NEWS MARCH 2015

FROM THE PRESIDENT ELENA R. DRUDY, MD

March madness is upon us already…I‘m not actually referring to the upcoming NCAA basketball tournament or the weather, but to the first end-to-end ICD-10 testing this year. If any of you have participated in the testing, that is great! For the rest of us who lag be-hind, don’t forget that the NJAO’s annual coding conference is coming up April 1st. We have a phenomenal speaker, Sue Vicchrilli, COT, OCS. She is the AAO’s Director of Cod-ing and Reimbursement and the author of EyeNet’s “Savvy Coder” and AAOE’s “Coding Bulletin”, the Ophthalmic Coding Coach, and the Ophthalmic Coding Series. It’s not too

late to sign up! Please join us - and encourage your colleagues to join us - on April 1st at Forsgate Coun-try Club in Jamesburg, and let the NJAO help you make this daunting transition. Also, please remember that the original deadline to attest to EHR Meaningful Use for the 2014 reporting period has been changed and is now March 20, 2015. This applies to PQRS reporting via EHR as well. Hope to see you in April- Elena

150 West State Street • Suite 110 • Trenton, NJ 08608 Ph: 609-392-1201 • Fax: 609-392-2664 • www.NJAO.org

REMINDER: Opportunities for ICD-10 Testing

Federal officials have, again, announced periods when physicians can participate in end-to-end ICD-10 testing. Unless it is delayed

again, all physicians must transition from ICD-9 to the new coding system by October 1, 2015.

End-to-end tests will take place the weeks of:

March 2-6, 2015

June 1-5, 2015

Information is available on your MAC website at the link below or through your clearinghouse (if you use a clearinghouse to submit

claims to Medicare). Any physician who submits claims electronically can participate in acknowledgement testing.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-

Contractor-Directory-Interactive-Map/

Key Points of the Testing Process

Make sure test files have the "T" in the ISA15 field to indicate the file is a test file

Send ICD-10 coded test claims that closely resemble the claims that you currently submit

PLEASE CLICK HERE TO PAY YOUR 2015 NJAO DUES!

SAVE THE DATE!

NJAO 2015 ANNUAL MEETING FRIDAY, SEPTEMBER 11, 2015

HOLIDAY INN , EAST WINDSOR, NJ

FROM THE THIRD PARTY PAYER CONSULTANT JAMES MCNALLY , CPC

As we write this update, Governor Christie proposed a $33.8 billion Fiscal year 2016 state budget to a

joint session of the Legislature. In his remarks to the Legislature, remarks that focused heavily on the

state’s pension system, the Governor said that the budget he proposed contains no new taxes and will

keep aid to towns and public schools as well as property tax relief at current levels.

As a result of the Governor’s decision to expand NJ FamilyCare in 2014, 390,000 additional New Jersey-

ans are covered by the program. The budget includes $45 million in State and federal funds to increase

reimbursement rates for certain primary and specialty care services offered through FamilyCare. The

Governor’s budget reduces charity care payments to hospitals by $148 million to a total of $502 million

and increases funding for Graduate Medical Education by $27 million for a total of $127.3 million.

The Legislature will begin its review of the Governor’s proposed budget next month. The budget must be

passed by the Legislature and signed by the Governor by July 1, 2015.

FROM THE STATEHOUSE JOSEPH S IMONETTA

Use valid submitter ID, NPI, and PTAN combinations

Use current dates of service on test claims (i.e. October 1, 2014 through March 1, 2015)

Do not use future dates of service or your claim will be rejected

EHR Incentive Programs: Public Health Objectives: Reporting Requirements in Stage 1 and 2

Public health registry reporting is required for providers participating in the Electronic Health Record (EHR) Incentive Programs.

Objectives include submitting data to an immunization registry, submitting data to a syndromic surveillance database, and submitting

reportable lab results to a public health agency (for hospitals only).

Stage 1 vs Stage 2 Requirements

In Stage 1, eligible professionals and eligible hospitals must complete (or qualify for an exclusion for) at least one public health ob-

jective in Stage 1 of meaningful use. In Stage 2 of meaningful use, some of the Stage 1 public health menu objectives become core

objectives, and new public health reporting requirements are added to the menu objectives. Eligible professionals must demonstrate

(or qualify for an exclusion for) the capability to submit electronic data for immunizations, while eligible hospitals must demonstrate

(or qualify for an exclusion for) the capability to submit electronic data for immunizations, reportable laboratory results, and syn-

dromic surveillance. Also in Stage 2, new public health menu objectives for eligible professionals include the capability to identify

and report cancer cases to a cancer registry and specific cases to a specialized registry (other than a cancer registry).

How to Report Public Health Measures

For information on how to report public health measures, please visit the EHR website. For more information about public health

objectives and public health registry reporting, download the Public Health Registry Tip Sheet. Use the links here.

EHR Website

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html

Public Health Registry Tip Sheet

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PublicHealthRegistry_Tipsheet-.pdf

FDA Releases Draft Guidance That Allows Repackaging of Bevacizumab

The Food and Drug and Administration (FDA) has released draft guidance that includes clarification on the use of repackaged drugs

from compounding facilities.

An initial review of the draft guidance by the American Academy of Ophthalmology (AAO) specifies that the FDA will allow oph-

thalmologists to access repacked Bevacizumab (commercially known as Avastin) from compounding facilities. The draft guidance

specifically recognizes a need for the “ophthalmic use” of repackaged biologics.

The Academy is in the process of reviewing the entire draft guidance, including recommendations on seemingly problematic and

restrictive beyond-use-date requirements. The FDA is seeking public comments. To read the draft guidelines, click on the link here.

http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM434176.pdf

CMS to Shorten 2015 Attestation Reporting Period

The Centers for Medicare & Medicaid Services (“CMS”) has announced it intends to give providers a “reprieve” by issuing a new

rule which would “update” the Medicare and Medicaid Electronic Health Records (“EHR”) incentive programs, and shorten the at-

testation period in 2015 from 365 to 90 days, in order to help “accommodate” those changes.

In a late January blog post (http://ow.ly/ISBdz ), the deputy administrator for innovation and quality and the Chief Medical Officer

(“CMO”) for CMS, Patrick Conway, M.D., stated that CMS is following “multiple tracks” to realign the Meaningful Use program

“to reflect the progress toward program goals and be responsive to stakeholder input.” This new rule would be separate from the pro-

posed rule implementing Stage 3 of the Meaningful Use program, which has already been submitted to the Office of Management

and Budget for review.

It was generally acknowledged, even by CMS, that the 365 day attestation period presented problems, so the proposed changes

should be welcome. In addition to shortening the attestation period, CMS is also considering proposals to modify other aspects of the

program in order to match long-term goals, reduce complexity and lessen providers’ reporting burdens, as well as shortening the

EMR reporting period in 2015 to 90 days in order to accommodate these changes.

Novitas Releases Top 10 Claim Submission Errors

Novitas has released a listing of the top claim submission errors and information on how to resolve them. Please take a moment to

review these errors and avoid them on future claim submissions.

New Jersey

http://tinyurl.com/qfengbd

CMS Announced New Accountable Care Organizations

The Centers for Medicare & Medicaid Services (CMS) announced that there are 89 new Accountable Care Organization

(ACO) participants as of January 1, 2015.

ACOs are groups of doctors, hospitals and other health care providers who come together to provide coordinated, high-quality

care to Medicare patients. According to CMS, coordinated care helps patients receive proper care while aiming to avoid un-

necessary duplication of services and preventing medical errors. Currently, ACOs enjoy certain federal fraud and abuse waiv-

ers, assuming that the requirements for a Medicare Shared Savings Program are met.

The following six new ACOs will serve New Jersey:

Capital Health Accountable Care Organization, LLC;

Chrysalis Medical Services, LLC;

Inspira Care Connect, LLC;

NewYork Quality Care;

Orange Accountable Care of New York; and

Quality Health Alliance-ACO LLC.

OIG Seeks Suggestions for New Anti-Kickback Safe Harbors

The U.S. Department of Health & Human Services, Office of Inspector General (OIG) recently published a request for public

comment on suggestions for new safe harbor provisions for the federal Anti-Kickback Statute. Suggestions for new safe har-

bors will be evaluated based on the potential safe harbors’ effects on patient access to health care; quality of services; patient

choice of provider; costs to federal health care programs; provider competition; potential for health care service overutiliza-

tion; and medically underserved areas and populations. The OIG will also consider potential financial benefits to health care

providers and other professionals that may affect decisions on ordering health care services or making referrals to particular

providers.

OIG Proposed Regulation on Gainsharing Looks to Lower Health Care Costs

The U.S. Department of Health & Human Services, Office of Inspector General (OIG) published a proposed rule that would

amend certain safe harbors to the federal Anti-Kickback Statute and the civil monetary penalty (CMP) rules under the author-

ity of the OIG. As part of the proposed rule, the OIG proposed to add a specific gainsharing CMP. The proposed gainsharing

regulation is seen by a number of health care commentators as potentially reducing health care costs while improving quality

of care.

The prohibition on gainsharing, codified in Section 1128A(b)(1) of the Social Security Act, prohibits hospitals from know-

ingly making payments to a physician as an inducement to reduce or limit services provided to an individual who is eligible

for Medicare or Medicaid benefits and who is under the direct care of the physician. Critics view the law as overly broad by

not allowing hospitals to offer appropriate incentives to physicians to control the cost of care and the items and services they

order in the hospital setting. The OIG has stressed that it has no authority to create an exception to the broad-based gainshar-

ing prohibition, such as limiting its application to a reduction or limitation of medically necessary items or services.

The new regulation would generally codify the statutory language, however, the OIG had proposed including a definition of

the term “reduce or limit services” in order to limit the broad nature of the statute. By doing this, the OIG hopes to align the

new regulation with the public policy goal of reducing health care costs while improving quality of care, such as through pro-

grams like the Medicare Shared Savings program, which promotes evidence-based medicine and patient engagement through

accountable care organizations.

NATIONAL UPDATE AT-A-GLANCE

LEGAL REPORT DEBRA LIENHARDT, ESQ

Texas Optometrists Seek Unprecedented Surgical Privileges Last month, Texas lawmakers introduced multiple bills that include a wide range of surgery and independent glaucoma treat-

ment, as well as an expansion of optometrists’ authority to administer and prescribe drugs. This would make Texas the largest

state in the nation to authorize optometrists to perform surgery. With support from the AAO, the Texas Ophthalmological

Association and the Texas Medical Association are uniting forces to block this legislation. Since Texas is a bellwether state,

the outcome of this battle has implications for patient care across the country.

Please consider a making confidential contribution to the AAO's Surgical Scope Fund by clicking here and to the NJAO's

OPAC by clicking here as well!

Medical Director Considered in “Position of Trust” for Sentencing

The U.S. Court of Appeals for the Third Circuit, on an appeal from sentencing in the trial court, held in United States v. Ba-

baria that a physician medical director of an MRI facility, which is an authorized Medicare and Medicaid provider, was prop-

erly sentenced for violations of the federal Anti-Kickback Statute based on his abuse of a “position of trust” and the scope of

the abuse.

The case may serve as a warning to physicians occupying medical director or similar positions. The fact that there was no

evidence the physician falsified patient records, billed Medicare or Medicaid for testing that was not medically necessary, or

otherwise compromised patient care, had no affect on the Third Circuit’s decision to affirm the lower court’s sentencing. Ad-

ditionally, although the court found that the mere possession of a medical license does not necessitate a finding that a physi-

cian occupies a “position of trust,” the court did find that if a physician “obtains his minimally-supervised position by virtue of

his professional training and license and then takes advantage of the discretion granted to him in a way which significantly

facilitates the [crime], [the court] can rightly say that he has abused a position of trust.”

Appellate Court Clarifies Exceptions to Affidavit of Merit Rule for Negligence Cases

In Hill International v. Atlantic City Board of Education, an appeals court in New Jersey recently clarified exceptions to rules

requiring plaintiffs to submit affidavits of merit in connection with lawsuits filed against licensed professionals, affidavits

which generally must be made by another professional and filed in malpractice cases to establish that the complaint has merit.

In the context of a dispute over whether an engineer who signed an affidavit of merit (the affiant) was qualified to opine about

the defendant architect’s conduct, the court held that, “minor variations in the scope or terms of the respective licenses held by

the affiant that do not bear upon material issues in the case will not disqualify the affiant, so long as both professionals are li-

censed within the same category of professionals.” As an example, the court stated that although nurses and physicians may

both be trained and authorized to take blood pressure readings, a plaintiff could not file a malpractice action against a physi-

cian for negligently taking blood, supported by an affidavit of merit from a nurse. However, the court reiterated that a perfect

match of credentials within the same license is not always required. For physicians, this means that a patient may file a mal-

practice lawsuit with an affidavit of merit from a physician who does not share the same specialty as the defendant physician,

so long as enough areas of their practice of medicine overlap.

Additionally, the court explained that New Jersey’s 1995 Affidavit of Merit Statute requiring an affidavit from a “like-

licensed” person in the same profession and area of expertise may be relaxed when the lawsuit claims only involve vicarious

or agency liability (instead of direct malpractice), and do not implicate the standards of care in the defendant’s profession. The

panel of judges deciding the Hill International case did not provide parameters for just who can provide affidavits of merit in

such cases, and instead left the adjudication of these details to future litigants.

New Jersey Law Requires Health Insurance Companies to Encrypt Personal Information

On January 9, 2015, Governor Christie signed into law Senate Bill S562 which requires health insurance companies operating

in New Jersey to encrypt personal information. The information must be secured by encryption or protected by any other

method or technology rendering the information unreadable, undecipherable or otherwise unusable by an unauthorized person. Compliance with the new law requires more than a password protection computer program.

The bill was introduced after several laptops containing policyholder information were stolen from Horizon Blue Cross Blue

Shield of New Jersey, Barnabas Health Medical Group and Inspira Medical Center. The information on the laptops was pro-

tected only by user passwords.

Focus on the States