President's Message - Susan Zwanger-Mendelsohn, M.D |
When I started my presidency a year ago, I was humbled, deeply honored, and a bit intimidated to be taking on this job that so many have done so ably before me, and only hoped that I’d be equal to the task. When I asked my predecessors for their input, the comment I received most consistently was, “You won’t believe how short this year will seem.” Until now, I had no idea just how accurate a statement this would prove to be. To say the least, it has been an eventful and somewhat tumultuous year, which has seen some notable successes and some disappointments. But despite a few setbacks, notably in the area of tort reform, I know we are moving in the right direction in our goal of advocating for the physicians of Nassau County and for our patients. In particular, we have made significant progress in bringing in new members, especially young physicians whose ideas, energy, and enthusiasm will see our medical society through the coming decades of what will certainly be profound change. We have done this not only by directly recruiting medical students but also by streamlining and modernizing our application process and our communications with our members.
However, recruiting these new members is only the first step—the next step is to keep them interested and involved. It is now up to all of us to inspire them—to provide them with educational opportunities, engage them in our committee work, and inculcate in them the understanding that participation in organized medicine is more important now than ever before, given the increasing challenges that physicians in practice will be facing in the years ahead. The value of our participation was brought home very vividly just last week, when the New York State Senate passed the Collective Negotiations Bill (S. 3186-A, Hannon), which would empower physicians to collectively negotiate participation terms with health plans. This represents a significant victory for physicians and patients against incredible pressure by the health insurance lobby—but the work is only half done: the companion bill in the Assembly (A.2474-A, Canestrari) must now be put on the table by Speaker Sheldon Silver for approval when legislators return to Albany later this year. It is imperative that all physicians contact Speaker Silver and the Nassau County Assembly Representatives to urge passage of this bill.
In closing, I would like to extend heartfelt congratulations to our incoming president, Dr. Michael Brisman, and to thank the staff and the Executive Committee of the Nassau County Medical Society for their tireless efforts and support. And most importantly, I would like to thank all of you for the privilege of serving as your president this past year.
C L A S S I F I E D A D S |
Although NCMS believes the following classified advertisements in this section to be from reputable sources. The NCMS does not investigate the offers made and assumes no responsibility concerning them:
SPACE FOR RENT/LEASE
GARDEN CITY—Plaza 230 Medical Center. 2150 SF, four exam rooms, bath, Quest lab, Nassau Radiology in Bldg. 24hr concierge , Ample parking call 516276-3854
GARDEN CITY—Garden City Medical Center, 520 Franklin Ave. has office space available. For information, call 516-747-2900.
GARDEN CITY—Garden City Medical Center, 520 Franklin Ave. Furnished medical office space for sublet. Suitable for almost all practices. Call 212-752-3739.
GLEN COVE—prime downtown area—2 spaces available 1,900 sq. ft. and 1,000 sq. ft. Ample parking. For information, call 516-671-1800.
HUNTINGTON, WEST HILLS—850 SF office with option of additional 1500SF office in prime free-standing bldg on Nas/ Suf Border. Will build to suit. Call 631-423-1008.
LAKE SUCCESS/NEW HYDE PARK—Medical office available to sublet, fully redone, 3 exam rooms, 2 MD offices, ample parking, near LIJ–NCMH. Call 516-354-2424.
MANHASSET—furnished medical office to sublet. 4 exam rms, 2 MD offices, secretarial area. Near SFH, NS/LIJ, Call Tracie 516-365-4899. rswe777@aol.com.
MASSAPEQUA—Office available for sublet. Excellent opportunity for an endocrinologist, hematologist, neurologist, psychiatrist, psychologist, dermatologist, physiatrist. Please call office at 516-541-5068.
PRACITICE FOR SALE
HEWLETT—Terms negotiable, Internal Medicine/Primary Care on South Shore Long Island. Call 516-612-2444.
MedPro Solutions, Inc. |
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Nassau Health Comissioner Maria Carney, MD, FACP |
To all,
I want to personally inform everyone that after much thoughtful consideration, I offered my resignation to both County Executive Edward Mangano and Board of Health Chair Diana Coleman. My last official day in the Nassau County Department of Health (NCDOH) headquarters will be July 15, 2011.
I want to thank County Executive Edward Mangano and Board of Health Chair Diana Coleman for the privilege of leading a vital and vibrant department in a county more populated than 11 US states during a period of challenging, yet fascinating, times in health care and government. In my years as Commissioner, the NCDOH faced a global pandemic, numerous communicable disease outbreaks, national health care reform, and a fiscal crisis that has led to three county wide retirement incentives and, hence, three departmental re-organizations. Yet with challenge came opportunity. Together, we created an evidence-based journal club series and several health education conferences; implemented research studies; produced multiple peer-reviewed publications; and developed health policy initiatives such as calorie menu labeling and banning of trans-fats. We increased and enhanced community partnerships, formed a non-for-profit organization to support the mission of the Health Department, and began cross training initiatives and information technology upgrades throughout the department. We also re-established Article 36 licensure for the department. Most recently, we developed and held a health evaluation program which improved access to care entitled “Health Checks.” All this has been possible largely, in part, because of the professional and dedicated staff. The Department’s workforce should be applauded and commended for its commitment to health and safety.
I thank you all for embracing my goals, ideas, and direction. I believe we positively impacted the health in our region. Dr. Larry Eisenstein will become the Acting Commissioner. With the full support of the administration and Board of Health, I am confident that he, in partnership with the NCDOH staff, will continue to be effective in protecting and promoting health in Nassau County.
As I leave the position of Health Commissioner, I will not end a relationship with the NCDOH, in fact, my goal is to maintain my membership in the Medical Reserve Corps and concentrate my efforts on the continued growth and success of the Nassau Center for Health Initiatives (NCHI), the non-for-profit organization that promotes health, longevity and safety in our region. I have also offered to maintain accessibility beyond July 15 to assist in the transition process.
It has truly been a privilege to have worked directly with the men and women in the Department, Board of Health, County, Legislature, Medical Society, and the physicians, nurses and community members advocating for health and emergency preparedness in Nassau County. Thank you.
Sincerely,
Maria Torroella Carney, MD, FACP
Commissioner
Nassau County Department of Health
Pay Your 2011 Dues By Credit Card |
This year we’ve made it easier to pay your dues promptly.
It’s quick and easy!
- Go to our website at NACMED.ORG and open the PayPal icon.
- Select the dues and contributions you want to pay by adding them to your cart (remember: county and state dues are mandatory).
- Finished? – go to your cart to review your total and click on the check out button.
- Enter your credit card information.
- Confirm your payment and you’re done! Safely and Securely.
Is Your Web Site Linked to Ours? |
As a member benefit, you can now have your web site linked
to ours. Increase visibility and access to your practice at no cost
to you as a member of NCMS.
HERE IS WHAT YOU WILL FIND AT WWW.NACMED.ORG
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Visit us TODAY at WWW.NACMED.ORG
We welcome your comments and suggestions on our web site and its contents.
Medical Billing |
Docsbackoffice is an Internet based medical billing service providing physicians and their staff with an easy an inexpensive way to process claims.
No monthly maintenance or software to purchase.
If you’re paying more than 4%, you’re paying too much.
Call Tim Haniffy at 516-622-2242.
Bits And Pieces |
MSSNY MEDICAL DIRECTORY NOW AVAILABLE AT WWW.MSSNY.ORG
MSSNY recently began a process of converting its Medical Directory from print form to an online version and CD–Rom. The online version — available at www.mssny.org to members only — is constantly updated and provides the latest available information on physicians throughout the state. Upon request, the 2011-2012 CD-Rom Directory will be shipped free of charge to any member who requests it. Please contact Annette Dobson at adobson@mssny.org to request your free copy. The cost of the CD-Rom to nonmembers will be $99.99 plus tax. Non-MSSNY members should contact Amelia Reyes at 516-488-6100, ext. 325.
Limited Print Copies
A small run of the hard copy Directory will be printed for sales purposes only. MSSNY members who have grown attached to the print publication can purchase a hard copy of the Directory for $40 plus tax. The Directory will be available to nonmembers at $140 plus tax. Members who want to order the hard copy edition should contact Annette Dobson at adobson@mssny.org; nonmembers should contact Amelia Reyes at 516-488-6100, ext. 325.
THE REAL-WORLD IMPACT OF ACROSS-THE-BOARD CUTS
As Congress considers ways to cut federal spending, the American Heart Association (AHA), the American Association of Retired Persons (AARP), the American Medical Association (AMA), the American College of Cardiology (ACC), and LeadingAge released a study showing the real-world impact of across-the-board cuts on the elderly, children and low-income families. The Lewin Group analysis found that the Commitment to American Prosperity Act, one of many proposals calling for arbitrary spending caps or targets, would cut $4.2 trillion from federal spending between 2013 and 2021, including $859 billion from Medicare and $575 billion in federal Medicaid payments to states.
Among other impacts, such cuts could force most hospitals into the red, physicians out of the Medicare program, 5.1 million people to lose their health insurance, and 1.3 million health care workers to lose their jobs, the study found. "Arbitrary caps that don't take into account the growing health care needs of our aging population are bad news for the patients and communities hospitals serve," said AHA President and CEO Rich Umbdenstock. In a letter, the groups urged Congress "to reject formulations that include arbitrary spending caps and across-the-board spending triggers that do not adjust to demographic changes or the needs of vulnerable populations."
SUNY ALBANY WORKFORCE STUDY ON NURSES: SHORTAGE UPDATED
Hospitals are dealing with a rising number of nurse vacancies and higher turnover rates, according to a new study from SUNY Albany's Center for Health Workforce Studies. Although nursing schools are rushing to fill a nursing shortage, new grads are having a hard time finding work because hospitals prefer experienced nurses. SUNY researchers found New York's demand for experienced nurses is growing, with a 6.1% RN vacancy rate in 2010, compared with 3.6% in 2009. The turnover rate also is rising, to 9.5% in 2010 from 7.1% in 2009.
Half of the study's respondents predicted it will still be harder to find experienced nurses this year. Newly graduated RNs face a career that is getting more complex as the population ages and more procedures are performed on an outpatient basis. That means patients who end up in the hospital are sicker than ever. The report also found that more than half the RNs in New York are at least 50 years old, but overall, only 4% said they planned to retire, down from 4.2% the previous year. The economy is apparently playing a role in these experienced nurses staying on the job.
2009 Update on 529 Plans by Chuck Toth |
Since they were created by Congress 10 years ago, 529 plans have been an attractive way to boost college savings for a child or grandchild. This year, changes in the tax code make them look even better.
529 plans, so called because they were authorized by Section 529 of the Internal Revenue Code, allow investment earnings to grow free from federal and, in most cases, state income taxes for the life of the account. The IRS does not tax 529 distributions, nor do many state governments, as long as they are used for qualified higher education expenses, such as tuition, room and board, mandatory fees, books, and even computers.
As of 2009, the amount of money donors may contribute has been raised to $13,000 per person—or $26,000 per couple filing a joint return—per child each year. All 50 states and the District of Columbia sponsor 529 plans; some states, in fact, offer more than one, offering a range of investment options that include stock mutual funds, bond mutual funds, money market funds and age-based portfolios that automatically shift to a more conservative balance of investments as the beneficiary gets closer to college age.
Those assets may be used to pay for education expenses at any accredited college or university in the United States, no matter which state’s plan you choose to participate in. However, residents of certain states have an incentive to invest with their home-state plan, since they may be able to deduct annual contributions from that state’s income tax. For example, New York State residents may deduct up to $5,000 per person—$10,000 per couple—per year for a contribution to their state’s plan; contributions by residents to New Mexico’s plan is fully deductible.*
529 plans have an additional benefit for parents who have already been saving for a child’s education through a custodial account under the Uniform Gift/Transfer to Minors Act. Historically, these custodial accounts were attractive because when the child took control of the money to pay for education expenses (at either age 18 or 21, depending on state law), the distributions were taxed at the child’s tax rate. Beginning in 2009, however, those distributions will be taxed at the parents’ higher tax rate for full-time students through the age of 23 for any investment income greater than $1,800.
You can maintain the tax efficiency of UGMA/UTMA accounts by transferring their assets to a “custodial” 529 plan before the end of 2009. The transferred funds still belong to the minor child, who is allowed to take control of the money when he or she reaches the age mandated by state law. Even better, student-owned 529 accounts do not have to be reported on the federal student aid application and thus have no impact on a child’s eligibility for federal financial aid.
Taxes on capital gains will likely increase after 2010, when current tax rates sunset, so transferring UTMA/UGMA assets now will have the smallest tax consequence. Besides improving your child’s chances of receiving federal financial aid, putting a 529 wrapper around those assets helps ensure that he or she will use those savings for college.
Because only cash may be contributed to a 529 plan, UTMA/UGMA assets must be liquidated to make the transfer, potentially triggering capital gains. Depending on the child’s age, the benefits of tax-free growth over a short time period may not outweigh the tax consequences of liquidating the UGMA/UTMA account. Talk to your Financial Advisor and your tax advisors to determine if this strategy is suitable for you.
In addition to tax-deductible contributions and tax-free withdrawals, noncustodial 529 plans provide a valuable tool for estate planning. You have the option of “front-loading” five years worth of contributions in a single year without incurring gift taxes. An individual may contribute up to $65,000 per beneficiary in one year, or $130,000 from a couple filing a joint return. If you donate the full amount, you use up your gift tax exemption for the next five years. Any other gift given to that same individual during those years will be taxed as a gift.
For all the advantages of 529s, there are a few key caveats to consider before committing the funds. The investment options are limited, and account holders are permitted to change their options only once a year, restricting your ability to respond to market changes. Of course, there is always the risk that investments in a 529 plan can go down in value. Front-loading now when asset values are low may yield superior returns for a child who won’t be entering college for 10 or 15 years, but you may prefer to explore more conservative options for older children. Talk with a Financial Advisor to find the best college-savings options for your situation.
Source: www.savingforcollege.com.
Chuck Toth is Director of Education Savings at Merrill Lynch
Before you invest in a 529 plan, request an official statement and read it carefully. The official statement contains more complete information, including investment objectives, charges, expenses and risks of investing in the 529 plan, which you should consider carefully before investing. You should also consider whether your home state or your beneficiary's home state offers any state tax or other benefits that are only available for investments in such state's 529 plan.
"For more information, contact Merrill Lynch Financial Advisor Jill B. Kremer of the Garden City, NY office at 516-877-8544 or visit www.fa.ml.com/jill_kremer".
Eye On Albany |
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BILL BANNING USE OF TANNING BEDS BY CHILDREN UNDER 18 STALLS IN NYS SENATE
Legislation (A.1074, Weisenberg/S. 2917, Fuschillo) which would build upon existing regulations in the use of tanning beds by prohibiting their use by children under the age of eighteen is now stalled in the NYS Senate. The bill had been passed by the NYS Assembly earlier this month. Currently, indoor tanning is permitted for children 14–18 with parental consent. However, the weight of scientific evidence shows that salon tanning raises the risk of skin cancer. Melanoma, the most commonly fatal form of skin cancer, makes up only 4% of skin cancers but is responsible for more an 80% of skin cancer deaths. Using tanning beds before the age of 30 has been scientifically demonstrate to increase one’s risk for melanoma by 75 percent.
Moreover, melanoma is increasing faster in females 15–29 years old, a pace that far outweighs males in the same age group. Notably, data show that forty percent of parents do not know that tanning devices are potentially more harmful to teenagers than adults. The legislation was favorably reported earlier this year by the Senate Health Committee to the Senate floor where it has now stalled. A significant number of organizations support the bill including: the American Academy of Dermatology Association, American Academy of Pediatrics, District II, American Cancer Society, League of Women Voters, Medical Society of the State of New York, New York Chapter of the American College of Physicians, NYS Academy of Family Physicians, NYS Association of County Health Officials, NYS Cancer Consortium, NYS Chapter of the American College of Surgeons, NYS Nurses Association, Roswell Park Cancer Institute and the Skin Cancer Foundation.
Physicians, are urged to call Senate Majority Leader Dean Skelos (516–766–8383) to ask that the Senate pass the bill.
LEGISLATURE PASSES BILL TO PROVIDE PROTECTIONS DURING OMIG AUDITS
The Assembly and Senate each passed legislation (A.5686–A, Gottfried/S.3184–A, Little) strongly supported by many health care provider associations that would provide additional protections for individual and entity health care providers who are audited by the Office of the Medicaid Inspector General (OMIG) for Medicaid overpayments. The bill is in response to complaints from a wide array of provider groups, including pharmacies, home care and hospitals, regarding the often unfair auditing tactics used by the OMIG. Among the protections the bill would provide for all providers including physicians, include:
- Recovery of payments only after notice, and not less than 60 days after final agency action;
- OMIG may not re-audit something audited by another agency unless for good cause;
- Protects providers from penalty if they complied with agency policies or interpretations, which may not be changed retroactively;
- Where a recovery is claimed for a technical or administrative error, the provider must have a chance to re-submit;
- When “extrapolation” is used, there must be detailed notice of the methodology, which must be statistically valid.
While we believe the bill would provide some increased protections against auditing abuses by the OMIG, MSSNY has expressed concerns that extrapolation should not permitted as an auditing tactic for public as well as commercial payors except for cases involving actual fraud. The bill will be delivered to the Governor later this year for his consideration.
LEGISLATION TO PERMIT PUBLICLY TRADED RETAIL CLINICS STILL PENDING
Legislation (A.81A, Paulin/S. 3673, Hannon) was considered this year which would permit publicly traded corporations to operate diagnostic or treatment centers through which health care services may be provided within a retail business including but not limited to a pharmacy, a store open to the general public or a shopping mall.
The measure was reported by the Senate Health Committee to the Senate Finance Committee earlier this month but did not move after that. In the Assembly, the bill was not considered by the Assembly Health Committee but did receive much attention at a round table discussion sponsored by Assembly Health Committee Chairman Richard Gottfried. ‘Convenient care clinics’ or ‘retail clinics’ operate in states outside New York in big box stores such as Walgreens or retail pharmacies such as CVS. They are a growing phenomenon across the nation. These clinics are usually staffed by nurse practitioners or physician assistants.
While the non-physician practitioners who would staff such clinics if they were to be allowed in New York would need to adhere to all scope of practice requirements, MSSNY opposed the bill on the grounds that the retail clinic model diverges from the medical home model in significant ways. the most significant divergence is that the PCMH model emphasizes comprehensive care which is coordinated in an integrated way across all providers and for all patients, even those with more complex and chronic illnesses. The retail clinic provides only episodic patient care and only for certain conditions in an uncoordinated care environment.
This issue will likely receive more attention later this year.
Visiting Nurse Association of Long Island, Inc. |
Newly launched in-home Cardiac Disease Management
Service helps patients confidently self-manage their illness.
The U.S. Centers for Medicare and Medicaid will be requiring hospitals to partner with community based home care organizations to provide viable solutions to the rising costs of health care. In cases of severe chronic or acute congestive heart failure and related cardiac disease, the need is greater to contain costs due to repeated hospital admissions and emergency care visits.
To help manage these costs the Cardiac Disease Management Service (CDMS) has been developed and launched by the Visiting Nurse Association of Long Island (VNA of LI), a community based not-for-profit Certified Home Health Agency located in Garden City. In tandem with physician care and through a series of home care visits and a combination of interactive tools, education and technology, patients can now take an active role in self-managing their medication, diet, day-to-day life style, weight and blood pressure. They can also learn to recognize the signs and symptoms of heart failure.
CDMS patients can anticipate:
- Gaining the confidence to successfully self-manage their symptoms and medications within two months of the start of care.
- Reducing hospital re-admissions by 25% within 6 months of participating in the CDMS.
- Reducing emergency visits by 25% within 6 months of participating in the CDMS.
HOW THE SERVICE WORKS
The service begins with a medical order, in home assessment and by providing information in stages. Patients learn the signs and symptoms to look for that will enable early intervention. Caregivers and family members are also involved throughout the process.
Utilizing a series of six RN visits within two weeks of hospital discharge, patients are educated about the basics of cardiac disease and their medications. At staged intervals, they are provided with essential tools that include an easy-to-understand booklet on cardiac disease, a color-coded symptom self-management grid that details signs and symptoms of the disease and a visual tool that will reinforce the teachings provided on previous visits.
Telehealth Monitoring is also provided so that direct transmission of data to VNA of LI can be received and compared against physician established parameters with irregularities reported to the physician. A patient specific dietary regimen is also established and at every visit, medications are reviewed and compliance assessed. Throughout this period, the education component is continually reinforced and tailored to each patient’s need.
Clients begin to record their symptoms, feelings, medications, weight and other relevant data in their own personal diary that can be shared with their physician during their in-office visit.
On the patient care side, CDMS is a major advance that will result in reducing a patient’s anxiety while increasing their confidence at home. On the fiscal side, it will reduce health care costs by reducing hospital re-admissions and emergency care visits.
For further information, contact Cindy Mueller, BSN, RN of the VNA of LI at 516–739–1270, Ext 216.
Cindy Mueller, BSN, RN is the Director of Performance Improvement/Staff Development for the Visiting Nurse Association of Long Island (VNA of LI), headquartered in Garden City. VNA of LI is a not-for-profit Certified Home Health Agency with a Long Term Home Health Care Program accredited by CHAP. The agency is committed to improving the quality of life for home health patients and advocates coordinated care and in home technology. For further information on the Cardiac Disease Management Service initiative or other VNA of LI programs and services, please contact Cindy at CindyM@vnali.org or dial (516) 739–1270, Ext. 216. Web site: www.vnali.org.
Historic Legislative Session Concludes (For Now) |
The New York State Legislature concluded the scheduled portion of its 2011 Legislative Session late Friday night, June 24. The 2011 Session will long be remembered for working with Governor Cuomo in a major attempt to place New York State on more sound financial footing. It began with the enactment of a State Budget which included a cut of $10 billion without increasing taxes or fees, and concluded with the enactment of a 2% property tax cap. The Budget included major Medicaid cuts and other cost containment actions that affected all health care providers, health insurers, and drug manufacturers. The session will also be remembered for its historic vote on the issue of same-sex marriage.
Given that some issues remain outstanding, return of the Senate and/or Assembly to Albany for a brief special session later in the year may well be necessary.
MSSNY, working together with county and specialty medical societies, made substantial progress on its two priority issues of medical liability reform and enactment of collective negotiation rights. Never before this year had a Governor affirmatively linked comprehensive medical liability reform to State Budget stability, and never before had one House of the State Legislature passed legislation that would grant to independently practicing physicians the right to collectively negotiate with health insurance companies. While these goals have not yet been finally achieved, the foundation has been laid to achieve future success.
Will Work to Advance Collective Negotiation for Vote Later in Year
With regard to the collective negotiation legislation, while concerns have been raised regarding some of the bill’s technical language as well as the impact the bill will have on the State’s public health insurance programs, Assembly leadership has committed to MSSNY its intent to work through these issues so the bill can ultimately be taken up in that house. MSSNY will continue to work with all key policymakers to assure that the Assembly advances the bill for a vote when legislators return to Albany later this year.
Defeated Lawyer Bills
Moreover, your medical society, working together with allies in the hospital and business communities, successfully pushed back against an aggressive legislative and political effort by the trial bar to advance a series of measures that would have driven medical liability costs far above their already intolerably high levels. The lawyers argued that they were “owed something” as a result of the enactment in the State Budget of the medical indemnity fund for neurologically impaired infants. The bills advanced, but were finally defeated. They would have:
- Created a “date of discovery” rule for the statute of limitation;
- Expanded “wrongful death” damages;
- Permitted the awarding of pre-judgment interest;
- Eliminated the limitations on contingency fees;
- Prohibited ex-parte interview of plaintiff’s treating physician; and Required that, when a medical liability lawsuit is brought against two or more defendants, a non-settling defendant must elect prior to trial to reduce their liability by either 1) the balance of the jury award to the plaintiff or 2) by an equitable share determined by the jury
Scope of Practice
Your medical society, working together with affected specialty societies, successfully pushed back against an aggressive legislative and political effort by many non-physician providers to expand their scopes of practice. These included bills that would have substantially increased the scopes of practice of:
- Nurse Practitioners
- Dentists
- Podiatrists
- Naturopaths
- Optometrists
- Nurse–Anesthetists
Modest Victories
The session also produced some modest “wins” for physicians, with the passage in the Assembly and Senate of legislation (still to be delivered to the Governor) that would:
- require health insurance plans to cover screening, diagnosis and treatment of autism spectrum disorders;
- require health insurance plans in New York to cover orally administered chemotherapy treatment in a manner that is no less favorable than intravenous or injectable chemotherapy treatments.
- provide additional protections for individual and entity health care providers who are audited by the Office of the Medicaid Inspector General (OMIG) for Medicaid overpayments.
Yes, many problems remain and there are many things still to be accomplished. However, the fact that there is much to do should never be allowed to obscure the fact that much has been done for our profession by MSSNY and by MSSNY’s physicians. The defeat of the many bills which could have decimated your practice is yet another example where your relatively small investment of MSSNY membership dues brings back to you tangible financial benefits that far, far exceed your investment. Moreover, substantial progress is being made towards enactment of legislation that is needed to preserve patients’ ability to continue to receive your services.
We thank you for all of your grassroots efforts this session and request your continued efforts to achieve these needed reforms.
Washington Watch |
CMS to Use Predictive Modeling Tools to Detect Medicare Fraud
The federal government on July 1 plans to launch predictive modeling software to uncover potential Medicare and Medicaid fraud prior to paying claims. Congress has directed Medicare to pay claims promptly, and while this is good, it also means scammers can submit fraudulent claims and then retreat at the first sign of an investigation.
According to CMS, the predictive modeling software will use technology similar to the tools that credit card companies use to identify fraud. The system will work by sorting different types of data from Medicare and Medicaid claims forms. For example, the software will examine factors such as:
- Ability of the beneficiary to receive the billed services;
- Geographic distance between health care provider and beneficiary; and Perceived likelihood that the services were provided.
The software will use data analysis techniques to identify patterns and generate a risk score for each claim. If a risk score reaches a certain level, the system will issue an alert and federal investigators will scrutinize the claim before payment is sent (AP/ Forbes, 6/17).
The new initiative stems from a provision of the federal health reform law that authorizes federal officials to withhold Medicare payments when there is a credible allegation of fraud. CMS Administrator Donald Berwick said that the agency awarded a $77 million contract to defense contractor Northrop Grumman to develop the predictive-modeling system (Modern Healthcare, 6/17). National Government Services and Federal Network Systems also are working on the system.
Are You Submitting a Handwritten Medicare Enrollment Application?
Medicare enrollment application forms are fillable on your computer. This means that you can fill out the information required by typing into the open fields while the form is displayed on your computer monitor. Filling out the forms this way before printing, signing and mailing means more easily-readable information – which means fewer mistakes, questions, and delays when your application is processed. Be sure to make a copy of the signed form for your records before mailing.
You will find the Medicare provider enrollment application forms available on the CMS website:
§ CMS 855A – Application for Institutional Providers
§ CMS 855B – Application for Clinics, Group Practices, and Certain Other Suppliers
§ CMS 855I – Application for Physicians and Non-Physician Practitioners
§ CMS 855R – Application for Reassignment of Medicare Benefits
§ CMS 855S – Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
Signatures are still required to be handwritten. Do not forget to complete this important step prior to mailing your typed form(s). Keep in mind that typed forms are easier for Medicare to process, but the most efficient method for submitting your enrollment application is to use the Internet-based Provider Enrollment, Chain and Ownership System (PECOS). PECOS guides you through the enrollment application so you only supply information relevant to your application. PECOS also reduces the need for follow-up because of incomplete applications. Using Internet-based PECOS results in a more accurate application and saves you time and administrative costs. Visit Internet-based PECOS to learn more.
IMG Committee: Info on Positions Available for IMGs Pursuing Residency
Please spread the word. MSSNY has information on positions that can offer International Medical Graduates valuable experience working in the US healthcare system. Some are paid positions and others are offered on a volunteer basis, but all make it possible for residency candidates to be involved in some way in healthcare, and can help them stand out from a crowd of applicants for training positions.
Assist in medical schools, research facilities or in physicians’ offices or nursing homes. Serve in an observer capacity or help with office projects such as entering physicians’ notes into an electronic record.
If your medical office, medical school, hospital or research facility could benefit from the assistance of medical graduates who have not yet entered residency training or become licensed to practice, please let MSSNY know. One medical school has already registered a number of positions with MSSNY, assisting in research and anatomy labs, tutoring and other areas.
If you know a candidate who could benefit from such an opportunity, please have him or her contact MSSNY Membership at 516-488-6100, ext. 403
10% Monthly Rental Discount |
Available space |
