- National Healthcare Decisions Day is April 16th
- NYS Health Commissioner Releases Advisory on Measles, Influenza in New York
- Medicare EHR Incentive Program Attestation Deadline is February 28!
- Health Advisory: Update on Influenza Prevention, Surveillance, and Control
- The Countdown to E-Prescribing
- If You’re Unprepared for Implementation of E-Prescribing, Read this Blog Post
- What to Look For If the Diagnosis Isn’t Ebola
- The Current and Future State of Stroke Treatment
- Updated CDC Resource Available on Ebola
Other Practice Management Resources:
- Materials Available to Assess and Address Fall Risk In Older Patients
- NY State Physician Organizations and Public Health Officials Launch "IMMUNIZE NY"
- Experienced Nurse Practitioners New Collaborative Relationship Rules Effective 1/1/15
- ACP Toolkit Improves Care Coordination
- Free Smoking Cessation Learning Module Available Online!
- Prescribe Opioid's Safely
- Counsel's Forum
- Public Health
- Health Information Technology
- Running a Practice
- Patient Care and Education
National Healthcare Decisions Day is promoted each year to inspire, educate and empower the public, as well as providers, about the importance of advance care planning. It is an initiative to encourage patients to express their wishes regarding end of life healthcare decisions and for providers and facilities to encourage early discussion of these issues.
Help your patients learn what forms and information will help them in making end of life decisions. The NYS Department of Health has endorsed the Medical Orders for Life-Sustaining Treatment (MOLST) form and created an informational portal on the NYS DOH Webpage. As April 16th approaches, be sure to help educate your patients on end of life decisions.
To help you prepare for the transition to ICD-10, the Centers for Medicare & Medicaid Services (CMS) offers acknowledgement testing for current direct submitters (providers and clearinghouses) to test with the Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor anytime up to the October 1, 2015, implementation date.
CMS previously conducted two successful acknowledgement testing weeks in March 2014 , November 2014 and currently this week, March 2-6. These acknowledgement testing weeks give submitters access to real-time help desk support and allow CMS to analyze testing data. Registration is not required for these virtual events.
Mark your calendar for the next testing week: June 1 through 5, 2015
How to participate:
Information is available on your MAC website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically can participate in acknowledgement testing.
What you can expect during testing:
Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system. Test claims will be subject to all current front-end edits, including edits for valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and codes, including Healthcare Common Procedure Coding System (HCPCS) and place of service. Testing will not confirm claim payment or produce a Remittance Advice (RA). MACs and CEDI will be staffed to handle increased call volume during this week
- 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
- 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
Other ICD 10 tools and resources can be accessed on the CMS
Opportunity to Earn 20 ABIM Maintenance of Certification Credits
NYACP continues to serve as a partner to the New York State Department of Health (NYSDOH) Fall Prevention Program for Older Adults. NYSDOH is entering its final year of a 5-year grant with the Centers for Disease Control (CDC) to implement three evidence-based programs to help prevent falls – Tai Chi: Moving for Better Balance, Tai Chi for Arthritis, and Stepping On – in Broome, Chautauqua, and Suffolk Counties. These programs are also proven to reduce healthcare costs.
The NYACP Geriatrics Task Force, chaired by Eleanor Weinstein, MD, FACP, regularly monitors activities of the program and would like to bring attention to information and tools developed by the CDC to assess and address older patients’ fall risk.
Tool Kit: http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/index.html
Materials can be ordered or downloaded for free through the CDC website.
Physicians who adopt STEADI can earn 20 ABIM/ABFM Maintenance of Certification credits. These credits qualify for Category II AMA credits as well.
For more information on earning credits or these programs, please contact Harrison Moss (email@example.com) at the NYS Department of Health.
Last week, New York State (NYS), outside of New York City (NYC), reported five confirmed measles cases in 2014 and one in January of 2015. In 2014, NYC reported 27 confirmed measles cases; two have been reported in 2015. You can read the measles advisory here.
In addition, Howard A. Zucker, MD, JD, NYS Health Commissioner released an advisory regarding the status of influenza prevention, surveillance, and control. This advisory contains updated information about influenza activity in New York with links and references to important influenza resources. You can read the advisory here.
If you are an eligible professional participating in the Medicare EHR Incentive Program, you have until February 28, 2015 to attest to demonstrating meaningful use of the data collected during your EHR reporting period for the 2014 calendar year. If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.
The CMS Attestation System is open and fully operational, and includes the 2014 Certified EHR Technology (CEHRT) Flexibility Rule options. Medicare eligible professionals can attest to 2014 data any time until 11:59 p.m. ET on February 28, 2015.
Reminder: You must attest to demonstrating meaningful use every year to receive an incentive and avoid a Medicare payment penalty.
Payment adjustments were applied beginning January 1, 2015 for Medicare eligible professionals that did not successfully demonstrate meaningful use in 2013 (or 2014 for first-time participants) and did not receive a 2015 hardship exception.
Medicare eligible professionals that did not successfully demonstrate meaningful use in 2014 and do not receive a 2016 hardship exception will have payment adjustments applied beginning January 1, 2016. The application period will open in early January 2015. For more information, please review the payment adjustment tipsheet.
If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid.
If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.
- Stage 1 Eligible Professionals Meaningful Use Table of Contents (2014 definition)
- Stage 2 Eligible Professionals Meaningful Use Table of Contents
- 2014 Stage 1 Attestation User Guide for Eligible Professionals
- 2013 Stage 1 Attestation User Guide for Eligible Professionals
- Stage 2 Attestation User Guide for Eligible Professionals
- CEHRT Flexibility Attestation Guide
This advisory contains updated information about influenza activity in New York with links and references to important influenza resources. You can read the entire Health Advisory Here.
With the recent outbreaks in West Africa, Internists have a heightened sense of Ebola symptoms presenting during diagnosis. However, Ebola is not always the disease. From ACP Hospitalist is an article on what to look for when Ebola is ruled out.
“If a patient comes to your hospital with a fever and history of travel to West Africa, there's no question what you'll be most worried about—Ebola.
But there are a number of other diseases that should be considered in differential diagnosis, even as you take precautions against the possibility of Ebola, because they will present with similar symptoms and are endemic to the same area. “
Read the full article here.
Like any field of medicine, new technology and procedures are devised and implemented at a rapid pace; the process of stroke treatment is no different. This article from the ACP Hospitalist features insights from S. Andrew Josephson, MD, Medical Director of Inpatient Neurology and Chair of the Neurohospitalist Program at the University of California, San Francisco (UCSF) is essential for any physician that routinely encounters patients that require stroke treatment.
An excerpt from the article:
“Much research and discussion have focused on the right time window for giving thrombolysis to patients with acute ischemic stroke. Yet a day may come when the debate about a cutoff of 3 or 4.5 hours will seem rather quaint".
Read the full article here.
MLMIC Announces a 7.5% Special Dividend for our Policyholders!
MLMIC’s President, Dr. Robert Menotti, said that dividends “provide meaningful financial relief to our policyholders,” and that “they are an integral part of our mission to provide high-quality insurance at low long-term cost.” Since inception, MLMIC has returned over $300 million in dividends to our policyholder owners.
To qualify for this 7.5% Special Dividend, policyholders must be insured by MLMIC on February 1, 2015. The dividend will be applied to policyholder accounts on March 1.
Questions? Contact MLMIC today.
A new year means new regulations for experienced nurse practitioners with more than 3,600 hours of practice experience. In lieu of a written practice agreement and protocols with a designated collaborating physician, a nurse practitioner is now required to have and document a collaborative relationship with one or more physicians or a hospital.
You can read the full article by our Chapter here.
Within you'll find excellent and succinct tips to the questions you'll have about e-prescribing, courtesy of NYACP Member Ankita Sagar, MD, MPH! You can read the blog post here.
In a video on Coding for ICD-10-CM: More of the Basics, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) provide a basic introduction to ICD-10-CM coding. The objective of this video is to enhance viewers’ understanding of the characteristics and unique features of ICD-10-CM, as well as similarities and differences between ICD-9-CM and ICD-10-CM. The video covers:
- How to assign a diagnosis code using ICD-10-CM
- ICD-10-CM code structure
- Coding process and examples: Combination codes, 7th character, placeholder “x,” excludes notes, unspecified codes, external cause codes
- Resources for coders
Keep Up to Date on ICD-10, effective October 1, 2015
Visit the Medicare Fee-For-Service Provider Resources web page for a complete list of MLN Connects videos on ICD-10. To receive announcements for MLN Connects videos and the latest Medicare program information, subscribe to the weekly MLN Connects Provider eNews.
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.
The Centers for Disease Control and Prevention (CDC) website has the latest information on Ebola Virus Disease (Ebola). New guidance has been added about the use of personal protective equipment in hospitals. Review and bookmark the CDC resources for health workers, and check back often for the latest updates.
New Resources Available on Ebola
Acknowledgement Testing Week: March 2 through 6, 2015
To help you prepare for the transition to ICD-10, CMS offers acknowledgement testing for current direct submitters (providers and clearinghouses) to test operability with the Medicare Administrative Contractors (MACs) and Common Electronic Data Interchange (CEDI) anytime up to the October 1, 2015 implementation date.
Acknowledgment testing gives submitters access to real-time help desk support and allows CMS to analyze testing data. Registration is not required for these virtual events. Mark your calendar:
- March 2 through 6, 2015
- June 1 through 5, 2015
How to participate:
Information is available on the website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically can participate in acknowledgement testing.
What you can expect during testing:
- Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims.
- Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.
- Testing will not confirm claim payment or produce a remittance advice.
- MACs and CEDI will be staffed to handle increased call volume during this week.
Information on acknowledgement testing and how to participate is available in MLN Matters® Article MM8858, "ICD-10 Testing - Acknowledgement Testing with Providers".
ACP's High Value Care Coordination Toolkit features resources to improve referrals and care coordination between primary care physicians and specialists, eliminate waste and duplicative care, and create more efficiency in care delivery.
The toolkit was developed collaboratively through ACP's Council of Subspecialty Societies (CSS) and patient advocacy groups.
The High Value Care Coordination Toolkit includes 5 components:
- a checklist of information to include in a generic referral to a subspecialist practice,
- a checklist of information to include in a subspecialist's response to a referral request,
- pertinent data sets reflecting specific information in addition to that found on a generic referral request to include in a referral for a number of specific common conditions to help ensure an effective and high-value engagement,
- model care coordination agreement templates between primary care and subspecialty practices, and between a primary care practice and hospital care team, and
- an outline of recommendations to physicians on preparing a patient for a referral in a patient- and family-centered manner.
These resources are part of ACP's High Value Care initiative, which is designed to help doctors and patients understand the benefits, harms, and costs of tests and treatment options for common clinical issues so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices
Update On Management, Prevention, and Containment
In recent weeks, there has been a growing concern over the potential spread of Ebola Virus disease (EVD) from its native locus of Western Africa to the United States and other parts of North America. The Centers for Disease Control and New York State Department of Health have both released guidelines for proper care and handling of patients with potential cases of EVD along with any laboratory material with suspected EVD exposure.
Ebola Virus is transmitted via bodily fluids of those infected with Ebola and through the handling of rodents and primates infected with the virus; it is NOT transmitted through the air or respiratory droplets. Clinical criteria includes pyrexia along with severe headache and generalized muscle pain and malaise, GI upset including vomiting and diarrhea along with potential hemorrhage. It is important to note that while there have been a total of 1,323 cases of EVD as of July 27th, 2014; there have been no reported cases of the virus in North America. However, it is prudent to understand the guidelines and regulations in handling suspected cases of the virus as international spread is always a possibility.
For any patient with suspected features of EVD with recent travel to known areas of primary EVD disease, the attending physician should take extreme caution when examining patient, place patient in private room with a closed door, instruct patient on how to use rubber gloves and surgical mask and to abstain from touching items in the exam room. All medical staff should be alerted of the potential EVD case on premises, the amount of staff that come in contact with said case should be limited and those who do should use the proper personal protective equipment (gloves, fluid impermeable gown, eye protection, facemasks, leg and shoe coverings) in cases with open wounds or bodily fluid, clean room suits should be used.
Once patient is sequestered and safely kept, the attending physician should call the Local Health Department with the following information:
The patient's risk factors and travel history, including dates, destinations and other potential contact including contact with animals and other people.
The patient's current status including physical and mental along with pressing concerns for the patient's immediate health.
The Local Health Department will then confer with the attending physician regarding the testing procedures (as outlined below) and any further information regarding a potential transfer to another medical facility.
Laboratory guidelines are as follows:
When possible, tests should be done in patient's isolation room using Point-Of-Care (POC) instruments and testing methods. Transferring specimen from isolated room to other rooms should be done as minimally as possible and should be done with extreme caution using Clean Room Suits and hand carried in a container that has been thoroughly wiped down with 10% bleach. All specimen manipulation must be done in a Class 2 biosafety cabinet (BSC2)
Guidelines for specific laboratory procedures can be viewed in the attached NYSDOH Brief.
The NYSDOH is advising health care providers and facilities to review the new CDC health advisory regarding recommendations for evaluating patients for possible Ebola virus disease (EVD). Main points from previous advisory are reminders to:
- Increase vigilance in inquiring about a history of travel to West Africa in the 21 days before illness onset for any patient presenting with fever or other symptoms consistent with EVD
- Isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting EVD symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions (gowns, facemask, eye protection, and gloves); and
- Immediately notify the local health department
Travel history should be asked of all patients who present with symptoms such as fever (greater than 101.5°F or 38.6°C), severe headache, muscle pain, vomiting, diarrhea, abdominal (stomach) pain, or unexplained hemorrhage (bleeding or bruising) at initial presentation in EDs or reception in primary or urgent care settings. Signage asking patients to provide travel history should also be prominently posted. Rapid recognition of possible EVD cases is critical to protecting health and safety.
The NYSDOH is also advising health care providers and facilities to review previously released CDC and NYSDOH guidance on EVD. See the full PDF attached.
The NYSDOH is advising health care providers and facilities to utilize the algorithm/decision guide included in this advisory when evaluating patients for potential EVD.
Hospitals and other healthcare providers are strongly encouraged to perform drills in the early identification and isolation of suspected EVD patients to review plans for hospitalization of a suspect or confirmed EVD patient, and to identify and train staff who would provide care to a suspect or confirmed EVD patient. The drills should include staff and rehearse procedures for the use of personal protective equipment (PPE).
We have also received the following updated message from the CDC - Ebola Key Messages - please click here.
In an effort to address the rise of preventable diseases due to lack of immunization, New York State physician groups and public health officials have launched a program to encourage New Yorkers to be vigilant in keeping their immunizations up-to-date.
The New York Chapter of the American College of Physicians (NYACP), along with The Medical Society of the State of New York (MSSNY), the New York State Chapter of Academy of Family Physicians and the New York State Association of County Health Officials have launched "IMMUNIZE NY" to promote immunizations within the adult population. The campaign strongly encourages adults to discuss immunizations with their physicians and to ask specifically about pertussis, influenza, pneumococcal, HPV and shingles vaccinations.
Preventing diseases through vaccine is one of the five public health priorities for the New York State Department of Health. The Affordable Care Act's prevention provisions now cover vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) with no co-payments or other cost-sharing requirements when those services are delivered by an in-network provider.
For information on how to stay vaccinated this season, as well as more comprehensive background information, check out these websites:
Tobacco use is leading cause of preventable death in the U.S., and as health care professionals we are in a prime position to help our patients successfully quit tobacco, while simultaneously lowering their risk of heart disease, stroke, COPD and other diseases.
Recently, the NYC Health Department has developed an excellent and free online learning module to assist physicians by enhancing your knowledge on how to effectively assess, counsel, and treat tobacco use, greatly improving patients’ chances of successfully quitting. For medical residents, this module meets five of the six Accreditation Council for Graduate Medical Education core competencies and is able to be placed in your learning management system. For attending physicians, this module provides 1 CME credit.
Highlights of the module include:
- The “5 A’s” model of treating tobacco use
- Provider/Patient communication techniques
- Treatment options and guidance, including combination therapy
- New York State Medicaid Benefits
- Billing information for smoking cessation counseling
Laurie Cohen, Esq., Partner at Wilson, Elser, Moskowitz, Edelman, and Dicker LLP and the Chapter's attorney provides members with support and direction through articles and answering questions relevant to general practice.
Managing Your Patients With Diabetes - Tools & Resources
- ACP Smart Medicine
- ACP Net
- Closing the Gap
- American Diabetes Association
- Bridges to Excellence Diabetes Care
- NCQA Diabetes Recognition Program
- ACP Diabetes Monthly
- Improving Diabetes Through Patient Engagement Webinar
- Patient Centered Medical Home - ACP has gathered a comprehensive collection of information, resources and demonstration projects to assist you in planning for a complete Patient-Centered Medical Home.
- Physician Quality Reporting System - tools and resources to help guide you through collecting and reporting quality measure data.
Patient Care and Education
The following patient-related resources provide guidance in effectively maintaining and enhancing the doctor-patient relationship.
Last updated :3.18.15