IHCAP Notice Requirement for Physician Offices

The New Jersey Department of Banking and Insurance (DOBI) recently adopted regulations requiring physician offices to post notice regarding patient rights under the Independent Health Care Appeals Program (IHCAP). MSNJ provided comments to DOBI on the proposed regulations requesting that the notice include language that clarifies that IHCAP may not apply to all patient plans. We thank DOBI for honoring our request. Note that IHCAP does not apply to most government-sponsored coverage, such as Medicare, the Federal Employee Health Benefits Program, the New Jersey State Health Benefits Program and self-funded plans according to DOBI. The notice language may be downloaded from DOBI’s website. The notice must be posted by August 3, 2014, include the specific content from DOBI’s website, and be printed on at least 8 ½” by 11″ paper with 12-point type or larger. Physicians may choose to print it on larger paper, in order to incorporate all the information on one sheet; in this case the text must also be at least 12-point type. MSNJ created a one page sample notice, for member use. Please feel free to download, print, and post this legal sized (8 ½” by 14″) poster in your office.

We also recommend that practice’s also have available, the plans that DOBI has excluded from the IHCAP appeal process. This information can be found on the DOBI website FAQ number 25 or downloaded here.

Sunshine Act Update: Open Payments Registration and Review/Dispute Process Began July 14

Registering in the Open Payments system is voluntary, however, it is a mandatory process if physicians want to review and dispute the data submitted by manufacturers and group purchasing organizations (the Industry) before the data is posted to the public on September 30, 2014. Any data disputes must be filed on or before August 27, 2014, in order to be reviewed and possibly corrected by the Industry which before going public, will be able to submit dispute corrections beginning August 28 through September 11. Please Note: Registration is a two-step process. Physicians must first register for the Enterprise Portal before registering for the Open Payments System. View MSNJ’s archived webinar regarding the complicated Enterprise Portal registration process. Read more on how to prepare for the review and dispute process. View AMA’s Sunshine Act resources.

CMS’ MLN Connects™ will host a National Provider Call on July 22 on this topic. Listen to a brief introductory presentation about Open Payments and an overview of the registration and review and dispute process. Register.

Register for MSNJ’s upcoming webinar that will provide an in depth look into: The Sunshine Act – Financial Interest Data Disclosure: Refuting Open Payments Data
Wednesday, July 30, 2014 from 12:00pm-1:00pm
Register online.

Key Provisions of Proposed Medicare Physician Fee Schedule for 2015

CMS published its proposed rule on Medicare’s payment schedule and policies on July 11. Comments on the proposal are due on September 2. Key changes in the proposal include:
• Doubling the value-based modifier (VBM) penalties to 4% and subjecting all physicians to 2017 VBM adjustments based on performance in 2015;
• Extending the VBM to ACOs and other alternate payment models;
• Eliminating global surgical services by 2018;
• Reducing the opportunity for comment, review time, and implementation for changes in local coverage determinations (LCDs) for clinical laboratory tests;
• Expanding reimbursement for telehealth services under certain circumstances to include psychotherapy services, prolonged services, and annual wellness visits in 2016;
• Reimbursing for chronic care management services on a per patient per month basis when certain conditions are met; among other things, beneficiaries must have two or more serious chronic conditions;
• Expanding public reporting of group-level measures in Physician Compare in 2016 and, if feasible, expanding measures for individuals making all 2015 PQRS individual measure collected via registries, EHR, or claims available on Physician compare in late 2016;
• Increasing the requirements for successful PQRS reporting and imposing a 2% penalty in 2017 for those eligible professionals who do not report satisfactorily in 2015. Read more details in AMA’s Summary of Key Provisions.

Note that CMS supports legislation to permanently address the SGR, but rates are only protected from payment cuts through March 2015 at which time payments will be reduced by over 20% if Congress does not act.

Important EHR Incentive Program Deadlines

This is the last year (2014) that Eligible Professionals (EPs) can start participating in the Medicare EHR Incentive Program to receive incentive payments. EPs who begin participation in the Medicare EHR Incentive Program after 2014, will not be able to earn an incentive payment for that year or any subsequent year of participation. If you choose to participate in the program for the first time in 2014, you should begin your 90-day reporting period no later than July 1, 2014 and submit attestation by October 1, 2014 to avoid the payment adjustment in 2015. Read more.

If you were unable to successfully demonstrate meaningful use for 2013 due to circumstances beyond your control, CMS is accepting applications for hardship exceptions to avoid the penalty for the 2013 reporting year. Applications for individual eligible professionals and eligible professionals submitting multiple NPIs are available. CMS will review the application to determine whether or not you are granted a hardship exception. Applications for the 2015 penalty are due July 1, 2014. If approved, the exception is valid for one year. Use CMS’ new interactive tool for eligible professionals to help determine if you will avoid the penalty by demonstrating meaningful use. Tipsheets are available on the CMS website. Use this timeline  to determine which year you will demonstrate Stage 1, Stage 2 and Stage 3 of meaningful use.

CMS and the ONC released a Notice of Proposed Rulemaking (NPRM) allowing providers participating in the EHR Incentive Programs to use the 2011 Edition of certified electronic health record technology (CEHRT) for calendar and fiscal year 2014 and extending Stage 2. Read more.

BME Issues Certificate of Waiver to Carry Out Overdose Prevention Act

The Overdose Prevention Act, which is meant to reduce overdose related deaths by encouraging victims and witnesses of overdose to obtain medical care without criminal or civil liability, supports distribution of Naloxone to those considered at risk for opioid overdose, as well as to their friends, family, or first responders. The Act allows physicians to prescribe Naloxone with civil, criminal, and professional disciplinary immunity.  

The NJ Board of Medical Examiners (BME) recently approved a regulatory proposal that explains physician rights and responsibilities under the Act. The BME issued a Certificate of Waiver to all licensed physicians in order to expedite operation of the Act, while the proposed rules are promulgated. The waiver explains that physicians may issue Naloxone prescriptions to family, friends, or first responders without requiring examination or follow-up of the at risk individual.

Sunshine Act: Payment Data to be Published September 30; MSNJ Objects to Timing & Dispute Resolution Process

The Sunshine Act requires that transfers of value in the amount of $10 or more from the pharmaceutical industry to physicians be tracked and reported by the industry in a database that will soon be made public. MSNJ supports transparency but has a long history of objecting to this requirement believing that the administrative burden on physicians of tracking and verifying the di minimis value of a lunch outweighs the usefulness of this reported data to the public. MSNJ’s delegation to the AMA will advocate that the threshold reporting amount be increased to $100 at the AMA Annual Meeting in Chicago this week. Meanwhile, implementation of the program dubbed the “Open Payments Program” continues:

  • Step 1: Beginning June 1 physicians were able to register in CMS’s Enterprise Portal;
  • Step 2: Beginning in July physicians must take the second registration step to register in the Open Payments system (via the CMS Enterprise Portal)
  • Step 3: Once the information is available, physicians will have a 45 day period to review and dispute the payment information
  • Step 4: On September 30 the public will be granted access to the database.

Physicians will only have 45 days to review and to attempt correction of any reporting errors. Under the final rule on plan implementation, physicians and the industry would then have an additional 15 days to resolve disputes or the payment at issue would be flagged as “disputed.”  However, CMS and the Office of Management & Budget (OMB) have proposed that industry be allowed to unilaterally dismiss physician disputes; the payment amounts at issue would be reported without a dispute flag. MSNJ objects to the proposal that would allow industry to unilaterally dismiss a dispute. On June 2 MSNJ filed comments with CMS asserting that the proposal contradicts the final implementation rule and violates physicians’ due process rights. We further urged CMS to delay release of the database to the public for at least six months to give physicians more time review the reported payments.

Physicians are urged to take the above two registration steps and to begin reviewing payments attributed to them as soon as possible. This will be a challenge because physicians will be seeing this data for the first time. Physicians are urged to participate in CMS’s webinar on June 12 that will further explain the process. Register online. MSNJ has developed a webinar with Jennifer Searfoss, Esq., a nationally recognized healthcare attorney and practice management consultant, who will describe the program, and its pitfalls, on June 19. Register online.

View more resources on Open Payments.

Statement by Paul J. Carniol, MD – 222nd President of the Medical Society of New Jersey:

May 22, 2014

“May is Melanoma/Skin Cancer Detection and Prevention Month and the statistics are sobering. According to the Centers for Disease Control and Prevention (CDC), skin cancer is the most common form of cancer in the United States and about 1 in 5 Americans will develop skin cancer in their lifetime. An estimated 2,530 New Jersey residents were diagnosed with melanoma in 2009 alone.

In addition, a recent survey by the American Academy of Dermatology determined that young adults are not aware of the dangers of tanning beds and how to properly protect their skin from sun damage. Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for teens and young adults 15-29 years old.

As Memorial Day weekend approaches and the start of the summer season begins, remember to seek shade whenever possible, cover up, wear a hat and sunglasses and always use sunscreen. Remind your friends and family members – young adults in particular – about the consequences of all types of tanning, including the risk of skin cancer. Stay safe and have a happy and health summer!”


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