Archive for November, 2011


P.O. Boxes No Longer Permitted in Billing Provider Address in 5010 Transactions Jan. 1

Wednesday, November 16th, 2011

Do you use a P.O. Box or lock box address as you billing provider address to receive payments?  If you submit claims electronically, you will be required use only a street address or physical location as the billing provider address.  Continuing to report a P.O. Box in the billing provider address field will cause your claims to reject.

Under the Health Insurance Portability and Accountability Act (HIPAA), all physicians and other health care providers that submit claims electronically are required to transition to the Version 5010 transactions by Jan. 1.  One of many data reporting changes in the Version 5010 transactions is the requirement to report only a street address or physical location as the billing provider address.

Practices that wish to continue having payments sent to a P.O. Box or lock box will report this address in the “pay-to” address field.

You may need to work with your practice management system vendor, billing service, or clearinghouse to have this address change made for your claims.  Talk to them today to find out if a change is needed and when it will be done.  This work needs to be done prior to Jan. 1 to prevent claims rejections and interruptions in your cash flow.

Visit or for more information on data reporting changes in the Version 5010 transactions and to prepare your practice for the Jan. 1 deadline.

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Posted in MEDICARE UPDATES | No Comments »

Academy of Medicine Donates Millett Funds To Lion’s Club Diabetes Education Board

Wednesday, November 16th, 2011

On November 15, the Nassau Academy of Medicine recently presented a check in the amount of $5,850, from the Joseph Millett, MD Memorial Fund to the Lions Club District 20k2 Diabetes Education Board.

Lions Club District 20K2 Treasurer, Thomas Grosso accepted the donation from NAM President Vincent Geraci, Jr. MD, while Helen McQuade, daughter of Dr. Millett was on hand to make the presentation of the ceremonial check.

Lions are an international network of 1.3 million men and women in 202 countries and geographic areas who work together to answer the needs that challenge communities around the world. They are best known for working to end preventable blindness and sponsoring camps for newly diagnosed children with Diabetes.

The Nassau Academy of Medicine was established in 1953 to establish, conduct, operate and maintain and Academy of Medicine to provide educational opportunities and training of a postgraduate nature for members of the medical profession in Nassau County, and to diffuse among people knowledge of the achievements of scientific medicine.

The Joseph Millett, MD, Memorial Fund was created in 1966, following the death of Dr. Millett, to provide an endowment for medical research. At the suggestion of Mrs. Joseph Millett, a donation this donation has been made to an organization such as the Lions Club as Dr. Millett dedicated his medical career to treating diabetes patients.


L. to R.: Joseph Cohn, MD, Greta Rainsford, MD, Mrs. Helen McQuade,

Mr. Thomas Grosso, Vincent Geraci, Jr. MD, Craig Marcus, MD  Arnold Prywes, MD

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New York Launches Their Medicaid EHR Programs This Month

Monday, November 14th, 2011

On November 7th, the Medicaid Electronic Health Record (EHR) Incentive Program launched in New York. This means that eligible professionals (EPs) and eligible hospitals in New York will be able to complete their incentive program registration. More information about the Medicaid EHR Incentive Program can be found on the Medicare and Medicaid EHR Incentive Program Basics page of the CMS EHR website.

If you are a resident of New York, and are eligible to participate in the Medicaid EHR Incentive Program, visit your State Medicaid Agency website for more information on your state’s participation in the Medicaid EHR Incentive Program. Click on a State below to access its website.

As of November 7th, 39 states have launched Medicaid EHR Incentive Programs and through October, 23 states have issued incentive payments to Medicaid EPs and eligible hospitals who have adopted, implemented, or upgraded certified EHR technology. CMS looks forward to announcing the launches of additional states’ programs in the coming months.

For a complete list of states that have already begun participation in the Medicaid EHR Incentive Program, see the Medicaid State Information page on the CMS EHR website.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

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More NY Courts to Focus on Medical Malpractice

Monday, November 14th, 2011

November 11, 2011 1:15 PM

(AP)  ALBANY, N.Y. — New York courts specializing in the state’s 4,000 medical malpractice cases filed each year have begun expanding following the success of a Bronx judge in settling cases early.

The approach, shown to cut court backlogs and save money, has been extended to Brooklyn, Queens and Manhattan, with some Erie County judges getting trained.

“It was proving to be a cost savings to hospitals and directly impacting the indemnity insurance of doctors,” New York Chief Administrative Judge Ann Pfau said.

Starting Dec. 1, Pfau will become coordinating judge of the court system’s medical malpractice segment. The pilot program is using a $3 million federal grant to train more judges in medical issues. Pfau herself will take cases in Brooklyn, where she is an acting state Supreme Court justice in the commercial division. She said it would be good to make the program citywide and makes sense to extend it to Long Island.

Bronx Justice Douglas McKeon, who began focusing on malpractice cases 15 years ago, said he has helped settle more than 1,000 since, with 12 to 15 cases now on the calendar monthly for intense discussions. Once the city’s Health and Hospitals Corp., which runs 11 public hospitals, created its own claims and law department in 2006 and explored settling cases sooner instead of later, the program “really took off,” with a 95 percent settlement rate for the corporation’s cases, he said.

Corporation deputy counsel Suzanne Blundi said they essentially revamped their whole commitment to patient safety, developing systems to improve care, manage claims and decrease payouts, which dropped from $196 million in 2003 to about $130 million last year.

The effort has entailed trying to investigate malpractice claims early on and also expediting settlements, Blundi said.

“If you have a matter that needs to be resolved, getting compensation to the injured person in a timely fashion is important. We see it as a continued relationship with our patients. … OK, there’s an error, and we’re going to help deal with it,” she said.

McKeon said it’s easier for the corporation as a municipal entity. “They don’t have investments they have to get certain returns on. They’re not an insurance company or one of these captive creations some hospitals put together,” he said.

Without close scrutiny by one judge, cases can come back several times before various judges with settlements discussed but doctors refusing to agree, McKeon said. “To me it’s a waste of court resources. … I always felt if you could extrapolate it across the state you could probably save a sizable sum of money.”

Now attorneys generally go through evidence discovery before serious settlement talks begin, Pfau said. “In a malpractice case, all of that discovery is very expensive.”

In one recent case, where a woman was hit by a car, taken to a city hospital and ended up brain damaged, a settlement was reached for about one-sixth of the initial demand and without the hospital admitting liability, Pfau said. At issue was whether the pressure in the patient’s head had been appropriately monitored.

Arthur Levin, director of the Center for Medical Consumers, an advocacy group, said he has questions about the special courts and their negotiated settlements that should be studied. “Even though people are not forced into it, I have no idea how coercive or not the pitch is,” he said.

Leslie Kelmachter, president of the New York State Trial Lawyers Association, said McKeon has put together a very good program, that malpractice issues are often straightforward, and the lawyers can support earlier settlements on behalf of their clients, the injured victims, as long as they are fair. “There shouldn’t be any pressure on the plaintiffs to settle. It should be voluntary,” she said.

It makes sense for the pilot program to target high-population areas with a large number of cases and high hospital malpractice costs, Pfau said. Many cases involve obstetrics and Medicaid patients, sometimes mothers coming to emergency rooms to give birth without any prenatal care, she said.

“What you’re finding is in poorer communities you’re getting higher incidence of this and in poorer communities you’re finding the huge verdicts,” said McKeon, a member of the medical malpractice reform working group of Gov. Andrew Cuomo’s team revamping Medicaid. He said other factors include lawsuits needlessly naming every doctor in a patient’s medical record who had little to do with the case, and preventive medicine’s increase in diagnostic tests, which create more opportunities for poor communications between diagnosing and treating physicians, he said.

Earlier this year, Pfau issued, and the Administrative Board of the Courts approved, new rules for the state trial courts on medical malpractice, calling for settlement conferences 45 days after court papers are filed indicating that the case is ready for trial. Only attorneys fully familiar with the case and authorized to settle it are to appear, and judges may also order insurance representatives and others with an interest to appear.

Federal data showed just over 1,800 medical malpractice payments statewide for $736 million in 2009, down from 2,400 payments for $822 million three years earlier. The New York Public Interest Research Group noted that 10 percent drop occurred even as the number of doctors practicing in the state increased to almost 65,000.

Brian Conway

Vice President, Communications

Greater New York Hospital Association

(212) 506-5477

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Nassau Academy of Medicine Annual Meeting

Monday, November 14th, 2011


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Clarification of Provider Enrollment Revalidation

Tuesday, November 8th, 2011

The American Medical Association (AMA) has advised local medical societies and physicians that they have met with the Centers for Medicare & Medicaid Services (CMS) regarding the enrollment revalidation process. In their letter the AMA stated that the CMS director agreed to extend the provider enrollment revalidation process through 2015.

CMS has indicated in the Medicare Learning Network (MLN) Matters Special Edition (SE) article SE1126, that it may be appropriate to delay; however there has been no delay to 2015 that has been formally announced by CMS. If CMS were to delay the final compliance date of revalidation into 2015, the process will still continue.

If you have received a revalidation request letter from National Government Services you are still required to complete your enrollment forms for revalidation and return them to National Government Services within 60 days from the date of the letter as the letter indicates. National Government Services is working toward sending the second letter soon. If you receive a letter during that phase you will also need to comply within 60 days from the date of the letter and revalidate your provider number by sending in a fully completed CMS-855. Failure to do so may lead to deactivation of your Provider Transaction Access Number (PTAN) and billing privileges to Medicare.

Note: Please remember that the revalidation process does not change or alter normal provider enrollment laws for Medicare. If you have a change of address, reassignments, additions to practice, changes in authorized officials or other information updates you are still required to submit that change within 30 days. You cannot wait for revalidation to update your enrollment record. That is not in compliance with Medicare regulation.

Please Remember:

  1. CMS has not delayed any timeframes in the revalidation process.
  2. If you receive a revalidation letter you must submit your fully completed application within 60 days from the date of the letter.
  3. Failure to reply to the revalidation request may lead to suspension of Medicare billing.
  4. If a change occurs, you must update the information to your enrollment record

For more information about the enrollment process and required fees, refer to MLN Matters article MM7350, which is available at: on the CMS Web site.

For more information about the application fee payment process, refer to MLN Matters article SE1130, which is available at on the CMS Web site.

The MLN fact sheet titled “The Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Provider and Supplier Organizations” is designed to provide education to provider and supplier organizations on how to use Internet-based PECOS to enroll in the Medicare Program and can be found at on the CMS Web site.

To access PECOS, your Authorized Official must register with the PECOS Identification and Authentication system. To register for the first time go to to create an account.

Thank you,

National Government Services, Inc.

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2012 NYS Guidelines Available on WCB Website

Tuesday, November 8th, 2011

The New York State Workers’ Compensation Board (WCB) has released the 2012
NYS Guidelines for Determining Permanent Impairment and Loss of Wage
Earning Capacity (2012 Guidelines), which will go into effect on January 1,
2012.  The WCB will provide web-based education programs for physicians and
other stakeholders beginning in mid-November.  Continuing medical education
credits will be available.
Please refer to the WCB Subject Number SN046-472 and the WCB website
at for full details.
Robert E. Beloten