NYCMS Member Alert 1/6/17

Vol. 12, Issue 1

Events for the new year:  You’re cordially invited to our Thursday, January 12, 2017, Medicare Update with NGS’s Judy Brown.  And we’re also looking forward to our Sunday, January 29, 2017, Breakfast with Legislators.  Come and meet the lawmakers face to face!  Be a part of the discussion! 

MACRA/MIPS:  We have some information, but we’re also expecting further developments.  Official notices have not yet been sent out to holders of the exemptions for low Medicare volume/revenue physicians – we’ll keep you posted.  Meanwhile, re what to do if you’re not exempt:  Click on What guidance are we waiting for, on bonuses or avoiding the 2019 penalty?   Re reporting right on your claims:  Click on How does claims-based reporting work?  Re the basics of MACRA/MIPS:  Click on How can you make MACRA easy on yourself?  (PS:  CMS is even asking for input from you.  Click on Help CMS with the “Practice Improvement” part of MACRA.)

The 2017 Medicare fee schedule has been posted on the NGS website.  Click on How to navigate the NGS website to access the fee schedule.  
About the proposed sale of MLMIC (the Medical Liability Mutual Insurance Company):  MLMIC directs your attention to this Politico article on the status of medical liability insurers in New York State.  Check out the article at  And if you have questions about MLMIC, contact the company at (800) 275-6564.
Finally!  Gov. Cuomo has signed MSSNY-supported legislation we greatly need.  Click on Gov. signs legislation:  eRx and other crucial issues, and Governor signs step therapy reform legislation into law.  And for a rundown on MSSNY’s current priorities, click on Insurer issues are high on MSSNY’s agenda. 
None of that would be possible without the help of MSSNYPAC.  Please support MSSNYPAC, and spread the word.  Click on About MSSNYPAC:  We couldn’t have said it better.
Wondering how to proceed before your NYS eRx waiver expires on March 26, 2017?  Click on Your eRx waiver:  What must you do – and when?
Has your practice been affected by Oxford’s cancellation of HMO plans?  How might you provide health insurance for your family and employees?  Click on our NY County Medical Society Membership Benefits section and read the first article, “Idilus Offers Physician Practices More Options.” 
Marketing your practice in today’s online environment:  Get help with website development, reputation management, social media programs and much more.  Click on our NY County Medical Society Membership Benefits section and read the second article, “Practice Builders:  Helping You Market Your Practice Today.”   
Your DEA registration and how to renew it:  The recent confusion has cleared.  Click on The DEA’s policy for registration renewals:  They’ve decided to keep the “grace period” after all!
Did you participate in Meaningful Use in 2016?  Be sure to read Last call to attest to 2016 Meaningful Use - to avoid penalty in 2018. 
Physicians in training:  Your ideas are of great interest.  Click on Four p.m., Tuesday, anuary 31,  2017, is the deadline for submissions for MSSNY’s 12th Annual Poster Symposium, for residents, fellows and medical students. 
MSSNY’S “Medical Matters” webinars are fascinating.  Click on Wednesday, January 18, 2017, webinar:  “Triage in a Disaster Event,” and on Wednesday, February 15, 2017, webinar:  “The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.”
NYCMS reminds you:  We have a huge variety of member benefits!
NYCMS offers members a fascinating range of possibilities.  Click on:  NY County Medical Society Membership Benefits.
And be sure to look at:   HIPAA Secure Now! provides many services to NYCMS members. 
NYCMS also reminds you…
Order your “Doctor on Medical Call” card! Send your check for $25.00, payable to the New York County Medical Society, and your request to: Parking Renewal Program, New York County Medical Society, 31 West 34th Street, Suite 7053, New York, New York 10001.   If you have questions, call (212) 684-4698.
Members have free access to expert consultant Jim McNally, who heads our NYCMS Third-Party Payer Assistance Program.  Jim can help you disentangle billing, coding and reimbursement problems quickly and efficiently.  Call Susan Tucker at 212-684-4681, or e-mail
Share this e-zine with staff:  Physicians, be sure to share this e-zine with your office manager.   Call 212-684-4681, or e-mail
Make your own member-to-member announcements:  At no charge, you can post announcements about practice relocation, real estate, consulting services and more.  Call Lisa Joseph at 212-684-4698, or e-mail   Also, don’t forget the classified section on our website,, for places to rent, share or buy; services to use; and people and positions available.   Go to and check out the MM News Classifieds.
Events – You’re Invited
Thursday, January 12, 2017, Medicare Update with NGS’s Judy Brown
"Next year" is now "This year," and it's time for our Medicare Update from NGS! The New York County Medical Society cordially invites physicians and their staff to our "Starting the New Year" Medicare session with National Government Services (NGS) expert Judy Brown, on Thursday, January 12, 2017 (please note start time:  9:00 a.m.), at MEETH (Northwell - Manhattan Eye, Ear and Throat Hospital, 210 East 64th Street). 
            2017 has arrived, and you're already seeing Medicare patients.   Everyone needs to know the latest developments, to keep the practice running smoothly even as the medical environment changes.  We did have an update in December, with quite a lot of information about MACRA; we encourage everyone to attend this January update too, to hear a different (and complementary) perspective.  Judy will not discuss MACRA.  Instead, she will go into detail about:     
-        Medicare Physician Fee Schedule
-        Medicare Part B Updates
-        Provider Enrollment
-        Preventive Services
-        ICD-10
-        Local Coverage Determinations (LCDs)
-        Medical Review
-        Re-opening and appealing claims
-        Using NGS Connex
-        New Medicare learning modalities, including great videos
-        And more! 
You'll have plenty of time to ask questions.  Judy plus the knowledgeable audience will make a lively interactive "panel"!  
          No charge for NYCMS members and their staff.  To register, call Lisa Joseph at 212-684-4698, or email  Be sure to tell us physician's name, name(s) of attendee(s), phone, fax and email - thanks.      
Wednesday, January 18, 2017, webinar: “Triage in a Disaster Event”
MSSNY will continue its Medical Matters webinars on January 18, 2017, at 7:30 a.m., with “Triage in a Disaster Event.”   Arthur Cooper, MD, vice-chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee and Zachary Hickman, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Educational objectives are: (1) Describe the importance of immediate bleeding suppression during a disaster event; (2) Describe the SALT methodology for triage, and where to access SALT training; (3) Recognize the importance of not just general triage training, but triage training for bio-events as well.
A copy of the “Medical Matters” flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at 
            Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.  MSSNY designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™.
Sunday, January 29, 2017, Breakfast with Legislators
Legislative discussion Sunday, January 29, 2017 – be a part of it!  It's time for our annual breakfast panel and open forum, hosted jointly by the New York County Psychiatric Society, the New York Council on Child and Adolescent Psychiatry and the New York County Medical Society.  We'll meet at the NY Academy of Medicine, 1216 Fifth Avenue, NYC. Start time:  9:30 a.m.
            Guests (lawmakers) will include Richard Gottfried (Chair, NYS Assembly Health Committee); Linda Rosenthal (Chair, NYS Assembly Committee on Alcoholism and Drug Abuse); Liz Krueger (Ranking Democratic member, NYS Senate Finance Committee), and a number of others.  Admission is $35 for members of any of the three Societies, and $50 for nonmembers.  Residents are invited to attend free of charge.  Members of MSSNY, APA and AACAP may attend at the member rates.  To RSVP:  Call Lisa Joseph at 212-684-4698, or e-mail  
            Among the issues: 
            We foresee big changes in the ACA (Affordable Care Act), MACRA, and perhaps Medicare and Medicaid as well.  What changes have we been hoping for?  What is actually happening?  What are the implications for NYS?     
           The draft NYS budget will likely have been released, and we foresee issues relating to retail clinics, Workers Comp, medical liability, the Excess Layer program and many other areas.  Which provisions should we strongly oppose, and which should we fight for? 
           We see many issues with the opioid abuse crisis.   How effective are new treatments?  How helpful are new laws?  How adequate are government funds and private insurance coverage?  What should we beware of as the political landscape changes?   
           We are watching big structural changes in the healthcare delivery system.  Hospitals are merging, office practices are in jeopardy, physicians' independent clinical judgment is under fire.  What should be done?  
           We continue to be concerned about New York's over-powerful health insurance industry, with its high deductibles, dwindling plan networks, lack of out-of-network coverage, and antitrust barriers that bar physicians from negotiating collectively on patients' behalf. 
Four p.m., Tuesday, January 31,  2017, is the deadline for submissions for MSSNY’s 12th Annual Poster Symposium, for residents, fellows and medical students.
Enter your poster in clinical medicine (includes clinical research, health policy, quality improvement, medical education), clinical vignettes or medical student research.  Submit entries in abstract form to by Jan 31, 2017, 4:00 p.m.  All entrants must be: 
  • Active in a residency/fellowship training program, or medical students
  • Current MSSNY members. Join at
  • Able to attend 2017 MSSNY House of Delegates meeting to present and discuss entry.
  • Entrants are responsible for travel and related costs.
Presentations will take place at the MSSNY House of Delegates, Friday, April 21, 2017, 2:00 to 4:30 pm, at the Westchester Marriott in Tarrytown, New York.  To learn more, email or call 516-488-6100, ext. 383. 

Wednesday, February 15, 2017, at 7:30 a.m.:  Webinar, “The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team” 
MSSNY’s February Medical Matters webinar will be: “The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team,” on Wednesday, February 15, 2017 at 7:30 a.m. Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here .  The educational objectives are: (1) Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event; (2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event; and (3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.
A copy of the “Medical Matters” flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at 
            Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.  MSSNY designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™.
The Legislative Horizon
 About MSSNYPAC:  We couldn’t have said it better
MSSNYPAC is on the move.  We need your help!  MSSNYPAC has nearly 1,100 members, and we are proud that this number has increased from last year.  And we are proud that the number of high donor “President’s Circle” and “Chairman’s Club” members have also grown.  But we have nearly 75,000 physicians practicing in the state of New York, and they all share in the extensive legislative victories that MSSNY and MSSNYPAC bring to physicians each year.  Not all support MSSNYPAC – they should!  We are already getting far outspent by many of our adversaries. We urge you to join our effort. You can do it right now by making a donation to MSSNYPAC.  And we challenge you to contact 10 colleagues to make sure they are members!
For just $15/month, basically four or five cups of coffee, you can be a member of the PAC. But why stop there? For $85/month, you can be a member of our prestigious Chairman’s Club.  And for $210/month, you can join our elite President’s Circle. We cannot emphasize enough the importance of supporting your profession. With the many challenges we will face this year, your support is more important than ever.   To contribute, please go to:
Here’s the column from MSSNY President (and NYCMS member) Malcolm Reid, MD, in MSSNY’s recent “News of New York”: 
            MSSNY’s persistent efforts that are financed by your membership and PAC donations have a direct impact on your practice. You may not be aware of this, but practicing would be even more challenging if MSSNY were not fighting for you in the trenches every day. In 2016, we enjoyed some great wins!
  • In a budget-cutting atmosphere, the legislature rejected a proposal that would have caused 13,000 physicians to be dropped for the Excess program.
  • Vetoing of legislation to allow pharmacists to change the length of prescription refills.
  • Signed into law legislation that permits an e-prescription to be forwarded from one pharmacy to another pharmacy.
  • Another tough year of beating back regressive tort bills including a date of discovery statute of limitations.
  • Defeated a proposal that would have allowed “limited service” clinics in retail stores owned by CVS, Walmart and Walgreens.
  • Establishment of Health Republic Insurance of New York Fund consisting of state-derived settlements funds at the discretion of the Director of the State Division of Budget.
  • Changes to Doctors Across New York to equalize awards up to $40,000 per year and reduce the service commitment.
All of these issues affect you directly. They affect your team of physicians in hospitals, too. We are there for you and we are effective. Keep it going by paying your dues in 2017. We cannot fight without funds for ammunition!
Moe Auster, MSSNY Senior Vice President for legislative and regulatory affairs, adds: 
            With the elections behind us, it is now time for actual governing to take place.  What will be in store for the New Year? There is no question we will again face major challenges during the 2017 legislative session. The trial lawyers will likely again be making an all-out press to increase lawsuits against doctors and hospitals. A wide array of non-physician groups will again seek to expand the types of care they can provide to patients. And big box retailers will likely again seek legal authority to open nurse practitioner-led clinics in their stores.
            And then we face the possibility of a huge loss of revenue from the federal government for support of New York’s extensive health insurance coverage programs if Congress and the new President act on their promises to repeal all or much of the Affordable Care Act.  I know that New York’s physicians have varying perspectives on the ACA, but one thing is certain:  Such a potential loss of federal funding would exacerbate an already significant state budget gap for the 2017-18 fiscal year, which state policymakers will have to address. What programs would have to be cut, or new revenue sources created, to make up for that deficit? And, perhaps most important, what would this mean for the hundreds of thousands of patients who are receiving coverage through these programs?
            Many More Issues to Address:  There are also many other issues that the Legislature must address.  Patients’ choice of physician is becoming far too limited as a result of insurers’ dropping physicians from their networks. Patients are unable to buy coverage that would enable them to go “out of network.” And for those physicians that remain in networks, insurers are increasing the frequency of time-consuming prior authorization requirements
Gov. signs important MSSNY-supported legislation:  eRx and other crucial issues
Governor Cuomo has signed into law legislation advocated for by MSSNY, that would permit an e-prescription to be forwarded from one pharmacy to another pharmacy. The law takes effect March 1, 2017.  The purpose of this legislation is to address situations where, up till now, if the first pharmacy did not have the medication in stock, a patient has had to ask a physician to issue a new e-prescription and send it to another pharmacy.  Now, thanks to this new law, the first pharmacy will be able to forward the e-prescription to another pharmacy requested by the patient.
            This is an “administrative simplification” measure signed into law this fall that was strongly advocated for by MSSNY and other specialty societies. Other measures signed into law include:
  • Eliminating the requirement for physicians to report to the DOH when a written prescription must be issued in lieu of an e-prescription. (Now, thanks to the new law, the physician can simply put a note in the patient’s chart.)
  • Requiring the DOH and the DFS (Department of Financial Services) to create uniform standards for how health insurers impose protocols for the prior authorization of prescriptions. 
  • Reducing from 90 to 60 days the time within which a health plan must review a physician’s application to be included in the plan’s network.   
Governor signs MSSNY-backed step therapy reform legislation into law
On New Years’ Eve, Governor Cuomo signed into law legislation (A.2834-D, Titone/S.3419-C, Young) that would provide stronger regulation of health insurers’ step therapy prescription medication protocols. Per the new law, a health insurer will be required to grant a physician’s override request of an insurer step therapy protocol if the physician can demonstrate that the drug required by the protocol is contraindicated or likely to be ineffective, or if the patient is stable on the medication the physician has requested.  If the physician’s request for an override of the step therapy protocol is denied, the new law will better enable a physician to formally appeal the decision, both within the plan’s existing appeal mechanism and via an external appeal.      
Insurer issues are high on MSSNY’s agenda 
Now that the state legislature’s new session has begun, MSSNY is pushing for changes to the state’s healthcare laws, even amid uncertainty about the future of the Affordable Care Act. Moe Auster, MSSNY senior vice president for legislative and regulatory affairs, has said insurers should be required to:
  1. Authorize medical treatments more quickly;
  2. Have decisions authorized by doctors who are in the same or a similar specialty as the physician requesting the treatment; and
  3. Offer a plan option that would reimburse patients for out-of-network care.  (Bills with this out-of-network provision didn’t make it out of committee last session, but MSSNY will push again.)
What guidance are we waiting for, on bonuses or avoiding the 2019 penalty?
MIPS, the Merit Based Incentive Payment Program, is the part of MACRA that’s appropriate for small practices.  Participating in MIPS doesn’t have to be difficult, but it does require a bit of practical knowhow.  This memo gives you what we think are some of the most important highlights, to date. 
Just to avoid the MIPS penalty:  If you are not completely exempt from MIPS and would like to avoid the 2019 penalty, CMS wants you to (1) look through its list of actions to improve care, (2) choose an action, (3) perform it (for just one patient) and (4) report it to CMS.  (If you would like to try for an incentive, you choose more actions and perform them for more patients.)
What’s in this memo:  In this memo we show you how to research the actions that are available for you to choose from; we provide links to actual CMS webpages, which have lists of actions for each category.  (Currently available are 2016 PQRS actions – just so you can get a taste.  We’re waiting for 2017 information.)
And, so you can find out what you’ll actually need to do for a particular action, we tell you how to navigate to CMS’s Measures Specifications documents. These documents contain a wealth of detailed instructions; we point you at the most important spots and tell you what to look for. (Currently available are 2016 Measures Specifications – again, just so you can get a taste.  We’re waiting for 2017 information.)
CMS’s list of actions to improve care has three categories: (1) The Quality Measures category, (2) the Improvement Activities category and (3) the Advancing Care Information category.  If you’d like to avoid the 2019 penalty, you’ll be able to look through all three categories to find an action that suits you. 
The first category, Quality Measures, contains many actions that may be familiar to you if you have already participated in PQRS.  The reporting methods will also be familiar:  You have the option of putting a special code right on the claim, or using other methods.  You won’t need an EMR for the Quality Measures category.   
The second category, Improvement Activities, has to do with care coordination, beneficiary engagement and patient safety.  We believe that some of these activities may be doable without an EMR (the picture is still evolving, and we will keep you posted).  You report on Improvement Activities by attestation.  Details on the exact procedure you will need to follow to attest, are to come.     
The third category, Advancing Care Information, requires an EMR.  Some of the actions may be familiar to you from the “Meaningful Use” program, and you report by attestation.  Of course, you don’t have to limit yourself to this category just because you have the technology for it. 
Note:  You can’t use these links to actually submit claims, or to actually attest to measures, objectives or activities.  They’re just for your preliminary research.  Click on each link and look around.  You may see actions that look quite doable for your practice. 
Quality Measures:  Click on:  (Note:  If you would like to report by putting a code right on the claim, you can “Filter by” Data Submission Method and then choose Claims.  Your choices will then be limited to measures you can report via claims.)
Improvement Activities:  Go to:
Advancing Care Information:  In 2017 you’ll be able to choose between two sets of measures, depending on which edition your electronic health record (EHR) is: 
-              Option 1: Advancing Care Information Objectives and Measures
-              Option 2: 2017 Advancing Care Information Transition Objectives and Measures
Go to  To determine your edition, click on, and then on the link that says: “Need help identifying your electronic health record edition?”)
Suppose you have been looking at the Quality Measures on, and let’s say that as a reporting method, you want to report right on your regular claim.  So, you’ve filtered the list by Data Submission Method, and you’ve clicked Claims.  Under Select Measures, there are 74 measures to choose from! 
Let’s say you’re interested in the second measure on the list, Acute Otitis Externa (AOE):  Topical Therapy.  You click Add, at right. 
Now, this measure will appear on the right side of the screen (“Selected Measures”).  Click “Download (CSV).”   
Now, on the lower left corner of your screen, a label will appear.  It says “Quality­_Measures (3). csv.”
Once you have clicked on that label you’ll see a spreadsheet.  In the sixth column, titled Quality I, you’ll find the number of the quality measure you have chosen – 91.   
Now go to 2016 PQRS Individual Claims Registry Measure Specifications.  This is a zip file. 
A list of PDFs appears.  Look down till you see the number of the quality measure you have chosen, Number 91.  Click on that PDF. 
At last, you’ve arrived at the key document - the technical specifications for the quality measures.  There’s a lot of detail!  But don’t be overwhelmed.
Just concentrate on this.  Your two most important questions are: (1) What code do I put on the claim? And (2) Which of my patients are going to be suitable for this particular action?   OK, here’s what to do: 
What code do I use?  Scroll down the document – you may need to go down quite some distance, possibly into the second page – till you see the word NUMERATOR. 
Below NUMERATOR – often, several lines down – you’ll see PERFORMANCE MET.  Close by you’ll see a brief statement of the action plus the code: 
“Performance Met: Topical preparations (including OTC) prescribed for acute otitis externa (4130F).”
Which of my patients will be appropriate?  Run your eye back up the document – often, quite some distance – till you see the word DENOMINATOR.  Here is detail about which patients are going to be appropriate for this measure. 
How does claims-based reporting work? 
In MIPS, the Merit Based Incentive Payment Program (the part of MACRA that’s appropriate for small or solo practices), three categories of physician actions are open to you: (1) The Quality Measures category, (2) the Improvement Activities (IA) category (this is a new component), and (3) the Advancing Care Information (ACI) category (this is the successor to the old “Meaningful Use” EHR program).  How you report a physician action, depends on the category you are working with. 
For the Advancing Care Information (ACI) category, you will report by “attesting” on a special CMS website, just as you did for Meaningful Use.  You’ll be able to make a signed legal statement on the screen, confirming that your EHR software has the capability to provide the required data and/or meet the requirements of the ACI objective(s). 
For the Improvement Activities (IA) component, you will also “attest.”  The special website will let you state that you have undertaken those IA activities which are germane to your practice.
For the Quality Measures category, on the other hand, you can report right on your regular claim.  (Or, if you wish, you can use a registry or submit through your EHR software.)  This memo tells you about reporting on your regular claim, for the Quality Measures category.
When must we submit the claim?  You have all of 2017 to submit this claim – in fact, the “window” will still be open until March 31, 2018.
Can we resubmit a claim just to add or correct a Measure code?  Unfortunately, no.
Where on the claim will the Measure code go?  On the claim, you put the Measure code just below the line where you’ve entered the Procedure Code.  The code goes in the Procedures field (24D).  (For electronic claims:  You will need to work with your vendor to be able to put the code on the claim.)  And note:  In the Charges field (24F), you’ll need to put $0.01.  
Where did you find the code?  The code is in CMS’s detailed “Measures Specifications” document, for the particular Quality Measure you are interested in.   Here’s how to find it:   
Preliminary steps at the Quality Measures list:  Let’s say you have been glancing through the Quality Measures list at   And, let’s say you have filtered that list by hitting Data Submission Method and then clicking Claims.  Now, under Select Measures, you have a list of measures to choose from.  Let’s say you’re interested in the second measure on the list, Acute Otitis Externa (AOE):  Topical Therapy. 
You click Add, at right.  Now, on the right side of the screen (“Selected Measures”), you’ll see the Acute Otitis Externa measure. 
Click “Download (CSV).”  Now, on the lower left corner of your screen, a label will appear that says “Quality­ Measures ( ). csv.”
Once you have clicked on that label you’ll see a spreadsheet.  In the sixth column of the spreadsheet, titled Quality I, you’ll find the number of the quality measure you have chosen. This one is Number 91.   
Now, click on the following zip file:  2016 PQRS Individual Claims Registry Measure Specifications.  (Right now, just so you can get to know the procedure, we are referring you to the 2016 Quality Measures.  As soon as the 2017 Quality Measures become available, we will include a reference to those instead.)
A list of PDFs appears.  Look down till you see the number of the quality measure you have chosen, Number 91.  Click on that PDF.  At last, you’ve arrived at the Measures Specifications document!  There’s a lot of detail, but don’t be overwhelmed.  Your two most important questions are: (1) What code do I put on the claim? And (2) Which of my patients are going to be suitable for this particular action?  
Finding the code:  Scroll down the Measures Specifications document – you may need to go down quite some distance, possibly into the second page – till you see the word NUMERATOR. 
Below NUMERATOR – often, several lines down – you’ll see PERFORMANCE MET.  Close by you’ll see a brief statement of the action, plus the code!   Here, the code is 4130F:   
“Performance Met: Topical preparations (including OTC) prescribed for acute otitis externa (4130F).”
Which of my patients will be appropriate for this measure?  Run your eye back up the document – often, quite some distance – till you see the word DENOMINATOR.  Here you’ll see detail about which patients are going to be appropriate for this measure.  For this measure, they obviously have to be patients with ear complaints; in fact, the document tells you the specific ICD-10 diagnosis codes that would apply.
If you just want to avoid the 2019 penalty, you just perform one measure on one patient, on one claim.  But if you’re trying for a bonus, bear the following in mind:   
Simply put (this is really quite an oversimplification, but it gives you the basic idea):  CMS’s systems can register the ICD-10 codes on your claims, and so, at the end of a reporting period, CMS can count your “pool” of patients who have been appropriate for a particular measure.  (For example, let’s say that you had a “pool” of 30 patients with ear complaints.  CMS will know that number, having registered the ICD-10 codes on your claims.)  On what percent of these patients did you actually perform the measure?   For 2017, the MIPS goal is at least 50 percent of the patients.   So, here, the goal would be at least 15 out of the 30 patients. 
CMS views this as a fraction – 15/30 (15 patients over 30 patients).  As we remember from grade school, a fraction has the numerator over the denominator, and CMS uses that idea here.  The “numerator” is 15, the number of patients on whom you performed the measure. (CMS gets this number from the Measure codes that you put on your claims.) And the “denominator” is 30, the size of your pool of appropriate patients. (CMS gets this number from your ICD-10 codes.)  
In the real world, the concepts are a little more subtle and there are a few additional complications – but we’ll talk about them in later memos.  Here, we just wanted to give you the most important basic points.  Meanwhile, if you have questions, call Susan Tucker at 212-684-4681 or email

Help CMS with the “Practice Improvement” part of MACRA

CMS is conducting a Clinical Practice Improvement Activities Study, as outlined in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule.  MIPS-eligible physicians who participate successfully in the study will receive full credit for the Improvement Activities performance category. Applications will be accepted until January 31. See the following website for more information:
How to navigate the NGS website to access the fee schedule
The 2017 Physician Fee Schedule has now been posted on the National Government Services (NGS) website, based on Medicare’s 11/2/2016 Final Rule. You can download the full fee schedule, or you can get pricing for specific CPT/HCPCS codes.  Just go to the NGS Medicare website at and follow these directions.  (There may be spots where you will need to double-click.)
(Note:  If you haven’t visited the NGS site recently, you may find yourself at the preliminary Welcome page first.  Here’s what you need to do.  In the red block at left, click Continue As A Guest.  In the dropdown menu titled “I am a…,” click Part B Provider.  In the dropdown menu titled “Please select,” click New York.  Then hit Next, and in the Attestation box click Accept.)
Now, click on the red "Fee Schedule Lookup" block at right. 
In the upper middle of the Fee Schedule Lookup screen is a block titled "Enter Search Criteria."  Inside this block it says "Select a Fee Schedule," and there is a dropdown menu ("Please Select") on the right.  In that menu, click on "Medicare Physician Fee Schedule Pricing." 
In that same "Enter Search Criteria" block, you will now see "Result Type" (on the second line).  Choose "Full Fee Schedule."  Another time, if you just want the fee for one particular code, you can choose "Specific to Fee Code." 
When you put the cursor in the "Date of Service" block, a calendar will appear. 
In the calendar’s date line at top (which probably shows a 2016 date now), click the far-right arrow until you get to January 2017.  Click any date in January 2017.       
For Region, you will see a dropdown menu ("Please Select") on the right.   In that menu, choose New York (area 01).  This is very important!  Don't choose New York (area 02), New York (area 03), New York (area 04), or New York (area 99).  Those are for locations other than Manhattan.  
Now, hit Search. 
In the middle of the screen, just under the "Enter Search Criteria block," you will now see a block titled "Code Search Results."  In that block, click on "Excel File."
Down at the bottom left corner of your screen, a block appears that says NY_MPFSP_FEES.  Click on it.  (Note again:  You may have to double-click.)
An Excel File appears.  Be sure that at the top left corner, it says "National Government Services, Inc. New York (Area 01) - MPFSP."   Note:  This system is sometimes a little unstable.  It may give you some other geographic area such as Illinois.  If that happens, go back and try again.
Last call to attest to 2016 Meaningful Use - to avoid penalty in 2018
The EHR Incentive Programs attestation system will be open from January 3, 2017, to February 28, 2017.  Physicians must attest by the attestation deadline to avoid a 2018 payment adjustment.
            To help physicians prepare for the 2016 EHR Incentive Programs attestation period, CMS has released an attestation worksheet.  Physicians can log their meaningful use measures for each objective in the worksheet, and use it as a reference when they are actually attesting online for the 2016 Medicare EHR Incentive Program in CMS’ Registration and Attestation System.  The link to the Registration and Attestation System is:
           CMS encourages physicians to visit the CMS 2016 Program Requirements webpage on the CMS website, to access the worksheets and review additional resources for 2016 EHR Incentive Program participation. To review this information, click on the link here:
The Practice Environment
The DEA’s policy for registration renewals:  They’ve decided to keep the “grace period” after all!
Lately, you may have heard that the DEA was planning to modify its policy for the renewal or reinstatement of DEA registrations – eliminating the one-month “grace period” for registrants who had failed to file a timely renewal application.  But, very recently, the DEA changed its mind!  Now, the DEA has stated that it will keep its current policy and procedures, with just one minor adjustment.
            The current DEA policy is as follows:
            If you submit your renewal application in a timely manner prior to expiration, you may continue operations (authorized by the registration) beyond the expiration date, until final action is taken on the application.       
            The DEA allows the reinstatement of an expired registration for one calendar month after the expiration date. If the registration is not renewed within that calendar month, an application for a new DEA registration will be required.
            Regardless of whether a registration is reinstated within the calendar month after expiration, federal law prohibits the handling of controlled substances or List 1 chemicals for any period of time under an expired registration.
            The one minor adjustment:  Starting January 2017, the DEA will no longer send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration.
            If you want to check your registration expiration date, please contact the DEA Registration Service Center at 1-800-882-9539, or email (include your DEA Registration number in your email).  For questions about this alert, please call Debra Cohn, Senior Washington Counsel, at (202) 789-7423, or email or
Your eRx waiver:  What must you do – and when? 
Many NYCMS members have asked what they must do before their NYS eRx waiver expires.  (The expiration date is March 26, 2017.)
Physicians who have the “low-volume certification” (fewer than 25 prescriptions per year):  You’ll need to send in a new certification.  Log onto the Health Commerce System at, navigate to the “Electronic Prescribing Waivers” section, get to Form DOH-5221, and do your certification there.  Or, if you need to request a paper form, please call 1-866-811-7957.  Once the NYS Department of Health has received your certification you will not need further approval – you are free to continue prescribing using paper, phone or fax. 
Physicians who have the “general waiver” (granted to them for various reasons):  You’ll need to submit a new request, with an updated statement of facts describing the continuing circumstances supporting the waiver.  Log into the Health Commerce System at and access the “Electronic Prescribing Waivers” (EPW) application.  Or, if you need to request a paper form, please call 1-866-811-7957.
For additional information about the waivers, call Susan Tucker at 212-684-4681, or email  And, there’s good information at
For a quick refresher on the Health Commerce System (how to set up an HCS account, etc.), call Susan Tucker at 212-684-4681, or email
And one more point:  What if, some day in the future, you decide to prescribe electronically and obtain the setup for it?  Be sure to let the Bureau of Narcotic Enforcement (BNE) know that you’ll no longer need a waiver.  Do this within five business days of gaining the capability to issue an electronic prescription.
NY County Medical Society Membership Benefits
(Keep a Copy Handy, and Share with Your Staff)
NY County Medical Society Membership Benefits
Idilus Offers Physician Practices More Options
As you may know, Oxford recently announced its decision to withdraw HMO health plan options from the individual and group markets effective January 1, 2017. Some of you have been notified of the cancellation of your HMO plan. 
            At New York County Medical Society, we find this presents a challenge for many of our members to provide medical insurance for themselves, their families and the employees within their practice. As the healthcare industry continues to rapidly evolve, insurance companies are offering smaller networks with fewer hospitals and specialty physicians - despite increasing prices. The insurance market has become especially narrow for individuals, and for small to mid–sized physician practices.
            As a result, we have chosen to partner with IdilusHR, an organization that provides custom HR and benefit solutions, to provide a variety of services to benefit both our members and their practices. Among these benefits is a variety of affordable and comprehensive medical insurance solutions for those affected by Oxford’s nonrenewal of HMO plans.
            IdilusHR offers eight different health plan options — with out-of-network benefits — to meet the needs of physician practice employees and owners. In addition, IdilusHR is offering all New York County Medical Society members a 20 percent discount on their administrative fee. 
            It is important to understand that IdilusHR is not an insurance broker, but instead a PEO (a professional employer organization).  This means that IdilusHR may be able to provide a physician practice with a comprehensive HR package, that lets the practice purchase health insurance and other benefits as a large employer – at a lower rate.  IdilusHR charges a fee for these services on a monthly basis.  Hopefully, the savings you’ll realize from large-volume purchasing and reduced accounting and payroll costs will offset a significant percentage of the monthly fee you’ll pay to IdilusHR. 
            For example, a qualified member could pay IdilusHR $689 per month*, which would include payroll administration, benefit concierge service, and health-insurance premium for a large national PPO plan.  In addition, for added premium, the enrollee would be able to access other benefits offered by Fortune 100 companies. *(Example price is for the Flex 2500 plan.)
            IdilusHR will be glad to analyze your practice and give you a quote for the services they provide, including health-insurance benefits. It is up to you to decide if the IdilusHR program is a good fit for you.  (Please note that some practices may not qualify for all plan offerings.)
            For more information, please visit

Expert Financial Planning Help

Vital Planning Group is dedicated to providing thoughtful advice and innovative solutions in the key areas of financial management and wealth preservation. Vital has extensive experience working with medical professionals helping them manage the unique financial arc of their careers. Society members get complimentary consultation and review, complimentary financial needs analysis, discounted financial planning fees, discounted asset management fees – and education, too. Work with people who understand physicians and their financial needs. Call Edward Alferoff at (212) 578-3003 or visit .
Professional Employer Organization (PEO) Gives You Big Time Status

Even small employers (and solos) can have big employer advantages when they join the Idilus PEO. All human-resource issues from payroll to benefit selection and staff manuals are taken care of. You are still in charge, but you have a large HR department behind you. PEO fees are discounted for Society members. If you don’t know what a PEO does, check out or call Matt Peterson at Idilus, (877) 545–5666.

Practice Builders:  Helping You Market Your Practice Today
The New York County Medical Society is pleased to announce the addition of a key Business Partner, Practice Builders, the largest think tank of its kind in North America. Practice Builders has consulted with more than 15,000 practices in nearly every area of health care, and no matter what size or type of practice you have, you can get the help you need to make it better.
            Practice Builders has services designed to help busy Society physicians like you attract the patients, cases, and payers you prefer, while increasing referrals and protecting your professional reputation online.  Society members will receive discounted consultations and discounted rates on a wide range of Practice Builders services, including: 
  1. Online practice reputation management - the unique positive solution for the unfair or disgruntled patient who criticizes online
  2. Social media programs
  3. Branding and collateral development
  4. Strategic growth marketing plan development
  5. Public relations and advertising
  6. Onsite staff training
  7. Field-Based referral outreach training
  8. Custom website development, search engine optimization, and hosting
  9. Reputation assessment, search engine assessment, social media assessment and “mystery shopper” call.  

Trust the Employees You Hire

Don’t put your office in a bind when you need permanent or temporary staff assistance. Winston Support Services, LLC is JCAHO–certified, and you can be assured that all of its candidates are selected and pre-screened for proper licensure, background checks (criminal and educational), references, skills, and physicals (including PPDs and ten panel toxicology screens). This saves you a great deal of time and ensures professional screening result. If you need someone in your office ASAP, AND you want to make sure that they are perfect for your position, AND you want a NYCMS discount, join and take advantage of your special member rates at Winston Support Services. Call Ivy Kramer, MSW, CSW, your designated account representative at (212) 687–4667, or email
Members Get Free Medical Translation Benefit

The Canopy Medical Translator is a free download for our members.  Canopy is supported by the NIH to create a next-gen translator app for medicine, enabling you to communicate with patients in Spanish, Chinese, Arabic, and more. To see how it works, watch the viheredeo. Don’t wait for a translator to show up, or worry about finding a “translator” phone in your hospital. You have the app and you have the access with Canopy.  The Canopy Translator allows you to communicate with your patient and reach out to the translator in your hospital, if you need more details.  Is there any place where doctors need this app more than New York City? Get your FREE benefit of Society membership today!
            Society members will get access to the app for free (value of $250). There are a limited number of free licenses, so act fast!
            Use access code 9333 to unlock the app after downloading:
            For iOS – click here. (*If using an iPad, switch the search to "iPhone Only.")
            For Android – click here .

MEDELITA for Lab Coats and Scrubs

Our partnership with Medelita allows members to save on premium Medelita lab coats and scrubs, at a special NYCMS rate. Members may choose to embroider the NYCMS logo without incurring any artwork digitization costs. Medelilta scrubs and lab coats represent a shift from traditional lab coats, offering sophisticated style, performance and fabric, and gender-specific sizing and style. For more information, visit or call (877) 987-7979 and mention the Society. To receive your Society discount, go the and click on the Medelita icon.
Be A Hero to Your Patients With Good Rx
Help your patients and your practice with savings of up to 80 percent on your patients' prescriptions. Use GoodRx in your practice to educate and empower your patients, whether they're insured or not. The result: Happier, smarter patients who save money and take their meds as prescribed. Member Only Benefit - Get your Free GoodRx Office Kit, GoodRx for Physicians.  To find out more about the tool, go to this link:   Prescription Drug Price Comparison Tool for Patients.
Commercial Tenant Concierge:  Effective real estate expertise - on demand and at your service.
Commercial Tenant Concierge (CTC) helps healthcare tenants cost effectively manage real estate leases. Their experienced real-estate professionals are on call to solve problems related to landlord billing, building services, HVAC complaints, alterations, subleasing, key action dates and other lease-related issues. Thorough monthly services allow you to subscribe when and if you need their help, when the time is right for you. If you need assistance with subleasing, verifying landlord bills, resolving billing discrepancies, or coping with operational issues such as alterations of your office - or if you need advice on marketing conditions and opportunities - CTC will work for you. Call the Society at (212) 684-4670 for referral to CTC directly
Save 10% On Your NYS Auto Insurance Premium

The New York County Medical Society is pleased to offer you The American Safety Institute’s 6 Hour Safe Driving Accident Prevention Program, at a member–only price of $26.00. The online course is approved by the New York State Division of Motor Vehicles, and by taking it, you can save 10 percent on your New York State automobile liability and collision insurance premiums. (If you live outside of New York State, check with your own insurance company regarding discounts.)  You can also reduce your driver violation point total by a maximum of four points.
                You must complete the six–hour course within 30 days. Following completion of the program, you will receive your certificate to give to your insurance carrier by mail.
                The insurance premium reduction applies to all motor vehicles principally operated by the motorist who completes the course. The discount can be applied to only one driver for each covered vehicle. To get the Society discounted pricing, you must create an account by clicking here .
Free HIPAA–Compliant Smart Phone Communications

Thanks to DocBookMD and the Society, you can have access through a smartphone platform, designed by physicians for physicians, that provides an exclusive HIPAA–compliant professional network to connect, communicate and collaborate with your Society colleagues.       Send pictures of x–rays and reports, wounds or other information, and be reassured that you are not taking any HIPAA risks.
                You will need to have your NYCMS Member ID ready. If you do not know it, call the membership department at (212) 684–4670, or email  Then go to your phone and download your free app from the iTunes App Store, or from the Android Market. Once you have downloaded the app to your device, open it up and follow the simple registration steps.
                Includes access to all Society members, as well as to all Manhattan pharmacies - right on your iPhone, iPad, and Android. Do you teach medical students or residents? You need this app.
WorkerbeeMD offers custom physician websites at preferred pricing to NYCMS

WorkerbeeMD is a medical website design company focused on designing and marketing websites for doctors. The company's solutions enable practitioners to enhance the impact and efficiency of their businesses by educating, empowering, and attracting patients through a visually compelling and informative online presence.
             WorkerbeeMD will design, maintain, host, and search-engine optimize your website - ensuring that patients can find you online. They will provide website analytics for you to track the number of visits to the site, as well as other metrics to measure your website's success.   
             Medical website design and development, hosting, maintenance and search engine optimization provided with preferred rates for Society members.  Email, or call (646) 472–5220 and request a complementary design!
Insurance with Service

Mercer is a global consulting leader in talent, health, retirement, and investments. Mercer helps clients around the world advance the health, wealth, and performance of their most vital asset— their people. Mercer’s 20,500+ employees are based in more than 40 countries. Mercer is a wholly owned subsidiary of Marsh & McLennan Companies (NYSE: MMC), a global team of professional services companies that offer clients advice and solutions in the areas of risk, strategy, and human capital. Call Mercer at (800) 888-6926, or Sony Hilado at the Society, (212) 684-4682, or go to
Web-Based Revenue Generator

athenahealth provides the only physician revenue and clinical cycle management offering that integrates web-based practice management and EMR software, continually updated payer knowledge, and back office processing into a single service.
            The results are faster payment at lower cost, improved patient care, higher revenue retention and less hassle, for thousands of healthcare providers using athenahealth nationwide.       
           The company collects over $2 billion on behalf of its clients annually.  athenahealth is dedicated to helping providers make optimum use of their time, ultimately improving the quality of service delivered and the financial reward for it. Call (888) 652-8200.
Credit Cards at a Great Rate

Improve your cash flow! Society members can accept patient payment by credit card at a very favorable rate that offers one source for processing all major credit cards, with fast direct deposit to your bank account. It's a payment option your patients will appreciate, at a processing rate you can appreciate. Call Eric Cole at Card Connect (913) 953-5304.
Doctor-Driven Liability Coverage

The Medical Liability Mutual Insurance Company (MLMIC), physician-owned and managed, is the only professional liability insurer we endorse. The company has the country's largest and most experienced professional liability claims department. Call (800) ASK-MLMI or visit our website.
When Third Parties Aren't Friendly

As a Society member you can get expert advice and assistance on managed care contracts, service denials, Medicare, workers' compensation and commercial claims, as well as other reimbursement issues, from consultant James McNally. Mr. McNally is a seasoned professional (previously with Empire Blue Cross/Blue Shield).  For referral, call (212) 684-4670.
Expert Legal Advice

The Society's Legal Services Program gives members an initial phone consultation on legal issues specific to medical practice, at no charge. If additional services are necessary, Einiger and Associates can provide them to members at a discounted fee. Get help on legal issues such as advice on managed care contracts, the Office of Professional Medical Conduct or licensure procedures, and other help. Call (516) 477-7909.
Parking Ticket Relief

Get a Doctor-On-Medical Call card, and use the Society's Parking Review Panel to get help on dismissal of parking tickets in New York City. Call (212) 684-4670 and join members who save on parking fines.
Education Opportunities

The Society sponsors CME conferences on the topics you think are important. This year, look for the important public health & practice management issues.
Discounts on Copying Needs

Superior Office Systems offers a 10 percent discount to members on all Canon products. Check out fax machines, copiers, and other printing products at (212) 695-5588.
Collect What's Due

I.C. System, Inc., the endorsed collection service of New York County Medical Society, offers "Value-Added Benefits" for members only! If you have a backlog of bad debt, no matter how large or small, or are having trouble with slow-paying unresponsive insurance carriers, I.C. System can help with effective and professional accounts receivable management services, tailored to your specific office requirements. Contact I.C. System (800) 279-3511.
Entertainment Discount Program

The Society offers you free access to a unique entertainment discount program, Working Advantage. View a wide variety of discounts on the internet and order online or call. Savings include discounts on movie tickets, theater and musical events, shopping, gifts and an advantage points program where you earn rewards while you save. Go to: to view current events and discounts. Call (212) 684-4682 to get your membership number.
MedNet Technologies Offers Special Packages for Society Members

MedNet is the leader in web development services for healthcare professionals, hosting and managing the websites of over 3,000 medical, dental and veterinary practices, hospitals, medical societies, physician networks, colleges, laboratories, insurance companies and other related businesses throughout the United States and internationally. No other web development company has built or manages as many healthcare websites as we do. Our clients include many of the most well-respected healthcare providers in the world.
            We invite you to browse our online portfolio and see some of the award-winning work we have done. Our team of more than 50 web designers, copywriters, search engine visibility specialists, programmers and support personnel work together with our clients to build, manage and market their sites on the Internet using cutting-edge technologies and strategies. Together with the extensive resources and unique expertise we offer as specialists in healthcare web development, MedNet's dedication to technical and artistic excellence guarantees that each website developed is effectively targeted to the client's desired patient base and optimized to direct appropriate web traffic to their practice.
            Our services include web design, content development and special feature programming, in addition to website hosting and management and web visibility services. Built with an unmatched attention to detail, each website we develop features eye-catching graphics, professional photography and detailed content optimized for successful search engine ranking. 
           Visit the MedNews blog for informative articles to help grow your practice. To learn more, call Jay Erickson, Senior Sales Executive, MedNet Technologies at (516) 285-2200 Ext. 6106 or check out   Ask about the Society discount.
HIPAA Secure Now! provides many services to NYCMS members
HIPAA Secure Now! helps you with HIPAA compliance.  As the healthcare system moves from paper to digital, the U.S. Department of Health and Human Services is emphasizing HIPAA much more than before.  HIPAA requires you to protect patient information, and provides specific guidance – yet the same complex HIPAA regulations apply equally to the largest hospitals and the smallest practices. 
        Naturally, most physician practices don’t have a special, dedicated HIPAA expert, but NYCMS has partnered with HIPAA Secure Now! to help our members with all these issues.  You can get a comprehensive, yet affordable, HIPAA compliance service to NYCMS members, at a 10 percent discount.  Everything you need is included: 
—    Risk Assessments
—    Training
—    Policies
—    Documentation Portal
—    HIPAA support and consulting
To talk about what HIPAA Secure Now! can do to take the headaches of HIPAA security out of your small (or large) practice, contact  And, note the following: 

You can get answers to your HIPAA questions via HIPAA Security Now’s free email “hotline.”  If you have a HIPAA question or issue, just send an email to
You can work with HIPAA Secure Now! if you’ve been targeted for a HIPAA audit.  OCR, the U.S. Department of Health and Human Services’ Office for Civil Rights, is now moving into what it calls “Phase 2 HIPAA audits.” If you’ve been picked for an audit, HIPAA Secure Now! is ready to assist you. 
OCR’s message will say that you have 10 business days to upload specified documents to an OCR portal.  They’re looking for just a sampling of your HIPAA compliance program – but of course, you can’t know in advance what samples they could possibly request!  The best strategy?  Make sure your HIPAA compliance program is in the best shape it can be. You can work with HIPAA Secure Now! on your compliance program, starting immediately. 
You can work with HIPAA Secure Now! to prepare for MACRA.  MACRA (the Medicare Access and CHIP Reauthorization Act) is a giant package of regulations that will change Medicare’s fundamental fee-for-service system.  The new MACRA system will tie physician payments to quality and value; the goals are better care, lower costs and improved health.
            Physicians will still be paid on the traditional fee-for-service basis, but their payments may be adjusted depending on their MACRA performance score.  The payment adjustments may start at around 4 percent in 2019; by 2022 they may be as high as 9 percent (plus or minus – depending on the physician’s score).  You will need to start complying with the new MACRA rules starting in 2017; the payment adjustments will be applied starting in 2019. 
            Each practice will be required to have performed a HIPAA Security Risk Analysis – otherwise you’ll get an automatic zero on a sizeable portion of the MACRA challenge.  And, be aware that CMS is explicitly encouraging private payers to implement similar programs.  You can work with HIPAA Secure Now! on your risk analysis.