Tag Archive | msnj

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.

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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.

Medicaid Agrees to Retroactive Payment to January 1

Medicaid has agreed to pay certain resubmitted claims retroactive to January 1 in response to an MSNJ request. In January 2013, the Medicaid program required that all physicians who order, refer, or attend Medicaid beneficiaries, but do not bill for their services, enroll in the program as non-billing providers. The program confirmed to MSNJ that enrolling will not cause a physician to become a participating provider, but it will allow participating providers to be paid and will bring the program into compliance with the Affordable Care Act.

MSNJ subsequently received complaints from Medicaid participating providers who are not being paid due to the ordering/referring physician’s failure to enroll as a non-billing provider. In April MSNJ requested that the Medicaid program “consider making an exception that allows for resubmission of claims for payment once the non-billing provider has enrolled.”  The program recently advised that the treating physician may resubmit denied claims after the ordering/referring physician enrolls as a non-billing provider.

In 2013, non-billing provider enrollment will be retroactive to January 1, 2013. In 2014 and going forward, non-billing provider enrollment will be retroactive to one year prior to receipt of the enrollment application. For instance, a non-billing provider who submits an enrollment application on March 15, 2014 will be retroactively enrolled back to March 15, 2013. This is to allow participating physicians enough time to resubmit claims within the timely filing limit (up to one year).

MSNJ appreciates the Medicaid program’s response to our request.

Congress Must Act to Avert Medicare Fee Cuts Before January 1

The annual rite of organized medicine seeking congressional action to avert steep Medicare fee cuts before January 1 is upon us. However, this year is different. Not only is a 27% fee cut scheduled to occur because of the flawed SGR formula, but physicians will also be subject to an additional 2% fee cut under the sequestration. Next week Congress and the President will return to Washington to face the fiscal cliff, in addition to resolving the annual Medicare fee issue. In anticipation of this, MSNJ joined virtually all of organized medicine to support SGR Transition Principles in personal letters to the New Jersey delegation. We previously gained the personal support of many of our delegation. (See MSNJ e-News dated February 16, 2012). Members are asked to watch for a strategically timed grass-roots “call to action” on this issue.

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 Press Release: Affordable Care Act (ACA) Supreme Court Decision

Today’s Supreme Court decision finding the Affordable Care Act (ACA) constitutional will have a significant impact on healthcare delivery in the United States.

While the Medical Society of New Jersey (MSNJ) did not support the passage of national healthcare reform legislation, largely because it did not address the sustainability of the Medicare and Medicaid programs and tort reform, MSNJ has a long history of supporting access to both affordable healthcare and affordable healthcare insurance.

Earlier this year, MSNJ supported the creation of a Health Insurance Exchange (Exchange) in New Jersey. This could increase competition and remove barriers in the healthcare insurance market so that more uninsured New Jersey residents may purchase affordable healthcare insurance with transparent terms. We stand ready to work with the Governor and the New Jersey Legislature to establish a robust Exchange. MSNJ fully supports expanding the availability of affordable healthcare insurance to our residents.

We are pleased for our patients that key provisions of the ACA, supported by MSNJ, were upheld by the Court including:

The elimination of pre-existing conditions as a barrier to coverage;

  • The right of parents to insure their children on their existing policies up to age 26; and
  • The elimination of maximum life-time caps on benefits.

MSNJ continues to have concerns about whether New Jersey has the physician capacity to treat all patients who will become eligible for Medicaid with expanded eligibility requirements. Because New Jersey has among the lowest payment rates for Medicaid in the nation, together with the highest practice costs, there is already a shortage of physicians who treat Medicaid patients. Expansion of the insured population through the Exchange and Medicaid will worsen the physician shortage.  We will further analyze the Court’s opinion and work with the Governor and the Legislature to address the needs of our state’s neediest population.

MSNJ is a tireless advocate for a sustainable Medicare program. We have advocated for a repeal of the broken funding and payment formula. We know that the cost of caring for our seniors must be reduced and we intend to be part of the solution by providing quality, cost-effective, coordinated care. MSNJ supports physician-led integrated care models to provide cost efficient, quality care.

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.