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    What’s New with Novitasphere Part B
    Blog: In the News ... | Posted By: GUEST | Released: May 16, 2018, 9:41 am

    Novitas, the Medicare Administrative Contractor (MAC) for Jurisdictions L (and Jurisdiction H), is always looking for ways to improve our customers’ Medicare experience. Novitasphere, a FREE, secure internet portal for providers, billing services, and clearinghouses...

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    Announcements | Medicare

    CMS Changes Name of EHR Incentive Program & Advancing Care Information Performance Category
    Blog: In the News ... | Posted By: Marlene Mathew Kalayilparampil | Released: May 4, 2018, 5:33 am

    In late April, the Centers for Medicare and Medicaid Services (CMS) announced proposed rule changes directly aimed at empowering patients and reducing administrative burden for physicians.

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    Announcements | Medicare | MIPS

    Diane B. Allen Equal Pay Act
    Blog: In the News ... | Posted By: Mishael Azam, Esq. | Released: May 3, 2018, 6:25 am

    The "Diane B. Allen Equal Pay Act," (S104) which takes effect July 1, modifies the Law Against Discrimination, (LAD), to strengthen protections against employment discrimination and promote equal pay for all groups protected from discrimination.

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    Announcements | equal pay

    Effective July 2: CMS Reinstating QMB Identifier on RAs
    Blog: In the News ... | Posted By: Amanda Shiber | Released: May 2, 2018, 10:33 am

    Medicare will include Qualified Medicare Beneficiary (QMB) identification on remittance advice (RAs) again beginning 7/2/18. Read more. Due to a system issue, CMS had to suspend publication of this information. The issue has been resolved and Medicare Contractors have been advised to start including

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    Announcements | Help and Training | Medicare | QMB

    Out of Network
    Blog: In the News ... | Posted By: Mishael Azam, Esq. | Released: April 26, 2018, 12:59 pm

    The "out-of-network" bill was passed by both houses. Please find a summary of the bill, which will likely be signed soon.

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    Announcements

    National Healthcare Decisions Week
    Blog: In the News ... | Posted By: Marlene Mathew Kalayilparampil | Released: April 26, 2018, 12:58 pm

    Last week was National Healthcare Decisions Week (April 16-22). The New Jersey Department of Health encourages residents to contemplate their healthcare preferences and plan ahead for end-of-life care decisions. The national theme for 2018 is "It Always Seems Too Early, Until It's Too Late."


    "Far

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    Announcements

    NJ DOBI Independent Health Care Appeals Program for Prior Authorization Denials
    Blog: In the News ... | Posted By: Amanda Shiber | Released: April 26, 2018, 6:44 am

    The NJ Department of Banking & Insurance administers an external review program for prior authorization denials for procedures and prescriptions. Since 2014, physicians are required to post notice regarding the Independent Health Care Appeals Program (IHCAP) in their office. 

     IHCAP is available to

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    Announcements

    UHC, Oxford, Americhoice Fined $2.5 Million for Regulatory Violations
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: April 5, 2018, 11:26 am

    The Department of Banking & Insurance (DOBI) fined UnitedHealthcare (UHC), Oxford and Americhoice $2.5 million for regulatory violations, some of which MSNJ brought to DOBI’s attention based on our members’ complaints. In particular, we asserted that UHC could not require physicians to provide patie

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    Announcements | Help and Training

    Vaccines
    Blog: In the News ... | Posted By: Mishael Azam, Esq. | Released: March 1, 2018, 7:50 am

    Continue to encourage your patients to get vaccinated! The flu vaccine is 36% effective this season and has been most effective for young children, according to interim estimates the Centers for Disease Control and Prevention (CDC) released [February 15th]. “These early VE (vaccine effectiveness) es

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    Announcements

    2017 MIPS Claims Data Performance Scores Now Available on QPP Website
    Blog: In the News ... | Posted By: Amanda Shiber | Released: February 15, 2018, 9:41 am

    If you submitted quality data via claims for the 2017 reporting year, you may now view your performance scores at: https://qpp.cms.gov/login by using the data submission feature.

    Submitting Quality Performance Data via Claims

    If you’ve already submitted quality data via claims, you don’t have to t

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    Announcements

    New United Opioid Coverage Policy
    Blog: In the News ... | Posted By: Mishael Azam, Esq. | Released: February 8, 2018, 12:35 pm

    New to Therapy Short-Acting Opioid Supply and Daily Dose Limits for UnitedHealthcare Community Plan and UnitedHealthcare Commercial Plans – Effective March 1, 2018. 

    Beginning March 1, 2018, UnitedHealthcare Community Plan in some states and UnitedHealthcare commercial plans will implement a short-

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    Announcements

    State Adopts Rules on Health Claims Processing & Payment Act
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: February 8, 2018, 11:55 am

    The Department of Banking & Insurance adopted regulations implementing the Health Claims Authorization Processing & Payment Act (HCAPPA) which was passed in 2006. MSNJ filed comments joined by the NJ Association of Osteopathic Physicians & Surgeons, NJ Society of Interventional Pain Physicians, New

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    Announcements

    DOJ Seeks More Information on Proposed CVS-Aetna Merger
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: February 8, 2018, 11:36 am

    On February 1, the Department of Justice made a second request for information concerning CVS’s attempt to merge with Aetna to create an integrated health system. Those who attended MSNJ’s last Policy & Strategy Panel meeting heard potential anti-trust concerns from the AMA which is carefully analyz

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    Announcements

    Medicare Mammography Payment Issue
    Blog: In the News ... | Posted By: Amanda Shiber | Released: February 1, 2018, 7:46 am

    Practices that perform mammography are urged to review their Medicare claims dating back to October 1, 2017 to ensure proper payment. There was a system edit, causing the rejection of mammography claims using new, more specific ICD-10 codes. The edit has now been deactivated and these claims may be

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    Announcements

    Prior Authorization Progress
    Blog: In the News ... | Posted By: Amanda Shiber | Released: January 26, 2018, 11:58 am

    Federal

    MSNJ supported the AMA in its Prior Authorization and Utilization Management Reform Principles in early 2017. As a result of publication of these principles, a workgroup comprised of the AMA, the American Hospital Association, America's Health Insurance Plans, American Pharmacists Associati

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    Announcements

    Tiered Network Surveys
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: January 26, 2018, 11:48 am

    In anticipation of a Senate hearing on OMNIA, MSNJ has published new Tier 1 and Tier 2 surveys to collect information from our members to help inform our testimony before the Legislature. Members are encouraged to complete the appropriate survey for their OMNIA tier designation.

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    Announcements

    Rules Limiting Compensation from the Pharmaceutical Industry Adopted
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: January 23, 2018, 7:50 am

    Rules governing prescribers' acceptance of compensation from pharmaceutical manufacturers became effective on January 16, 2018, Governor Christie's last day of office. Even with improvements urged by MSNJ and adopted, the rules are the most restrictive in the nation. Together with other stakeholders

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    Announcements

    New Jersey Physicians Boost the State’s Economy, Generating 281,923 Jobs
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: January 11, 2018, 8:16 am

    New Jersey Physicians Boost the State’s Economy, Generating 281,923 Jobs

    New study demonstrates that physicians drive $55.4 billion in economic activity

    Lawrenceville, NJ – Physicians add opportunity, growth and prosperity to the New Jersey economy by creating 281,923 jobs and generating $55.4 bil

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    Announcements

    Connecting for Better Care with New Statewide Health Information Exchange
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: December 4, 2017, 10:14 am

    The Medical Society of New Jersey (MSNJ) announces the launch of OneHealth New Jersey, a statewide health information exchange (HIE) that is now live. OneHealth New Jersey encompasses an interoperable health information exchange, as well as a patient health portal, extensive data analytics tools, an

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    Announcements

    NEW BENEFIT: MIPSwizard
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: November 15, 2017, 8:41 am

    Up to 4% of your Medicare Payments are At Risk—Are You Ready?

    Satisfy your MIPS Requirements with MIPSwizard

    The #1 Registry for Quality Measures reporting to CMS

    MIPSwizard is an easy to use online tool to help eligible clinicians quickly and easily participate in the Merit-based Incentive Payme

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    Announcements

    Call for Nominations
    Blog: In the News ... | Posted By: Sue Hoisington | Released: November 9, 2017, 2:10 pm

    We are accepting applications from interested candidates for positions on the Board of Trustees, AMA Delegation, Judicial Council and various committees. Please review the MSNJ Open Positions for 2018 and read a brief synopsis of the committees and expectations. Your involvement is key to the Succes

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    Announcements

    Due December 31: MIPS Annual Security Risk Analysis
    Blog: In the News ... | Posted By: Amanda Shiber | Released: November 9, 2017, 2:10 pm

    Security Risk Analysis is a required measure under the Advancing Care Information Category for 2017 MIPS reporting. If you plan to report data for this category, you must complete your analysis by December 31. For more information, please see Quality Insights' webinar slides; recording; or transcrip

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    Announcements

    MSNJ Weighs-in on PIP, EOBs, In-plan Exceptions & IURO Rules
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: November 9, 2017, 2:08 pm

    PIP: MSNJ filed comments on a pre-proposed rule that would link certain PIP fees to Medicare. We have long advocated against the use of Medicare to set fees. This is particularly true for PIP since the statute sets the standard at 75% of reasonable and prevailing fees in the region. 

    EOBs: MSNJ has

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    Announcements

    New Narrow Network Horizon Medicare Advantage Product
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: November 2, 2017, 9:58 am

    Horizon announced this week that it will offer a new Medicare Advantage product during open enrollment for the 2018 plan year.  Horizon has chosen select providers from its Managed Care Network to participate in the Medicare Blue Advantage HMO plan. Letters were mailed last week to participating and

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    Announcements

    Horizon BCBS News & Legal Notices- updated 06/20/18
    Blog: In the News ... | Posted By: Amanda Shiber | Released: November 2, 2017, 9:48 am

    Horizon BCBS requires providers to visit its website or NaviNet in order to review communications regarding material adverse policy changes. We have asked Horizon to provide MSNJ notice of these changes, so that we can inform our members. As a service to MSNJ members, we will post these changes

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    Announcements | Horizon

    Sign-Up for Payer Notices to Stay up to date on Policy Changes
    Blog: In the News ... | Posted By: Amanda Shiber | Released: November 2, 2017, 9:40 am

    Members are urged to sign up for payer notices, in order to stay up to date on policy changes that could impact your practice. While MSNJ reviews payer policies and works with the state and national specialty societies on potential issues, it is important that practices also stay informed and tell u

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    Announcements

    Write To Your Legislators To Repeal the Flawed IPAB!
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: October 30, 2017, 12:12 pm

    Legislation to repeal the Independent Payment Advisory Board (IPAB) is moving on Capitol Hill, but Congress needs to hear from America's physicians in order to push it over the finish line. Please urge your legislators to support H.R. 849 to repeal the arbitrary and flawed IPAB by calling AMA’s toll

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    Announcements

    PreCheck MyScript: New Online Drug Prescribing Solution for UnitedHealthcare Commercial, Medicare and Medicaid Benefit Plans
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: October 12, 2017, 7:22 am

    By Dr. Marilyn Gordon, Medical Director, UnitedHealthcare of New Jersey

    As physicians, we know you spend several hours each week on prior authorization requests, especially

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    Announcements

    UPDATE: UHC Delays Consult Code Policy
    Blog: In the News ... | Posted By: Amanda Shiber | Released: September 22, 2017, 12:24 pm

    In July, MSNJ was joined by 36 medical and specialty societies in a letter to United Healthcare (UHC) opposing its proposed policy change to no longer pay for consultation CPT codes 99241-99245 and 99251-99255 for dates of service on and after October 1. This week, UHC advised MSNJ that it will dela

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    Announcements

    Medical Society of New Jersey to Partner with KaMMCO Health Solutions for Statewide Interoperability and Analytics Tools
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: September 14, 2017, 11:02 am

    LAWRENCEVILLE, NJ, Sept. 14, 2017: Physicians and health care professionals nationwide are in the midst of unparalleled industry transformation. Successful adoption of the new performance- based delivery and payment models will rely heavily upon interoperability and development of actionable intelli

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    Announcements

    MSNJ Implores HHS to Reduce Regulatory Burdens on Physicians
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: August 17, 2017, 5:59 am

    Physicians Advocacy Institute (PAI), of which MSNJ is a founding member, seeks the assistance of Secretary Tom Price to reduce the regulatory burdens on physicians and alleviate administrative expenses in a 12 point advocacy document to the US Department of Health & Human Services. First, and foremo

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    Announcements

    MSNJ Weighs-in on Insurer Transparency & Accountability
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: August 3, 2017, 7:47 am

    MSNJ has long advocated for more meaningful explanation of benefits (EOBs) and description of appeal rights for patients. We believe that EOBs on out-of-network bills are purposefully misleading. We have also advocated that insurers be required to pay the fees they agree upon with out-of-network pro

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    Announcements

    MSNJ Supports Self-Critical Analysis Privilege
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: July 28, 2017, 6:10 am

    MSNJ and the AMA joined together to file an amicus brief with the New Jersey Supreme Court urging it to find the self-critical analysis privilege in the Patient Safety Act (PSA) to be absolute. The PSA allows physicians in a hospital setting to engage in candid discussions about circumstances giving

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    Announcements

    NJ Supreme Court Sides with Tier 2 Hospitals on Discovery of OMNIA Documents
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: July 28, 2017, 6:10 am

    The New Jersey Supreme Court has agreed with two separate trial courts that:

    discovery geared toward unmasking Horizon's methodology and particular determinations during the [tier] selection process, as well as other information illuminative of Horizon's acts and intentions, was relevant to plainti

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    Announcements

    Due August 7: UnitedHealthcare Premium Designation Reconsideration Requests
    Blog: In the News ... | Posted By: Amanda Shiber | Released: July 28, 2017, 6:08 am

    UHC participating physicians should have received their Premium Designation Program assessment letters, which were mailed the week of July 6. Physicians are urged to review their assessment reports and to request a reconsideration of their designation, if they disagree with UHC's determination, by A

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    Announcements

    DOBI Issues Three Rule Amendments to Increase Insurer Transparency & Accountability
    Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: July 28, 2017, 6:07 am

    The NJ Department of Banking & Insurance has issued three rule amendments addressing topics on which MSNJ has steadfastly advocated. The topics are:


    Explanation of benefits;
    In-plan exceptions; and
    Unfair claims settlement practices.

    The rule amendments were issued under Governor Christie's Exec

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    Announcements

    MSNJ Urges UHC to Continue to Honor Consult Codes
    Blog: In the News ... | Posted By: Amanda Shiber | Released: July 28, 2017, 6:07 am

    MSNJ was joined by 36 medical and specialty societies in a letter to United Healthcare (UHC) opposing its proposed policy change to no longer pay for consultation CPT codes 99241-99245 and 99251-99255 for dates of service on and after October 1. UHC is aligning their policy with CMS, which stopped r

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    Announcements

    MSNJ Congratulates Dr. Donald Chervenak on Receiving the 2017 De Groote Award
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: July 24, 2017, 10:14 am

    This year’s De Groote Award was presented to MSNJ Board Member, Dr. Donald Chervenak at the Inaugural Gala on Saturday, May 13. The De Groote Award was established by resolution to honor the selfless work of Dr. Robert De Groote in service to the medical profession. Read Dr. Chervenak’s acceptance s

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    Announcements

    UPDATE Effective August 1: AmeriHealth Will Pay E&M Services Appended with Modifier 25 at 50% in Some Instances
    Blog: In the News ... | Posted By: Amanda Shiber | Released: July 21, 2017, 8:15 am

    Beginning August 1, AmeriHealth plans to change its payment policy to now pay evaluation and management (E&M) codes appended with modifier 25 at 50% when they are submitted for the same date of service by the same provider as a minor procedure or when they are submitted for the same date of service

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    Announcements

    Resolutions Due - August 15, 2017
    Blog: In the News ... | Posted By: Melissa Zarzycki | Released: July 21, 2017, 8:13 am

    Revolving Reference Committee - Thursday, August 31 at 7:00pm

    The next Revolving Reference Committee meeting is Thursday, August 31 at 7:00 pm. All resolutions need to be vetted by the County Medical Society prior to submission to MSNJ. Resolutions are due from the County Medical Societies by Augus

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    Announcements


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