 |
 |
 |
 |
             |
Archive for January, 2010
|Temporary Change in Medical Reporting Requirements
Friday, January 29th, 2010
Authorized Provider Shortage in Rochester Area;
Temporary Change in Medical Reporting Requirements
Date: January 26, 2010
Physicians, with limited exceptions, podiatrists, chiropractors and psychologists must be authorized by the Chair in order to treat workers’ compensation claimants. Physical and occupational therapists may treat claimants either under the direct supervision of or upon referral by a physician. Nurses and other health providers may only treat workers’ compensation claimants under the direct supervision of an authorized physician.
It is important that injured workers have access to authorized providers in order to receive necessary care and treatment. Further, it is also important that injured workers receive such care and treatment as quickly as possible in order to ensure the best and speediest recovery. The faster an injured worker is treated and recovers, the faster such worker can return to work. In order to receive treatment quickly there must be authorized providers available to treat injured workers.
In the past two years a number of physicians have voluntarily surrendered their authorizations to treat workers’ compensation claimants. A large number of these physicians are located in the Rochester area of the state resulting in a temporary shortage of authorized providers to treat injured workers. Specifically, the temporary shortage of authorized physicians exists in the counties of Monroe, Livingston, Steuben, Allegheny, Wyoming and Ontario.
When these providers surrendered their authorizations, injured workers treated by them were forced to find a new provider. In addition, newly-injured workers had to find other providers to treat them. This has resulted in an increased demand for the services of the providers who have retained their authorization to treat injured workers. This demand has placed a burden on authorized providers to timely complete and submit the prescribed medical report forms. Delays in the submission of medical reports cause delays in the receipt of benefits by injured workers.
I find that there is a temporary shortage of authorized providers in the counties of Monroe, Livingston, Steuben, Allegheny, Wyoming and Ontario. These counties shall collectively be deemed the Provider Temporary Shortage Area.
In order to address this situation, in the Provider Temporary Shortage Area I am including in the list of prescribed medical report forms the CMS-1500 (or HCFA-1500) form with detailed narrative reports or office notes. Authorized physicians, podiatrists, chiropractors and psychologists in the Provider Shortage Area may submit a CMS-1500 with a detailed narrative report or office notes in lieu of one of the prescribed C-4 forms. If a CMS-1500 is submitted without the detailed narrative report or office notes, it is not a prescribed form. A narrative report or office notes are considered detailed when they contain the necessary information in sufficient detail so the insurance carrier can properly process the submission.
Further, the statement in Subject Number 046-301R dated March 23, 2009, that the Board will not enforce payment for examinations, services and/or treatments provided after April 1, 2009, if they are not reported using the correct new C-4 report is rescinded Statewide. In all areas of the State, the Board will enforce payment in accordance with the Workers’ Compensation Law and regulation regardless of the version of the C-4 form used to report examinations, services and/or treatments rendered by providers. For providers located within the Provider Temporary Shortage Area, the Board will also enforce payment in accordance with the Workers’ Compensation Law and regulations if a CMS-1500 (or HCFA-1500) with detailed narrative report or office notes is used to report examinations, services and/or treatment for the duration of the shortage.
Insurance carriers may not refuse to pay bills for failure to file one of the prescribed C-4 forms; however, they may raise an objection to the bill if the service is not sufficiently detailed in the office notes or narrative reports.
The Provider Temporary Shortage Area designation and addition to the prescribed list of medical report forms takes effect immediately. Once it is determined that the shortage no longer exists the list of prescribed medical report forms will be revised to require use of the C-4 forms.
Any questions regarding these matters should be referred to the Office of General Counsel at 518-486-9564.
Robert E. Beloten
Chair
Posted in WORKERS' COMPENSATION UPDATES | No Comments »
NYS Dept. of Health INFLUENZA VACCINE UPDATE
Thursday, January 21st, 2010
January 15, 2010
Dear H1N1 Influenza Vaccine Provider,
The purpose of this letter is to:
• Request that you continue to vaccinate patients for H1N1 influenza and retain your current stocks of vaccine in case there is a disease resurgence;
• Remind you about the need for a second dose of H1N1 vaccine for children less than 10 years of age; and
• Remind you to report all vaccine doses administered or wasted.
Continue to vaccinate for H1N1 influenza and retain current vaccine stocks. January through March is the traditional influenza season. While disease activity is now low, there is a real possibility of a third wave of H1N1 influenza disease, similar to what happened in the 1957-1958 pandemic. As a result, the New York State Department of Health (NYSDOH) is encouraging you to:
• Continue to offer and encourage H1N1 influenza vaccination to your patients;
• Retain your current supply of H1N1 influenza vaccine in your office, unless you do not have sufficient space to store it. Contact your county health department if you have vaccine that you are unable to store;
• Call 1-800-KID-SHOT to place a vaccine order. You may check your order status at: http://www.health.state.ny.us/diseases/communicable/influenza/h1n1/health_care_providers/vaccine/ordering_history.htm;
• Instructions on what to do with unused vaccine will be provided in the future.
Reminder on second vaccine doses for children less than 10. Children less than 10 years old are recommended to get a second dose of H1N1 vaccine at least 28 days after the first dose. The state immunization registry, NYSIIS, can be used to check on which children need a second dose and can generate reminder lists and letters. A short on-line tutorial for using the NYSIIS Reminder-Recall function (Module #10) is located at: https://commerce.health.state.ny.us/hpn/bcdc/immunization/instantdemo/tutorials.html
• Either nasal spray (if appropriate) or injectable vaccine may be used for the second dose regardless of the type of vaccine administered for the first dose.
• Pre-filled 0.25 ml syringes for children under age 3 years are no longer available. Please use Sanofi or CSL multi-dose vials for second doses of injectable vaccine.
• NYSDOH has waived the provisions of state law which usually restricts the use of thimerosal-containing influenza vaccines in pregnant women and children under the age of 3 years. There is no scientific evidence of harm caused by the low doses of thimerosal in vaccines. For more information, see: http://www.nyhealth.gov/diseases/communicable/influenza/h1n1/health_care_providers/frequently_asked_questions/vaccine_containing_thimerosal.htm
Reminder to report vaccine doses administered. The federal provider agreement which you signed to receive H1N1 influenza vaccine commits you to report vaccine usage.
• Vaccine administered to persons less than 19 years of age must be reported by state law to the New York State Immunization Information System (NYSIIS). For more information, see: http://www.health.state.ny.us/prevention/immunization/information_system/
• Doses administered to persons age 19 years and older may be reported to NYSIIS with patient consent, or aggregate doses administered must be reported to the NYSDOH telephone or web-based systems. See the following website for additional information: http://www.nyhealth.gov/diseases/communicable/influenza/h1n1/health_care_providers/vaccine/docs/vaccine_reporting_requirements.pdf.
For more information on your order, second dose administration, or reporting, please call 1-800 KID-SHOT.
Thank you for your continued efforts to vaccinate New Yorkers against influenza.
Posted in FLU/IMMUNIZATION UPDATES | No Comments »
MANAGED CARE REFORM LEGISLATION ADVANCES IN ASSEMBLY
Wednesday, January 20th, 2010
The Assembly advanced a series of MSSNY-supported bills to provide comprehensive reform to the many hassles experienced by patients and physicians in their dealings with health insurance companies. Very significantly these bills included legislation (A.4301, Canestrari, Gottfried et al.) which was unanimously approved by the Assembly Health Committee and which fundamentally changes the nature of health plan-physician interactions by granting physicians and other health care providers the legal ability to collectively negotiate critically important patient care and reimbursement contract terms with health plans. The bill now advances to the Assembly Ways and Means Committee.
Additionally a number of bills that passed the Assembly last session, but not the Senate, have been advanced for consideration again by the full Assembly, including the following legislation:
- A.723 (Gottfried) – Would require a coverage denial decision made by a health plan to be made by a physician board-certified in the same or similar specialty as the physician who typically provides the recommended treatment.
- A.726 (Gottfried) – Would prohibit health plans from including certain offensive provisions in contracts with health care providers, such as limiting referrals to out of network providers, and “most favored nation” clauses
- A.729 (Gottfried) – Would better assure the ability of a patient to be successful in an external appeal of a health plan denial by facilitating evidence-based appeals founded on medical and scientific literature, the patient’s medical record, and other pertinent information.
- A.764 (Gottfried) – Would mandate the use by health plans of universal credentialing and re-credentialing forms
All physicians are asked to communicate their support for these bills to their elected member of the Assembly. All Assembly members can be reached by calling (518) 455-4100.
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
NY MANAGED CARE REFORM LEGLISLATION TAKES EFFECT JANUARY 1, 2010
Tuesday, January 12th, 2010
As reported in Kern, Augustine, Conroy and Schoppmann “Statlaw”,
managed care reforms beneficial to physicians become effective January 1. Under the new law, providers who submit claims electronically must be paid in 30 days instead of 45 days and providers have at least 120 days to submit a claim, as opposed to the standard 60 or 90 days allotted by most contracts. Physicians are encouraged to take advantage of the new reforms.
For more information on any items mentioned in this Statlaw, visit www.drlaw.com.
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
PHYSICIAN COLLECTIVE NEGOTIATION BILL
Tuesday, January 12th, 2010
Physicians are urged to call the members of the Assembly Health Committee to express your support for this bill. These Committee members are as follows:
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
NEW REQUIREMENTS FOR OFFERING INFLUENZA VACCINATION
Tuesday, January 12th, 2010
January 11, 2010
Dear Chief Executive Officer, Directors of Neonatal Intensive Care Units (NICUs), and Chiefs of Pediatrics and Infection Control:
The purpose of this letter is to advise you of new requirements for offering influenza vaccination to parents and anticipated caregivers of NICU patients and of the reinstatement of requirements for offering influenza vaccination to each admitted person age sixty-five years or older, both effective January 15, 2010. Both requirements are for monovalent H1N1 vaccine.
New requirement in NICUs. On July 31, 2009, Governor Paterson signed into law an amendment to Public Health Law (PHL) section 2805-h that requires all general hospitals with NICUs to offer influenza vaccination annually, between September 1 and April 1, to all persons who are parents or are reasonably anticipated to be caregivers in the households of newborns being treated in NICUs. This law became effective November 25, 2009; however, pursuant to my authority under the statute and because of inadequate supplies of seasonal and 2009 H1N1 influenza vaccines, I modified the requirement by:
- Waiving the requirement for offering the 2009 trivalent seasonal influenza vaccine for the 2009-2010 influenza season, and
- Delaying the effective date of the requirement to offer monovalent 2009 H1N1 influenza vaccine until January 15, 2010.
The amendments to PHL section 2805-h support the recommendations of the Advisory Committee on Immunization Practices (ACIP) on influenza. Influenza vaccination is not licensed for children aged less than six months and antiviral medications are not licensed for use in infants less than 12 months of age. Therefore, protection of young infants, who have hospitalization rates similar to those observed among the elderly, depends on vaccination of infants’ close contacts. By providing parents and caregivers of these high-risk infants with the opportunity to receive influenza vaccination while in NICUs, those infants receive some protection against influenza disease. Beginning January 15, 2010, you must offer H1N1 vaccine; I also encourage you to offer seasonal vaccine, when available.
Reinstated requirement for admitted persons age sixty-five years or older. PHL 2805-h also contains a requirement that the administrative officer or other person in charge of each general hospital must offer to each admitted person age 65 years or older vaccination against influenza virus. The requirement, effective since 2006, applies annually between September 1 and April 1.
On November 18, 2009, I waived this provision for seasonal trivalent influenza vaccine and monovalent H1N1 vaccine because of shortages of both vaccines and because monovalent H1N1 vaccine was not recommended for persons over age 65 years or older. However, since that time, H1N1 vaccine has been recommended for persons of all ages greater than six months and sufficient supplies of vaccine have become available. Therefore, I am reinstating this requirement for H1N1 vaccine effective January 15, 2010. You are also encouraged to offer seasonal vaccine, when available.
Hospitals must take steps to adopt and implement both policies as required under law.
Any questions regarding this letter may be directed to the Department’s Bureau of Immunization at (518) 473-4437 or the Office of Health Systems Management at (518) 402-1003.
Sincerely, Richard F. Daines, M.D. Commissioner of Health
Posted in FLU/IMMUNIZATION UPDATES | No Comments »
New 3-Year Physician Licensure Proposal from NYS Dept. of Ed.
Thursday, January 7th, 2010
The State Education Department (SED) Board of Medicine is seeking regulatory changes to physician licensure requirements for New York State and new requirements for maintenance of licensure.
Currently, a physician who has completed one year of post-graduate training and passed two of the three levels of the U.S. Medical Licensing Examination (USMLE) is eligible for a license in New York State. The proposed regulation would require that a physician complete three years of categorical residency training and pass the third level of the USMLE to be eligible for a license.
For maintenance of licensure:
- board-certified physicians would have to demonstrate continued competence by an authorizing entity approved by the Board of Medicine;
- non board-certified physicians would have to demonstrate continued competence by possessing credentialing verification and practice privileges at The Joint Commission-accredited hospitals;
- non-certified licensed physicians who do not have hospital privileges would have to demonstrate current competence by completing 50 annual hours of continuing medical education; and
- physicians licensed before these requirements would retain certification through a special “grandfather clause.”
Additionally, the Board is considering creating a “resident license,” to be renewed annually through SED at the resident’s expense. This license would enable a resident who meets all the specified criteria to write a prescription for medications or durable medical equipment without the explicit approval of a supervising physician. Currently, residents can write prescriptions that must be approved by their supervising physician.
The New York State Board of Medicine plans to develop language for these proposed regulations in January, for final passage in June.
MSSNY is planning to meet with Board of Medicine Executive Secretary Walter Ramos on January 11 to discuss these proposals.
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
Web Advertising Agreement
Tuesday, January 5th, 2010
Click here to download and print out our website advertising order form.
Posted in Sponsors and Advertisers | No Comments »
NCMS Website Advertising Information and Policies
Tuesday, January 5th, 2010
Format
Ads on the NCMS Web conform with standard sizes suggested by the voluntary Interactive Advertising Bureau (IAB). We accept ads that will appear on the “Sponsors and Advertisers” page.
Audience
Ads appearing on the NCMS Web site are directed generally toward physicians.
No pharmaceutical advertisements directed to patients will be accepted on the NCMS Web site.
Advertisers
The NCMS Web sites may contain advertisements of third parties. The inclusion of advertisements on the NCMS Web sites does not imply endorsement of the advertised products or services by NCMS. NCMS shall not be responsible for any loss or damage of any kind incurred as a result of the presence of such advertisements on the NCMS Web sites. Further, NCMS shall not be responsible or liable for the statements or conduct of any third party advertisers appearing on the NCMS Web sites. You shall be solely responsible for any correspondence or transactions you have with any third party advertisers.
Links to Third Party Web sites
The NCMS Web site may provide links to other sites on the Internet for your convenience. These other sites are maintained by third parties over which NCMS exercises no control. The appearance of any such third party links is not intended to endorse any particular company or product. If you decide to access any of the third party sites linked to the NCMS Web sites, you do so entirely at your own risk.
Advertising Principles
These principles are applied by the NCMS to ensure adherence to the highest ethical standards of advertising and to determine the eligibility of products and services for advertising on the NCMS Web sites.
The appearance of advertising on the NCMS Web sites is neither a guarantee nor an endorsement by the NCMS of the product, service, or company or the claims made for the product in such advertising. The fact that an advertisement for a product, service, or company has appeared on the NCMS Web sites shall not be referred to in collateral advertising.
As a matter of policy, the NCMS will sell advertising space on its Web sites when the inclusion of advertising does not interfere with the mission or objectives of the NCMS or its publications.
To maintain the integrity of the NCMS Web sites, advertising (i.e., promotional material, advertising representatives, companies, or manufacturers) cannot influence editorial decisions or editorial content. Decisions to sell advertising space are made independently of and without information pertinent to specific editorial content. The NCMS staff and/or Officers have no prior knowledge of specific editorial content before it is published including all content posted on the NCMS Web site.
The NCMS, in its sole discretion, retains the right to decline any submitted advertisement or to discontinue posting of any advertisement previously accepted.
Advertising
1. Digital advertising may be placed on the NCMS Web site.
2. Digital advertisements must be readily distinguishable from editorial content.
3. Digital advertisements may appear as fixed banners only.
4. Digital advertisements that are fixed in relation to the viewer’s screen should be placed to ensure that juxtaposition will not occur as screen content changes.
5. The NCMS logo may not appear on commercial Web sites as a logo or in any other form without prior written approval by the individuals responsible for the respective areas within NCMS.
6. Advertisements may link to additional promotional content that resides on the NCMS Web site.
7. The NCMS will not link to Web sites that frame the NCMS Web site content without express permission of the NCMS; prevent the viewer from returning to the NCMS Web site or other previously viewed screens, such as by disabling the viewer’s “back” button; or redirect the viewer to a Web site the viewer did not intend to visit.
8. The NCMS reserves the right to not link to or to remove links to other Web sites.
Posted in Sponsors and Advertisers | No Comments »
Medical Liability Mutual Insurance Company (MLMIC)
Tuesday, January 5th, 2010
Medical Liability Mutual Insurance Company (MLMIC)
Posted in Sponsors and Advertisers | No Comments »
-
You are currently browsing the Medical Care Long Island blog archives for January, 2010.
Archives
Categories
- FLU/IMMUNIZATION UPDATES (4)
- HEALTH DEPARTMENT UPDATES (5)
- HEALTH INSURER UPDATES (1)
- MEDICARE UPDATES (38)
- MEDICAID UPDATES (4)
- NATIONAL HEALTHCARE NEWS (15)
- NEWS FROM THE NYS LEGISLATURE (16)
- SEMINARS AND PROGRAMS (3)
- Sponsors and Advertisers (3)
- Uncategorized (2)
- WORKERS' COMPENSATION UPDATES (2)
