Bergen County Medical Society

CMS Extends Deadline for Choosing Medicare Participation Status to February 14, 2012

2012-01-09T13:51:00.002-05:00

Physicians now have until February 14, 2012 to choose their Medicare participation status for the year. The previous deadline was December 31, 2011. The effective date for any participation status change during the extension, however, remains January 1. If you feel you have to stop taking new Medicare patients in anticipation of the payment March 1, 2012 scheduled cut, share your disappointment with your representatives. BCMS will keep physicians updated on the situation once Congress returns from its holiday recess in early January.

To share your concerns with your legislative office visit http://www.BCMSNJ.org

Congress Passes Two Month Renewal of Payroll Tax

2011-12-23T10:22:00.003-05:00

Physicians got a brief reprieve from a 27.4 percent Medicare pay cut Friday when the U.S. Senate and House of Representatives each passed a two-month extension of several important policies that expire on Jan. 1.

The U.S. Senate last week voted to extend current Medicare payment rates for two months. After the House first balked at the two-month extension earlier in the week, the two chambers reached an agreement to extend the physician payment rates as well as the two percentage point Social Security payroll tax cut, and to extend unemployment benefits. A House-Senate conference committee will convene in January to work on a longer-term agreement.

At a press conference, House Speaker John Boehner (R-Ohio) said the goal is to extend all the expiring programs for a full year, except for the physician payment cut reprieve,which is to be extended for two years.

Physicians and their patients are still urged to contact their Legislative offices and demand they repeal Medicare's flawed SGR formula.

To call your Legislative office - 800-833-6354

To email: log onto http://www.bcmsnj.org/

BCMS will update our members and their patients as more information unfolds.

Republicans Accept Short-Term Payroll Tax Cut

2011-12-22T16:15:00.002-05:00

House Republican leaders have decided to accept a short-term extension of the payroll tax cut. The plan involves passing a short-term extension in exchange for a promise from Democratic Senate Leader Harry Reid that he will appoint members of a conference committee to negotiate a long-term extension.

House Republican leaders will present this to their membership at a conference call later this evening.

The bill could be passed, potentially, by unanimous consent, which would not require the full House to return to a vote.

As more information unfolds, BCMS will keep its membership and their patients informed.

Update on the SGR and 2012 Medicare Physician Payments

2011-12-21T11:44:00.002-05:00

On December 20, the House of Representatives held a series of votes regarding H.R. 3630,
legislation that would extend an expiring payroll tax reduction and unemployment insurance benefits, as well as stop a 27.4 percent Medicare physician payment cut that is scheduled to take effect on January 1. The net result was to leave the status of 2012 payment rates in limbo.

Votes on H.R. 3690. As originally passed by the House on December 13 by a vote of 234-193, the legislation would have provided Medicare physician payment updates of 1 percent a year for two years, followed by a return to the current negative trend line produced by the sustainable growth rate (SGR) formula. But, due to disagreements over financial offsets and other policy issues unrelated to the SGR, the legislation could not attract a sufficient number of votes to pass the Senate.

On December 17, the Senate voted 89-10 to pass an amended version of the bill that would extend all the expiring policies, including current Medicare physician payment rates, for two months. The rationale for the short-term extension was to avoid disruptions on January 1 and
provide time for further negotiations on financing longer-term extensions.

House action on December 20

Following the Senate’s action, a significant number of House Republicans expressed strong opposition to the two-month extension, and several relevant votes were scheduled for that day. Most important of these, the House approved a resolution by a vote of 229-193 to disagree with the Senate and appoint members to a House-Senate conference committee, which would be charged with working out differences between the two versions of the bill.

Prior to the House votes on the 20th, the Senate leadership announced that the Senate would not reconvene over the holidays to engage in further negotiations and votes. In addition, members of the House departed yesterday evening for the holidays, after being informed that they could be called back to Washington on short notice. At this time, it does not appear likely that the outstanding issues will be resolved before January 1.

Outlook for January

On December 19, the Centers for Medicare and Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days, until January 17, to avoid processing payments at the lower rate. After that date claims will be processed on a first in, first paid basis at the reduced rates until the situation is resolved.

The House is currently scheduled to return to Washington on January 17, while the Senate
is scheduled to return on January 23. However, there are reports that the House, at least, may move up the date of its return to January 3.

As more information comes in, BCMS will keep our physician members and their patients informed.

Agreement on a Two Month Extension on SGR Fix

2011-12-19T08:32:00.003-05:00

On Friday December 16th, Senate leaders reached agreement on a two- month extension of important expiring programs, including benefits for the long- term unemployed and current payroll tax rates, as well as a reprieve from the 27 percent Medicare physician payment cuts scheduled to take effect January.
Details have not yet emerged, but reportedly the $30 billion package does not include significant cuts in any health care programs.
At this point, it still is not clear whether the House leadership will agree to this proposal. The House adjourned Friday with tentative plans to reconvene on Monday.
The BCMS strongly opposes further short term patches to the sustainable growth rate system that lead to program instability, increase the size of future payment cuts, and raise the cost of permanently repealing the formula.

We will keep you informed over the next few days.

New Jersey One-Room Licensing Legislation Passes Key Committee

2011-12-08T12:27:00.001-05:00

Legislation requiring single-operating room (OR) facilities in New Jersey to be licensed by the Department of Health and Senior Services (DHSS) was reported favorably from the Assembly Health and Senior Services Committee last week. Senate Bill 2780 , sponsored by Senator Joe Vitale (D), brings single-ORs under the New Jersey definition of ambulatory care facility and stipulates that these facilities must be licensed by DHSS within one year of enactment. Single-OR facilities certified by the Centers for Medicare & Medicaid Services (CMS) or accredited by any accrediting body recognized by CMS are exempt from the physical plant requirement and ambulatory care assessment fee. However, The fee will be assessed, if the facility expands to include additional ORs.

Supercommittee Failure Leaves 27% Medicare Payment Cut in Place

2011-11-23T14:07:00.002-05:00

With the Joint Select Committee on Deficit Reduction failing to reach agreement on a deficit-reduction proposal, physicians still face a 27 percent cut in Medicare physician payments scheduled to take effect Jan. 1. Congress has missed an opportunity to address the nation's fiscal problems, stabilize the Medicare program and permanently repeal the sustainable growth rate (SGR) formula.

Proposals to repeal the SGR fell victim to disagreement over fundamental principles for achieving deficit reduction. Sharp partisan division over the mix of entitlement cuts and tax hikes prevented the supercommittee from reaching any agreement on a deficit-reduction package.

Democratic and Republican leaders in Congress have publicly stated their commitment to take action this year to avert the 27 percent cut. Options for SGR relief outside of the supercommittee process have ranged from short-term patches of a year or two to longer-term relief that provides for transition to a new Medicare physician payment system.

WHAT YOU CAN DO:

Contact your Legislative Office and send an email demanding Congress repeal the Medicare's Flawed SGR. www.BCMSNJ.org

Call your Legislative Office and demand that Congress repeal the Medicare's Flawed SGR. 800-833-6354

Print a flier for your office and let your patients know to call their Legislative Offices. www.BCMSNJ.org

Congress Acts to Eliminate 3% Withhold

2011-11-23T14:03:00.000-05:00

the U.S. House of Representatives passed an amended version of H.R. 674, legislation that prevents a planned 3 percent tax-withhold for many Medicare payments, by a vote of 422-0.　 The Senate passed this legislation on November 10 by a vote of 95 to 0. 　
The statute, originally passed in 2006 and delayed several times, called for all federal, state, and local government payments to those providing services or goods to have 3 percent of their payment withheld until the following tax year in an effort to increase tax compliance.　 However, the original statute was overly broad and would have applied even to Medicare payments made to physicians.
The legislation, now headed to President Obama for his expected signature, completely repeals this provision of law and eliminates the planned withholding.　
The cost of this repeal was offset by a change in the definition of Medicare Adjusted Gross Income for the calculation of eligibility for Medicaid or insurance subsidies under the Affordable Care Act.　
This modification was supported by a majority in Congress and the White House.
This represents a significant victory for physicians and a step forward in stabilizing the Medicare system. 　
The additional burden of a 3 percent tax-withhold would have been untenable in the current Medicare payment environment. 　
There is already a 20 percent gap between Medicare’s payments to physicians and the growing cost of providing care to seniors, and physicians now face a 27.4 percent cut on January 1 due to the broken Medicare physician payment formula.

90 Day Enforcement Discretion Period for Compliance with New HIPAA Transaction Standards

2011-11-23T13:54:00.002-05:00

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Notwithstanding OESS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0).

CMS’ Office of E-Health Standards and Services is the U.S. Department of Health and Human Services’ component that enforces compliance with HIPAA transaction and code set standards.
OESS encourages all covered entities to continue working with their trading partners to become compliant with the new HIPAA standards, and to determine their readiness to accept the new standards as of January 1, 2012. While enforcement action will not be taken, OESS will continue to accept complaints associated with compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 transaction standards during the 90-day period beginning January 1, 2012. If requested by OESS, covered entities that are the subject of complaints (known as "filed-against entities") must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period.

OESS made the decision for a discretionary enforcement period based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012 compliance date, testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by January 1st. Feedback indicates that the number of submitters, the volume of transactions, and other testing data used as indicators of the industry’s readiness to comply with the new standards have been low across some industry sectors. OESS has also received reports that many covered entities are still awaiting software upgrades.

Version 5010, NCPDP Telecom D.0 and NCPDP Medicaid Subrogation 3.0 standards represent significant improvement over the current standard versions. NCPDP Telecom D.0 addresses certain pharmacy industry needs. NCPDP Medicaid Subrogation 3.0 allows state Medicaid programs to recoup payments for pharmacy services in cases where a third party payer has primary financial responsibility. Version 5010 in particular provides more functionality for transactions such as eligibility requests and health care claims status Implementation of Version 5010 also is a prerequisite for using the updated ICD-10 CM diagnosis and ICD-10-PCS inpatient procedure code set in electronic health care transactions effective October 1, 2013.

CMS Pushes Back Medicare Revalidation Deadline to 2015

2011-11-16T11:51:00.000-05:00

Responding to pressure from physician organizations, the agency administering the Medicare program will extend by two years the deadline to re-enroll more than 750,000 physicians.
The move will provide the Centers for Medicare & Medicaid Services with more time as it embarks on the massive enrollment revalidation effort. The latest change to the timeline would allow for a smoother re-enrollment process, CMS said.
The Medicare agency had planned to re-enroll 1.4 million physicians, nonphysician practitioners and other health care professionals by March 2013. Physicians revalidating their enrollment records would be subjected to new screening controls required by the health system reform law.
The new standards are designed to prevent fraud in the Medicare system. But physicians are considered to be low fraud risks and would be subject only to license and identification verifications instead of the more stringent screenings required for device suppliers and home health firms.
The American Medical Association had requested the delay in September. In doing so, the Association asked CMS to re-examine the statute requiring the revalidation and to consider other changes to enrollment.
"We are very pleased that CMS has agreed to the two-year extension on the deadline to revalidate physicians' Medicare status," said AMA President Peter W. Carmel, MD. "This extension, recommended by the AMA, allows physicians to be one of the last groups who will have to face this time-consuming process."
The AMA and other health professional organizations said Medicare contractors would have been hard-pressed to revalidate 1.4 million enrollment records within an 18-month window. Contractors already process about 27,000 new enrollments and more than 30,000 billing reassignments each month. The organizations worried that the new revalidation effort would have led to application backlogs or other unintended consequences, such as doctors being inadvertently banned from the program.
The health system reform law says that by March 23, 2013, no physician or other health professional may be enrolled or re-enrolled in Medicare without going through the enhanced screening procedures. A Sept. 23 letter from the AMA to CMS referenced the law and noted that the section did not require the agency to complete the effort by the 2013 date. The law provided flexibility to implement the new screening methods from that date onward, the Association said.
However, the extra time given to physicians will not affect those doctors and practices who already have received a revalidation notice, CMS said. The physician still must meet the deadlines outlined in the revalidation letter he or she received. Failing to revalidate within the designated timeframe will cause a physician's enrollment record to be deactivated.
The first set of revalidation notices were sent to those who bill for Medicare services but are not in CMS' electronic enrollment record, the agency said. Typically, these recipients are doctors who have not updated their enrollment in several years. Medicare contractors searched enrollment databases to determine which physicians are not in the electronic system.
The Association had recommended that CMS exempt physicians from the revalidation effort altogether because they are low fraud risks to Medicare. The Medicare agency also should allow physicians to revalidate at any time, and not require doctors to print, sign and mail enrollment certification statements when applications are submitted online, the AMA said.
CMS declined to exempt physicians from the process, but it was willing to make other changes. A Nov. 4 CMS email on the revalidation states that physicians who believe they are not in Medicare's Provider, Enrollment, Chain, and Ownership system, or PECOS, can call their administrative contractors about revalidating.
The agency also has told the AMA that it will make improvements to the online enrollment system. New features will include electronic signatures, document upload capabilities, seamless password resets, enhancements for authorized officials, reassignment reports, new "My enrollments page" and "Fast track view" screens, and fewer duplicative document submission requirements.
CMS has said it will introduce these changes by the end of 2012.

CMS Publishes Final ACO Rule

2011-11-01T12:00:00.001-04:00

On October 20th, the United States Department of Health & Human Services (HHS) announced that CMS published the Final Rule on the Medicare shared savings program, better known as the rule on accountable care organizations (ACOs). According to HHS, the agencies carefully considered more than 1,300 comments filed on the proposed rule. Among the positive changes
is the removal of down-side financial risk from the one-sided model.

On behalf of the county Medical Societies in NJ, MSNJ filed comments on the proposed rule strongly objecting to the down-side financial risk in the third and final year of the one-sided model. Now, only savings will be shared in the one-sided model.

The United States Department and Federal Trade Commission also published a joint Anti Trust Statement concerning ACOs. It includes an expedited review process for newly created ACOs.

BCMS will be working on sponsoring seminars to educate its members on accountable care organizations. Please check the BCMS website frequently for upcoming seminars.

To view CMS' Final Rule:

http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf

To view the Federal Trade Commission's Anti Trust Statement on ACO's:

http://www.justice.gov/atr/public/health_care/aco.html

Medicare Physician Fee Cuts Scheduled

2011-11-01T11:31:00.000-04:00

On January 1st, Congress is scheduled to cut physician payments from Medicare by 30%.

Yet again, Congress is threatening the livelihood of physician practices, access to care for our seniors and to the disabled.

Contact your Legislative Offices and demand that they repeal the SGR once and for all.

800-833-6354

Get your patients involved! Let them know to call and demand that Congress stop interfering in their access to care.

Senate Approves Single Room Licensure Bill

2011-06-30T17:26:00.000-04:00

The New Jersey State Senate this week approved a measure that would require the licensure of Single Room Surgical Practices (SRSPs) by a 30 to 8 vote.

S-2780, sponsored by Senator Joseph Vitale (D – Middlesex), was amended earlier to exempt all SRSPs from the gross receipts assessment currently paid by ambulatory care facilities, and exempt CMS certified SRSPs from the “physical plant and functional requirements” in the current Department of Health & Senior Services regulations. SRSPs that are not CMS certified can apply to the Department for a similar exemption.

In May, the Senate Health, Human Services & Senior Citizens Committee approved additional language that would require the Department to meet with SRSP physician owners and their representatives to promulgate regulations that better reflect the unique characteristics of a Single Room Surgical Practice.

The bill is now pending before the Assembly Health & Senior Services Committee with its Assembly counterpart, A-4099, sponsored by Assemblyman Herb Conaway, MD (D – Burlington).

FREE MEMBERSHIP OFFER

2011-04-27T16:37:00.000-04:00

Open a business account with Sun National Bank and have your county and state Medical Society dues paid in full for one year.

Contact Anthony P. Mai, Senior VP at (201)750-5155 or anai@sunnb.com