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Nassau Academy of Medicine Annual Meeting
November 14th, 2011
PRESENTATION OF FELLOWS CITATIONS
PRESENTATION OF PAST-PRESIDENTS CITATION
GUEST SPEAKER – PAUL A. HAMLIN, MD, PRESIDENT MSSNY
Posted in EVENT PHOTOS |
Clarification of Provider Enrollment Revalidation
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:
- CMS has not delayed any timeframes in the revalidation process.
- If you receive a revalidation letter you must submit your fully completed application within 60 days from the date of the letter.
- Failure to reply to the revalidation request may lead to suspension of Medicare billing.
- 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: http://www.cms.gov/MLNMattersArticles/downloads/MM7350.pdf on the CMS Web site.
For more information about the application fee payment process, refer to MLN Matters article SE1130, which is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1130.pdf 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 http://www.cms.gov/MLNProducts/downloads/MedEnroll_PECOS_ProviderSup_FactSheet_ICN903767.pdf 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 https://pecos.cms.hhs.gov/pecos/PecosIAConfirm.do?transferReason=CreateLogin to create an account.
Thank you,
National Government Services, Inc.
Corporate Communications
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Posted in CLASSIFIED ADS |
2012 NYS Guidelines Available on WCB Website
November 8th, 2011
Posted in WORKERS' COMPENSATION UPDATES |
New Incentives for Providers to Work Together Through Accountable Care Organizations
October 24th, 2011
HHS Announces New Incentives When Caring for People With Medicare
New tools help doctors and other healthcare providers improve quality of care
Thu Oct 20 – People with Medicare will be able to benefit from a new program designed to encourage primary care doctors, specialists, hospitals, and other healthcare providers to coordinate their care under a final regulation issued today by the Department of Health and Human Services (HHS). Created by the Affordable Care Act, these final rules on Accountable Care Organizations add to the menu of options for providers looking to better coordinate care for patients and will make it easier for providers to deliver high quality care and use healthcare dollars more wisely.
The initiatives announced today are just two of several efforts made possible by the Affordable Care Act to help bring better health, better care and lower costs not just to Medicare beneficiaries, but to all Americans. For example, the Bundled Payments for Care Improvement Initiative and Comprehensive Primary Care Initiative offer alternatives to coordinate and improve healthcare.
The two initiatives launched today – the Medicare Shared Savings Program and the Advance Payment model – will help providers form Accountable Care Organizations and reflect the significant input provided by stakeholders as well as lessons learned by innovators in care coordination in the private sector.
- The Medicare Shared Savings Program will provide incentives for participating healthcare providers who agree to work together and become accountable for coordinating care for patients. Providers who band together through this model and who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program. The higher the quality of care providers deliver, the more shared savings the providers may keep.
- The Advance Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems. The advanced payments would be recovered from any future shared savings achieved by the Accountable Care Organization.
The Shared Savings Program final rule is posted at: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf.
The CMS press release is available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4132.
The Advanced Payment solicitation is posted at: http://innovations.CMS.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.
For more information, fact sheets are posted at: http://www.HealthCare.gov/news/factsheets/2011/10/accountable-care10202011a.html and http://www.CMS.gov/ACO/.
The joint CMS and HHS Office of Inspector General (OIG) Interim Final Rule with Comment Period addressing waivers of certain fraud and abuse laws in connection with the Shared Savings Program is posted at: www.OFR.gov/inspection.aspx.
The Antitrust Policy Statement is posted at: www.FTC.gov/opp/aco/ and http://www.justice.gov/atr/public/health_care/aco.html.
The Internal Revenue Service (IRS) Fact Sheet, Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care (FS-2001-11), will be posted at: http://www.IRS.gov.
For additional information you may view the CMS Fact Sheets (10/20) posted at: https://www.CMS.gov/apps/media/fact_sheets.asp
Federal Register Links:
ACOs: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf
Stark Waivers: http://www.ofr.gov/OFRUpload/OFRData/2011-27460_PI.pdf
Advanced Payment: http://www.ofr.gov/OFRUpload/OFRData/2011-27458_PI.pdf
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS |
Problem with September 2011 Influenza Vaccine Pricing
October 20th, 2011
Description of the Problem
For dates of service in September 2011, influenza vaccinations are being priced using the 2010-2011 influenza season rates.
What This Means to You
Providers are receiving incorrect payment for influenza vaccination claims. If you identify influenza vaccinations where you were paid incorrectly, please hold your appeal requests. As soon as the pricing files are updated you will be notified and you may request an adjustment of your claims. Until the new pricing files are uploaded National Government Services cannot reprocess any claims. If you have not already submitted your influenza vaccinations for September, please consider holding your claims until the new pricing files are in effect.
Current Status
10/20/2011: National Government Services is aware of this issue and is working in collaboration with the Centers for Medicare & Medicaid Services (CMS) in order to rectify the pricing disparity as soon as possible. Thank you for your patience.
National Government Services, Inc.
Corporate Communications
Posted in FLU/IMMUNIZATION UPDATES, MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS |
URGENT NOTICE – Compliance deadline Jan.1, 2012
October 20th, 2011
2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning Sun Jan 1, 2012
Only 10% of the NGS’ Medicare provider volume has tested their HIPAA Version 5010 claims on an individual basis. If you bill electronically, please be sure that you or your billing vendor, clearinghouse or service provider has successfully tested your claims submission before the January 1, 2012 deadline (i.e. the first two weeks of December). Please make sure, by asking them, if you have not asked them, already. Not doing so will have serious negative cash flow implications – your claims will not be paid. If you do not have an Administrative Simplification Compliance Act (ASCA) waiver, you will not be permitted to default to paper claim filing.
In May 2011, CMS released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) (form CMS-R-131), which will replace the 2008 version of this form. The 2011 version contains no substantive changes from the 2008 version of the notice and was approved by the Office of Management and Budget. The 2008 and 2011 ABN notices are identical except that the release date of “3/11” is printed in the lower left hand corner of the new version. The ABN is used by all providers, practitioners, and suppliers paid under Medicare Part B, as well as hospice providers and religious non-medical healthcare institutions (RNHCIs) paid exclusively under Part A.
When the 2011 ABN was posted to the CMS website on Mon May 16, CMS announced a mandatory use date of Thu Sep 1 and permitted providers and suppliers to begin using the new form immediately. Subsequently, we received requests from the industry to extend this deadline in order to permit providers and suppliers with pre-printed stockpiles of ABNs time to exhaust their supplies.
Providers and suppliers are allowed to use either the 2008 or 2011 version of the ABN through the end of this year; beginning Sun Jan 1, 2012, they must begin using the 2011 version. ABNs issued after Sun Jan 1 that are prepared using the 2008 version of the notice will be considered invalid by Medicare contractors. 2008 versions of the ABN that were issued prior to Sun Jan 1 as long-term notification for repetitive services delivered for up to one year will remain effective for the length of time specified on the notice.
Information and a copy of the 2011 version of the ABN (form CMS-R-131) can be found online at http://www.CMS.gov/BNI, under the “FFS Revised ABN” link.
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS |
Responding to EMTALA as a Member of the Medical Staff
October 18th, 2011
Considerations for Medical Staff Bylaws
Professional Discipline • Litigation and Arbitration • Contracts and Business Transactions • White Collar Crime Regulatory Compliance • Practice Formation • Mergers and Acquisitions • Asset Protection and Estate Planning Medical Financial Audits
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency departments (and Critical Access Hospitals) to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition (EMC). The provisions of EMTALA apply to all individuals (not just Medicare beneficiaries) who attempt to gain access to a hospital for emergency care. The regulations define “hospital with an emergency department” to mean a hospital with a dedicated emergency department (ED) and define “dedicated emergency department” as any department or facility of the hospital that: (1) is licensed by the state as an emergency department; (2) is held out to the public as providing treatment for emergency medical conditions; or (3) on one-third of the visits to the department in the preceding calendar year actually provided treatment for emergency medical conditions on an urgent basis.
Enforcement of EMTALA is complaint driven, i.e., the investigation of a hospital’s policies and procedures, and any subsequent sanctions, are initiated by a complaint. CMS surveyors review the bylaws, rules, and regulations of the medical staff and the ED policies and procedures manual to help determine if a hospital is in compliance with EMTALA requirements. If the results of a complaint investigation indicate that a hospital violated one or more of the anti-dumping provisions of EMTALA, a hospital may be subject to termination of its provider agreement and/or the imposition of civil monetary penalties (CMPs). CMS refers cases it has investigated to the HHS Office of Inspector General (OIG) when CMS finds violations that appear to fall within the OIG’s EMTALA jurisdiction. CMPs may be imposed by the OIG against both the hospital and individual physicians for EMTALA violations. The OIG can also terminate a physician’s provider agreement for gross and flagrant or repeated EMTALA violations. A physician found to have violated EMTALA may also be sanctioned by the state licensing board, payors and other third-party entities, and be sued by the hospital for indemnification.
TO RECEIVE THE COMPLETE 19-PAGE REPORT, Contact the Nassau County Medical Society at nassaumed@verizon.net.
Tags: LEGAL SERVICES AND INFORMATION
Posted in NATIONAL HEALTHCARE NEWS |
You MUST Transition to Version 5010 for Electronic Claims – 1/1/2012
October 4th, 2011
If you use HIPAA electronic standard transactions (such as claims submission), you are required to comply with the Jan. 1, 2012 deadline of moving to version 5010 of these transactions. Make sure your practice is ready so you can avoid rejected claims and cash-flow interruptions.
Please be sure to check with your biller, vendor, practice management software staff and/or clearinghouse to ensure that they have transitioned to version 5010. Don’t wait until the last minute.
LESS THAN 3 MONTHS REMAIN
to Transition to Version 5010 for Electronic Claims.
Are you:
- An individual physician?
- A physician group practice?
- A hospital?
- A home health facility?
- A hospice facility?
- A federally qualified health center?
- A billing service?
Did you know that ALL covered entities must submit version 5010 electronic claims as of January 1, 2012?
Currently, only one percent of National Government Services total electronic data interchange (EDI) trading partners are sending version 5010 production electronic claims. That leaves 99 percent of National Government Services trading partners to transition prior to January 1, 2012. Don’t wait to transition to version 5010, transition NOW to prevent last minute delays, electronic claim file front-end rejections or possible payment delays.
Thank you,
National Government Services, Inc.
Corporate Communications
Posted in MEDICARE UPDATES |
Robert Bruce Bergmann, MD
September 30th, 2011
Robert Bruce Bergmann, M.D.
1926—2011
It is with deepest regret that we mourn the passing of our esteemed colleague and friend on September 21, after a lengthy illness.
Dr. Bergmann joined the Medical Society in 1961 and served faithfully for 50 years. A graduate of Rutgers University, Dr. Bergmann received his M.D. degree from The State University of New York – Brooklyn in 1948 and thus began his long and distinguished career in medicine.
Dr. Bergmann interned at Methodist Hospital, Brooklyn in 1948-49, continued his ophthalmology education at the University of Pennsylvania Graduate School in 1949-50, and completed his residency training at Brooklyn Eye and Ear Hospital from 1950 to 1952. From 1952 to 1955, he served as a Captain in the United States Air Force before entering private practice in 1955 in Massapequa where he continued to practice until just recently.
Dr. Bergmann was a Diplomate of the American Board of Ophthalmology, a Life Fellow of the American College of Surgeons and the American Academy of Ophthalmology and a Life Member of the American Medical Association. His hospital affiliations included New Island and Syosset Hospitals, and Brunswick Hall where he was President of the Executive Medical Board and the Hospital Medical Staff.
In addition to his national society affiliations, Dr. Bergmann was a Past President of the Nassau County Medical Society and a Fellow and Past President of the Nassau Academy of Medicine as well as Past President of the NAM Section on Ophthalmology. Dr. Bergmann also chaired the NCMS Board of Censors and served on the Executive Committee and the Academy Board of Trustees.
Dr. Bergmann served on many committees of the Medical Society of the State of New York including MSSNY Councilor, President of the Second District Branch, MSSNY Delegate since 1985, Alternate Delegate to the AMA, and member of the Physician Discipline and Membership Committees. He also served as a member of the NY State Board for Professional Medical Conduct for 12 years.
Dr. Bergmann was a Past President of the Long Island Ophthalmology Society and recipient of the New York State Ophthalmology Society 2004 Hobie Award for Lifetime Service.
Most recently Dr. Bergmann was honored as the 2010 Recipient of the Sidney Mishkin, MD Lifetime Distinguished Service Award from The Nassau County Medical Society.
Dr. Bergmann served on the Massapequa Board of Education, where he served as President.
All who were blessed to know him will sorely miss his indomitable spirit and his passion for the profession he loved so deeply and strove to preserve.
Posted in In Memoriam |
Important E-Prescribing (eRx) Incentive Updates
September 30th, 2011
Please see the important deadline reminder below.
******************************************************************************************
Good morning everyone,
Please share the message below with your internal and external partners interested in the Medicare Electronic Prescribing (eRx) Incentive Program. In your message, please direct eligible professionals and others interested in the Medicare Electronic Prescribing (eRx) Incentive Program to cut and paste the URLs into their internet browser should they have a problem accessing the URLs embedded in the message.
Thanks
The Centers for Medicare & Medicaid Services (CMS) would like to remind eligible professionals and group practices participating in the Medicare Electronic Prescribing (eRx) Incentive Program that the deadline to request a hardship exemption for the 2012 eRx payment adjustment is November 1, 2011.
Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the MLN Article SE1107. If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule.
In addition, a Quick Reference Guide is available to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program. As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit a significant hardship exemption request and rationale.
Please note, to be considered for an exemption under the significant hardship exemption category “Eligible professionals who register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Programs and adopt Certified EHR Technology,” an eligible professional must:
(1) have registered for either the Medicare or Medicaid EHR Incentive Program (for instructions on how to register for one of the EHR Incentive Programs, we refer readers to the Registration and Attestation page of the EHR Incentive Programs section of the CMS Web site at http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage);
AND
(2) provide identifying information as to the Certified EHR Technology (as defined at 42 CFR 495.4 and 45 CFR 170.102) that has been adopted for use no later than October 1, 2011. Please note that, in order to qualify for an exemption to the 2012 eRx payment adjustment under this significant hardship exemption category, it is not necessary that an eligible professional receive an incentive payment under the Medicare or Medicaid EHR Incentive Program.
Eligible professionals wishing to register for the Medicaid EHR Incentive Program in states that have not yet launched their respective programs may initiate the registration process at the CMS Registration and Attestation System, and obtain a registration number but will not be able to successfully complete registration. If a State has not launched its Medicaid EHR Incentive Program, the State name will not appear in the drop-down menu for eligible professionals to choose from. However, a registration number is assigned even if registration is not successfully completed.
In order to initiate registration for the Medicaid EHR Incentive Program, please visit https://ehrincentives.cms.gov/hitech/login.action and follow the instructions to begin the registration process. Obtaining a CMS EHR Incentive Programs registration number, even if the registration is not successfully completed, suffices for the purposes of applying for a significant hardship exemption for the 2012 Medicare e-Prescribing payment adjustment.
To request an exemption, individual eligible professionals must submit their hardship exemption requests through the Quality Communications Support Page and group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS.
Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.
For additional information and resources, please visit www.cms.gov/erxincentive on the CMS website.
Geanelle G. Herring MSW
Geanelle Griffith Herring
Centers for Medicare & Medicaid Services
Provider Communications Group
Division of Provider Relations & Outreach
Posted in MEDICARE UPDATES |
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