Register Now for Multi-Payer Expo in Hickory on June 25
Blue Cross and Blue Shield of North Carolina (BCBSNC), UnitedHealthcare, MedCost and Humana are collaborating to provide a venue for providers to meet with multiple payers and third-party vendors on June 25 in Hickory, N.C.
Attendees will have the opportunity to network with industry peers, as well as speak with payers and representatives, during an open forum from 8 a.m. to 1 p.m. Also, attendees will have the option to register and attend break-out sessions with guest speakers, Cam Cox and Lee Ford, from 8 a.m. to 1 p.m.
Practice managers, compliance officers, administrative, office billing staff and hospital billing staff in the Hickory area who have questions related to payer policies, guidelines or entity-level services issues should plan to attend.
BCBSNC representatives from key business areas like Contracting, Provider Services, Network Pricing, and eSolutions will be available at the Expo to answer your questions.
As the Expo will be an open forum, privacy concerns and HIPAA provisions will preclude any onsite discussions that may involve confidential personal health information, including claims discussions. If you wish to discuss specific claim issues, please work with the payer to schedule separate time away from the Expo for such discussions.
To attend, please complete and fax back the registration form for the Multi-Payer Expo in Hickory, and submit it by Friday, June 19.
BCBSNC-Specific Session: Please register here for the BCBSNC-specific session from 1:15 p.m. to 2:30 p.m. that will focus on BCBSNC policies, procedures and updates.
Nominate an Outstanding Physician Leader for the 2015 Harris Award!
The Carolinas Center for Medical Excellence (CCME) currently is accepting nominations for the 2015 Harris Memorial Award in honor of the life and memory of one of its founding members, T. Reginald Harris, MD.
Presented each year at the Annual Meeting of the North Carolina Medical Society in October, the award honors a North Carolina physician for outstanding achievements in the areas of health care quality and service to the medical community.
“In memory of Dr. Harris, we continue to honor a deserving physician who has made a significant contribution to the practice of medicine and outstanding patient care,” said John B. Smith, MD, board chairman of CCME. “Dr. Harris devoted his career to improving the quality of health care for patients in North Carolina. He provided decades of service to the medical community through the North Carolina Medical Society, the American Medical Association, and many other professional, civic, and community activities.”
To nominate a physician, please complete and submit the nomination form for the physician leader you think is most deserving by Tuesday, June 30, 2015. Download the nomination form. For more information, contact Chris Pfitzer at 800-682-2650, ext. 5687, or [email protected].
Reach Your Leadership Potential -- Apply to the Leadership College
Applications for Leadership College 2016 are now being accepted. The deadline to apply is July 15, 2015.
The NCMS Foundation Leadership College, part of the Kanof Institute for Physician Leadership, was developed for physicians from across the state who want to develop their leadership skills, and who are interested in attending a professional leadership development program. Since its inception in 2002, the Leadership College has graduated 200 scholars, almost half of whom have advanced to leadership positions in their workplace and/or professional organization.
If you would like to learn more about this selective program, please contact Erin Grover, 919-833-3836, x134. You also can apply online. All applications will be reviewed by the Kanof Institute for Physician Leadership Advisory Committee and scholars will be notified the beginning of September.
Anderson Award Open for Nominations
The North Carolina Medical Society (NCMS) is accepting nominations for the John Huske Anderson Award, given annually to a layperson whose contributions have had a positive impact on the medical profession and public health. The award honors Mr. Anderson's service to medicine and the Society, having served as NCMS legal counsel from 1937 until his retirement in 1983. Nominations must be made by an NCMS member.
The deadline for submissions is July 1. You may send the completed nomination form by scanning it and emailing it to Abbey Ruggiero, faxing it to her attention at 919-833-2023 or mailing it to her attention at P.O. Box 27167, Raleigh, NC 27611. If you have questions, please contact Abbey via email or by calling 919-833-3836 x147. Download the nomination form here.
Nominations for NCMS Leadership Positions Open
The Nominating and Leadership Development Committee is seeking nominations from physician members for NCMS leadership positions that will become vacant in 2015. The deadline for receiving all nominations is July 1. If you are interested in serving in the following positions, please submit your nomination form to Devdutta G. Sangvai, MD, Chair of the Nominating and Leadership Development Committee, NCMS, PO Box 27167, Raleigh, NC 27611-7167.
NCMS BOARD OF DIRECTORS:
- Officers
- President-Elect (1-year term)
- Region and At-Large Members (3-year term)
- Region 1 Representative (1) (incumbent eligible for re-election)
- At-Large Member (1) (incumbent eligible for re-election)
OTHER POSITIONS:
- AMA Delegates (3) (2-year term) (incumbents eligible for re-election)
- AMA Alternate Delegate (1) (2-year term) (incumbent eligible for re-election)
The NCMS Board of Directors is seeking nominations for the following positions. If you are interested in serving in these positions, please submit your nomination form and resume to Robert E. Schaaf, MD, President, NCMS, PO Box 27167, Raleigh, NC 27611-7167.
- North Carolina Medical Care Commission (1) (4-year term) (incumbent eligible for re-election)
- North Carolina Commission for Public Health (2) (4-year term) (incumbents eligible for re-election)
NOMINATING AND LEADERSHIP DEVELOPMENT COMMITTEE (6) (2-year term)
The Committee strives to identify, attract, and develop the most competent physician leadership in the Society.
- Region 1 (1) (incumbent not eligible for re-election)
- Region 2 (1)
- Region 3 (2)
- Region 4 (2) (One incumbent not eligible for re-election)
Region 1 includes:
Beaufort, Bertie, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Halifax, Hertford, Hyde, Jones, Lenoir, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, Washington, Wayne, Wilson
Region 2 includes:
Alamance, Caswell, Chatham, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Johnston, Lee, Montgomery, Orange, Person, Randolph, Rockingham, Stokes, Vance, Wake, Warren
Region 3 includes:
Anson, Bladen, Cabarrus, Cleveland, Cumberland, Gaston, Harnett, Hoke, Lincoln, Mecklenburg, Moore, Richmond, Robeson, Sampson, Scotland, Stanly, Union
Region 4 includes:
Alleghany, Alexander, Ashe, Avery, Burke, Buncombe, Caldwell, Catawba, Cherokee, Clay, Graham, Haywood, Henderson, Iredell, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rowan, Rutherford, Surry, Swain, Transylvania, Watauga, Wilkes, Yadkin, Yancey
To obtain a nomination form for any of the above positions, please contact Abbey Ruggiero at (800) 722-1350 or by email at [email protected].
High Point University Enrolls First PA Class
High Point University’s newest graduate school program, Physician Assistant Studies, enrolled its first class of 20 students on Sunday, June 7. The program doesn’t yet have a permanent home, but gave white coats to the incoming students at a special ceremony. More than 800 applicants applied for this master’s degree program. High Point is the ninth North Carolina college to offer a physician assistant degree. Two others are in the works, including one at UNC-Chapel Hill.
In the News
ICD-10: AMA Considers Grace Period To 'Save Docs,' MedPageToday, 6-7-15
Next Season's Flu Shot Is Going To Be Very Different, The Huffington Post, 6-6-15
Understanding Value-Based Health Care Authors Interviewed, Clinical Conversations Podcast, 6-5-15
VA Nurse Practitioners Could Practice Independently Under Senate Bill, ModernHealthCare, 6-3-15
Big Business Backs Virtual Doctor Visits As Texas Loses Fight For Limits, USA Today, 6-3-15
Are the Vaccine Court's Requirements Too Strict? NPR, 6-3-15
New Tally: Almost 663,000 In Carolinas Have ACA Health Coverage, The Charlotte Observer, 6-2-15
New York Doc Practice Goes It Alone To Launch Health Insurance Company, ModernHealthCare, 6-2-15
Seeking Rate Increases, Insurers Use Guesswork, The New York Times, 6-1-15
Federal Investigators Fault Medicare's Reliance On Doctors for Pay Standards, The New York Times, 5-31-15
New CMS Rule Could Reshape Medicaid Managed Care, ModernHealthCare, 5-30-15
10 Incidents Discovered At Nation's Biolabs, USA Today, 5-29-15
Patient Finds Shopping for Low Priced CT Scan Doesn't Pay Off, Kaiser Health News, 5-28-15
Consultant: Charlotte Needs Four-Year Medical School, The Charlotte Observer, 5-27-15
New Medicaid Rules Put States In Tough Position, ModernHealthCare, 5-27-15
A Top Medical School Revamps Requirements -- To Lure English Majors, Kaiser Health News, 5-27-15
NCMS Update: June 4, 2015
NCMS Leadership College at the Legislature:
The NCMS Leadership College Class of 2015 spent yesterday meeting with lawmakers and observing what goes on at the North Carolina General Assembly as part of White Coat Wednesday. Leadership College scholar Karen Cannon, MD, Chief Medical Operations Officer for CHESS, a population health management company based in High Point, was recognized as a guest in the Senate gallery by her Senator Joyce Krawiec (R-Yadkin, Forsythe).
Bird Flu Advisory from the CDC:
The Centers for Disease Control and Prevention (CDC) is warning clinicians that humans could be infected by highly-pathogenic avian influenza (HPAI) A H5 viruses that have been circulating among US poultry flocks. Read the CDC advisory.
NCMS Annual Meeting Speaker To Address Physician Burnout:
With dismal statistics showing that 46 percent of practicing American physicians suffer burnout, the NCMS is bringing in an expert on how health care practitioners -- physicians and physician assistants -- can remain resilient in dealing with the many pressures they face and the burgeoning bureaucracy in the practice of medicine today. Watch your snail mail and email for the details on this important program. And mark your calendar for our Annual Meeting on Oct. 23-24 at the Grandover Resort in Greensboro. You won't want to miss it!
Another Step Toward RAC Reform in the US Senate
The Senate Finance Committee today passed the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, an original bill to improve the Medicare audit and appeals process.
“Today, the Committee took an important bipartisan step toward streamlining the Medicare audit and appeals process to help healthcare providers better serve millions of patients across the nation,” said committee Chairman Orrin Hatch (R-Utah). “This is a common sense bill that will help untangle the web of red tape that ensnares the current audit and appeals process and guarantee Medicare patients continue to have access to high-quality care. I look forward to continuing to work with my colleagues on both sides of the aisle to move this bill forward.”
The North Carolina Medical Society (NCMS) has been pushing for such legislation for years. Working closely with Sen. Richard Burr (R-NC), NCMS Past President Robert Monteiro, MD, testified in March 2014 before a special meeting of key Senate Finance Committee staff hosted by Sen. Orrin Hatch. Dr. Monteiro detailed his practice’s experience with a flawed RAC audit and the financial hardship it caused.
This latest progress on Capitol Hill comes just more than a week after Rep. George Holding (R-NC) introduced a RAC reform bill in the House. Holding’s legislation “The Fair Medical Audits Act of 2015” reflects years of effort by the NCMS working with the Physicians Advocacy Institute (PAI) to address many concerns physicians throughout the country have with the extraordinary lack of transparency and expensive, time-consuming and often unfair processes plaguing the current Medicare audit program.
“It seems the momentum to make these necessary reforms is building in Washington, D.C.,” said NCMS CEO Robert W. Seligson. “We applaud Sen. Burr and Rep. Holding as well as the members of the Senate Finance Committee for making this a priority. We look forward to working with our Congressional delegation to make these reforms a reality for the doctors of North Carolina.”
An executive summary of the committee markup will be posted here.
Additional information on the AFIRM Act can be found here.
Watch your email and the NCMS Bulletin for updates on this important issue.
NCMS Update: June 2, 2015
If you’re an ‘early adopter’
Apparently the new Apple Watch has several apps just for physicians and PAs. Check them out. The reviews of the apps were written by Iltifat Husain, MD, Founder, Editor-in-Chief of iMedicalApps.com, and Assistant Professor of Emergency Medicine and Director of Mobile App curriculum at Wake Forest University School of Medicine.
Are you on Doximity?
The NCMS would like to know if you use this networking site to connect with your colleagues and, if so, how you like this method of communication. Please take our quick (30-second) survey.
Acronym du jour:
Here's one we see all the time, but do you know what it actually stands for? HIPAA = Health Insurance Portability and Accountability Act of 1996.
NCMS Update: June 1, 2015
Acronym du jour:
Here's a fun one -- PECOS. That stands for Medicare Provider Enrollment, Chain and Ownership System. For pages of more acronyms explaining the PECOS system and provider enrollment process, visit the PECOS FAQ page.
Beware the Lassa Fever:
It's not as deadly as Ebola, but, like Ebola, Lassa fever is a hemorrhaggic fever and is spread through contact with infected bodily fluids. A New Jersey man recently died of the diesease after returning from a visit to Liberia, and 150 peole with whom he had contact now are being watched closely for symptoms of the fever, which include sore throat, back and abdominal pain, facial swelling, vomiting, hearing loss and tremors. Learn more at the CDC's Lassa fever website.
Carolinas Healthcare Visits the White House:
Tomorrow officials from Carolinas Healthcare will visit the White House with a select group of organizations to participate in the White House Forum on Antibiotic Stewardship. The Forum will engage top leaders from a range of industries -- including health care, diagnostics and food -- in conversation about ways to leverage their industry expertise to more aggressively combat antibiotic-resistant bacteria at the national level.
“Carolinas HealthCare System is excited to contribute to this larger conversation on preventing and combatting the overuse of antibiotics, both in healthcare and other settings,” said James C. Hunter, MD, chief medical officer for the System, who will attend the Forum. “We are proud of the work we are already doing in this area and applaud the White House for placing additional emphasis on this important topic.”
Update on House Budget Provisions Affecting Physicians
The North Carolina House adopted its update to the Governor’s budget proposal last week. We expect the Senate budget released in the coming weeks. Below are some provisions in the House version that could have an impact on physicians and physician assistants.
The bill includes modest teacher and state employee pay raises, increased transportation funding and a number of health care related spending items. While the House budget does not include legislative language on Medicaid reform, it does provide funding to the Department of Health and Human Services for planning and reform of the program to a capitated model.
North Carolina Medical Society (NCMS) staff has highlighted some additional budget provisions affecting physicians below.
Authorizing the Secretary of the Department of Health and Human Services (DHHS) to administer the Medicaid and Health Choice programs within their enacted budgets
- This provision of the budget gives the DHHS Secretary broad authority to administer the Medicaid and Health Choice programs within their enacted budgets. This effectively provides the Secretary with the ability to cut funding to certain programs or providers as necessary to run these programs within their enacted budget amounts. This is an unprecedented change, taking the budgeting responsibility from legislators and transferring that responsibility to DHHS and the Secretary. The impact of this change is not certain at this time, however the .9 percent reduced appropriations funding for Medicaid allotted in each year of the fiscal biennium indicates the Secretary would have broad authority to reduce program funding in certain areas and/or to provider payments under this provision to meet the outlined budget amount.
Creation of a Joint Legislative Oversight Committee on Medicaid
- Establishes a new Joint Legislative Oversight Committee consisting of 14 members of the General Assembly to examine budgeting, financing, administrative functions, outcomes and operational issues related to the Medicaid and Health Choice programs.
Funding for Medicaid reform planning and implementation
- Provides $2.5 million in fiscal year 2015-2016 and $2.5 million in fiscal year 2016-2017 for planning and reform of the Medicaid program to shift utilization risk from the state under a capitated model.
Transition to performance-based managed care, care management, health services and health-related service contracts
- Requires DHHS to ensure any contract related to managed care, care management, health services and health-related services are performance-based contracts. This includes requirements for including measurable outcomes for contractors.
Continued funding for programs to improve birth outcomes and lower infant mortality rates
- Funds are provided for a competitive grants process in the sum of $2.5 million in recurring funds for each year of the 2015-2017 fiscal biennium and $2.5 million in nonrecurring funds for the 2015-2016 fiscal year to establish a competitive grants process for local health departments for evidence-based program proposals to improve birth outcomes and lower infant mortality rates.
Creation of the Office of Program Evaluation Reporting and Accountability within DHHS
- Creates a new Office of Program Evaluation Reporting and Accountability within DHHS that will assess the evidentiary basis of all department programs, and evaluate any programs when directed by the General Assembly or the Secretary.
Health Information Technology
- Transfers oversight and administration of the statewide Health Information Exchange (NC HIE) network to DHHS in the event of the dissolution of the NC HIE.
- Provides $3,160,611 in fiscal year 2015-2016 and $3,160,611 in fiscal year 2016-2017 to be used by DHHS to effect the transfer of the NC HIE to the Department in the event of the dissolution of the NC HIE.
Continued funding for NCTracks
- Provides $2.3 million for the 2015-2016 fiscal year and $940,000 for the 2016-2017 fiscal year to match federal funds for NCTracks.
Medical Examiner funding
- Provides an increased medical examiner autopsy fee of $1,750 and an increased medical examiner fee of $200. The budget also requires annual continuing education training by county medical examiners and provides funding for this training. In addition, $2, 195, 000 in nonrecurring funds also are provided to replace and upgrade the Medical Examiner Information System. Additional money is provided to develop and implement an electronic Death Records system as well.
Funding for local inpatient psychiatric beds
- Provides $43,049,144 for the 2015-2016 fiscal year and $43,049,144 for the 2016-2017 fiscal year to be used to purchase additional local inpatient psychiatric beds or bed days.
Funds to increase capacity for behavioral health crisis centers
- Appropriates $2 million in nonrecurring funds to increase the number of co-located or operationally linked behavioral health urgent care centers and facility-based crisis centers and to increase the number of facility-based crisis centers designated as facilities for the custody and treatment of involuntary clients. A priority will be given to those areas of the state experiencing a shortage of these types of facilities currently. These funds will also help support reimbursement for services provided by facility-based crisis centers. Lastly, funds are provided to develop and operate a psychiatric bed registry to provide real-time information about available beds at each licensed inpatient facility in the state.
- The budget bill also establishes a behavioral health partnership pilot program aimed at increasing inpatient bed capacity for short-term care of individuals experiencing an acute mental health, substance abuse or developmental disability crisis.
The NCMS will continue to keep members updated as the Senate begins their budget process and the negotiations between the chambers take place over the coming weeks.
CMS Proposes New Rules for Medicaid MCOs
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a proposal that would bring the rules governing Medicaid managed care plans into alignment with those for other private insurance and Medicare Advantage plans.
The proposed rule would also “implement statutory provisions; strengthen actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promote the quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It would also ensure appropriate beneficiary protections and enhance policies related to program integrity. This proposed rule would also require states to establish comprehensive quality strategies for their Medicaid and CHIP programs regardless of how services are provided to beneficiaries.”
Like many other states, North Carolina is struggling with the future direction of its Medicaid program. Some in the General Assembly seek to outsource it to corporate managed care organizations as other states have done with mixed results. Other legislators and the McCrory administration are in favor of following the path endorsed by the North Carolina Medical Society (NCMS) and other stakeholders in the health care community of forming homegrown provider-led entities to assume the financial and operational risk of caring for our state’s most vulnerable citizens. In either instance, this new proposal generally strengthens patient protections and holds the managed care organizations to a higher financial standard for quality of care than previously required.
Hard-Won RAC Reform Legislation Introduced
In case you missed the announcement, on the Friday afternoon before the long Memorial Day weekend, Rep. George Holding (R-NC) filed legislation to reform the RAC audit process – something the North Carolina Medical Society (NCMS) has long been advocating for in Washington, D.C.
The legislation entitled “The Fair Medical Audits Act of 2015.” reflects years of effort by the NCMS working with Physicians Advocacy Institute (PAI) to address many concerns physicians throughout the country have with the extraordinary lack of transparency and expensive, time-consuming and often unfair processes plaguing the current Medicare audit program.
“Here in North Carolina, I have witnessed firsthand how the current Medicare audit process can destroy a practice,” said Robert W. Seligson, MBA, MA, EVP/CEO of the NCMS and President of PAI. “It is time to address fundamental problems that have contributed to the backlog of audit appeals and caused a great deal of unnecessary expense and confusion for physicians nationwide. We commend Congressman Holding for his leadership on this critically important issue.”
Learn more about the details of the legislation.
The NCMS has been integrally involved in pushing for this legislation over the years, and looks forward to supporting its passage. To highlight the issue of fairness and transparency in the RAC audit process, the NCMS profiled one practice in New Bern that was devastated by the current system in a documentary titled “Guilty Until Proven Innocent: When Medicare Audits Cause Casualties.” Watch it now.
Currently, Medicare pays recovery audit contractors or “RACs” on a contingency basis to find overpayments to health care providers, providing these contractors with undue monetary incentives to audit doctors. This legislation would establish incentives for RACs to make more accurate audit findings and increase educational efforts to help physicians avoid common mistakes. Since its inception in 2006, the PAI has been committed to advocating for more fair and transparent medical audits.
“Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency and fairness to the audit process so doctors can spend more time caring for their patients and less time proving their innocence,” said Rep. Holding. “Medicare frauds must be found and severely punished but not at the cost of the independent practice of medicine.”
Rep. Holding is a member of the House Ways and Means Committee, which has jurisdiction to consider legislation to reform the RAC program.
The NCMS also has been working closely with Sen. Richard Burr (R-NC) on this issue. Thanks to Sen. Burr, former NCMS President Robert Monteiro, MD, testified in March 2014 before a special meeting of key Senate Finance Committee staff hosted by Sen. Orrin Hatch. Dr. Monteiro detailed his practice’s experience with a flawed RAC audit and the financial hardship it caused. Sen. Burr has been working to address the issues with the current RAC audit system, and hopes to introduce legislation in the near future.
“Unfortunately, one of the most common complaints I hear from North Carolina’s health care community is the need to improve Medicare’s audit and appeals processes,” Burr said. “I will continue working with my constituents and colleagues in Congress to restore the proper balance to Medicare’s audit and appeals processes on behalf of all North Carolinians.”
Watch future Bulletins for updates on the progress of this legislation.
No More Excuses: Improvements to CSRS Make It Easier to Use
To help tackle a growing epidemic of opioid abuse, the state’s Drug Control Unit launched its redesigned Controlled Substances Reporting System (CSRS) on March 17, 2015. The new web-interface is intended to provide prescribers and pharmacists with more intuitive control of the site. It also provides new convenient features like password reset, profile update, and prescribing history. In addition, the new system provides easy to read reports that include new information like MME (morphine milligram equivalents) conversion and method of payment. An online, 9-minute WebEx training video is available to allow prescribers and pharmacists to become familiar with the new interface. Go to the CSRS training video.
The North Carolina Medical Society (NCMS) encourages physicians and physician assistants and those licensed practitioners who they delegate to use the CSRS to do their part to combat opioid abuse. The Drug Control Unit is committed to improving the CSRS system to make using it easier and so it is a valuable clinical tool for patient care.
Prescription drug and heroin abuse have risen to epidemic proportions and are a significant public health concern. The U.S. House of Representatives Energy and Commerce Committee, Subcommittee on Oversight and Investigations has opened a series of hearings to understand what steps the states are taking to combat opioid abuse and to explore how state and federal policies can maximize and expand evidence-based practices in their communities. See more on the Energy and Commerce Committee website.
Prepare for ICD-10 With This Free Software
The Physicians Foundation’s recent national physician survey showed 50 percent of respondents thought the transition to ICD-10 would create a severe administrative problem, while 75 percent agreed it will unnecessarily complicate the coding process. With that in mind, The Physicians Foundation, which was founded in 2003 by a group of medical societies including the North Carolina Medical Society (NCMS) as the result of a class-action lawsuit against private third-party payers, wanted to make you aware of a free resource designed to help your practice make this daunting transition. ICD10Charts.com was developed by a medical student, Parth Desai, who saw the need for such a resource while working in his father's medical practice. Below is Parth's description of ICD-10 Charts.
My name is Parth Desai, I am a first year medical student at Mercer University, and founder of ICD10Charts.com. I'd like to invite you to try our revolutionary new system that allows any medical practice in America to be full-prepared for ICD-10, using interactive tools specially designed with practicing physicians in mind. ICD-10 Charts is a collection of innovative ICD-10 training resources that can help streamline your entire ICD-10 implementation process and save your practice a considerable amount of time and money during this transition. All of our ICD-10 training resources were created purely to support hard-working physicians and will always be completely free and accessible to anyone.
Click here to watch a short informational video detailing how the site works.
The Physicians Foundation, in its continuing efforts to offer its member organizations like the NCMS useful resources and information, is not responsible or liable for the consequences of any use of ICD-10 Charts.
CMS, NCTracks Gearing Up for ICD-10 -- And Want You To Join Them
The date for ICD-10 implementation is October 1, 2015, which is just around the corner. All indications are that implementation will not be delayed yet again, so please – get ready to transition from ICD-9 to ICD-10.
If you want some help counting down to ICD-10, there are timers you can download to your computer desktop. For instance both Free Countdown Timer and Time Left are free, and can help you stay on track.
The first step in your preparations may be simply to start asking questions. Is your practice management software vendor or trading partner/billing clearinghouse ready for ICD-10? Do physicians know what is expected of them? Are your coders trained in ICD-10?
If you're a small practice or solo provider and would like a comprehensive overview of how to prepare for ICD-10, check out the "Road to 10" on the web site of the Centers for Medicare and Medicaid Services (CMS).
Other organizations providing guidance are:
- North Carolina Healthcare Information & Communications Alliance, Inc. (NCHICA) www.nchica.org.
- Workgroup for Electronic Data Interchange (WEDI) www.wedi.org.
- American Health Information Management Association (AHIMA) http://www.ahima.org/topics/icd10
- Healthcare Information and Management Systems Society (HIMSS) http://www.himss.org/library/icd-10-transition.
NCTracks offers Crosswalk, which will tell you what your ICD-10 codes will be based on the ICD-9 codes you currently use. The ICD-10 codes in the crosswalk are the ones that will be used in NCTracks when we switch to ICD-10 codes on October 1. Remember, a few non-specific ICD-9 codes don't crosswalk – in either NCTracks or CMS’ crosswalk. If you enter a specific ICD-9 code and you don't receive corresponding ICD-10 codes, contact NCTracks at [email protected].
CMS also just released a video on how they’re planning for ICD-10: Medicare’s Testing Plan for ICD-10 Success: Run time: 7 minutes.
And mark your calendar for June 18 when CMS will host a National Provider Call in which subject matter experts will present strategies and resources to help you prepare. Registration is open.
Stay up to date on all the resources and help that is out there for you at the CMS ICD-10 website. Sign up for CMS ICD-10 Industry Email Updates and follow CMS on Twitter.
Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals who 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 CMS considers barriers to achieving meaningful use, and how to apply.
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.
Supporting documentation must also be provided 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
- Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)
The application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered. CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception. If approved, the exception is valid for the 2016 payment adjustment only.
For more information visit the EHR Incentive Programs website.
PQRS Reporting System Streamlined
The Centers for Medicare & Medicaid Services (CMS) has announced that an important system update for Physician Quality Reporting System (PQRS) participants is scheduled to be in place on July 13, 2015. It is hoped that the new process will streamline the password process to access CMS data systems.
The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM). The EIDM system provides a way for business partners to apply for, obtain approval and receive a single user ID for accessing multiple CMS applications.
Existing PQRS IACS users, their data, and roles will be moved to EIDM and will be accessible from the ‘PQRS Portal’ portion of the CMS Enterprise Portal at http://portal.cms.gov. Users will then access the PQRS Portal to submit data, retrieve submission reports, view feedback reports, or conduct various administrative and maintenance activities. New PQRS users will need to register for an EIDM account.
Stay tuned for more information and resources in the coming weeks and months! In the meantime, please ensure that your IACS account is active, current, and you’re able to log in. This will help ensure a smoother transition to EIDM.
For additional assistance regarding IACS or EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via email at [email protected]. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in email inquiries to the QualityNet Help Desk.
To stay up-to-date on all the latest news involving quality of care initiatives, log on to Quality Time with the NCMS.
NCMS Supports Exemption of CME From Sunshine Act
The North Carolina Medical Society (NCMS) has joined other state medical and medical specialty societies in support of Congressman Michael C. Burgess’ (R-Texas) legislation ensuring that certain educational programs and materials are excluded from Open Payments reporting. Rep. Burgess’ bill (HR 293) would make the current regulatory exemption for independent Continuing Medical Education (CME) permanent. In addition, medical textbooks and journal reprints would be added to the list of exempt transfers of value.
The Open Payments Program, often referred to as the Sunshine Act, was designed to promote transparency with regard to payments and other financial transfers of value between physicians and the medical product industry.
“Passage of this bill is urgently needed to remedy onerous and burdensome reporting obligations imposed by the Centers for Medicare and Medicaid Services (CMS) that have already chilled the dissemination of medical textbooks, peer-reviewed medical reprints and journals, and to avert a similar negative impact on access to independent certified and/or accredited continuing medical education (CME),” reads the letter to Rep. Burgess. “H.R. 293 would ensure that efforts to promote transparency do not undermine efforts to provide the most up-to-date independent medical knowledge, which improves the quality of care patients receive through timely dissemination of medical knowledge.”
Develop Your Leadership Skills; Apply to the NCMS Leadership College Today
Applications for Leadership College 2016 are now being accepted. The deadline to apply is July 15, 2015.
The NCMS Foundation Leadership College, part of the Kanof Institute for Physician Leadership, was developed for physicians from across the state who want to develop their leadership skills, and who are interested in attending a professional leadership development program. Since its inception in 2002, the Leadership College has graduated 200 scholars, almost half of whom have advanced to leadership positions in their workplace and/or professional organization.
If you would like to learn more, please contact Erin Grover, 919-833-3836, x134. You also can apply online. All applications will be reviewed by the Kanof Institute for Physician Leadership Advisory Committee and scholars will be notified the beginning of September.
NCMS Member Benefits for Retirees
The North Carolina Medical Society (NCMS) offers its members health coverage and other benefits through the NCMS Employee Benefit Plan (NCMS Plan), a partnership with the MMIC Agency, LLC. The NCMS Plan provides our members with a value-added plan that is customized to meet your practice and employees’ needs.
One of the benefits of the NCMS Plan that stands out in the health insurance market is retiree coverage. Physicians who retire from a practice in the NCMS Plan, along with spouses and dependents of retired physicians, can retain their coverage until eligible for Medicare. Early retiree benefits also can extend to non-Physician employees who retire early, at age 55 with at least 10 years of service.
When physicians or their dependents retire or plan for retirement, many decisions need to be made about insurance coverages. The MMIC Agency can assist with these decisions, outside of the NCMS Plan. Insurance products available include:
- Individual health and dental insurance – available for early retirees.
- Long-term care insurance – marketed by Southeast Senior Strategies, an MMIC Agency endorsed vendor.
- Medicare & Medicare Advantage – marketed by Marc Jessup Insurance and Southeast Senior Strategies, each an MMIC Agency endorsed vendor.
- Medicare Supplement – marketed by Marc Jessup Insurance and Southeast Senior Strategies, each an MMIC Agency endorsed vendor.
- Voluntary Insurance Products, including Critical Illness, Cancer Assist and Hospital Confinement coverages, which are products that when purchased as an active employee are portable when retiring.
For more information on accessing these NCMS member benefits, contact the MMIC Agency at (919) 878-7587 or (800) 662-7917, or visit www.ncmsplan.com.
Save the Date: NCMS Annual Meeting Oct. 23-24
Fall foliage and cool breezes may seem far away, but October will be here before you know it. Be sure to mark your calendar for the NCMS Annual Meeting, Oct. 23-24 at the Grandover Resort, Greensboro.
In addition to the opportunity to reconnect with your colleagues, we will have interesting speakers on topics like how to stay resilient in the face of the many pressures facing physicians and physician assistants these days. The House of Delegates also will be considering major changes to the governance of our society, which you won't want to miss.
Anderson Award Open For Nominations
The North Carolina Medical Society (NCMS) is accepting nominations for the John Huske Anderson Award, given annually to a layperson whose contributions have had a positive impact on the medical profession and public health. The award honors Mr. Anderson's service to medicine and the Society, having served as NCMS legal counsel from 1937 until his retirement in 1983. Nominations must be made by an NCMS member.
The deadline for submissions is July 1. You may send the completed nomination form by scanning it and emailing it to Abbey Ruggiero, faxing it to her attention at 919-833-2023 or mailing it to her attention at P.O. Box 27167, Raleigh, NC 27611. If you have questions, please contact Abbey via email or by calling 919-833-3836 x147. Download the nomination form here.
NCMS and AMA Leadership Positions Open
The Nominating and Leadership Development Committee is seeking nominations from physician members for NCMS leadership positions that will become vacant in 2015. The deadline for receiving all nominations is July 1. If you are interested in serving in the following positions, please submit your nomination form to Devdutta G. Sangvai, MD, Chair of the Nominating and Leadership Development Committee, NCMS, PO Box 27167, Raleigh, NC 27611-7167.
NCMS BOARD OF DIRECTORS:
- Officers
- President-Elect (1-year term)
- Region and At-Large Members (3-year term)
- Region 1 Representative (1) (incumbent eligible for re-election)
- At-Large Member (1) (incumbent eligible for re-election)
OTHER POSITIONS:
- AMA Delegates (3) (2-year term) (incumbents eligible for re-election)
- AMA Alternate Delegate (1) (2-year term) (incumbent eligible for re-election)
The NCMS Board of Directors is seeking nominations for the following positions. If you are interested in serving in these positions, please submit your nomination form and resume to Robert E. Schaaf, MD, President, NCMS, PO Box 27167, Raleigh, NC 27611-7167.
- North Carolina Medical Care Commission (1) (4-year term) (incumbent eligible for re-election)
- North Carolina Commission for Public Health (2) (4-year term) (incumbents eligible for re-election)
NOMINATING AND LEADERSHIP DEVELOPMENT COMMITTEE (6) (2-year term)
The Committee strives to identify, attract, and develop the most competent physician leadership in the Society.
- Region 1 (1) (incumbent not eligible for re-election)
- Region 2 (1)
- Region 3 (2)
- Region 4 (2) (One incumbent not eligible for re-election)
Region 1 includes:
Beaufort, Bertie, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Halifax, Hertford, Hyde, Jones, Lenoir, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, Washington, Wayne, Wilson
Region 2 includes:
Alamance, Caswell, Chatham, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Johnston, Lee, Montgomery, Orange, Person, Randolph, Rockingham, Stokes, Vance, Wake, Warren
Region 3 includes:
Anson, Bladen, Cabarrus, Cleveland, Cumberland, Gaston, Harnett, Hoke, Lincoln, Mecklenburg, Moore, Richmond, Robeson, Sampson, Scotland, Stanly, Union
Region 4 includes:
Alleghany, Alexander, Ashe, Avery, Burke, Buncombe, Caldwell, Catawba, Cherokee, Clay, Graham, Haywood, Henderson, Iredell, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rowan, Rutherford, Surry, Swain, Transylvania, Watauga, Wilkes, Yadkin, Yancey
To obtain a nomination form for any of the above positions, please contact Abbey Ruggiero at (800) 722-1350 or by email at [email protected].
Nancy Lowe Honored By Meeting Professionals International Chapter
Nancy Lowe, Associate Director, Specialty Society and Meeting Services, was honored with the Meeting Professionals International-Carolinas Chapter (MPI-CC) Hall of Fame Award for 2014-15 on May 18.
The chapter’s Hall of Fame Award recognizes and rewards MPI-CC members who exemplify excellence and enduring service to MPI. To receive the honor the awardee must be a current member of MPI in good standing with at least 10 years of cumulative service as a Carolinas Chapter member. Lowe has been a member of MPI-CC for 25 years. The Hall of Fame Award is evaluated in the areas of MPI service; Chapter and International participation; industry contributions such as articles written in the hospitality press and speaking engagements; awards and professional recognition; community service through civic, charitable, and fundraising activities; professional/career advancement including professional designations; biographical information and current letters of commendation.
Congratulations, Nancy!
Cummings Leaves NCDHHS to Become Chancellor of UNC-Pembroke
Robin Gary Cummings, MD, who currently serves as deputy secretary for health services and state Medicaid director for the N.C. Department of Health and Human Services will leave his post on June 5 to become Chancellor of the University of North Carolina-Pembroke on July 15. Dave Richard, the state's top official for behavioral health services, will succeed Cummings as Medicaid director on June 1.
Cummings, a long-time North Carolina Medical Society (NCMS) member, is a retired cardiothoracic surgeon, who earned his undergraduate degree at UNC-Chapel Hill, and his medical degree at Duke University Medical School. Cummings interned and completed his surgery residencies at Duke University Medical Center, then practiced cardiothoracic surgery at the Pinehurst Surgical Clinic and Moore Regional Hospital. He headed Moore Regional's division of cardiothoracic surgery from 1999-2000 and its section of cardiovascular and general surgery from 2000-2003.
In early 2013, he joined the N.C. Department of Health and Human Services as director of the N.C. Office of Rural Health and Community Care. Six months later, he was named deputy secretary for health services and acting state health director. Since March 2014, he has had additional responsibility for the Division of Medical Assistance, overseeing Medicaid delivery for more than 1.8 million low-income parents, children, seniors and people with disabilities who cannot afford health care.
With Cumming’s departure, Megan Davies, MD, has been named acting State Health Director while continuing her role as State Epidemiologist, which she has held since 2009. Dr. Davies earned her Medical Degree from the University of North Carolina in 1991.
The search for a State Health Director is ongoing.
Jarrett Named 2015 Medical Administrator of the Year
North Carolina Medical Group Management Association (NCMGMA) named Sandra Jarrett, Practice Manager for Salisbury Orthopaedic Associates, PA, its 2015 Administrator of the Year.
The Administrator of the Year award honors a medical practice administrator who has demonstrated exceptional leadership and management proficiency, and who has helped enhance the effectiveness of health care delivery in North Carolina. Sponsored by Medical Mutual Insurance Company, the Administrator of the Year Award also provides the recipient with a stipend for continuing education at a state or national Medical Group Management Association (MGMA) meeting.
Jarrett has been the practice manager at Salisbury Orthopaedic Associates since 2013 and is a long-time member of the NCMGMA. She is the chair of the Medicaid Committee, a past member of the Worker’s Compensation Committee and a regular participant in the NCMGMA’s Legislative Days and the North Carolina Medical Society’s White Coat Wednesday, where delegates from across the state meet with North Carolina law makers to address their health care industry needs and concerns.
Congratulations, Sandra!
In the News
Government Backs Down On Some Requirements For Digital Medical Records, USA Today, 5-25-15
Doctoring Without The Doctor, The New York Times, 5-25-15
Second Opinions Often Sought, But Value Is Not Yet Proven, Kaiser Health News, 5-26-15
Medicare Recovery Audit Program Targeted For Reform Following Spike In Observation Stays, ModernHealthCare, 5-20-15
Interstate Medical License Compact Becoming A Reality, ModernHealthCare, 5-20-15
As Insurers Limit Access To Hep C Drugs, Patients and Doctors Bristle, ModernHealthCare, 5-20-15
Newman's Notes: Quiet Fortitude in the ER, MedPageToday, 5-13-15
Learning Opportunities
June 2, 2015, Predictive Analytics Workshop, The Research Triangle Foundation, RTP, NC
This one-day workshop will demonstrate how Accountable Care Organizations and others are using predictive analytics to support their goals of improving quality and reducing costs. Speakers include Shantanu Nigam (Jvion), Angela Diaz (CCME) and J.C. Layton (InfraScience). The registration fee is $199 NCHICA member/$299 non-member. Click here for further details and to register.
Learn more about the 2014 Mid-Year Quality and Resource Use Reports (MYQRURs) on this Medicare Learning Network (MLN) National Provider Call on Wednesday, June 3; 1:30-3pm. The call will provide an overview of the 2014 MYQRUR and explain how to interpret and use the information in the report. Learn more about the reports on the MYQRUR web page. To Register: Visit MLN Connects® Upcoming Calls. Space may be limited, register early. The call will be more meaningful if you have your MYQRUR in front of you to follow along. Visit the How to Obtain a QRUR web page and access your report prior to the call.
Cleveland Clinic Florida’s 6th Annual Internal Medicine Review Board, May 30, 2015 – June 3, 2015 at the DoubleTree by Hilton in Sunrise, Florida, assists Internal Medicine physicians and residents who are preparing to take their boards. More info.
June 12, 2015, for Go SIMple, an opportunity to learn about the hottest trends in simulation education from experts. The training session will be held at Campbell University College of Osteopathic Medicine in Lillington, NC.
Thursday, June 18, the Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call in which subject matter experts will present strategies and resources to help you prepare for ICD-10. Registration is open.
Thursday, June 18 - 9 to 11 a.m. – NCTracks Recipient Eligibility Verification training. Learn to use the Eligibility Verification System (EVS), which provides information regarding a recipient's eligibility for services in real time. At the end of training, providers will be able to submit an Individual Recipient Eligibility Inquiry, submit a Batch Eligibility Inquiry, and view an Eligibility Response. This course will be taught at the CSC facility in Raleigh. The course includes hands-on training and will be limited to 45 participants.
Register for these courses in SkillPort, the NCTracks Learning Management System. Logon to the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Open the folder labeled Provider Computer-Based Training (CBT) and Instructor Led Training (ILT). The courses can be found in the sub-folder labeled ILTs: On-site, listed by topic.
Move to Value Summit, the ultimate primer on value-based health care will be held at Biotech Place in Winston-Salem Aug. 27-28. Hosted by CHESS Health Enablement Solutions and sponsored by Wake Forest Baptist Health and LabCorp, the Move to Value Summit is designed to provide you with a broad and deep understanding of what it takes to transform your fee-for-service-dependent organization to one rooted in pay-for-value. Learn more and register.
RAC Reform Closer to Reality: Rep. Holding Introduces Legislation
Today, Rep. George Holding (R-NC) introduced legislation entitled “The Fair Medical Audits Act of 2015.” This legislation reflects years of effort by the North Carolina Medical Society (NCMS) working with Physicians Advocacy Institute (PAI) to address many concerns physicians throughout the country have with the extraordinary lack of transparency and expensive, time-consuming and often unfair processes plaguing the current Medicare audit program.
“Here in North Carolina, I have witnessed firsthand how the current Medicare audit process can destroy a practice,” said Robert W. Seligson, MBA, MA, EVP/CEO of the NCMS and President of PAI. “It is time to address fundamental problems that have contributed to the backlog of audit appeals and caused a great deal of unnecessary expense and confusion for physicians nationwide. We commend Congressman Holding for his leadership on this critically important issue.”
Learn more: How the FMAA Will Help Physicians (PDF).
The NCMS has been integrally involved in pushing for this legislation over the years, and looks forward to supporting its passage. To highlight the issue of fairness and transparency in the RAC audit process, the NCMS profiled one practice in New Bern that was devastated by the current system in a documentary titled “Guilty Until Proven Innocent: When Medicare Audits Cause Casualties.” Watch it now.
Currently, Medicare pays recovery audit contractors or “RACs” on a contingency basis to find overpayments to health care providers, providing these contractors with undue monetary incentives to audit doctors. This legislation would establish incentives for RACs to make more accurate audit findings and increase educational efforts to help physicians avoid common mistakes. Since its inception in 2006, the PAI has been committed to advocating for more fair and transparent medical audits.
“Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency and fairness to the audit process so doctors can spend more time caring for their patients and less time proving their innocence,” said Rep. Holding. “Medicare frauds must be found and severely punished but not at the cost of the independent practice of medicine.”
Rep. Holding is a member of the House Ways and Means Committee, which has jurisdiction to consider legislation to reform the RAC program.
The NCMS also has been working closely with Sen. Richard Burr (R-NC) on this issue. Thanks to Sen. Burr, former NCMS President Robert Monteiro, MD, testified in March 2014 before a special meeting of key Senate Finance Committee staff hosted by Sen. Orrin Hatch. Dr. Monteiro detailed his practice’s experience with a flawed RAC audit and the financial hardship it caused. Sen. Burr has been working to address the issues with the current RAC audit system, and hopes to introduce legislation in the near future.
“Unfortunately, one of the most common complaints I hear from North Carolina’s health care community is the need to improve Medicare’s audit and appeals processes,” Burr said. “I will continue working with my constituents and colleagues in Congress, to restore the proper balance to Medicare’s audit and appeals processes on behalf of all North Carolinians.”
Watch the Bulletin for updates on the progress of this legislation.
NCMS Update: May 21, 2015
Teen Skin Cancer Prevention Act Is Now the Law:
Governor McCrory signed the hard-won Jim Fulghum Teen Skin Cancer Prevention Act into law today at the Executive Mansion with the late Rep. Fulghum's wife Mary Susan, and his daughter, son-in-law and granddaughter at the Governor's side.
After the brief signing ceremony, those from the North Carolina Dermatology Association and NCMS who have been involved in the years-long effort to get this legislation passed gathered to celebrate at the NCMS Center for Leadership in Medicine across the street from the Governor's house.
“This law will save lives and significantly help protect children and young adults from the growing epidemic of skin cancer," said Russell Kilpatrick, MD, a Greenville dermatologist and president of the N.C. Dermatology Association. "We thank our legislators and the governor for their support and action on this important health issue.”
Let DHHS Know What You Think of NCTracks:
CSC, the fiscal agent responsible for NCTracks, is required to conduct an annual customer satisfaction survey of NCTracks users. Let them know what your experiences have been with the Medicaid claims system. The survey is anonymous and should take about 10 minutes to complete. The results will be compiled and submitted to the Office of NCTracks. The deadline to complete the survey is May 29. Here's the link
Duke University Hospital Makes Honor Roll in US News Rankings:
The 2014-25 US News & World Report rankings cover nearly 5,000 medical centers across the country and span 16 medical specialties from cancer to urology. Hospitals with very high scores in at least six specialties earned a spot on the Honor Roll. Just 17 hospitals made this year's list with Duke University coming in at 14. Read more about the rankings.
NCMS Update: May 20, 2015
Acronym du jour:
This is an easy one -- or at least it should be if you've been paying attention. PQRS stands for Physician Quality Reporting System. According to the CMS (another ancronym we all know and love), PQRS is a quality reporting program that encourages individual doctors and practices to report information on the quality of care, by "giving them the opportunity to assess the quality of care they provide helping to ensure that patients get the right care at the right time."
Tanning Bed Bill Signing Ceremony:
Governor McCrory will sign the hard-won Jim Fulghum Teen Skin Cancer Prevention Act into law Thrusday at 11:15 a.m. at the Executive Mansion. Afterwards, come celebrate at the NCMS Center for Leadership in Medicine across the street.
YouTube Takes On the Value-Based Modifier:
Now you can’t say you didn’t know about the PQRS/Value-Based Provider Modifier – it’s on YouTube! A video recording of the "PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015" presentation has been posted to the CMS MLN Connects® page on YouTube.
Not to be outdone in the realm of delivering information in the most advanced way, the US Department of Health and Human Services has redesigned its website to deliver content “anytime, anywhere on any device.” They also trashed 154,000 obsolete files to speed things up. Check it out.
Headlines:
House Medicaid Budget Provision Draws Fire, WRAL
Cancer Charities Bilked Donors Out of $187 million, Government Says, The Washington Post
NCMS Update: May 15, 2015
The House has released parts of its budget proposal:
The state’s news media have been reporting on the portions of the House budget released thus far. NCMS staff in a preliminary look at the proposal for the Department of Health and Human Services, which pertains most directly to NCMS members, found concerns about certain provisions, but were pleased to see that no additional physician rate cuts in Medicaid were requested by the House.
Acronym(s) du Jour:
In case you’re feeling hungry for some new acronyms to sprinkle through your prose, here are a couple to whet your appetite gleaned from a recent CMS (that’s Centers for Medicare and Medicaid Services) announcement:
“The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM).”
NCMS’ Seligson to Continue as The Physicians Foundation Treasurer
The Physicians Foundation – a nonprofit organization that seeks to empower physicians to lead in the delivery of high-quality, cost efficient healthcare – announced that NCMS CEO Robert W. Seligson will continue in his role as treasurer for the Foundation. Walker Ray, MD, a retired pediatrician with more than 40 years of experience practicing medicine in Georgia and in many physician leadership roles, will serve as its new President.
What’s the most distinctive cause of death in NC?
‘Other’ nutritional deficiencies is the most distinctive cause of death in our state, according to Preventing Chronic Diseases. This is based on the ratio of age-adjusted death rate for each cause of death relative to the national age-adjusted death rate for each cause. Read the article and view the map to see what the most distinctive cause of death is in the other 49 states.
New Bills Threaten Physician Supervision of Mid-Levels
The General Assembly is considering several bills this session that would remove physician supervision requirements for many non-physician practitioners. Among the most aggressive of these proposals is one introduced by Sen. Ralph Hise, SB 695, Modernize Nursing Practice Act, which enhances the already broad authority of the North Carolina Board of Nursing.
Now is the time to contact your state senator to explain why physician supervision helps ensure the safety of your patients. Our current law allows nurses to expand their expertise well beyond their formal education by working side by side with a supervising physician. In fact, advanced practice nurses in North Carolina can perform any medical act approved by a supervising physician. The current supervision law allows nurses to practice to the fullest extent possible, while maintaining the safety net of physician expertise vital to patient safety. Contact your legislator now.
SB 695 proposes to include adding advanced practice registered nurse (APRN) licensure for nurse practitioners, certified nurse midwives and clinical nurse specialists. In addition, the legislation proposes to expand the APRN scope of practice beyond the current RN scope of practice by authorizing these mid-level practitioners to:
- Conduct an "advanced assessment" (a new defined term in the Act);
- Delegate and assign therapeutic measures to assistive personnel;
- Perform other acts that require education and training consistent with professional standards and commensurate with the APRN's education, certification, demonstrated competencies and experience.
The bill also specifically permits the following areas of focus for APRN practice:
- The family or individual across the life span
- Adult gerontology
- Neonatal
- Pediatrics
- Women's health
- Psychiatric or mental health
The practical implications of the sweeping changes in SB 695 are not yet understood. It is our belief that if this bill is not modified to impose limits on the proposed changes, the quality and cost benefits of physician supervision are at risk.
Another assault on physician supervision is SB 240, Define Scope of Practice of CRNAs, by Sen. Jim Davis. The bill proposes to eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). SB 240 proposes to define the practice of nursing by a CRNA as including the following components:
- Perform nurse anesthesia activities in collaboration with a physician, dentist, podiatrist or other lawfully qualified health care provider with each provider contributing his or her respective area of expertise consistent with the lawful scope of practice and according to established policies, procedures, practices and channels of communication that lend support to nurse anesthesia activities;
- Define the roles and responsibilities of the certified registered nurse anesthetist within the practice setting;
- Maintaining individual accountability of the outcome of individual actions.
The value of physician supervision and the contributions to patient safety made by physicians are being questioned. It is important that you tell legislators the important role physician supervision plays in protecting patients in our health care system. Take Action Now >>
NCMS Update: May 14, 2015
Acronym du jour: MACRA
This is a new one to add to your collection. We could say it replaces SGR (sustainable growth rate) since it is the abbreviation for the legislation that repealed the SGR after many years. It stands for Medicare Access and CHIP Reauthorization Act. Please add it to your acronym lexicon since it will no doubt be used a lot in the coming years as this new law plays out.
Thoughts on Passage of Ban the Tan Bill:
“Today we celebrate passage of this important legislation, but we also honor those who have had their lives changed by skin cancer – the survivors, the family members, those who lost the battle. We take pride in knowing that this legislation will save lives, helping in a tangible way in our children and young adults to fight the growing epidemic of skin cancer. As doctors, we are thankful to our legislators for their support and action on this important health issue.” -- Russell Kilpatrick, MD, President, North Carolina Dermatology Association
See news story below for details on the long-awaited passage of this bill.
What Do Other States’ Medicaid Programs Look Like:
Here is a useful state-by-state description of Medicaid programs throughout the country: http://medicaid.gov/medicaid-chip-program-information/by-state/by-state.html
Headlines:
NC Senate Oks Under-18 Tanning Bed Ban, Raleigh News & Observer
This Breast Cancer Screening Catches Way More Tumors Than Mammography, Huffington Post
NCMS Works Hard To Refine Medicaid Reform Proposal
For the last month, North Carolina Medical Society (NCMS) staff has been working closely with the North Carolina Hospital Association and other provider groups to fashion a framework for Medicaid reform in North Carolina. The many early morning and late night meetings have resulted in a high-level statement of principles that all parties can accept. Read the NC Provider Community Medicaid Reform Proposal.
This document is an important step in what will likely be a long process of working through the many minute details to make this vision into a legislative reality. The NCMS appreciates the valuable participation and input of the state medical specialty organizations. We are moving toward what we hope will be meaningful Medicaid reform, which takes into account the various interests of the health care community, taxpayers and, most importantly, the patients who receive Medicaid services.
The proposal’s overarching goal is to pursue the Triple Aim:
- Reducing the per capita cost of health care;
- Improving the health of populations; and
- Improving the patient experience of care (including quality and satisfaction).
The organizations delivering the care would be governed and led by providers, who would take on the state’s financial uncertainty over Medicaid enrollees’ utilization of services through capitation. These provider-led entities would then have a vested financial interest in delivering efficient care for Medicaid enrollees. The ultimate goal would be to integrate physical health, mental and behavioral health, long-term services and supports, with the move to capitation expanding to all those groups over time.
This is a work in progress, and the legislature has indicated, while they want to enact Medicaid reform this session, it may not happen before the budget is complete. The NCMS would like to hear your thoughts on Medicaid reform. Please email [email protected] with your comments and questions.
'Ban the Tan' Bill Headed to Governor's Desk to Be Signed Into Law
The Jim Fulghum Teen Skin Cancer Prevention Act is headed to Governor McCrory’s desk after the Senate passed the bill on a vote of 48-2 on Wednesday. The bill would ban children under 18 from using tanning beds in North Carolina.
The North Carolina Medical Society (NCMS) supported the North Carolina Dermatology Association in their long battle to get this bill passed, citing the many scientific studies linking tanning sessions to increased risks of skin cancer like melanoma. The House approved the bill in March and previously in 2013. The Senate had been the obstacle to passage, with some lawmakers worried about government intervention on an issue they say should be left to parents.
The current law requires parental permission for children age 14 to 17 to use a bed and a doctor's written prescription for those 13 and under.
Pioneer ACO Model Generates Medicare Savings, Independent Report Reveals
The US Department of Health and Human Services released an independent evaluation report showing an innovative payment model created as a pilot project by the Affordable Care Act generated substantial savings to Medicare in just two years. Additionally, the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) has certified that this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.
The Pioneer Accountable Care Organization (ACO) Model was found to generate over $384 million in savings to Medicare over its first two years, according to the independent evaluation report. This equates to an average savings of approximately $300 per participating beneficiary per year, while continuing to deliver high-quality patient care. Pioneer ACOs generated Medicare savings of $279.7 million in 2012 and $104.5 million in 2013. To date, actuarial analyses show that ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program have generated over $417 million in total program savings for Medicare. The primary analyses in the evaluation are also reported in an article published in the Journal of the American Medical Association (JAMA).
Additional information about the Pioneer ACO Model and its actuarial certification can be found on the Pioneer ACO Model web page.
From Contraceptives to Colonoscopies Feds Clarify What the ACA Covers
To help clear up any confusion about what preventative health benefits are covered by the Affordable Care Act, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury put together a list of Frequently Asked Questions (FAQs) including information on contraceptives, BRCA testing, immunizations and colonoscopies. Review the questions and answers.
What MACRA Means to You -- Detailed Summary of Historic SGR Repeal Bill
The AMA has produced a detailed summary of HR 2, the hard won legislation that repealed the sustainable growth rate formula and is now known by the new acronym MACRA (the Medicare Access and CHIP Reauthorization Act of 2015). The summary describes the new payment model among other aspects of the legislation and includes a timeline for implementation. Read the summary and review the timeline.
More NCTracks Users Need to Prepare for ICD-10 Implementation
The results of the second ICD-10 readiness survey for users of the state’s NC Tracks Medicaid claims system, shows a slight improvement in the number of providers prepared for the transition to ICD-10 on Oct. 1, but still not the number who need to be ready for the changeover. The NC Department of Health and Human Services Director of the Division of Medical Assistance, Robin Gary Cummings, MD, described the results as “concerning.”
Of the 727 providers who replied to the question ‘how complete is your implementation of ICD-10 for your organization,’ 218 or 30 percent had not yet started to implement the new codes. The majority of respondents (467) were somewhere between 1 and 99 percent complete. For 42 respondents the implementation was complete.
For those who had not begun or completed the implementation, the most commonly given reasons were other priorities or competing interests as well as lack of staffing/resources. Nearly 62 percent of those taking the survey felt confident they would be ready come Oct. 1, while 35 percent were not sure. View all the results.
NC Tracks will be running another survey on May 20 to assess how prepared providers will be on Oct. 1. In the meantime, NC Tracks staff is standing by to answer questions at [email protected]. You also may find your ICD-10 codes on the NCTracks ICD-10 Crosswalk at http://ncmmis.ncdhhs.gov/icdxwalk.asp. Here are some frequently asked questions submitted over the past few weeks:
Q: What is the soonest you will accept a claim with an ICD-10 code on it?
A: The federal government has mandated that October 1 is the earliest we can accept a claim with ICD-10 codes.
Q: If a date of service is prior to October 1, but the claim is not submitted until after October 1, which ICD codes should be used?
A: The codes to use will be based on date of service, no matter when you submit the claim. So if the date of service occurred before October 1, but you're submitting the claim after October 1, you will use ICD-9 codes.
Q: Can claims with ICD-9 codes and claims with ICD-10 codes be submitted in the same batch?
A: Yes. Claims for dates of service prior to October 1 (using ICD-9 codes) and claims for dates of service on or after October 1 (using ICD-10 codes) can be submitted in the same batch. However, ICD-9 codes and ICD-10 codes cannot be used on the same claim.
Q: This crosswalk does not locate any of my codes. I tried searching common codes such as 401.9, 250.02, 250.00, 789.00.
A: Those codes are on the crosswalk, but as the directions state, you have to remove the decimal point. For example, enter ICD-9 code 707.10 as 70710. Once you do that, you will find the corresponding ICD-10 code.
ICD-10 Medicare Testing Opportunity Still Available
During the week of July 20-24, 2015, a final sample 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. The Centers for Medicare and Medicaid Services (CMS) is accepting additional July volunteers through May 22, 2015. This is your chance to participate in end-to-end testing with Medicare prior to the October 1, 2015, implementation date.
Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing. This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Note: Testers who participated in the January and April end-to-end testing are able to test again in July without re-applying.
To volunteer as a testing submitter:
- Volunteer forms are available on your MAC website
- Completed volunteer forms are due May 22
- CMS will review applications and select additional July testers
- The MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing by June 12
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 for set-up purposes by the deadline on your acceptance notice; 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.
CMS Offers Help On ICD-10 Implementation
It’s not too late to get ready for ICD-10 implementation on October 1, 2015. During this Medicare Learning Network (MLN) Connects National Provider Call, Centers for Medicare and Medicaid Services (CMS) subject matter experts will present strategies and resources to help you prepare. Also, learn about ICD-10-PCS Section X for new technologies, which will be used by hospitals. A question and answer session will follow the presentations. Thursday, June 18; 1:30-3pm. To Register: Visit MLN Connects® Upcoming Calls. Space may be limited, register early.
Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the Continuing Education Credit Information web page to learn more.
Review Your Open Payments Reports
The Centers for Medicare and Medicaid Services’ (CMS) Open Payments program collects data from drug and device manufacturers and group purchasing organizations (GPOs) about payments they make to physicians and teaching hospitals. The program also reports information about ownership interests in drug and device manufacturers and GPOs held by physicians and their immediate family members. It’s important that physicians and teaching hospitals confirm the accuracy of the financial relationships reported about them.
CMS encourages all physicians to register and review any payments reported about them. There are instructions and quick tips to help. The review period opened on April 6, 2015, and will be open for at least 45 days. Reporting inaccuracies helps to make sure that the information posted to the Open Payments website is correct. The only way for physicians to confirm the data reported about them is correct is to register and review that data now during the current review period.
Last fall, CMS reported 4.45 million payments valued at $3.7 billion, which were made in the last five months of 2013. These payments were for items such as medical research, conference travel and lodging, gifts and consulting (along with physician ownership or investment interest in industry). CMS will collect this data annually and continue to make it publicly available, downloadable, and searchable. Data from the full 12 months of 2014 has been collected and will be released publicly by CMS on June 30, 2015.
Learn more about the Open Payments program or send questions to [email protected].
More Codes Open for Billing by PAs and NPs in NCTracks
There is some news in the long-running saga of CPT codes closed to PAs and NPs since the NCTracks Medicaid claims system for North Carolina went live in July 2013.
The Department of Medical Assistance (DMA) announced 66 more codes open for billing by Physician Assistants (PA) and Nurse Practitioners (NP). DMA’s posted chart incorporates these newly-opened codes into the list of codes previously opened in February. For your convenience, NCMS isolated the new codes and created the below chart. Newly added codes include many E&M services and injections/infusions.
As DMA opens codes to PAs and NPs, the updates to the codes should be retroactive to July 1, 2013. But you must resubmit claims for these services in order to get them paid. Medicaid IS NOT reprocessing claims automatically.
At the urging of NCMS, both DMA and CSC, the company administering NCTracks, have pledged to improve how they communicate the status of codes they are reviewing for PAs and NPs. They have recognized much of providers’ frustration is because it’s not known where this ongoing process stands. Be on the lookout for more messages from them about this. This is subject to change, but here’s a glimpse of what they have in mind:
DMA plans to draft a biweekly communication article that should address the communication issue discussed earlier today. High level, DMA will instruct NCTracks to publish a biweekly article through NCTracks such as every other Monday. The article will have the status on codes that DMA received /under review AND acceptance or denial on codes. The codes accepted or denied will then be removed from the biweekly publication and submitted for the next month Medicaid bulletin. These codes will be published one time in the Medicaid Bulletin.
| NP/PA Codes Announced May 2015 | |||
| 22325* | 22633 | 96367 | 99241 |
| 22326* | 22634 | 96372 | 99242 |
| 22327* | 22802* | 96374 | 99244 |
| 22328* | 22804* | 96375 | 99245 |
| 22532* | 22843* | 96415 | 99291 |
| 22533* | 22845 | 96417 | 99292 |
| 22534* | 27245 | 96523 | 99304 |
| 22548* | 27269* | 99170 | 99305 |
| 22552* | 61070 | 99217 | 99306 |
| 22554* | 61154 | 99218 | 99355 |
| 22556* | 62252 | 99220 | J2270 |
| 22558* | 63045* | 99222 | J2469 |
| 22560* | 63281 | 99223 | * open to modifiers 80 and 82 only |
| 22595* | 63709* | 99234 | |
| 22600* | 64721 | 99235 | |
| 22610* | 82728 | 99236 | |
| 22612* | 83550 | 99238 | |
| 22630* | 96366 | 99239 | |
Helpful Tips on Diagnosing Acute Pesticide Poisoning
The North Carolina Pesticide Incident Surveillance Program, a program within the NC Division of Public Health, monitors the frequency of acute pesticide poisonings in the state and requires health providers to report confirmed or suspicious cases to them. Like many illnesses linked to environmental exposures, however, pesticide poisonings are commonly under diagnosed due in large part to barriers in seeking care and lack of recognition. Learn more about screening for and diagnosis of pesticide poisoning here.
Credible Newest Gold Level NCMS Vendor Partner
Credible, the leading independent marketplace for student loan refinancing, is the newest gold level partner with the North Carolina Medical Society (NCMS) to benefit members through the NCMS Marketplace. The partnership will help address the growing student debt issues of young doctors, who hold an average of over $170,000 of student debt at graduation.
Credible serves as a matchmaker between borrowers and lenders through its online marketplace, enabling graduates to save money by easily receiving and comparing their student loan refinancing options. With Credible, student debt holders can submit a single form and receive offers from multiple lenders. The average medical school graduate who refinances with Credible saves over $40,000.
“Doctors graduate with some of the highest student loan debt of any professional field,” said Stephen Dash, Founder and CEO of Credible. “We’re thrilled to be able to partner with NCMS members to enable them to alleviate some of their student loan burden through simplifying the student loan management and refinancing process.”
Franklin Walker, NCMS Director of Rural Health Initiatives, oversees vendor services for the NCMS Marketplace.
“We are pleased to partner with Credible and know they will offer excellent service to our members,” Walker said . “Our Vendor Services Program has become the go-to website for NCMS members when they are looking for a variety of services to help manage their practices.”
Problem Solved: How Do I Find My Local AHEC?
If you need an answer or a problem solved regarding your practice, as a North Carolina Medical Society (NCMS) member you have access to our Solution Center Coordinator, Belinda McKoy, who is standing by to help you solve the problem or answer your question. Call (919-833-3836 x142) or email Belinda the next time you need a problem solved.
Here is a common question Belinda receives:
| How do I find my local Area Health Education Center (AHEC)? |
| Please review the NC Area Health Education Centers website to find your local AHEC. |
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