to make those decisions. To demonstrate the need, MSSNY conducted a survey of its members and found the following:
- 86% had a pre-authorization request or claim submission denied by an insurer based on the review of a health care provider that didn’t specialize in their specialty.
- 42% of the respondents frequently had pre-authorization or claim submission from a physician not in the same specialty and 77% at least sometimes did.
- Oncology (cancer care) was the specialty most impacted by this practice.
The bill would prohibit a health plan from denying a patient’s treatment unless the reviewing physician is board-certified, or board eligible, in the same or similar specialty as the physician who originally recommended the treatment under review. It would also require that the reviewing physician have a license to practice medicine issued by New York State.
Please contact Governor Hochul and urge her to sign this important bill into law as soon as possible!
To learn more about this issue, please read an opinion editorial coauthored by Dr. David Eagle and Dr. Jeff Vacirca, which recently ran in Newsday.
President Biden Signs “Inflation Reduction Act” into Law that Continues Expanded ACA Subsidies through 2025
President Biden this week signed into law “The Inflation Reduction Act” that passed the United States Congress last week. Among the bill’s many provisions are an extension through 2025 of the expanded patient subsidies and tax credit provisions for the purchase of private health insurance coverage that had been adopted by Congress in 2021 and were scheduled to expire at the end of the year. According to data from the New York State of Health, over 138,000 New Yorkers have benefitted from these additional subsidies, with a per enrollee savings of $1,453.
Another provision would establish a $2,000 cap on patient cost-sharing responsibilities for Medicare Part D enrollee medications starting in 2025, as well as for the first time permitting Medicare to negotiate a limited number of prescription medications – 10 medications covered by Medicare Part D in 2026, 15 medications covered by Part D in 2027, 15 medications covered by either Part D or Part B in 2028, and 20 medications covered by Part D or Part B in 2029 and thereafter.
Kings County Legislative Day
The Executive Committee of the Medical Society of the County of Kings and the Board of Trustees of the Academy of Medicine of Brooklyn are very proud to invite you to participate in our 2022 Legislative Day during our Bicentennial Year Celebrations. We are grateful for your support and legislative accomplishments to our organization and the physician community over the years.
Join us on Thursday, September 15th, 6:00 -9:00 PM at the Brooklyn Borough Hall, 209 Joralemon Street Brooklyn, NY 11201. RSVP to Joselin Lajara, MSCK Executive Director, by Sunday, September 11th
- Tel: (718) 745·5800
- Email: Exec@msck.org
- Fax: (718·745·5833)
New York State COVID regulation is strictly enforced. Proof of COVID vaccination or negative test 48 hours prior is required.
Is Your Office Having Issues with Medical Records Requests from United/Optum?
Is your office having issues with medical records requests from United/Optum? Have you found your claims denied, requesting medical records, only to have the insurance company send a response advising that they never received them? If yes, please get in touch with Heather Lopez today as MSSNY is working on a unique project to get to the bottom of this issue.
In some cases, offices will send the medical records multiple times, only to have a response of recoupment come back, advising the reason is due to missing medical records. It is time-consuming and cumbersome and needs to stop. To be a part of this project, contact Heather Lopez to work on getting your examples reviewed.
If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | email@example.com
Register Today for the 2022 New York State Suicide Prevention Conference September 20-22, 2022
Social connection is the experience of feeling close to and a sense of belonging with others. A large volume of research with diverse populations and age groups shows that social connectedness is one of the most important factors in determining not only our mental health but also our physical health.
This three-day, virtual conference will bring together internationally recognized experts to summarize the latest prevention science and explain why we should all be more focused on supporting social connection across the lifespan—from early childhood and adolescence through our working and older-age years. Participants will be able to take ideas showcased in the conference back to their diverse communities and begin or build on existing work aimed at supporting healthy social connections.
Who Should Participate:
- Population, community, and public health leaders
- Medical providers, including pediatricians and family practitioners
- Mental health professionals
- Youth-serving organizations, including school administrators
- Employers and unions
- Leaders from the business community
- Elder services organizations
- State and local government officials & policymakers
- Children and family advocacy organizations
- Peers with lived experience and suicide prevention advocacy organizations
MSSNY Job Board
Members have access to the MSSNY Job Board. Whether you are looking for the next step in your career or looking for your next hire, we have you covered!
Health Advisory: Update #2 Regarding Poliovirus in New York State
Click here to access the NYSDOH health advisory regarding Poliovirus for clinical staff in Epidemiology/Infection Control, Emergency Department, Infectious Disease, Neurology, Radiology, Nursing, Internal Medicine, Pediatrics, Family Medicine, Intensive Care, Pharmacy, Laboratory Services, and all patient care areas. Questions? Send an e-mail to firstname.lastname@example.org.
Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate
Rheumatology Practice Sublet – Great Neck, NY
Sublet opportunity available at an established medical office in Great Neck, NY. Prime location near LIJ, Northshore University and St. Francis Hospitals. Fully equipped office with onsite parking and proximity to mass transit. Contact email@example.com for more info.
Medical Office with Ample Patient Parking + 1 Family For Sale in the Most Desired Area of Hollis Hills. Priced to Sell!
One of a kind medical office investment opportunity and growth in the most desirable areas of Hollis Hills! This property is an S1 zoning that allows a medical practice, located within proximity of LIJ and Manhasset hospital, Lake Success Pro Health Medical offices with ample patient parking and much more, this unique property features a residential space split level style with 5 bedrooms, 3.5 baths living room, dining room with a wood burning fireplace, kitchen, oversized sunroom/den, 1 car garage and laundry room.
The Lower level has a separate entrance, 4 exam rooms, a doctor’s private office, filling rooms and endless closet storage.
Conveniently located near schools, worship houses, transportation, GCP, LIE, Cross Island & Clearview Expressway, restaurants, shopping centers and much more! To inquire, please call Claudia (917-554-4158) or Bella at (718-344-2153).
Recruiting for Full or Part time (20 hours per week Chief of Medical Services). Salary is negotiable.
Oversees and directs the planning, implementation, and supervision of health and medical services for residents at the NYS Veterans Home at St Albans. Develops, implements, and evaluates medical treatment standards and procedures; and provides technical and operational guidance and direction to medical and health care staff. Serves as a medical consultant and liaison; and develops recommendations for medical assessments, treatments, and care. Implements and monitors contract agreements and the provision of contracted medical and health related services. Participates in program audits and reviews. Supervises the credentialing and privileging process to ensure that medical staff possess appropriate credentials and maintain appropriate levels of continuing education; and participates in the development of recruitment programs and hiring and selection processes. Provides clinical and administrative supervision and guidance to physicians and other health care professionals. Possession of a license and current registration to practice medicine in New York State and six years of post-licensure medical practice experience, two years of which must have been in an administrative or supervisory capacity. Must be fully COVID 19 vaccinated.
Send CV to: RecruitmentStAlbans@nysvets.org
Office Space To Share / Financial District NYC.
111 John St., Ste 1460, NYC 10038 (between Cliff & Pearl St.)
A block away from the South Street Seaport. Easy access to office Central hub for all subway lines (A, C, 2, 3, 4, 5, J, Z, E), a quick walk from NJ path train.
Beautifully renovated, 1,300 sq ft. modern space. Available Monday, Wednesday, Friday and weekends.
Private rooms with pocket doors. Access to building 24/7, security/door man in the lobby, very safe. Daily rate $450. Contact (917) 514-1299 text/call.
Medical Office for Share in Medical Park with Free Big Parking Lot in Westchester County
Medical office for sublet in Medical Park with free big parking lot, located at West Harrison, border of White Plains in Westchester County. Office includes a big waiting room with a kitchen, doctors office, exam room, and reception area. All rooms are available for whole days of Monday, Tuesday, Wednesday, Saturday, Thursday (Thursday full day on every 1st and 3rd week and Thursday morning on every 2nd and 4th week each month, or we can discuss more options). Monthly rent $600 for once a week usage, $1100 for twice a week usage, $1500 for three-day a week usage. Newly renovated and fully furnished. Text May if you are interested 646-338-4803
Board Certified Internal or Family Medicine Physician
Join our caring team and our mission to provide the highest standard of healthcare to each of our patients. Medical office in Eastern Nassau County looking a for a hard-working, responsible Physician to join our team.
Responsibilities include care for, diagnosing and managing patients.
Please send Curriculum Vitae to firstname.lastname@example.org.
MANHATTAN MEDICAL SUITE FOR SALE –Prestigious Coop on 45 East 62nd St. between Madison & Park!!
This approximately 1100 square foot medical suite has a grand reception area that is large enough for 2 or 3 people to work from. There is an additional nook area currently used for paper chart files that could also be utilized to update charts online or for bookkeeping. The waiting room has approximately 10 ft ceilings and a marble fireplace. The mahogany veneered office also has high ceilings. The reception area and hallway have a drop ceiling that was installed to accommodate duct work for air conditioning. There are 1.5 bathrooms. Medical equipment is also available for sale. The property needs a cosmetic renovation update.
To schedule a showing: melissaA@nestseekers.com or Call: Melissa Alonso with Nestseekers International: 646.403.7311
IDEAL LOCATION: 45 East 62nd – Prime Lennox Hill
PRICE: $1,100,000 with 50% Financing Permitted
Monthly Maintenance: $4775
Rendr – Transforming Healthcare – Leadership Opportunity: Associate Chief Medical Office, SVP of Population Health, Bilingual English and Chinese (Mandarin or Cantonese) preferred
Job Position: Associate Chief Medical Office, SVP of Population Health in this role, you will lead and provide a wide range of support through population health, quality measures, practice transformation, Rendr360 department, House Calls, and other projects. Please send resumes email@example.com. We are offering leadership opportunities to Physicians who are interested in providing high-quality clinical care to our patients in the diverse communities that we serve. As a rapidly growing network, we provide a supportive environment for our physicians to practice medicine under the guidance of dedicated medical leadership. www.rendrcare.com.