Blogs

MSNJ House of Delegates/Annual Meeting
House of Delegates Resolutions due April 12
Resolutions must come from county societies, a MSNJ committee or council or the MSNJ Board of Trustees. Resolutions submitted directly to MSNJ by an individual member will be forwarded to that member's county society for action. The county societies will d

Summary of Appellate Division Decision in Allstate v. Lajara
By: Richard Robins, Esq., Brach Eichler

By way of background, the trial judge had issued rulings that a radiologist, Dr. Damien, violated several sections of the New Jersey State Board of Medical Examiners (“BME”) regulation at N.J.A.C. 13:35-2.6 (the “rule”),  because he did not examine or review

A Message from the CEO - Insurance Products
Dear Colleagues,

Several months ago I addressed our membership with exciting news about "our" comprehensive insurance agency team, MSNJ Risk Advisors.  As President of MSNJ Risk Advisors, I introduced Monty, our Executive VP, and Jennifer, our VP who had just joined our team of professionals. As I

Governor Murphy Releases Budget Address
By: Sabeen Masih, Capital Impact Group

Governor Phil Murphy delivered his second budget address today, proposing a $38.6 billion state budget for Fiscal Year 2020, including a plea to lawmakers to raise taxes on millionaires and work towards a common goal throughout the negotiation process. 

Murph

Direct messaging—an opportunity to improve care coordination, patient safety, family empowerment, efficiency
Meaningful care coordination and more efficient clinical workflows depend on seamless data exchange between providers, specialists, facilities, and their patients. And while it has been a struggle to achieve universally, Direct messaging is one way to offer simple, secure sharing of patient data. Tr

MSNJ Opposes “Medical Aid in Dying for the Terminally Ill Act”
Last Thursday, the Senate had a hearing on S-1072, the "Medical Aid in Dying for the Terminally Ill Act;" which permits qualified terminally ill patients to self-administer medication to end life in a humane and dignified manner. MSNJ opposed the legislation, as elements of the bill require physicia

3 ways to maximize employer diabetes prevention tools for your patients
From the AMA:

For many of your patients, work makes up—and takes up—a great deal of their lives. In fact, it’s probably where they spend most of their time. So it only makes sense that their jobs would support them in their health, especially when it comes to type 2 diabetes prevention.

Type 2 dia

Update on Rule Limiting Compensation from Pharma to Prescribers
Members have asked about the status of the proposed amendments to the rule limiting compensation from pharmaceutical manufacturers to prescribers. We understand that the Division of Consumer Affairs intends to adopt the amended rule in the first quarter of 2019. This is due to the number of comments

OneHealth New Jersey – A Valuable Tool in MIPS Participation
OneHealth New Jersey wants to help Medical Society of New Jersey members have the best opportunity to earn positive incentives under the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) and the Merit-Based Incentive Payment System (MIPS) requirements. In 2019 all MIPS par

State Board Vacancy
The Motor Vehicle Commission seeks cardiologists, neurologists, endocrinologists and psychiatrists to serve on its Medical Review Unit. This distinguished Panel is appointed by the Governor and compensated on a per diem basis. They are seeking physicians in the following specialties: cardiology, neu

At – Large Trustee Position
There is one At – Large Trustee position available on the Board. The candidates may come from any of the three districts. The candidate with the most votes will become the At-Large Trustee from their district. The At-Large Trustee is elected after all other candidates are selected from a county not

New HIE Tool to Combat Drug Overdose Deaths
In early December, the Centers for Disease Control and Prevention (CDC) released startling numbers on the increase in deaths from drug overdose. Between the years of 2011 and 2016, the number of overdose deaths increased by 54 percent. The report notes there were 41,340 drug overdose deaths in 2011

CMS Streamlines Systems for QPP Data Submission and Access
If your organization participates in the Quality Payment Program (QPP) or you are a representative of an Alternative Payment Model (APM) reporting data to the Centers for Medicare & Medicaid Services (CMS) through the QPP website (such as a Medicare Shared Savings Program Accountable Care Organizati

Physician Compare 30-Day Preview Period Extended to 1/7
From CMS:

On November 30, CMS opened the 30-Day Preview Period for the 2016 performance information targeted to be publicly reported on Physician Compare starting in early 2019. The preview was scheduled to end on December 31 at 8pm ET. We are extending preview through Monday, January 7 at 8pm ET (

KAMMCO Develops New Tool to Assist Healthcare Providers Combatting Opioid Epidemic
Physicians, hospitals and behavioral health providers participating in the OneHealth New Jersey health information exchange will appreciate access to a new analytic dashboard—Opioid/Controlled Substances. Developed by physicians in response to the widespread opioid crisis in this country, the new to

Physician Fee Schedule for 2019 Includes Changes to Evaluation-and-Management Services
The 2019 Medicare physician fee schedule final rule included several changes when it comes to payment for evaluation-and-management (E/M) services. Physicians should make note about three things in next year’s fee schedule from the Centers for Medicare & Medicaid Services (CMS).

1. CMS has postpone

Court Finds Insurer Violated the NJ Consumer Fraud Act
The 3d Circuit Court of Appeals reversed a New Jersey Federal District Court decision on the issue of whether an insurer may be liable under the New Jersey Consumer Fraud Act (CFA). This auto liability case is contrary to others that have found the CFA does not apply to insurance policy disputes whe

Court Orders Correctional Institute to Administer Methadone Per Physician’s Order
A Massachusetts Federal District Court ordered a correctional institute to provide methadone to a recovering addict who is expected to be incarcerated. The Massachusetts Medical Society filed an amicus brief in support of the injunction. The patient was treated unsuccessfully with non-opioid medicat

HIEs Valuable During Times of Natural Disasters
Health care demands rise dramatically when threatened with a natural disaster such as a hurricane or tornado, or wild fires. Significantly impacted are patient access to care, access to health data, and clinician workflows. Determining the best course of medical action requires secure access to pati

The Medical Society of New Jersey Welcomes Holy Name Medical Partners
Lawrenceville, NJ – The Medical Society of New Jersey (MSNJ), the country’s oldest professional society established in 1766, is pleased to welcome Holy Name Medical Partners (HNMP) to its membership ranks.

This alignment offers HNMP physicians the access to professional membership in MSNJ and provi

Tips to Secure Health Care Communications
A 2017 health care consumer survey by Accenture found more than 1 in 4 individuals have had their personal medical information stolen in a health care data breach. Even worse, half of those data-breach victims were then victimized again by some type of medical identify theft, costing an average of $

Health Care Needs To Catch-Up; It’s Time To #killthefax
In medical facilities throughout the country, physicians, nurses, and staff are placing medical records in a tray, dialing a number, pressing send to fax private health information across town, across the state, or around the world. According to one private firm’s estimate, 75 percent of all health

Reopenings and Redeterminations: Save time with Novitasphere
Novitas, the Medicare Administrative Contractor (MAC) for Jurisdictions H and Jurisdiction L, highly encourages providers to perform claim corrections and submit redeterminations on their claims through Novitasphere, our free internet portal.   These features are fast, and easy to use – saving provi

Return on Investment for Health Information Exchange Participation
By: Laura McCrary, Ed.D, Executive Director, Kansas Health Information Network and Senior Vice President, KAMMCO

What is the return on investment (ROI) for participating in a health information exchange (HIE)?  As the Executive Director of one of the most successful HIEs in the nation, I am often a

What’s New with Novitasphere Part B
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...

CMS Changes Name of EHR Incentive Program & Advancing Care Information Performance Category
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.

Diane B. Allen Equal Pay Act
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.

Effective July 2: CMS Reinstating QMB Identifier on RAs
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

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

National Healthcare Decisions Week
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

NJ DOBI Independent Health Care Appeals Program for Prior Authorization Denials
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

UHC, Oxford, Americhoice Fined $2.5 Million for Regulatory Violations
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

Vaccines
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

2017 MIPS Claims Data Performance Scores Now Available on QPP Website
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

New United Opioid Coverage Policy
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-

State Adopts Rules on Health Claims Processing & Payment Act
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

DOJ Seeks More Information on Proposed CVS-Aetna Merger
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

Medicare Mammography Payment Issue
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

Prior Authorization Progress
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

Tiered Network Surveys
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.