Tag Archive | healthcare

Practice Alert! October 1 Notice Requirement under the Affordable Care Act

Employers covered by the Fair Labor Standards Act are required to provide notice to employees of the existence of the Health Insurance Marketplace (previously Exchange) by October 1. 

Any business with gross revenue of $500,000 or more is covered, so virtually all medical practices will be required to give the notice. Read the Department of Labor’s (DOL) FAQ. The DOL has two recommended forms, one for employers who provide health insurance and one for employers who do not provide health insurance. While some advisors have warned of a per day penalty for failure to report, there is no penalty. This notice is required by the labor laws even though other employer obligations to report and make payments under the Affordable Care Act have been delayed for a year.

Read the DOL guidance document. The purpose of the notice is to inform all employees  of the Health Insurance Marketplace; indicate if the employer plan’s share of the costs of benefits is less than 60% then the employee may be eligible for a premium tax credit; and that if the employee purchases a plan in the Marketplace that he/she may lose the employer’s contribution to the plan offered by it.

Practice Alert! October 1 Notice Requirement under the Affordable Care Act

Employers covered by the Fair Labor Standards Act are required to provide notice to employees of the existence of the Health Insurance Marketplace (previously Exchange) by October 1. 

Any business with gross revenue of $500,000 or more is covered, so virtually all medical practices will be required to give the notice. Read the Department of Labor’s (DOL) FAQ. The DOL has two recommended forms, one for employers who provide health insurance and one for employers who do not provide health insurance. While some advisors have warned of a per day penalty for failure to report, there is no penalty. This notice is required by the labor laws even though other employer obligations to report and make payments under the Affordable Care Act have been delayed for a year.

Read the DOL guidance document. The purpose of the notice is to inform all employees  of the Health Insurance Marketplace; indicate if the employer plan’s share of the costs of benefits is less than 60% then the employee may be eligible for a premium tax credit; and that if the employee purchases a plan in the Marketplace that he/she may lose the employer’s contribution to the plan offered by it.

Federal Government Creates Public-Private Healthcare Fraud Partnership

This week, the U.S. Attorney General and the Secretary of Health & Human Services announced the launch of a partnership between the federal and state governments, private healthcare insurance companies and other healthcare anti-fraud groups to prevent healthcare fraud. The effort is aimed to safeguard healthcare dollars.

The partnership will share information to improve detection of fraudulent healthcare billing.  “A potential long- range goal of the partnership is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect healthcare fraud schemes.” [Press Release, U.S. Dept. of HHS (July 26, 2012)] According to the Secretary of Health & Human Services, by sharing information across payers—public and private– potential fraudulent activity can be stopped:

In the past, we followed a ‘pay and chase’ model, paying claims first – then only later tracking down the ones we discovered to be fraudulent. … Since we have put this system in place, it has stopped, prevented, or identified millions in payments that should never have been made. And because the system is designed to get smarter over time, as it analyzes more data, it’s only going to be more effective in the future. [Speech of Secretary of U.S. HHS (July 26, 2012)]

The Affordable Care Act permits enhanced screening of physicians who treat Medicare and Medicaid patients and the suspension of payments to physicians engaged in suspected fraudulent activity. This public-private partnership will build on these fraud prevention tools.

The Federal Government has recovered fraudulent payments of $10.7 billion over the past three years. Read more about fraud prevention under the Affordable Care Act.

MSNJ Member in the News: “New Brunswick & Lumberton Physicians Share Health IT Story in the Nation’s Capital”

Now that Drs. Frank Sonnenberg, Robert Wood Johnson Medical Group, and Kennedy Ganti, Virtua Lumberton Family Physicians, have successfully implemented their electronic health record (EHR) systems, they are ready to share with the rest of our nation’s healthcare community how this technology has improved patient care. Dr. Sonnenberg (New Brunswick, NJ) and Dr. Ganti (Lumberton, NJ) are two of 82 healthcare providers from across the country whose progress in health IT will be recognized by the White House and Health and Human Services (HHS) at two events in Washington, D.C. on June 18-19, 2012.

NJ Health IT Coordinator, Colleen Woods, acknowledges, “Dr. Ganti and Dr. Sonnenberg are two of our great Health IT leaders in New Jersey.  They are remarkable physicians who saw the benefit of EHR’s early on, and seized the opportunity to improve their patients’ care.  They are an inspiration to all of us working in healthcare.”

The New Jersey Health Information Technology Extension Center’s (NJ-HITEC) Executive Director, Bill O’Byrne adds, “NJ-HITEC is very proud of the hard work and excellent example that Drs. Sonnenberg and Ganti have set in the community of doctors. They have earned this distinction and we celebrate in their achievements that advance the timely delivery of high quality medical care to the people of this State. It should also be noted that these two fine doctors are also representatives of the thousands of doctors that are NJ-HITEC members that have also committed to improving the delivery of healthcare to their patients through the use of health information technology.”

The HHS Office of the National Coordinator for Health IT (ONC) is hosting a Health IT Vanguard Conference in which a variety of health care professionals will share lessons learned in adopting and implementing electronic health records. As designated MUVers, Dr. Sonnenberg, Dr. Ganti, and others of the Meaningful Use Vanguard (MUVers) will discuss solutions for a variety of health IT barriers, including privacy and security and the challenges of building systems that can “talk to each other.” Some will discuss ways of leveraging health IT to promote better health in communities. MUVers throughout the country have been recognized for their leadership in local efforts that will eventually move the nation toward an electronically enabled healthcare system.

Dr. Sonnenberg explains, “One of the biggest challenges we face in the implementation of healthcare information technology is the disconnect from providers who are using a different types of EHR technology.  Even if two physicians are using the same technology, there can still be difficulties in sharing information.  We need to discuss and adopt a universal interchange.”

Dr. Ganti adds, “Meaningful Use is the single most important initiative since President Lyndon B. Johnson’s Great Society programs in the 1960’s.  The ability to view and harness the vast amounts of health information through EHR technology assists doctors in providing true comprehensive care.  Moreover, my patients leave with their personal healthcare summary so they can review what was discussed during their visit.  This is so important because in the 10 to 15 minutes that a patient spends with a doctor, so much information is reviewed.  The patient healthcare summary provides the status of an individual’s health, past and current medication lists as well as referral information to further engage a person in his/her healthcare management.

At the White House Health IT Town Hall on June 19, senior White House and HHS officials will discuss progress and barriers to a national Health IT system with MUVers in attendance. In addition to discussing the Meaningful Use of EHRs, providers will share their insight on the important role that Health IT programs, such as the Regional Extension Centers (RECs), have played in helping them implement EHR technology. Over 132,000 primary care providers, almost half in the country, are partnering with RECs to overcome the significant barriers that primary care and rural providers face in EHR adoption.

O’Byrne states, “We are the Garden State’s sole Regional Extension Center working with providers to assist them in achieving Meaningful Use.  With a membership close to 6,000, we have assisted over 835 providers successfully achieve Meaningful Use.  These providers have received over $15 million federal incentives. We are committed to a health IT and assisting our members improve healthcare in New Jersey through EHR technology.”

About NJ-HITEC
NJ-HITEC is the primary care provider’s trusted advisor in the timely delivery of high quality healthcare through the selection, implementation, and achievement of Meaningful Use of an accredited Electronic Healthcare Record (EHR) system. NJ-HITEC is the federally designated Regional Extension Center (REC) for New Jersey established by the New Jersey Institute of Technology (NJIT) and funded through the Office of the National Coordinator (ONC), U.S. Department of Health and Human Services.  To learn more about NJ-HITEC or to become a member, visit us at http://www.njhitec.org or call (973) 642-4055.

NJ-HITEC Media Contact:  Denise Anderson, denisea@adm.njit.edu, 732-618-3867.

MSNJ’s Marathon for Out-of-Network Physicians – President’s Message: June 22

By Dr. Mary Campagnolo, MSNJ President

MSNJ is “running a marathon” to protect the rights of out-of-network physicians to continue to provide medical treatment and be adequately compensated. We have actively advocated on this issue for years, not just for physicians, but also to ensure that patients may avail themselves of the benefits for which they have paid dearly.

We have:

  • Stopped a bill that would have criminalized the waiver of deductibles and co-insurance
  • Convinced the sponsor of the pending bill to remove a provision that could have forced facility-based providers to accept any payment offered by an insurer.

To come this far, we have:

  • Testified twice in 2012 and three times in 2011
  • Held dozens of meetings with legislators and stake-holders
  • Participated in a multi-member coalition
  • Provided written testimony on recent amendments to pending legislation.

In the words of John Poole, MD, the Chair of MedAC and JEMPAC and Secretary of AMPAC, on the issue of pending out-of-network legislation, “this is a marathon and we are only at the beginning of the race.”

MSNJ chose to submit written comments to be introduced into testimony on Monday, June 18, before the Assembly Financial Institutions & Insurance Committee on A-2751, legislation that seeks to reform how out-of-network care is delivered and paid for. Our representatives, who were present at the committee, signed-in to oppose the legislation and delivered our written comments on the amendments under consideration that day.  We were able to do so because Monday’s committee amendments were available on June 7 to MSNJ, and the coalition of physician groups which has been advocating on this issue for several years. The amendments were discussed and analyzed extensively during MSNJ’s open-to-the-public Board of Trustees meeting on Sunday, June 10.

MSNJ has been a leader on this issue since its outset, which is why we are recognized by policy makers as one of the most prominent stakeholder representatives in the debate. Our leadership goes far beyond committee testimony.  MSNJ empanelled our own working group of out-of-network providers in early 2010 to provide guidance on this issue. We are part of a multi-member coalition that has actively advocated for out-of-network physicians, in the trenches, for years. We participated in dozens of meetings with legislators and stakeholder groups prior to the initial introduction of this legislation, and worked hard to defeat less favorable bills, such as one that would have criminalized the waiver of co-insurance.  In fact, it was our testimony last month that convinced the sponsor to remove a provision that could have forced facility-based providers to accept any payment offered by an insurer.

We’ve met countless times with our coalition partners, specialty societies, ambulatory facility representatives, and the New Jersey Hospital Association to help foster and preserve a unified provider voice. We delivered our message to the Speaker of the Assembly, Senate President, and Senate and Assembly Minority Leaders more times than anyone can accurately recall.

Our 246 years of advocating for physicians gives us the experience to know that this is not a sprint. The time we’ve spent on this issue gives us the wisdom to recognize that while the bill was improved on Monday, its impact as written remains very much the same and deserving of our continued opposition. Our steadfast leadership on behalf of all physicians continues to give us confidence that the outlier business practices of a small number of out-of-network providers can be addressed in legislation that doesn’t harm the vast majority of physicians who are billing in good faith.

MSNJ has been and will continue to be your voice before the legislature, administration, and the courts on this and all other matters impacting your practice, profession and patients.  We appreciate your faith and support, and look forward to our continued advocacy success together.

Read archived updates on MSNJ’s advocacy efforts on this issue.