Health Information Technology (HIT)
Medicare / Medicaid and ICD-10
As part of New York State’s Ending the Epidemic initiative, a series of Statewide Regional and NYC Borough discussions are scheduled to engage community partners and gather input on the HIV/AIDS epidemic, ultimately moving the Ending the Epidemic Blueprint to action.
These discussions will give physicians an opportunity to have an open forum with other local physicians to provide input on service gaps, confer strategies to end the HIV/AIDs epidemic, identify local leadership, and provide an opportunity for participants to engage in planning discussions to identify best practices, local resources and next steps in responding to key recommendations of the Blueprint.
Please follow the links below to register:
Opportunities to Support a New Practice Partner or for Physicians Establishing their Practice:
The Cycle 4 DANY Awards Are Now Available for Application!
$100,000 in Practice Support (105 grants) or $150,000 in Loan Repayment (71 grants) are NOW available for those who agree to practice in New York State in areas where there are physician shortages. The service commitment for Practice Support is two years, the commitment for Loan Repayment is five years. The definition of a “shortage” area is broader than federally qualified HPSAs.
The Chapter has developed an easy to use FAQ on applying for a Doctors Across New York (DANY) grant. Click here to view the NYACP DANY page.
The application should be submitted immediately – as the original application deadline (showing on the DOH website) will change from July 31 to August 31st, and awards are given on a “first come first served” basis.
For full information on Doctors Across New York (DANY) go to: http://www.health.ny.gov/professionals/doctors/graduate_medical_education/doctors_across_ny/
Have you looked at the data reported on you?
On June 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published 2014 Open Payments data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.
The Open Payments program was created by the Affordable Care Act and requires drug and device manufacturers to report transfers of value (i.e. payments, honoraria or research grants) to health care providers, as well as other industry-related investments providers may have.
The program relies on voluntary participation by physicians and teaching hospitals to review the information submitted by these companies. As a physician, are you reviewing the financial data which may have been provided about you before it goes public? If not, click here for the rules.
To review your personal data, go to this link: https://openpaymentsdata.cms.gov/search
Two New Posts from NYACP Attorneys at Nixon Peabody:
Be Aware – New Physician Compensation Arrangements May Violate Federal Anti-Kickback Rules
As new physician compensation arrangements emerge with alternative payment models being tried and tested throughout the country, the Department of Health and Human Services Office of Inspector General (the "OIG")recently issued a fraud alert highlighting certain physician compensation arrangements that run a high risk of violating the federal anti-kickback statute (the "AKS"). The OIG emphasizes that in order to prevent AKS violations, physician compensation arrangements—including medical directorships—must reflect fair market value for the bona fide services that physicians actually provide under the arrangements.”
To read the full post, click here.
CMS Releases Final Rule Addressing Changes to the Medicare Shared Savings Programs
The Centers for Medicare & Medicaid Services (CMS) released a Final Rule on June 4 addressing changes to the Medicare Shared Savings Program. The new rule makes several modifications to requirements for accountable care organizations (ACOs), ACO participants, and ACO providers/suppliers, including eligibility, ACO participant agreements, identification and reporting requirements, governance, and leadership and management.
The NYACP attorneys at Nixon Peabody have written a blog post to help explain and navigate all of the Final Rule changes, which can be read here.
MLMIC Announces "No Rate Increase for Physician Policyholders"
MLMIC has released great news for physician policyholders and our chapter members who take advantage of this valuable membership benefit. The New York State Superintendent of Insurance has accepted MLMIC’s recommendation for rates to remain unchanged for the July 1, 2015 – July 1, 2016 policy year.
In addition, the 5% dividend announced in April (for policyholders who were insured on May 1, 2014, and maintained continuous coverage through July 1) will be credited to invoices for the upcoming renewal period. This is MLMIC’s third consecutive year of dividend returns!
A video recording of the presentation entitled: "PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015"has been posted to the CMS MLN Connects® page on YouTube. This covers essential PQRS topics including updates to PQRS reporting in 2015, an outlook for the quality-tiering approach in 2017, and the Informal Inquiry Process for the Value-Based Payment Modifier.
This presentation is the same as the March 31, 2015 and April 7, 2015 webinars. A link to the video can be found here:
Regulations have been released 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.
The full requirement list can be read here.
A sample collaborative practice agreement form can be read here.
Questions about collaborative relationships, collaborative practice agreements or practice protocols may be referred to the Nursing Board Office by:
- E-mail: firstname.lastname@example.org
- Phone: (518) 474-3817 ext. 120.
It is not within the purview of the Nursing Board Office to interpret laws governing financial relationships between NPs and collaborating physicians.
Medicare / Medicaid and ICD-10
Chronic care management (CCM) is a unique physician fee schedule service designed to pay separately for non-face-to-face care coordination services furnished to part B Medicare beneficiaries with multiple chronic conditions. It applies to practices and patients that are not included in alternative payment models. The code (99490) fills a long-awaited void in treating patients with multiple chronic conditions and was included in the Centers for Medicare and Medicaid Services' final Physician Fee Schedule rule for 2015.
MLN Releases Chronic Care Management FAQ
MLN Matters® Special Edition Article #SE1516: "Chronic Care Management (CCM) Services FAQ" has been released to view and download. This article is designed to provide education on Medicare's requirement for 24/7 access by individuals furnishing CCM services to the electronic care plan, rather than the entire medical record. It includes FAQs regarding billing CCM services to the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) under CPT code 99490.
Chronic Care Management Services Fact Sheet
The Chronic Care Management Services Fact Sheet (ICN 909188) was released and is available in downloadable format. This fact sheet is designed to provide background on the separately payable Chronic Care Management (CCM) Services for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. it includes information on eligible providers and patients; Physician Fee Schedule billing requirements; and a table aligning the CCM Scope of Service Elements and billing requirements with the Certified Electronic Health Record or other electronic technology requirements.
Other CCM Resources
With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have announced additional help for physicians to get ready ahead of the October 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.
CMS’ free help includes the “Road to 10” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips.
CMS also detailed its operating plans for the ICD-10 implementation. Upcoming milestones include:
- Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
- Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
- Completing the final window of Medicare end-to-end testing for providers this July.
- Offering ongoing Medicare acknowledgement testing for providers through September 30th.
- Providing additional in-person training through the “Road to 10” for small physician practices.
- Hosting an MLN Connects National Provider Call on August 27th.
In addition, CMS has created an FAQ on ICD-10, which can be read here.
To read the full release, click on this link.
The Centers for Medicare & Medicaid Services (CMS) recently announced a grace period for ICD-10 implementation during which Medicare Part B claims for physician services and other practitioner services will not be denied for “lack of specificity” for one year after the October 1 implementation. This means that providers will not incur denials as long as the ICD-10 code, which will be required on each claim, is valid and from the correct family of codes. Providers will also be able to apply for payment advances in the event that Medicare Part B contractors are unable to process claims due to ICD-10 implementation issues.
This guide, prepared by CMS, outlines 5 steps health care professionals should take to prepare for ICD-10 by the October 1, 2015, compliance date. You can complete parts of different steps at the same time if that works best for your practice.
The five steps:
- Make A Plan
- Train Your Staff
- Update Your Processes
- Talk to Your Vendors and Health Plans
- Test Your Systems and Processes
To read the guide in more detail, please follow this link.
Last week, the Centers for Medicare & Medicaid Services (CMS) shared five facts common misperceptions about transitioning to ICD-10. Here are five more facts addressing common questions and concerns we have heard about ICD-10:
- If you cannot submit ICD-10 claims electronically, Medicare offers several options.
Prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:
- Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
- In about ½ of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
- Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met
If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.
- Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015.
Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.
- Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes.
Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
- Costs could be substantially lower than projected earlier.
Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.
- It’s time to transition to ICD-10.
ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:
- Improve coordination of a patient’s care across providers over time
- Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
- Support innovative payment models that drive quality of care
- Enhance fraud detection efforts
The first "Five facts about ICD-10" were printed in our previous YCIA and can be accessed here.
During the week of July 20 through 24, 2015, a group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing. Testers who are participating in the January and April end-to-end testing weeks are able to test again in July without re-applying.
New volunteer applications for a testing submitter has been closed as of April 17.
If selected, testers must be able to:
- Submit future-dated claims.
- Provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs) that will be used for test claims. This information will be needed by your MAC by May 29 for set-up purposes; Testers will be dropped if information is not provided by the deadline.
Any issues identified during testing will be addressed prior to ICD-10 implementation. Educational materials will be developed for providers and submitters based on the testing results.
For other ICD-10 tools, FAQS, and resources, please go to the CMS ICD-10 Website at:
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
- 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.
Practice Management Tools
For New York State, the Department of Health has a website of resources including the Medical Orders for Life-Sustaining Treatment (MOLST) form.
The DOH has created a portal that contains a wealth of information on advanced care decisions, including legal requirements checklists, frequently asked questions, and guidance documents for physicians and patients.
MOLST legal requirements checklists and general instructions for adult patients are:
- MOLST Adult General Instructions and Glossary (3/2012) (PDF, 114KB, 6pg.)
- MOLST Checklist 1 - adult with capacity any setting (5/1/13) (PDF, 49KB)
- MOLST Checklist 2 – adult with health care proxy any setting (5/1/13) (PDF, 91KB)
- MOLST Checklist 3 - adult with FHCDA surrogate (3/2012) (PDF, 95KB, 4pg.)
- MOLST Checklist 4 - adult without FHCDA surrogate (12/1/10) (PDF, 58KB, 4pg.)
- MOLST Checklist 5 - adult without capacity in the community (12/1/10) (PDF, 59KB, 4pg.)
The MOLST legal requirements checklist for minor patients is:
- MOLST Checklist for Minor Patients and Glossary (3/2012) (PDF, 120KB, 7pg.)
Frequently Asked Questions regarding MOLST:
Making Fall Prevention Part of Primary Care
Implementing CDC's STEADI Toolkit in a NYS County Health System (recorded webinar now available)
Falls among older New Yorkers (age 65 and over) are the leading cause of injury deaths, hospitalizations, and emergency room visits. To reduce falls, the CDC developed the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) Toolkit. The STEADI Toolkit is a comprehensive resource designed to help healthcare providers incorporate fall risk assessment and proven interventions into clinical practice.
The Chapter is excited to offer this one hour CME accredited recorded webinar on "Implementing CDC's STEADI Toolkit in a NYS County Health System" .
Frank Floyd, MD, FACP, Associate Medical Director & STEADI Champion, United Health Services presented the webinar, which highlighted:
- Information on the burden of falls in older adults in New York State
- Resources in the CDC STEADI Toolkit
- Challenges of incorporating fall prevention into clinical care
- Tips for incorporating fall prevention into clinical care
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
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.
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
Prescribe Opioid's Safely with Pri-Med
ACP and its curriculum partner Pri-Med offer an online training program to educate clinicians about safety and efficacy when prescribing opioids. ACP's curriculum provides a comprehensive educational program for primary care clinicians to safely and effectively manage patients with chronic pain. The program is available through the Pri-Med website.. Find out more.
Laurie Cohen, Esq., Partner at Nixon Peabody 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 Quality Connect
- American Diabetes Association
- Bridges to Excellence Diabetes Care
- NCQA Diabetes Recognition Program
- ACP Diabetes Monthly
- Improving Diabetes Through Patient Engagement Webinar (password required)
Learn about NY's information network, Meaningful Use, e-Prescribing, privacy and security and best practices.
The following patient-related resources provide guidance in effectively maintaining and enhancing the doctor-patient relationship.
- 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.
Last updated: 6.25.15