NYCMS Member Alert - September 28, 2017

Vol. 12, Issue 8

NYCMS members, get New York Jets tickets at special low prices for October 29 (Atlanta Falcons).  Click on:  New York Jets Corporate Huddle:  Special ticket offer for NYCMS members. 
 
Emblem is shrinking its networks again – “non-renewing” many physicians’ contracts, and jeopardizing the physician-patient relationship.  Click on:  Please tell legislators about Emblem – and, what to do if you receive a non-renewal letter.   
 
The bad medical liability bill:  We may beat it yet, since it hasn’t gone to the Governor.  Click on Tell Cuomo to veto the bill – you can use MSSNY’s instant message system.   
 
Get involved in our legislative activities.  Click on:  Join MSSNY’s Physician Advocacy Liaison (PAL) network.
 
NYCMS’s own committee year is also beginning, with interesting discussions, colleagues and projects.  Click on:  NYCMS Committees:  Join one today.   
 
Dealing with payers is getting a bit easier.  Click on:
            To find Medicare fees on the web, use the new NGS lookup tool.
            Using NGSConnex to cope with Medicare:  October, 2017, training webinars for beginners and “advanced Connexers.” 
            Medicare preventive services – here’s an easy way to get codes, reimbursement information and more. 
            Aetna issues guidance on how to access your fee schedule.
 
Important Medicare dates are coming.  Click on:              
            NGS’S ban on handwritten paper claims:  The Manhattan deadline is November 13, 2017. 
            Patients start receiving new Medicare cards in April, 2018.  What should you do now?
 
CMS’s MACRA/MIPS programs:  Click on: 
            Might you be exempt from MACRA/MIPS?  Use this quick Lookup Tool.
            If you’re not exempt from MACRA/MIPS:  Take easy steps now to avoid the 4% penalty – without an EMR.
             
Problems continue with commercial payers.  Click on:  Annoyed about United Healthcare’s plan to stop paying for consult codes? 
 
Meanwhile, the practice environment has other challenges.  Click on: 
            Wednesday, October 18, 2017, at 7:30 a.m.:  MSSNY CME webinar, Herd Immunity Protects Vulnerable Populations.
             New law:  You cannot charge patients for copies of medical records, if they’re for a government benefit application. 
            MSSNY President Charles Rothberg, MD, talks about when – and when not – to switch your EMR/EHR. 
            MSSNY studies physician burnout, seeks way forward.
            Alzheimer’s Association develops resources for physicians.
            In-office buprenorphine treatment may work for patients with opioid use disorder.
            Governor reduces health insurance barriers to substance abuse treatment coverage.


 
Do you have our new NYCMS address?  We’re at 261 West 35th Street, Suite 504, NY, NY 10001. 
             Our phones and fax remain the same:  The general number is 212-684-4670, the fax number is 212-684-4741.  Staffers’ email addresses and individual phone numbers remain the same too:  cmalone@nycms.org (212-684-4691), stucker@nycms.org (212-684-4681), shilado@nycms.org (212-684-4682), ljoseph@nycms.org (212-684-4698). 
            Check the envelope before you send in your next Doctor On Call Parking Card request, or your 2018 dues or registration payment.  (Pass this message on to your staff.)
 
Don’t forget the classified section on our website, www.nycms.org, for places to rent, share or buy; services to use; and people and positions available.   Go to www.nycms.org and check out the MM News Classifieds.
 
           
NYCMS reminds you:  We have a huge variety of member benefits!
 
NYCMS offers members an amazing 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 Committees:  Join one today 
 
The New York County Medical Society's new committee year is starting up this fall, and YOU ARE KEY!  We promise: It WON'T be onerous. It WILL be interesting. You WILL meet colleagues.  Contact Cheryl Malone at cmalone@nycms.org to participate:
           CME: Interested in planning CME programs? Join the CME Committee.
            Government Affairs:  Want the first news on the legislative front?  We ask this group to call and email legislators when we need to get the word out. Grassroots letters (via MSSNY’s instant system) make it easy, and your passion and experience do the rest.

            Membership: What do doctors want? How can we give it to them? How can we help our members interact with each other? If you like networking and want to set the agenda for membership initiatives, this group will be for you.
            Public Health:  Do you like to discuss the big picture? Recent topics for this group have included the Opioid Crisis, Medical Marijuana, and even Tattoo Ink. 
            Public Relations and Social Media: YouTube? Twitter? We need people with big ideas and social networking skills for this group.
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, 261 West 35th Street, Suite 504, New York, New York 10001.   If you have questions, call Lisa Joseph at (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 email stucker@nycms.org.
 
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 stucker@nycms.org.
  
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 email ljoseph@nycms.org.   Also, don’t forget the classified section on our website, www.nycms.org, for places to rent, share or buy; services to use; and people and positions available.   Go to www.nycms.org and check out the MM News Classifieds.
 
Events – You’re Invited
 
New York Jets Corporate Huddle:  Special ticket offer for NYCMS membersNew York Jets tickets at low prices – 300 level tickets start at $45, and 100 and 200 level tickets start at $95.   Date:  October 29 (Atlanta Falcons).  Please use promo code NYCMS (case-sensitive).  Go to:  https://www.fevo.com/discovery/Jets-Corporate-Huddle-qLxNR0tG?promo.
If you have questions, please contact Shane Brennan with New York Jets.  Call 973-549-4846 or email sbrennan@jets.nfl.com
 
 
Wednesday, October 18, 2017, at 7:30 a.m., MSSNY CME webinar, Herd Immunity Protects Vulnerable Populations


MSSNY will begin its 2018 Medical Matters continuing medical education (CME) webinar series with “The Importance of Herd Immunity” on Wednesday, October 18, 2017 at 7:30 a.m.  William Valenti, MD, chair of MSSNY’s Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee, will serve as faculty for this program.  Registration is now open for this webinar hereAdditional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.  The educational objectives:
  • Review the epidemiology of vaccine-preventable infectious disease and role of herd immunity.
  • Describe how herd immunity protects vulnerable populations such as newborns, the elderly and those who are too sick to be vaccinated.
  • Discuss the percentage(s) of a population who need to be vaccinated to allow herd immunity to be effective.
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 
 
The Legislative Horizon

Join MSSNY’s Physician Advocacy Liaison (PAL) network
 
To everyone concerned with physicians’ issues:  This is to invite you to join a new “key contacts” network MSSNY is creating, which will include all the county societies.  This new Physician Advocacy Liaison (PAL) network will help get our message across at the local level and boost our visibility.
            Says John Belmont, MSSNY Vice President for Legislative and Regulatory Affairs: “Do you want to play a critical role in protecting the future of medical care delivery?  To reach and energize our membership, we need to expand the ways by which we communicate with physicians to help to greatly increase our activist network to conduct necessary grassroots efforts.
            “MSSNY is building an even more powerful grassroots infrastructure to increase physicians’ contacts with their local legislators.  We must mobilize physicians to better ensure the enactment of favorable legislation and the defeat of proposals that will adversely impact the care that you provide to your patients.  We must make certain that our elected officials remain committed to championing the issues that matter most to MSSNY members and their patients.  We are aware that many of you already have close relationships with various legislators, and/or are aware of other physician activists who do.  Therefore, we are looking to you to help update our list of key contacts so that we can expand the physician community’s involvement in the legislative process. 
           “There has never been a greater need for physicians to become active.  With so many changes occurring in our health care system, and other opposition interests seeking to marginalize the physician’s role as leader of the healthcare team, we must make up for it with an overwhelming presence in grassroots activity that will make it impossible for legislators to ignore.”
           Many of you have already been calling or writing letters whenever we have an urgent legislative issue.  As a PAL member, what will your additional responsibilities include?   
  • You’ll educate other members on issues facing physicians – e.g., at county medical society or medical staff meetings.
  • Working with your county medical society, you’ll be available to meet with your members of the legislature at least twice a year.
  • You’ll attend training programs on legislative issues.
  • You’ll enlist other member to support our action plans, and mobilize them to action.
  • You’ll join MSSNYPAC and recruit others to join.  (Contributions need not be large!)    
 
To sign up, call Susan Tucker at 212-684-4681 or email stucker@nycms.orgAnd, thank you to the many physicians who have already answered the call and added their name to the list!
 
 
Please tell legislators about Emblem – and, what to do if you receive a non-renewal letter  
 
Once again, Emblem Health (the HIP/GHI parent company) is notifying some physicians that their contracts will not be renewed.  The effective date is December 2017.  Please send your legislators an instant letter – tell them that physicians must have due process in these non-renewal situations.  MSSNY's Grassroots Action Center sets up the message and instantly sends it for you.  Just click on: 
https://cqrcengage.com/mssny/app/onestep-write-a-letter?3&engagementId=340313
 
If you receive a non-renewal letter:  This issue came up in 2013, when Emblem and other major insurers were terminating physicians in order to narrow their Medicare Advantage and commercial plan networks. The insurers assert that the current move is not a termination but a non-renewal; but it accomplishes the same objective.  Emblem does provide an appeal mechanism, but ONLY for its Medicare Advantage line.
 
If you participate in one of Emblem’s Medicare Advantage plans:  You should submit your Medicare Advantage appeal as soon as possible.  Go to:
Join MSSNY’s Physician Advocacy Liaison (PAL) network
 
To everyone concerned with physicians’ issues:  This is to invite you to join a new “key contacts” network MSSNY is creating, which will include all the county societies.  This new Physician Advocacy Liaison (PAL) network will help get our message across at the local level and boost our visibility.
            Says John Belmont, MSSNY Vice President for Legislative and Regulatory Affairs: “Do you want to play a critical role in protecting the future of medical care delivery?  To reach and energize our membership, we need to expand the ways by which we communicate with physicians to help to greatly increase our activist network to conduct necessary grassroots efforts.
            “MSSNY is building an even more powerful grassroots infrastructure to increase physicians’ contacts with their local legislators.  We must mobilize physicians to better ensure the enactment of favorable legislation and the defeat of proposals that will adversely impact the care that you provide to your patients.  We must make certain that our elected officials remain committed to championing the issues that matter most to MSSNY members and their patients.  We are aware that many of you already have close relationships with various legislators, and/or are aware of other physician activists who do.  Therefore, we are looking to you to help update our list of key contacts so that we can expand the physician community’s involvement in the legislative process. 
           “There has never been a greater need for physicians to become active.  With so many changes occurring in our health care system, and other opposition interests seeking to marginalize the physician’s role as leader of the healthcare team, we must make up for it with an overwhelming presence in grassroots activity that will make it impossible for legislators to ignore.”
           Many of you have already been calling or writing letters whenever we have an urgent legislative issue.  As a PAL member, what will your additional responsibilities include?   
  • You’ll educate other members on issues facing physicians – e.g., at county medical society or medical staff meetings.
  • Working with your county medical society, you’ll be available to meet with your members of the legislature at least twice a year.
  • You’ll attend training programs on legislative issues.
  • You’ll enlist other member to support our action plans, and mobilize them to action.
  • You’ll join MSSNYPAC and recruit others to join.  (Contributions need not be large!)    
 
To sign up, call Susan Tucker at 212-684-4681 or email stucker@nycms.orgAnd, thank you to the many physicians who have already answered the call and added their name to the list!
 
 
Please tell legislators about Emblem – and, what to do if you receive a non-renewal letter  
 
Once again, Emblem Health (the HIP/GHI parent company) is notifying some physicians that their contracts will not be renewed.  The effective date is December 2017.  Please send your legislators an instant letter – tell them that physicians must have due process in these non-renewal situations.  MSSNY's Grassroots Action Center sets up the message and instantly sends it for you.  Just click on: 
https://cqrcengage.com/mssny/app/onestep-write-a-letter?3&engagementId=340313
 
If you receive a non-renewal letter:  This issue came up in 2013, when Emblem and other major insurers were terminating physicians in order to narrow their Medicare Advantage and commercial plan networks. The insurers assert that the current move is not a termination but a non-renewal; but it accomplishes the same objective.  Emblem does provide an appeal mechanism, but ONLY for its Medicare Advantage line.
 
If you participate in one of Emblem’s Medicare Advantage plans:  You should submit your Medicare Advantage appeal as soon as possible.  Go to:  
https://www.emblemhealth.com/Providers/Provider-Manual/Dispute-Resolution-for Medicare-Plans/2016-Provider-Non-Renewal-Appeal-Rights.
 
If you participate in one of Emblem’s commercial networks:  The insurer’s "right" not to renew a contract is current New York law – but you should still challenge the non-renewal, to put the insurer on notice that these actions will have far-reaching consequences for the insurer’s subscribers (your patients).  Go to:  https://www.emblemhealth.com/Providers/Provider-Manual/Dispute-Resolution-for-Medicare-Plans/2016-Provider-Non-Renewal-Appeal-Rights.   
 
You can use our template letters:  Below are links to letters you can revise to fit your own situation:   
  • Letter to your Emblem Health/Emblem Health Medicare Advantage Patients, explaining that they may keep you as their physician. 
  • Letter to your legislators, warning them of the risk that the contract non-renewal poses to your patients and the doctor-patient relationship. 
  • Letter for your patients to send, so that your patients can make their own protest to the insurer.
  • Appeal letter for you (the physician) to send to the insurer, appealing the decision to "discontinue" your network contract or not renew it.  Personalize this letter with any specifics about your practice, especially if you participate in Medicare-based quality programs such as PQRS or EHR/CQM.  State whether you are using the facts in the letter to make your appeal, or whether you request a hearing with the plan.  Be sure to follow the appeal directions.   
090117 Emblem Health Non Renewal Templates
 
Emblem Health Non Renewal Letter Page 1
 
Emblem Health Non-Renewal Letter Page 2
 
After you file your written appeal:  You may, if you wish, call the 800 number provided, or send an email to Jeff Danilo at jdanilo@emblemhealth.com.  This move won't replace your formal written appeal, but it is a way to express your grave concerns with the potential damage that the contract non-renewal could cause your patients.             
            Furthermore, and ONLY AFTER your written appeal:  If the insurer mentions concerns about value or quality in its response to your appeal, you may want to contact Emblem’s regional medical director, Eliza Ng, MD, Medical Director, Emblem Health, 55 Water Street, New York, NY.   
            Alert your patients to what's going on.  Have them call Emblem Health or contact Jeff Danilo, or - if applicable - bring the issue to their employer's attention.  Remind patients that Medicare's Open Enrollment period is only open for a limited time.  If you are in network with another Medicare Advantage plan, patients may be able to sign up with that plan.  Or, they can revert to traditional fee-for-service Medicare so they can go to any physician they wish.  Patients with Medicare can call 1-800-MEDICARE or visit www.medicare.gov for plan information. 
 
 Tell Cuomo to veto the bill – you can use MSSNY’s instant message system
 
All physicians are urged to continue to call Governor Cuomo at 518-474-8390 and send a letter here, urging the Governor to veto the so-called “cancer only” medical liability statute of limitations expansion bill (S.6800/A.8516).  Tell the Governor that we need comprehensive medical liability reform instead.
             This extremely bad bill – which was ambiguously drafted, and was rushed through the 2017 Legislative Session’s final hours - passed the Legislature over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.  The bill would expand the medical liability statute of limitations for cases that involve “alleged negligent failure to diagnose a malignant tumor or cancer.”  The bill would permit lawsuits 2.5 years from the “date of discovery” of such alleged negligence, up to an outside limit of 7 years.  Actuaries have estimated that this legislation could increase already exorbitant premiums by 10 to 15 percent, at a time when no increases can be tolerated.
New law:  You cannot charge patients for copies of medical records, if they’re for a government benefit application
 
The Governor has signed into law legislation (S.6078, Valesky/A.7842, Gottfried) prohibiting healthcare providers and facilities from charging patients for copies of medical records, when the records are needed “for the purpose of supporting an application, claim or appeal for any government benefit or program.”
            The previous law had already prohibited charging for medical records when a patient was unable to pay.  Now, the law will also address records requirements for applications for Social Security Disability Insurance (SSDI), the Supplemental Nutritional Assistance Program (SNAP) and other programs designed to help lower-income patients; and, records requirements for other benefit programs such as those for 9/11 first responders.
Governor reduces health insurance barriers to substance abuse treatment coverage


New York Governor Andrew Cuomo has announced new regulatory guidance to help New Yorkers overcome insurance-coverage barriers that could prevent them from receiving medications they need for the treatment of a substance abuse disorder. This move is part of a series of initiatives to facilitate new addiction treatment, recovery services and support services to residents suffering from substance-use disorders in underserved communities throughout New York City and Long Island.
 
Specifically, the New York Department of Financial Services (DFS) has issued a new regulation that will require insurers who offer large-group coverage to allow consumers to appeal coverage denials for medically necessary addiction medications, when these medications are not on the list of covered drugs.  The regulation calls for an insurer to notify the patient and the prescribing physician within 72 hours of the request, and to provide coverage of the non-formulary medication for the detoxification or maintenance treatment of a substance-use disorder for the duration of the prescription, including refills. 
 
The regulation also requires an expedited appeal process for “exigent circumstances”:  In those situations, notification of the determination must be provided to the patient and the prescribing physician no later than 24 hours following receipt of the request.
 
Moreover, DFS has issued a “circular letter”  to New York insurers designed to eliminate impediments to addiction services coverage, “to prevent insurers from excessively reviewing the medical necessity of opioid treatment, and to bar the inappropriate delay of coverage.”
Medicare Issues
 
To find Medicare fees on the web, use the new NGS lookup tool
Says NGS: “Did you know we have a convenient way to access each type of fee schedule? The Fee Schedule Lookup Tool is a quick and easy way to determine the allowed amounts for the services you render, and so much more. We encourage you to review the How to Use the Fee Schedule Lookup Tool article to learn more about this useful calculator. To read the full article, click on:  JK: Part B.”

Using NGSConnex to cope with Medicare:  October, 2017, training webinars for beginners and “advanced Connexers”

NGSConnex: Getting Started:  NGSConnex is a web-based portal that provides claim status, beneficiary eligibility, financial data, provider demographics, individual claim entry submissions, and the ability to submit redeterminations, reopenings, and ADR letters. This webinar will focus on getting started in our self-service portal, NGSConnex. Wednesday, 10/11/2017
12:00-12:30 p.m. CT / 1:00-1:30 p.m. ET
Click here for details and registration

Using NGSConnex for Part B Claim Submission:  Submit your Part B claims electronically to National Government Services using our self-service portal, NGSConnex. We will provide simple step-by-step instructions to get you started in submitting your claims. You will also learn about the recent enhancement to copy claims which makes entering claims even easier!  

            Please note: We will focus specifically on the functions mentioned above. To obtain training on other NGSConnex features please view our education calendar for additional training opportunities on all of the features NGSConnex has to offer. *Note: Your registration is complete only when you receive a confirmation at your email address immediately after submitting your registration.
Using NGSConnex to Verify Eligibility:  Did you know that you can verify Medicare beneficiary eligibility in our self-service portal NGSConnex? You can also find out whether the patient has other primary insurance and home health and hospice benefit information. NGSConnex is quick and easy to use; users can access information without calling the Provider Call Center or accessing the IVR. Please join us as we demonstrate these features in our self-service portal, NGSConnex. Thursday, 10/12/2017
12:00-12:30 p.m. CT / 1:00-1:30 p.m. ET
Click here for details and registration*
Using NGSConnex for Viewing Claim Status, Overlaps, and Part B Financials:  Did you know that you can view claim status and claim overlaps in NGSConnex? This webinar will show NGSConnex users how simple it is to get the claim status information and obtain the NPI of the facility or office that your claim may be overlapping, without making a call to the NGS Provider Contact Center. We will also review Part B financial information, which includes viewing and obtaining FCN and check information. Might you be exempt from MACRA/MIPS?  Use this quick Lookup Tool
 
Certain physicians are exempt from MIPS:  Their yearly Medicare revenues may be under a certain level, or they may see fewer than a certain number of Medicare patients per year, or they may fall into certain other categories.  There is a MIPS Participation Lookup Tool you can use to find out your status.  Click on the link here:  https://qpp.cms.gov/.   Then, look on the right-hand side and enter your NPI.
 
 
 
If you’re not exempt from MACRA/MIPS:  Take easy steps now to avoid the 4% penalty – without an EMR  
             
If you're not exempt from MACRA/MIPS, you can still avoid the 4% penalty in 2019.  You just send CMS a small amount of MACRA/MIPS information, reflecting your activities during the 2017 reporting period.  You don’t need an EMR/EHR to do this.  The final date for submitting the information is March 31, 2018. 
 
We’ll get into the details, but first, here’s an overview.  We will assume that you would like to report right on the claim, which is free of charge, rather than signing up with a Registry, which might cost money.     
 
  1. You choose one Quality Measure.  Quality Measures are physician activities much like the old PQRS measures, some of which you may already be doing - e.g., diabetic screening. You may be able to choose a Quality Measure related to your specialty.  Various specialty societies have created their own lists of measures; some of these measures are relevant to the particular specialty, while others are applicable to many specialties.  We use Dermatology as an example in the following instructions, but once you see the pattern you will be able to find the measures for your own specialty.   
 
  1. You find the special reporting code or codes for that measure.
 
  1. You put the special code(s) right on your regular claim. 
 
You just have to report one MACRA/MIPS measure on one patient on one claim!  Theoretically, just one measure on one claim for one patient visit should be sufficient, but if you want to be super-sure, you could do more than one measure.
 
 
Example:  Dermatology measures, to be reported on claims:  For reporting on claims, the dermatology specialty has picked out four specific measures.  One measure focuses on Psoriasis; the other three could be suitable for many specialties.    
 
Documentation of Current Medications in the Medical Records - Quality ID Number 130. 
           
Preventive Care and Screening:  Screening for High Blood Pressure and Follow-Up Documented - Quality ID Number 317.
           
Preventive Care and Screening:  Tobacco Use:  Screening and Cessation Intervention - Quality ID Number 226.
 
Psoriasis:  Clinical Response to Oral Systemic or Biologic Medications - Quality ID Number 410.  
 
Make a note of the Quality ID Number.  It is very important - even though it is NOT the code you will eventually put on the claim!  We’ll explain why it’s so important later.    
 
Explore the measures a bit, just to see what they’re all about.  Go to https://qpp.cms.gov/measures/quality, and scroll down to Select Measures.  
            In the Filter By area, click on Data Submissions Method and click the box for Claims. (That’s important, because you’re going to report right on the claim.)
            Then, click on Specialty Measure Set and click the box for Dermatology.   
            Click in the margin to clear the screen, and then scroll down a bit. You will see the list of four measures.  Click on the first measure title and look at the general overview for that measure.  When you’re ready to close the overview, click on the measure title again.   
 
 
Finding the code(s) you will actually put on the claims
 
Next comes a challenge!  You need to find the actual code or codes that you are going to put on the claim - the Measure Code or Codes. We will give you an example, using the Psoriasis measure (Quality ID Number 410). The other measures follow the same pattern, with slight variations. 
 
Zeroing in on the Measure Code(s) - Step One:  Go to:  https://qpp.cms.gov/docs/QPP_quality_measure_specifications.zip.
 
At the bottom left corner of your screen, you will see a rectangle that says QPP_quality_measu...z..  This rectangle may ready for you to click on it, or it may tell you to wait a few seconds for the ZIP file to be ready.  After you have let that time elapse (if necessary), click on the rectangle. 
 
Now, at the top of your screen, you will see QPP_quality_measure_specifications.  Click on that, and then click on Claims-Registry-Measures. 
 
You'll see a long list of Measure Specifications documents, which are PDFs.  These documents are numbered using the Quality ID numbers.  (Ahah!  That’s why you needed to know the Quality ID numbers!)
 
Scroll quite far down, to the PDF whose Quality ID Number is 410.  This is the Psoriasis measure.  You will see two versions - one that says "Claims" and one that says "Registry."  Be sure to click on the “Claims” version, not the “Registry” version.
 
 
Zeroing in on the Measure Code(s) - Step Two:  You will now see the actual Measure Specifications document.  It is a PDF, headed “Measure 410:  Psoriasis:  Clinical Response to Oral Systemic or Biologic Medications.” 
 
There's a lot of detail here, but concentrate on two questions: (1) What Measure Code(s) do I put on the claim? And (2) Which of my patients are going to be suitable for this particular measure – in other words, which ICD-10 diagnosis codes will be appropriate?     
          
What Measure Code(s) do I put on the claim?  Scroll down till you see NUMERATOR, and read the whole NUMERATOR section.  Look just below "Numerator Quality-Data Coding Options.”  You'll see three different scenarios, each with its own Measure Code or Codes in bold type.  Which scenario applies to the situation you are dealing with today, with this patient, for this claim?   
 
            (First scenario:) “Psoriasis Assessment Tool Documented, Met Specified Benchmark.” The Measure Codes:  You'll need to enter two codes on the claim, G9649 and G9764.
            (Second scenario:) “Documentation of Patient Refusal or Contraindications.”  The Measure Code:  You'll need to enter one code on the claim, G9765.
            (Third scenario:) Psoriasis Assessment Tool Documented, Not Meeting Specified
Benchmark.”  The Measure Codes:  You'll need to enter two codes on the claim, G9651 and G9764.
 
Which of my patients will be suitable for this measure – in other words, which ICD-10 diagnosis codes will be appropriate?  Scroll up till you see DENOMINATOR.  It says: “All patients with a diagnosis of psoriasis and treated with an oral systemic or biologic medication for psoriasis.”  Then, it lists the ICD-10 code or codes that are appropriate.   
 
 
Finally – putting the Measure Code(s) on the claim!
 
Where on the claim will the Measure Code(s) go?  You put the Measure Code(s) in the Procedures field (24D), just below the line where you've entered the Procedure Code.  And note:  For electronic claims:  You will need to work with your vendor to be able to put the code(s) on the claim.   Don’t forget the Charges field (24F).  In the Charges field (24F), you'll need to put $0.01.  
 
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.
 
 
More about avoiding the 4% 2019 penalty:  AMA educational resources
 
MSSNY reports:  “The AMA continues to hear from physicians who feel unprepared to participate successfully in Medicare’s new Merit-based Incentive Payment System, despite the transitional flexibility provided for 2017…Physicians who never participated in Medicare reporting programs before need basic information on how to avoid a payment penalty in 2019 through minimal reporting in 2017.
           “To help address this need, which we believe is particularly acute for physicians in smaller practices, the AMA is extending ‘Pick Your Pace’ activities to run through the end of the year to disseminate simple instructions on how to report ‘one patient, one measure, no penalty.’  The AMA has developed a short video, titled ‘One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,’ which is accessible on the AMA web site at ama-assn.org/qpp-reporting.  Also on this web site, physicians can find a sample CMS-1500 claim form, links to quality measures on the CMS web site, a link to the CMS MIPS eligibility tool, and other materials.  
            “The AMA has also released a new customizable resource, the MIPS Action Plan, geared towards helping physicians think strategically about how to successfully implement MIPS in 2017. This resource will help physicians determine the right course of action for their practice, provide recommended steps to meet program requirements, and measure their performance against important milestones. DON’T DELAY – act now to avoid penalties and succeed in MIPS for 2017.”
 
 
Patients start receiving new Medicare cards in April, 2018.  What should you do now?
 
To help fight identity theft and safeguard taxpayer dollars, CMS is preparing a fraud prevention initiative in which beneficiaries’ Social Security numbers will be removed from Medicare cards.  CMS will begin sending beneficiaries new cards in April 2018, and will meet the congressional deadline for replacing all Medicare cards by April 2019.  
            CMS has now given the public its first look at the newly designed Medicare card.   To view the new card (and other important information), go to:  https://www.cms.gov/medicare/new-medicare-card/nmc-home.html.
            Each Medicare beneficiary will be assigned a new, unique, randomly assigned number, called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) that’s currently on the card.  The MBI number will contain a combination of numbers and uppercase letters.  
            Beneficiaries will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential.  Issuance of the new MBI will not change the benefits that a Medicare beneficiary receives. 
            Both healthcare professionals and beneficiaries will be able to use secure lookup tools providing quick access to MBIs when they need them.  Starting in June 2018, you’ll be able to look up your patients’ new Medicare numbers through the secure web portal of your MAC (NGS, National Government Services).
            Your systems will need to be able to accept the new MBI format by April 2018, so CMS encourages you to begin working with your billing vendor now to make sure your system will be updated.
            If you wish, you can start using the MBI as soon as your patients get their new cards - beginning in April 2018.  However, to ease the changeover, there will be a 21-month transition period, starting October 2018, during which providers will be able to use either the MBI or the HICN.  Through the transition period, when you submit a claim using your patient’s valid and active HICN, CMS will return both the HICN and the MBI on every remittance advice. The MBI will be in the same place on the advice where you currently see the “changed HICN.”
            All HICN-based claims have to be received by the January 1, 2020, cutoff date. After the transition period ends on January 1, 2020, you’ll need to use MBIs on your claims (with a few exceptions).
            Don’t forget - beginning in April 2018, Medicare patients will start coming to your office with new cards in hand!  CMS has a website dedicated to the Social Security Removal Initiative (SSNRI), where you can find the latest information and sign up for newsletters. CMS is also planning regular calls to share updates and answer provider questions, before and after the new cards are mailed beginning in April 2018.  Meanwhile, here are steps to take today to help your office get ready:
 
  1. Talk to your vendor about preparing for April 2018.  If you use vendors to bill Medicare, contact them if they haven’t already shared their new Medicare card system changes with you; they can also tell you how they will pass the new Medicare number to you.  Visit the New Medicare Card Provider webpage for the latest information at the link here: https://www.cms.gov/Medicare/New-Medicare-Card/index.html
 
  1.  Go to the CMS provider website and sign-up for the weekly MLN Connects® newsletter.
 
  1. Attend quarterly calls with CMS to get more information. CMS will let you know when calls are scheduled, in the MLN Connects newsletter.
 
  1. Verify the addresses of all your Medicare patients. If the addresses you have on file are different than the Medicare addresses that you get on electronic eligibility transactions, ask your patients to contact Social Security and update their Medicare records, by either calling Social Security at 1-800-772-1213, or going online to their online account at www.ssa.gov/myaccount.  This process may require coordination between your billing and office staff.
 
  1. Work with CMS to help your Medicare patients adjust to their new Medicare card.  This fall, CMS will provide helpful information you can pass along to your patients.  You can hang posters in your office to help spread the word.
 
  1. Test your system changes and work with your billing office staff to be sure your office is ready to use the new MBI format.
 
 
 
NGS’S ban on handwritten paper claims:  The Manhattan deadline is November 13, 2017
 
Paper claim submitters:  Don’t forget about NG’s date for the ban on handwritten paper claims.  The date for Manhattan physicians is November 13, 2017. Starting then, NGS will return to the provider any paper claim with handwriting on the face of the claim that is not in a signature field.  (The signature fields are Items 12, 13, or 31.)  A notice will be attached to the front of the returned claim, and you will need to submit a new claim.  (Note:  NGS will be looking at the date the claim is received, not the dates of service.  Any claim that NGS receives on or after November 13 must not be handwritten regardless of the dates of service.)  

Typewritten paper claims are still OK.  (You can use handwriting for Items 12, 13 and 31, as we have said.)  Or, some physicians have billing systems or practice management systems that can print out claims.  Note that:   


You can use NGSConnex to send individual claims via the web.  NGSConnex is easy to use.  Here’s how NGS describes it: “NGSConnex is our web-based self-service portal, free of charge, and available through Internet access. You can login to NGSConnex and submit claims to us. In addition to claims submission, NGSConnex has other useful functions, including verifying Medicare entitlement, submitting appeals on claims, and viewing and downloading your remittance advice. Take this opportunity to get started on NGSConnex today!”

And/or, you can get started with electronic claims submission.  Says NGS: “Electronic claims, and other transactions submitted electronically, are processed by NGS’s system considerably faster than paper claims. The Electronic Data Interchange (EDI) page on the NGS website explains how to enroll, and what capabilities your office needs to be able to submit electronic claims.”

One of your EDI options:  NGS’s free Medicare billing software, the PC-ACE system.  PC-ACE is a stand-alone claims processing system that lets an electronic submitter store demographic information, enter and store claim information, and prepare files for Medicare Part A and Part B claims. These files are prepared in the HIPAA-compliant 837 ANSI 5010A2 format.  All providers with access to the Internet should have the capability to download this billing software free of charge. However, if that is not the case, this software will continue to be available on CD for a $25 nonrefundable fee.
To learn more about PC-ACE, visit the Electronic Data Interchange Software tab on the NGS web site, www.NGSMedicare.com,  and choose Claims & Appeals.   For assistance, please contact the EDI Help Desk or submit an EDI E-mail Inquiry Form for assistance. If it is determined that you are not capable of downloading the software, you will be provided with the appropriate form to request the PC-ACE software on CD.
 
Medicare preventive services – here’s an easy way to get codes, reimbursement information and more 
 
You can code and get paid by Medicare for a huge range of preventive services, from the Annual Wellness Visit and the Initial Preventive Physical Exam, to Alcohol Misuse Screening and Counseling, to Intensive Behavioral Therapy for Obesity, to screening for lung cancer, prostate cancer, glaucoma, HIV, Hepatitis C virus - and many other services.
            A wonderful new interactive “chart” (right on your computer screen) lets you click on any one of these preventive services to get the description of the service, the codes, the recommended frequency and many other details.  Go to: 
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
Commercial Insurers
 
Aetna issues guidance on how to access your fee schedule
 
Aetna has provided information about accessing your fee schedule. If you’re affiliated with an Independent Practice Association (IPA), you can contact your IPA for a copy of your fee schedule. But if you’re directly contracted with Aetna, you can call their Provider Service Center for help with up to ten current procedure terminology (CPT) codes. Call the Contact Center at:
 
  • 1-800-624-0756 – HMO-based and Medicare Advantage plans
  • 1-888-MD-Aetna (1-888-632-3862); all other plans
 
For requests of eleven or more codes, you can enter the codes on an Excel spreadsheet (be sure to include tax ID, contact telephone number, CPT and modifier) and email the spreadsheet to Aetna at feeschedule@aetna.com.
            For additional information, call Susan Tucker at 212-684-4681 or email stucker@nycms.org.  

Annoyed about United Healthcare’s plan to stop paying for consult codes?  
United Healthcare (UHC) was going to stop paying for consultation codes 99241-99245 and 99251-99255 for dates of service on and after October 1, 2017.  But after strong objection by organized medicine, the company is now delaying implementation of the policy.  Their October 2017 Network Bulletin will have more details, and we will keep you posted as more information becomes available. 
The Practice Environment
 
MSSNY President Charles Rothberg, MD, talks about when – and when not – to switch your EMR/EHR
A September 16, 2017 article in ICIMS, a diagnostic imaging publication from UBM Medica, quotes Dr. Rothberg on three potential dangers of a systems switch: (1) It may be hard to move data from the old system to the new system; (2) the data, once “migrated,” may still be hard to get at; and (3) the switch may cut physicians’ productivity significantly - e.g., more than 20 percent (which might approximate the practice’s overhead costs).  If these problems develop, they can seriously disrupt physicians’ ability to care for patients. 
            In addition, cautions MGMA expert Robert Tennant, physicians should be especially wary if a prospective new vendor offers an EHR that’s integrated with a practice management system.  It all sounds very hi-tech, but if you prefer to keep your existing practice management system, you might have trouble meshing it with the new EHR! 
            Read more at http://www.diagnosticimaging.com/ehr/3-reasons-stay-your-current-ehr-vendor
 
 
 
 
MSSNY studies physician burnout, seeks way forward  
 
An interesting statistical study of burnout among physicians is described in the September 2017 issue of MSSNY’s monthly “News of New York.”  The study had over 1000 respondents, and while the results are not surprising, the details are worth a look.  Go to http://mssny.informz.net/MSSNY/data/images/nony_Sept2017_low_Final.pdf, and scroll down to page 6. 
            The study analyzes burnout by age, gender and specialty; it also contrasts burnout causes that the individual can combat (e.g., via scribes or better time management), with causes the individual can’t control (e.g., new regulations).  Clearly the situation is serious:  Only 58% of respondents, if they could revisit their career choice, would choose to be a physician again – and 2/3, when filling out applications licensure, hospital privileges, etc., might not report if they had  received mental healthcare services.  It is crucial that we find ways to protect the public, “while still promoting the mental health of those taking care of the public in currently highly stressful healthcare environment.”            
MSSNY is working to find interventions “that can be useful now in the fight against burnout, at the individual, organizational and national level.”  Stay tuned for future information about MSSNY’s physician burnout task force. 
 
 
Alzheimer’s Association develops resources for physicians
 
There are 390,000 New Yorkers with Alzheimer’s disease, and that number is expected to rise to 460,000 by 2025.  In a recent “Dear Colleague” letter, NYS Health Commissioner Zucker encourages physicians to talk to patients about cognitive evaluation, activities of daily living, and advance care planning.  Where can you start?   The Alzheimer’s Association is available to help you.  If you have questions, contact Jeannine Smith at the Alzheimer’s Coalition.  You can also visit www.alz.org, or call 1-800-272-3900, a free 24-hour Helpline that’s available in more than 200 languages. And for New York State information, you can visit www.alznys.org.
 
Resources for patients:  You can refer patients and their families to the Alzheimer’s Association, and provide a list of other resources.   To download a “prescription pad” referral sheet with many resources related to Alzheimer’s disease and other dementias, go to:   
http://www.mssnyenews.org/wp-content/uploads/2017/08/09GetStevetoCreateLinktothisforAlzheimersStory.pdf
 
Care-Planning Toolkit: After January 2017, when Medicare began covering care-planning visits for patients with cognitive impairment, the Alzheimer’s Association developed a toolkit to help clinicians provide the best care under the new Medicare code. The new code lets you provide services that can contribute to a higher quality of life for your patients.
            A Harvard School of Public Health survey determined that 95 percent of Americans age 60 and older would want to know if they had Alzheimer’s, yet only 45 percent are actually notified of their diagnosis (Alzheimer’s Association, Facts & Figures 2017).  Early detection and diagnosis allows individuals and their caregivers to:
• Access available treatments, build a care team, use support services and participate in clinical trials;
• Create advance directives regarding care and finances; and  
• Manage medications better.   
            Care planning for individuals with dementia is an ongoing process, and a formal update to a care plan should occur at least annually.  When you download the toolkit – which includes best practices, validated tools, codes, rating scales and assessment guides – you’ll see how it can facilitate diagnosis and care planning.
 
 
 
In-office buprenorphine treatment may work for patients with opioid use disorder
 
Buprenorphine is an effective medication that is approved for treatment of opioid use disorder.  It can be prescribed in office-based primary care settings, just like other medications that are prescribed for chronic health conditions.  A partial opioid agonist, buprenorphine reduces drug use and risk of overdose death from opioids; it helps keep patients in treatment and improves a range of health and social outcomes.
            The New York City Department of Health and Mental Health (DOHMH) offers free physician training on prescribing buprenorphine, plus free mentoring, technical assistance and educational resources. The reason for the training (a requirement of SAMHSA, the federal Substance Abuse and Mental Health Services Administration):  Physicians who are not board-certified in addiction medicine must have a federal waiver to prescribe buprenorphine in an outpatient setting.  The NYC DOHMH’s training course meets the requirements to apply for the waiver. 
             Sign up now to be notified about future trainings!  Contact buprenorphine@health.nyc.gov.  And, go to the following link to see a fascinating issue of the DOHMH’s publication “City Health Information,” full of clinical information related to buprenorphine and the treatment of opioid use disorder:  http://www1.nyc.gov/assets/doh/downloads/pdf/chi/chi-34-1.pdf.
            If you think patients might benefit from the Shared Medical Appointment (SMA) approach, you may want to learn about this modality.  A physician meets for 90 minutes with a group of 15 to 20 patients who have a common condition; patients benefit from social workers and peer coaches as well as from the primary care provider.  The format allows time for discussion, and patients provide peer support and encouragement. One network that offers buprenorphine treatment with the SMA approach is Advocate Community Providers.  For information, contact Martine Baron:  Call 917-677-4138 or email mbaron@acppps.org.