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NYS Department of Health Medicaid Managed Care Call September 14
September 7th, 2011
Do you have questions regarding prescription drug coverage for your Medicaid patients when, starting October 1, their pharmacy coverage will be transitioned to Medicaid Managed Care?
At the request of the Medical Society of the State of New York (MSSNY), on Wednesday, September 14, Department of Health staff led by Janet Elkind, Director of the Bureau of Pharmacy & Policy Operations, will host a call specifically for physicians and their staff to ask questions regarding this important change in Medicaid prescription drug coverage.
The call will take place at 5:00 PM.
The call-in information is:
Call in #: 866-394-2346
Passcode: 590 814 6107
Please confirm your participation in this call by e-mailing mhardin@mssny.org
As has been previously reported in the MSSNY e-news, all physicians that treat Medicaid beneficiaries should be aware that, effective October 1, their patients enrolled in Medicaid Managed Care (MMC) plans will begin receiving their prescription drug coverage through their plans, rather than through the state fee for service program. The change was one of a myriad of cost-saving measures that were proposed by the Governor’s Medicaid Redesign Team and enacted as part of the 2011-12 State Budget. Medicaid prescription drug coverage had been “carved out” of MMC since the late 1990s.
MMC plans will establish their own formularies and prior authorization procedures. However, health plans will be required to include on their formularies all categories of prescription drugs that are currently part of the New York State Medicaid fee for service prescription program. Consistent with New York’s managed care utilization review laws, plans will also be required to maintain internal appeals systems and assure access to an external appeal to address circumstances where patients are denied coverage for medications that are prescribed by their treating physicians.
MMC plans are required to develop and implement comprehensive implementation and communication plans to assure patient access to needed medications. These transition plans must be approved by the NYS Department of Health (DOH). DOH has indicated that it will permit a one-time, temporary fill of non-formulary drugs for up to a 30 day supply of medication. This would include drugs that are on a plan’s formulary but require prior authorization or step therapy under a plan’s utilization management rules.
Recognizing the confusion that implementation of this change may cause, MSSNY has urged DOH to take a number of steps to reduce transitional issues. These include asking DOH to maintain a link on its website where physicians will be able to easily check the formularies and prescription authorization procedures that will be established by each MMC plan; assuring MMC plans have sufficient staff to promptly respond to physician requests for non-formulary medications; and facilitating meetings and communications with physicians across the State of New York to get local physician feedback.
Posted in MEDICAID UPDATES |
The Countdown to Version 5010 Implementation Is Underway
September 6th, 2011
National Government Services News
- Did you know that effective January 1, 2012 all covered entities will be required to use the new Health Insurance Portability and Accountability Act (HIPAA) 5010 version for electronic filing?
- Did you know that effective January 1, 2012 electronic submitters who are not using version 5010 for HIPAA electronic transactions will have their claims rejected and they won’t receive payment?
- Did you know that there are less than 130 days for the version 5010 implementation?
Medical offices and providers should feel the pressure to get their systems ready for the version 5010 implementation. National Government Services has created several helpful resources to assist electronic submitters to prepare for the version 5010 transition. These resources are available on the Version 5010 Implementation page located on the Electronic Submission (EDI) section on the National Government Services Web site.
We have also offered free monthly Webinars for all providers and facilities to join and will continue to offer these free monthly webinars. However, despite these free education opportunities, medical offices are still not prepared for the version 5010 change. Be proactive and start preparing for version 5010 today!
- Electronic Data Interchange Claims Transmission and Report Download for the Labor Day Holiday
- National Government Services Provider Outreach and Education Survey
* * *
Posted in MEDICARE UPDATES |
MESF to Launch Education at Sea Program in February
September 1st, 2011
A special CME program entitled “Surviving 2012: Key Physician Practice Management Issues” will be offered on a 10 night Caribbean cruise scheduled for Feb 17-27, 2012 from the Port of New York’s Cape Liberty. The program has been scheduled for the Royal Caribbean Lines Explorer of the Seas and is designed specifically for physicians and office managers. Expert faculty will present a 14 hour CME program focused on critical Practice Management issues facing today’s physician community. Topics include:
- Negotiating Sale of Your Practice
- Staying Clear of Regulatory Agencies
- Ways to Reduce Your Med Mal Risk
- What to Do When the Auditors Arrive
- Office Legal Issues.
- Getting Your EHR to Pay Its Way
The specific cruise was selected because of Royal Caribbean Lines reputation for excellence and fact that it was over the President’s week holiday when many children are out of school. (The ship offers great kid-friendly facilities.) In addition, the cruise was in and out of New York harbor so most participants would not have to fly to reach the ship. Parking is available on the pier adjacent to the ship. Medical, Educational and Scientific Foundation (MESF) President Leah McCormack called the program “the first of what we hope to be an ongoing educational series, plus you get to visit some of the great fun spots in the Caribbean while the Northeast is freezing.”
Go to http://www.continuingeducation.net/coursedetails.php?program_number=1110
or call 1-800-422-0711for more information.
Posted in SEMINARS AND PROGRAMS |
AMA Continues to Press CMS on E-prescribing Penalty
August 30th, 2011
The AMA continues to hear concerns expressed by physicians, states and specialty societies that a significant number of physicians will be subjected to the e-prescribing penalty in January 2012.
Consequently, the AMA’s Executive Vice President, James Madara, MD, called Centers for Medicare & Medicaid Services (CMS) Administrator Donald Berwick, MD, to urge the agency to provide more flexibility so that a 1 percent penalty in 2012 does not affect as many physicians. During the call, Dr. Madara thanked Dr. Berwick for issuing a recent proposed rule creating additional penalty exemptions, but went on to alert the administrator to the concerns being expressed. He urged Dr. Berwick to consider additional steps, such as establishing a new reporting period in 2012 and refraining from applying the penalty until 2013.
The AMA strongly believes that the agency plans to apply the penalty a year earlier than called for by Congress. Dr. Madara’s call follows a July 25 sign-on comment letter to CMS, where the AMA was joined by 92 states and specialty societies in calling for greater program flexibility. The AMA will continue to follow-up with CMS to secure additional changes to the program.
Posted in MEDICAID UPDATES, MEDICARE UPDATES |
Six Month Check-In: Act Now for the Version 5010 Transition
July 27th, 2011
The Version 5010 transition is less than six months away for all HIPAA-covered entities. This means that to submit transactions electronically, all covered entities must upgrade from Version 4010/4010A to Version 5010. Version 5010, unlike Version 4010, accommodates the new ICD-10 code sets, and is a required preliminary step for the use of the new ICD-10 medical code sets.
Before the compliance deadline of Sun Jan 1, 2012, you should conduct internal and external transactions within your organizations and with your billing partners – including payers, vendors, clearinghouses, and providers. External testing should take place now in order to make sure that you are able to send and receive compliant transactions effectively. Testing now will help identify any potential issues that may arise, and allow the necessary time to address them.
The CMS ICD-10 website has resources to support providers, payers, and vendors as they make the transition to Version 5010 and ICD-10. Keep up to date on Version 5010 and ICD-10 by visiting http://www.CMS.gov/ICD10 for the latest news and resources to help you prepare.
Posted in MEDICARE UPDATES |
Recap of Albany Legislation as Session Ends
June 28th, 2011
PHYSICIANS COLLECTIVE NEGOTIATIONS PASSES SENATE
LONG ISLAND PHYSICIANS ADVOCACY EFFORT CRITICAL TO THIS SUCCESS
ASSEMBLY LEADERSHIP PLAN TO MEET WITH MSSNY DGA STAFF AND PHYSICIAN LEADERSHIP TO PASS COLLECTIVE NEGOTIATIONS THIS YEAR
By the close of the Legislative Session, the physicians collective negotiations bill S3186A (Hannon et al)/A2474A (Canestrari et al) had passed the Senate by a 43-19 margin, with bipartisan support. While the bill was not voted upon in the Assembly, it did move from the Assembly Insurance Committee to Ways and Means. The companion Assembly bill has about 70 co-sponsors, roughly half of the Assembly. Communications with Albany leadership including Speaker Silver’s office, Assemblyman Gottfried’s office, and Assemblyman Canestrari’s office have made it clear that that they support collective negotiations legislation. In addition, communications with the Attorney General’s office and the Governor’s office have indicated that they support this legislation. However, in recognizing the importance and the historic nature of this unprecedented legislation, they want to take some time to address bill language and to assure that passage will not result in increased costs to publicly funded programs such as Medicaid.
Key Albany leadership has made a commitment to meet with MSSNY DGA (Division of Governmental Affairs) Staff and physician leadership over the summer weeks to address these concerns. The Assembly will return to Albany during the summer or fall to address unfinished business. At that time, it is hoped that they will bring collective negotiations legislation to a vote and passage. The Senate will then be asked to pass clean-up legislation that addresses Assembly leadership concerns. Then the legislation can go to the Governor for his signature.
Long Island physicians should be pleased to know that all 9 Long Island Senators voted for this legislation. There is no doubt that the activism of Long Island physicians was essential to getting the bill passed in the Senate. Doctors who called these Senators advocating for the bill should now call or write to thank them for their leadership in bringing this bill to passage.
This is the first time this legislation has passed either chamber in Albany. Physicians should be pleased and proud of their effort to bring this bill to passage in the NY State Senate. And physicians should remain hopeful that this legislative goal can be achieved before the end of 2011. And physicians must be prepared to continue their successful advocacy efforts to bring this legislation to passage in the Assembly and to the Governor’s desk for his signature this year.
In addition, physicians should understand and appreciate the tremendous effort put forth by MSSNY DGA staff including Gerry Conway, Liz Dears, Moe Auster, Pat Clancy and Barbara Ellman. The opposition to this legislation by the insurance industry was tremendous, and extremely well funded and worked daily to kill this legislation, but out DGA staff remained vigilant, putting in 15 hour days, day after day toward the end of the legislative session. Their efforts kept this legislation alive and were critical to bring this legislation to passage in the Senate. No doubt they will be there for us throughout the summer as we work to address Assembly leadership concerns and to bring this bill to passage in the Assembly. Physicians should remember to let MSSNY DGA Staff know how much their efforts on behalf of NY State physicians is appreciated.
Posted in NEWS FROM THE NYS LEGISLATURE |
ATTENTION PHYSICIANS! E-PRESCRIBING INCENTIVE REMINDER:
June 23rd, 2011
The New York Medicaid e-prescribing incentive program applies only to non-facsimile electronic transmissions when compliant with Medicare Part D data standards.
E-Prescribing Incentive checks are being returned by prescribers who claim they do not e-prescribe.
PLEASE NOTE THE FOLLOWING:
Electronic Prescription Definition
New York State Pharmacy Regulations (http://www.op.nysed.gov/part63.htm) recognize two distinct types of electronically-transmitted prescriptions:
· a prescription transmitted electronically by facsimile;
- · a prescription transmitted electronically by means other than facsimile; such non-facsimile prescriptions are required by regulation to be electronically encrypted, meaning protected to prevent access, alteration or use by any unauthorized person.
The New York Medicaid Program accepts both types of electronically-transmitted prescriptions for standard claim reimbursement. However, pharmacies must verify a prescription is compliant with Medicare Part D data standards and requirements and NYS Pharmacy Regulations before submitting for the e-prescribing incentive.
Claims for prescriptions transmitted electronically by means other than facsimile and not Medicare Part D compliant are recognized by New York Medicaid for claim reimbursement purposes, but do not qualify for the e-prescribing incentive reimbursement.
The e-prescription must originate from the prescriber’s computer system (an electronic health record, electronic medical record, or stand-alone e-prescribing software) and must be transmitted to the retail pharmacy’s computer system.
For more information go to: http://www.health.ny.gov/health_care/medicaid/program/update/2009/2009-11spec.htm
Posted in MEDICAID UPDATES |
ACT NOW!
June 20th, 2011
The Legislature is working toward its stated goal of ending session by Monday, June 20th but several major unresolved issues appear to threaten that possibility. Unresolved issues included” same-sex marriage, rent control and a real property tax cap
As of today, the fate of the Collective Action legislation, strongly supported by MSSNY, was unclear. The final outcome on this bill will be determined by the extent to which every physician, every county medical society and every specialty society take the action we have requested of them. Every single legislator must be contacted by physicians from the legislators’ district a well as the physician leaders of organized medicine in that district.
Ø Call your legislator. To find your respective legislator, click here.
Ø Call them at their Albany office.
Ø Senators can be reached at (518) 455-2800; Assemblymembers can be reached at (518) 455-4100.
If you cannot reach the legislator personally, leave a message.
Please call and ask your representative to make certain that A.2474-A, Canestrai/S.3186-A, Hannon, is brought to a vote and that they vote for it. Collective Action is essential for physicians and patients if the growing insurance company domination of our healthcare system is to be halted.
Your call is essential. CALL NOW!
Posted in NEWS FROM THE NYS LEGISLATURE |
The Centers for Medicare & Medicaid Services Banking Change
June 20th, 2011
JUNE 17
Important News from National Government Services:
The Centers for Medicare & Medicaid Services (CMS) has converted its banking contracts with JP Morgan and U.S. Bank to Federal Acquisition Regulation (FAR) contracts. These banks serve all the Medicare contractors. Accordingly, CMS has instructed the banks to close all bank accounts and letters of credit associated with the old configuration and contracts.
Normally, Medicare checks are valid for a 12-month period after the payment date on the check and then they are automatically stale-dated, at which point they become void. CMS needed to close some of the old bank accounts prior to the end of the 12-month period due to contractual requirements. Some checks drawn on these old bank accounts may be presented for payment within the next two to three months, but will be returned and annotated “account closed.” If providers encounter this situation, they may contact the Provider Contact Center and have the checks reissued under a new appropriate account number. If the provider receives a fee for the check being returned as unpaid please bring that to the attention of the Provider Contact Center and they will address that issue as well for the provider. While we do not anticipate this being a large impact for providers it is important that you are aware of what to do if the situation arises.
Please visit our Web at www.NGSMedicare.com for the Provider Contact Center information located at Resources > Contact Us > Provider Contact Center.
Thank you,
National Government Services, Inc.
Corporate Communications
Posted in MEDICARE UPDATES |
NOW IS THE TIME! PHYSICIAN ACTION NEEDED TO ENACT COLLECTIVE NEGOTIATION BILL
June 14th, 2011
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You can make the difference. With just a few days remaining in the 2011 Legislative Session, all physicians must make their voices heard loud and clear in support of legislation (A.2474-A, Canestrari/S.3186-A, Hannon) to permit independently practicing physicians to come together under close state supervision to collectively negotiate their participation contracts with health insurers. In addition to calling the numbers listed below, physicians can send a letter from the MSSNY Grassroots Action Center by clicking here.
S.3186-A was unanimously reported from the Senate Health Committee to the Senate Finance Committee. Earlier in the Session, A.2474-A was unanimously reported from the Assembly Health Committee to the Assembly Ways and Means Committee. You must urge that this bill be brought up for a vote in the Assembly and Senate and enacted into law! If you want to keep your practice viable and overcome the dominance of the monopolistic health insurers in your community, you must make these contacts! Sen. Thomas K. Duane: (518) 455-2451 (Albany); (212) 633-8052 (District) Asm. Linda B. Rosenthal: (518) 455-5802 (Albany); (212) 873-6368 (District) |
Posted in NEWS FROM THE NYS LEGISLATURE |
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