HORIZON: Compliance Dispute on Modifiers 25 & 59
This week, MSNJ filed an amended compliance dispute against Horizon alleging additional violations of the national class-action settlement agreement. The compliance dispute is based on Horizon’s February 2010 announcement of a payment policy change that will be effective on May 17, 2010. The announced policy change will result in significant discounts for procedures appended with modifiers 25, 52, 53, 54, 55, 56, 59, 73, and 76. The discount for modifiers 25 and 59 is 50%. The discount for modifier 56 is 90%.
Among the requests for relief is a new request that Horizon cease and desist from conducting modifier 59 audits. We have also asked Horizon to voluntarily suspend the modifier 25 and 59 audits until the pending compliance dispute is resolved. Horizon has not agreed to do so.
Members are asking MSNJ whether they must comply with these audit requests and chart reviews. If you are a participating provider the answer is yes. Horizon provider contracts contain a provision that obligates physicians to allow audits and chart reviews. Physicians should review their contracts and be guided accordingly. Non-participating providers are not covered by the February 2010 payment policy change announcement.
Physicians who object to Horizon’s announced payment policy change should contact Horizon immediately. The phone number for such calls is: 1-800-624-1110. Physicians have 30 days from the mailing of the letter to decide whether to terminate their contracts. However, the letter is not specifically dated so MSNJ has asked for clarification on the expiration of the 30-day time period for termination decisions. Members are urged to calculate the financial impact that these discounts will have on their practices.
Members who are participating providers should review the compliance dispute and alert MSNJ if they believe that there may be other violations of the settlement agreement.
MEDICARE: Physician Payment & SGR Update
This week, the Senate voted to pass H.R. 4691, the "Temporary Extension Act of 2010," which included provisions to extend 2009 Medicare physician payment rates through the end of the March. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1. Details on the legislation can be found on MSNJ’s blog.
Congress must decide how to address the Medicare payment crisis. The AMA, MSNJ, and organized medicine continue to press for a permanent repeal of the sustainable growth rate (SGR), rather than repeating the pattern of short-term remedies that serve to make future payment cuts more severe and increase the cost of permanent Medicare payment reform. MSNJ’s efforts are focused on a permanent repeal of the SGR by ensuring that our congressional delegation is committed to this approach. Physicians and patients can use the AMA grass roots tool to write to Congress to support a repeal of the SGR. Physicians may refer patients to a recent letter to Senate Majority Leader Reid that explains why the SGR repeal is necessary.
To date, CMS has not extended the March 17 deadline for physicians to make Medicare participation decisions.** MSNJ believes that physicians must begin making decisions about the financial viability of treating Medicare patients now. It is difficult to do so without knowing the fee schedule. However, physicians must review the participation options now.
The AMA has updated its guidance document, “Medicare Participation Options for Physicians” to address important considerations for physicians when making their 2010 participation decision. MSNJ urges members to review the guidance document now to plan for the possibility of a cut, a freeze, or a moderate increase in Medicare fees.
- We have been asked whether physicians may decide to stop accepting new Medicare patients. The answer is yes.
In an effort to better understand the implications for Medicare beneficiaries given the scheduled 21 percent cut in Medicare physician payments, the AMA is conducting a brief survey on physicians’ plans for Medicare participation. MSNJ members are urged to participate in this survey.
** We are monitoring CMS to determine if it will extend this deadline. We believe an extension is necessary for physicians to have meaningful fee information on which to make participation decisions.
Consultation Code Guidance Update
The Centers for Medicare & Medicaid Services (CMS) has revised its guidance on services formerly coded as inpatient consultations under the Medicare. Please review this important bulletin on reporting inpatient hospital evaluation and management services that could previously be described by CPT consultation codes.
MSNJ CORPORATE PARTNER PROFILE
It is important to note that MSNJ does not endorse any vendor, service, or product. However, we encourage members to please consider our Corporate Partners first as the financial support received from these organizations is vital to our association. It is our hope that their investment in MSNJ will help keep your membership dues and programming affordable. For information regarding our corporate partners visit MSNJ’s web site. The following is a message from Bank of America, a Gold Level Partner:
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MSNJ EVENT: 2nd Annual Wine Tasting at Jasna Polana
MSNJ presents
The 2nd Annual Winter Evening Wine and Food Tasting
“Taste the wines and cuisine of Spain…”
Featuring Kevin Zraly, Windows on the World Wine School
Sponsored by CoolVines
Saturday, March 13, 2010 @ 6:00 p.m.
TPC Jasna Polana, Princeton
Last chance to register as the event will soon be filled to capacity!
MSNJ FAMILY MEMBER BENEFITS: College Scholarship
This year Healthcare Employees Federal Credit Union (HECFU) is proud to offer an opportunity for our high school credit union members to win a $1,000 college scholarship! Applicants must be a HEFCU credit union member in good standing and must be enrolled as a high school senior at the time of application. Eligible members must complete the application, which is available in our branch, as well as online to download, by the deadline date of April 2, 2010. This program is sponsored by the New Jersey Credit Union League’s Youth Involvement Board (YIB). Applications will be judged on academic performance, community involvement, honors and other criteria and all decisions on applicants’ entries will be made by the YIB.
Membership in HECFU is a benefit to MSNJ members. Sons and daughters of MSNJ/HECFU members and who meet the criteria above may apply on-line for the college scholarship. Visit MSNJ’s web site if you need more information about becoming a member of HECFU.
Macy*s Business Smart Pass is Back! MSNJ members take an additional 15% off from March 1-March 31. Download Coupon.
Any MSNJ member who enrolls one or more children at ESF, which is located at The Lawrenceville School or Moorestown Friends School, will receive a 10% discount that is applied to each child’s camp tuition. This discount is in lieu of the group and family discounts. Members can use Club OT, the extended day program, at no charge. Additionally, MSNJ members will receive a 5% discount off the Phillies Baseball Academy (co-ed, ages 6-14), The Official Camp of the Phillies, held at several New Jersey locations and the Phillies Phantasy Camp (Adults, ages 30 and up) in Clearwater, Florida!
For more information call Mike Trachtenberg, ESF Summer Camps Director of Camper Development at 800-529-CAMP (2267), ext. 231 or visit www.esfcamps.com.
MSNJ POLICY: Education on End-of-Life Issues
MSNJ has committed itself to the issue of end-of-life care. Recently, MSNJ’s Board of Trustees adopted several policies on end-of-life issues. One of the policies adopted by the Board is to support continuing education on communication techniques with families and to facilitate proper referrals to palliative care and hospice. To that end, we have partnered with Samaritan Hospice to provide educational webinars for our physicians and practice managers. We received excellent feedback from the first webinar.
The second will take place on March 24 at noon. The second webinar will focus on billing options for your patients receiving hospice and palliative care. It will present your option to follow your patients care through your referral to hospice and palliative care and how to bill for oversight of their care.
Members have asked whether these seminars are approved for continuing medical education credits. They are not approved for AMA PRA Category 1 CreditsTM. However, participants may claim AMA PRA Category 2 CreditsTM. Participants are required to keep records to support these credits.
Dr. Stephen Goldfine, Samaritan’s Chief Medical Officer who is Board Certified in Palliative Care, will conduct these webinars. He was recently named the New Jersey Hospice and Palliative Care Organization’s Hospice Physician of the Year.
Register now for the March 24 webinar.
PRACTICE MANAGEMENT: May 14 Annual Meeting
Registration is now open for the May 14 annual meeting at the Westin in Princeton. Be sure to pay your 2010 annual dues in the amount of $60 before registering for the annual meeting. Dues paying members who register on-line and early will be able to attend the all-day annual meeting for the nominal fee of $50.
This week, we are highlighting the session on “Transition from Paper to Electronic Medical Records.”
Speakers: Jack Cappitelli, MD, President/Managing Partner, NJ Associates in Medicine; Holly Parlavecchio, Chief Administrative Officer, Somerset Pediatrics and Chair of MSNJ’s Medical Practice Management Section; Linda Macey, Practice Manager, Internal Medicine Associates
Description: If your practice is paper-based or if you are in the process of converting from paper to the digital world this panel discussion is for you. Even if you are in the process of implementing electronic medical records (EMR) you can learn from your colleagues. Physician and practice management panelists will talk about the good, the bad, and the ugly of the transition from paper and give pointers on how to plan and to implement EMR.
The first step is to be sure that you have paid your 2010 annual dues.
Then, register for the annual meeting on-line to receive the full discounted rate. Be sure to register for both the morning and afternoon breakout sessions.
PUBLIC HEALTH: Conference on Vaccine Preventable Diseases
Save Monday, July 26, 2010 for a one-day conference on Vaccine Preventable Diseases: Facts of Vaccine Science, Safety & Surveillance. This conference will be held simultaneously at three locations in New Jersey: Montclair State University, Monmouth University, and Cumberland County College.
Registration will begin soon. For information, contact Juana Canela at canelaju@umdnj.edu or at 732-235-4958.
MEDICARE: Electronic Prescribing Conference Call on March 10
The Centers for Medicare & Medicaid Services' (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 1:30 p.m. to 3:30 p.m., EST, on Wednesday, March 10, 2010. In order to receive the call-in information, you must register for the call. Registration will close at 1:30 p.m. EST on March 9, 2010, or when available space has been filled.
CODING CONFERENCE: The Cherry Hill Chapter of the American Academy of Professional Coders will conduct its Eighth Annual Health & Coding Conference on Saturday, May 15th in Cinnaminson. Coders and other healthcare workers are welcome to attend this conference. It has been approved for eight CEUs. For more information, visit the AAPC web site and click on the local chapter seminar and then “view agenda.”
MSNJ & COUNTY Notes & Reminders
MSNJ’s Board of Trustees will meet on Sunday, March 21, at 9:30 a.m., at the MSNJ Conference Center in Lawrenceville.
PASSIAC: The Passaic County Medical Society invites all physicians to join them for educational dinner meeting “Preserving Your Assets Through Uncertain Times with Life Insurance and Section 79” at 6:30 p.m. on Thursday, March 18, 2010, at Chand Palace Indian Restaurant, 269 Littleton Road, Parsippany, NJ 07054; (Phone: 973-334-5444). (http://www.chandpalace.com/).
For more details or to RSVP, e-mail Dr. Vijay Gupta at vkg615@gmail.com.
SAVE THE DATES! The list below contains new meeting dates since last week’s issue of e-News along with meetings for March and April. Please visit the MSNJ website for a complete listing of events. If you’d like to post your specialty society’s meeting information, please contact Lisa Hibbs, Manager of Member Outreach for MSNJ, at lhibbs@msnj.org.
New Jersey Chapter, American College of Surgeons – Socioeconomic Session
Saturday, March 13, 2010, 7:30 a.m.-4:00 p.m.
Crowne Plaza Monroe in Monroe Township
Register before March 5, 2010; contact the Chapter Office at 973-539-4000
New Jersey Psychiatric Association – 2010 Annual Spring Meeting
“Healthy Minds in Healthy Bodies: Psychiatry and Primary Care Working Together”
Saturday, March 27, 2010
Renaissance Woodbridge Hotel & Conference Center, 515 Route 1 South in Iselin
Register Online www.psychnj.org.
**MSNJ Members receive NJPA Member registration rate.**
New Jersey Academy of Otolaryngology/New Jersey Academy of Facial Plastic Surgery – Annual Symposium
Wednesday, April 14, 2010, 7:15 a.m.-2:30 p.m.
PNC Bank Arts Center in Holmdel
For details or to register email Lauren Myers at lmyers@blynchassociates.com
New Jersey State Society of Anesthesiologists – Annual Meeting
Saturday, April 17, 2010, 8:00 a.m.-2:00 p.m.
Forsgate Country Club in Jamesburg
Contact Linda Bartolo, Executive Director, at 973-597-0938 or lbartolo@successcomgroup.com