Health Information Technology (HIT)
Medicare / Medicaid and ICD-10
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.
The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use.
To file a hardship exception, you must:
- Show proof of a circumstance beyond your control.
- Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.
- Provide supporting documentation for certain hardship exception categories.
CMS will review applications to determine whether or not a hardship exception should be granted.
You do not need to submit a hardship application if you:
- are a newly practicing eligible professional
- are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or
- are an eligible professional with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)
To be automatically granted a hardship exception, CMS will use Medicare data to determine your eligibility.
Apply by July 1
As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered. If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.
In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:
- Medicaid only
- No claims to Medicare
Want more information about the EHR Incentive Programs?
Visit the EHR Incentive Programs website for the latest news and updates on the programs.
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:
The NYACP and our local Capital District leaders invite you to complete a brief survey on physician burnout and coping. As we face many changes to the practice of medicine in New York, we know that many of our members are frustrated by requirements to improve outcomes, transform practice without interoperable information technology, new regulatory rules and endless legislative mandates. We would like to assess the extent of physician burnout and consider attitudes and practices that may be helpful to minimize the stresses leading to burnout. The survey should take less then 10 minutes to complete.
We realize that everyone is busy, but we believe this brief questionnaire is important. The study is anonymous and no personal identifying data will be collected. Our plan is to share these findings in our Spring 2016 ACP plenary meeting and in other forums to engender discussion amongst physicians, including residents and medical students.
Kindly follow this link for access: https://yalesurvey.qualtrics.com/SE/?SID=SV_6Wik2exf1M8C1Sd
This study has been approved by Yale's Human Investigation Committee (HIC # 1412015037). If you have any questions or concerns, feel free to contact the investigator, Benjamin Doolittle (email@example.com, or 203.785.7941). If you would like to talk with someone other than the researchers to discuss problems, concerns, and questions you may have concerning this research, or to discuss your rights as a research subject, you may contact the Yale Human Subjects Committee at (203) 785-4688.
Many thanks for your participation.
A new law went into effect on March 31, 2015 that protects consumers from surprise medical bills when services are performed by a non-participating (out-of-network) doctor and when a participating doctor refers an insured patient to a non-participating provider.
The New York Chapter ACP's Legal Counsel, Laurie Cohen, Esq. from Nixon-Peabody, has provided an article detailing guidelines for physicians to ensure they are prepared for implementation.
The article covers these important questions:
- What is a surprise medical bill?
- What is the process for a physician to notify a patient of a potential surprise medical bill?
- What must you do to comply with disclosure requirements?
- What are the procedures for compliance?
These questions and more are answered in the article, which can be read 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
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