ICD10: One Year Fiscal Reprieve!!!!! – July 10, 2015

 Dr. Joseph R. Maldonado
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July 10, 2015
Volume 15, Number 26

Dear Colleagues:

This week, we received news that our efforts to get some relief from the onerous outcomes for implementation of ICD-10 in October had met with positive action.  Officials at the CMS announced that for a period of one year, physicians would not incur any penalties or delays in payment as a result of incorrect use of the ICD-10 codes.

Thanks to all of you that assisted us with the efforts advanced by the Big Four (California, Florida, New York and Texas) and the AMA.  After sending the Big Four letter, we had a conference call with CMS representatives who listened to the Presidents of the four state societies as well as others.  We relayed our concerns regarding the onerous nature of implementation at a time when physicians are trying to grapple with other reform efforts.  We explained our reasoning for a two-year grace period during which physicians would have to utilize the ICD-10 codes for billing but would not be penalized for errors in the use of ICD-10 codes.  The rationale and justification seemed to resonate with CMS as we have received a grace period– albeit of one year.

The specifics of the announcement are:

  • For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.  In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes.  This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
  • To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
  • CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
  • CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation. 

The granting of this one-year grace period does not mean our advocacy efforts are completed.  Congress is still in session and it is important we continue advocacy efforts to insure the proposed changes are implemented as regulation.  In addition, efforts are needed to attain relief from commercial payers.  .

With less than 100 days to go until the go-live date of October 1, physicians should be testing ICD-10. If not, you need to get going now. Please make the most of CMS’ one-year grace period and tap the additional resources now offered by AMA and CMS. Also, our MSSNY website offers additional resources on our home page to bring your office up to date.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org




No Change in MLMIC Rates for 2015-2016; 5% Dividend Will Apply to Renewals
MLMIC has just been informed by DFS that they have approved MLMIC’s physician rate request for no base rate change effective July 1, 2015. There were no requested specialty or territory rate changes.  The 5% dividend can now be applied to the July 1, 2015 renewals to provide financial relief to renewing policyholders. If you have any questions please contact MLMIC at 1-888-793-0393.

CMS Proposes End-Of-Life Counseling Payment
On Wednesday, July 8, CMS stated that Medicare plans to reimburse physicians for having discussions with patients about advance care planning. The proposal, which was included in the agency’s 2016 physician payment rule, was praised by advocates and medical groups.

Dr. Patrick Conway, chief medical officer for CMS, said, “We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team.” According to the article, the plan would allow “qualified professionals like nurse practitioners and physician assistants,” as well as physicians, to be reimbursed for face-to-face consultations with a patient and any relatives or caregivers the patient chooses to include. Dr. Conway said a final decision on the proposal will be made by Nov. 1.

CMS is seeking public comment on the proposal until Sept. 8 at rule. In particular, CMS is asking for feedback on whether the payment for end-of-life conversations should be part of annual wellness exams. You may submit electronic comments on this regulation to www.regulations.gov. Follow the instructions for “submitting a comment.”

Urologist Calls for Personalized PSA Screenings for Prostate Cancer
In the New York Times (7/6, Kapoor), urologist Deepak A. Kapoor writes an op-ed calling for changes to guidelines in prostate cancer screening, which have been discouraged since 2012 for patients without symptoms of the disease. Dr. Kapoor cites improvements in screening techniques that can better predict prostate cancer risk and the need for further testing. Kapoor explains that the 2012 guidelines stemmed from the fact that prostate-specific antigen testing may lead to unnecessary surgery among patients who did not have prostate cancer or whose cancer was likely to remain dormant. He warns that an increase in prostate cancer mortality, though not yet identified, “may be a matter of time,” as “one study concluded that annual prostate cancer deaths may increase as much as 5 percent, for the first time in more than 20 years.” Finally, Dr. Kapoor recommends that men over 40 continue to pursue PSA testing and develop a personalized screening plan, rather than avoid the test altogether.

Dr. Kapoor is Chairman and CEO of Integrated Medical Professionals, a multi-specialty group of 100 physicians in the greater New York Metropolitan. IMP is one of a growing number of physician groups that have adopted a policy of 100% membership in MSSNY and their county medical societies. 

Applications Due July 31 for Physician Practice and Repayment Programs
The NYS DOH, Office of Primary Care and Health Systems Management is pleased to announce that applications for Cycle IV of the Doctors Across New York (DANY) Physician Practice Support and Physician Loan Repayment Programs will be accepted beginning July 8 through July 31, 2015.

Physician Practice Support (PPS) provides up to $100,000 in funding to support for new practices, improvements, loan repayment or other support to physicians in exchange for a two year service commitment to provide health care in an underserved region within New York State.

Physician Loan Repayment (PLR) provides up to $150,000 in loan repayment funding in exchange for a five year service commitment to provide health care in an underserved region within New York State.

Application materials can be found on the Department of Health website here.

All applications must be submitted electronically (in PDF) to gme@health.ny.gov

Questions should be directed to: Physician Practice Support-Lianne Ramos at 518-473-3513 or gme@health.ny.gov or Physician Loan Repayment: Amy Harp at 518-473-7019 or gme@health.ny.gov

Update to Physicians Advocacy Program from KACS Law Firm
Kern Augustine Conroy & Schoppmann, P.C. is proud to announce that the Physician Advocacy Program® has expanded to include the new Premier Partner Program.

The Premier Partner Program, as a stand-alone program, or an addition to your current Physician Advocacy Program® membership, will provide members with immediate access to their own expert health law defense team, in case of a legal investigation, as well as trusted advisors to build proactive solutions regarding Asset Protection, Estate Planning, HIPAA Compliance as well as Billing and Coding Documentation for reimbursement. Premier Partner Program.

CMS Proposes Revisions to Two Midnight Rule to Give Physicians More Discretion
To respond to physician and hospital concerns regarding the “two midnight rule”, CMS has proposed to allow hospitals on a case-by-case basis to receive Part A reimbursement for patients whose stay is expected to last less than two midnights.  To read the CMS release, click here.  According to the release, for stays expected to last less than two midnights – CMS proposes the following:

  • For stays for which the physician expects the patient to need less than two midnights of hospital care (and the procedure is not on the inpatient only list or otherwise listed as a national exception), an inpatient admission would be payable under Medicare Part A on a case-by-case basis based on the judgment of the admitting physician.  The documentation in the medical record must support that an inpatient admission is necessary, and is subject to medical review.
  • CMS is reiterating the expectation that it would be rare and unusual for a beneficiary to require inpatient hospital admission for a minor surgical procedure or other treatment in the hospital that is expected to keep him or her in the hospital for a period of time that is only for a few hours and does not span at least overnight.  CMS will monitor the number of these types of admissions and plans to prioritize these types of cases for medical review.

Under the current two-midnight rule, a physician can treat Medicare beneficiaries as inpatients only when the hospital stay is expected to span two nights — from one midnight to the next — or longer.  Implementation of the rule has been delayed multiple times by Congress, including through September 30 as part of the MACRA legislation enacted this past spring.

Medicare Physician Fee Schedule on Line
Effective July 1, 2015, please be aware that the new Medicare Physician Fee Schedule is up on-line at www.NGSMedicare.com Although the increase is only 0.5%, it is an increase.  Please be sure to have your staff review the appropriate fee schedule for your locality at your earliest possible convenience.  Again, there is a 0.5% increase that became effective July 1, 2015.

Study: Medicaid Recipients Using Multiple Pharmacies Made Up Nearly Half of All Deaths Resulting From Narcotic Pain Medicine Overdose
Nearly half of all deaths resulting from an overdose of narcotic painkillers involved Medicaid recipients who used multiple pharmacies to fill their prescriptions, according to a study published in the Journal of Pain and conducted by CDC researchers. After examining “the records of more than 90,000 Medicaid recipients aged 18 to 64, who were long-term users of narcotic painkillers,” researchers found that “patients who used four pharmacies within 90 days…had the highest odds of overdosing.” http://www.jpain.org/article/S1526-5900(15)00530-1/abstract

Calling All Amateur Photogs for MSSNY’s Social Media Feeds
We’d like to include more happenings from around the state in our Twitter, Facebook and Instagram feeds. If you’re at an event that you think might be of interest to our followers, please snap a picture with your phone and send to jvecchione@mssny.org.  Be sure to include a caption or some identifying words. We’re open to any and all ideas and hope to hear from you!