November 2018 Issue
The following remarks are from Society President Naheed Van de Walle, MD.
The time has come to engage in the uncomfortable discussions about ELOC (End–of–Life Care). With the evolution and availability of highly sophisticated healthcare, longevity has increased to new highs. According to the US Census Bureau, 6.1 percent of population is under five years of age whereas 14.9 percent of population is over 65 years of age, which is projected to go up to 19 percent by 2030. What that means in terms of EOLC is that physicians will be faced with the complex decision making process more frequently. As such, physicians need to be better prepared to have these difficult and complex discussions with patients and families.
According to multiple surveys, a mere 12 to 14 percent of physicians surveyed have had ELOC discussion with their patients. In spite of the fact that Medicare considers such discussions as reimbursable as of January 1, 2016, that statistic is unchanged. It is worth pondering why that is so. There are several barriers for the reluctance to discussion of ELOC.
- Physicians are not adequately trained to develop the necessary skill to feel comfortable discussing the subject with patients.
- Losing a patient translates to a sense of failure on the part of the physician for not being able to conquer the disease and help patients. In order to initiate the discussions about end–of–life choices, physicians need to change the way they view EOLC.
- The complexity of health care choices available also makes the decision making process more complex.
- Lack of understanding of individual cultural, ethnic, and religious differences in our multi–cultural society.
- Infusion of politics in this important discussion needs to be left out and allow the discussion to take place between a physician and the patient.
The way to overcome these barriers is first to pay attention to physician education. We should begin training about EOLC at the medical school level and throughout the continuum of residency and fellowship and attending years. Specialists in Geriatrics, Palliative Care, Oncology, as well as Intensivists, offer training in ELOC discussions. Not just these specialists, but all physicians, need to remember that just as it is our responsibility to offer the best possible care, delivered with compassion to save our patients’ lives, it is also our responsibility to be able to discuss the options for people to die with dignity. Our role as physician is to provide care that heals and extends life and to aid a dying patient in alleviating the suffering associated with end of life, making way for a smooth transition from end of life to death with peace and dignity.
With proper training a physician should be equipped with the skills (knowledge and comfort level) to communicate to patient or surrogate the appropriate options clearly and in detail. Each aspect of DNR, DNI, or AND (Allow Natural Death) — implications, expected outcomes and any pain or suffering involved — needs to be articulated clearly and slowly. It is equally important to give information and listen to what the patient’s desires are, expressed through a living will or a health care proxy (if it exists).
Because of the level of sophistication in medicine today, we have complicated the process of dying. We certainly do not wish to prolong death at the end of life. That is why it is every physician’s business to become educated in EOLC issues so as to ease the discomfort and pain of dying for our patients.
Leo Tolstoy in War and Peace says, “ Though the doctors treated him, let his blood and gave him medications to drink, he nevertheless recovered.” We all work towards recovery for the patient, in spite of this cynical (but funny) outlook.
It may be better to end with these inspiring words from Danielle Ofri, MD, Clinical Professor of Medicine at NYU School of Medicine, in a recent article in the New York Times: “The awe of discovering the human body. The honor of being trusted to give advice. The gratitude for helping someone through a difficult illness. These things never grow old.”
The officers, Board of Directors, and staff of the New York County Medical Society wish you well in the coming holiday season. May you, your families, and your staffs enjoy a happy 2019 and all the best of the season. Thanks to your participation, your Society represents you and your interests in so many spheres of health care in Manhattan today. Call (212) 684–4670 to get more involved or to get assistance for your practice.
At its meetings on September 17, and October 15, 2018, the Board of Directors of the Society did the following:
- reported on meetings with Assemblymember Richard Gottfried to discuss the New York Health Act and concerns about single payer legislation;
- continued work on maintenance of certification issues with a Board subcommittee;
- agreed to form committees on gun violence and physician wellness; and
- discussed issues related to legalization of marijuana and statewide listening sessions.
The next meeting of the Board is November 26, 2018.
New York State has a new sexual harassment prevention law, included in the 2019 State budget that Governor Cuomo signed on April 12, 2018. Sexual harassment is offensive and unlawful. Businesses (including all medical practices with one or more employees) must have a written sexual harassment prevention policy document and a training program. (The New York State Department of Labor has a website with resources for employers and employees about the law, including materials that can be used in connection with the prevention policy and the training.) Everyone in the business or practice must know the policy, be aware of the issues, and avoid inappropriate or unlawful behavior.
As we notified our members, you need to have a policy document in your office now. On its website, the New York State Labor Department has provided a model policy document that you are encouraged to use as a starting point.
You can see this document as a PDF at https://www.ny.gov/combating-sexual-harassment-workplace/employers (scroll down for the PDF). But since you will need to insert your own practice’s name into the document, we recommend instead that you open it as a Word document that you can modify. Members can gt the Word document to insert your own practice's name in all the spots where it's indicated by contacting the Society at (212) 684–4670. Print out the policy document and give each employee a copy, have a copy at the front desk for reference, and incorporate the policy in your employee handbook. (Note: You're required to have a complaint form ready - there's a link for that too at the bottom of this memo.) Have Each Employee Sign An Acknowledgment of Receipt Note to Keep in Employee Files.
This policy document may evolve in the coming months. We recommend that you review it carefully and talk it over with your own attorney, or consult with the NYCMS General Counsel, to consider questions of documentation, the special obligations of employers and supervisors, and related issues. We'll update you periodically on any required changes and/or any new guidance from the Labor Department.
By January 1, 2019 Have Your Training Sessions Completed.
January 1, 2019, is the deadline for the training program. You must have provided the training to each employee by that date, and you must provide the training again within one year. Anyone you newly employ after January 1 must receive the training within 30 days, and must receive it again within one year of employment.
The Labor Department website has a detailed model script that you can refer to as you develop your training program. This model training script includes examples of prohibited conduct that would constitute unlawful sexual harassment; information on federal and state laws concerning sexual harassment; information about filing complaints, and about remedies for victims of sexual harassment; and many other important topics.
You can view the script as a PDF. Go to https://www.ny.gov/programs/combating-sexual-harassment-workplace. Scroll quite far down to “Protection Against Sexual Harassment.” Below that, on the left, click on "”For Employers.” Next screen: On the left, click on “Training Requirements.” Next screen: Click on “Sexual Harassment Prevention Model Training.Pdf.” You can print the PDF if you wish.
Read this script carefully and review it with legal counsel. Again, the script may evolve in the future. We will keep you updated.
Note one requirement that is still under discussion: Your training program must include at least some features that make it “interactive.” That means trainees must be able to participate actively, by asking questions and getting live answers if possible, or at least by giving you feedback on the training program and how it might be improved. The New York County Medical Society is in communication with the New York State Labor Department concerning this issue and will keep you informed.
Any active member who wishes to make a nomination for elective office in the New York County Medical Society may do so beginning February 1st, but no later than March 1st. Nominations for officers and delegates to be elected at the next annual election may be made in writing by no fewer than 10 active members in good standing. (Members must have paid 2019 dues. Names must be printed next to signatures.)
These positions are open for 2019 – 2020: President–Elect, Vice President, Secretary, Assistant Secretary, Treasurer, Assistant Treasurer, and one Trustee. In addition, there will be ten at–large seats on the Board.
Elections will also be held to fill spots for delegates and alternate delegates to the Medical Society of the State of New York.
Direct nominations to Jessica J. Krant, MD, MPH, Secretary, New York County Medical Society, 261 West 35 Street, Ste. 504, New York, NY 10001.
The following is by New York County Medical Society Counsel Scott Einiger, Esq., with content contribution by James McNally, CPC.
Your practice routinely submits bills for medical services with the expectation that you get paid.
Then years later, after receiving payment for prior services, you get a love note in the mail from a commercial insurance carrier (special investigations or similar department) requesting you send multiple charts of patients you have treated, oftentimes not even sharing the true agenda in making the record request.
Of course being diligent, you tell your staff to send out these records to comply immediately, right? Wrong!
Instead, alarm bells should go off before you respond in any way to these carrier audit requests, as their goal is typically to seek a large refund from you, whether you are an in–network physician or for out–of– network services.
So what should you do instead? Remember the acronym “TRAP.”
Do not fall into one; instead apply the steps outlined in “TRAP.”
1) Take your time.
2) Review charts.
3) Assume you are under audit.
4) Professional Guidance from the Society ombudsman or Society counsel or your own private counsel.
Records that contain protected health information are protected under HIPAA and New York State Public Health Law (18) as confidential and while they may be released under HIPAA for payment review purposes, under New York State Public Health Law 18 there is a higher threshold for such record release requiring appropriate consent.
Further, State law is not superseded or preempted by federal law in this regard. So patient or other lawful (guardian) authorized (written) consent is required prior to release.
Carrier representatives, who often are not attorneys, may send misleading letters to you that advise you to send the numerous charts being requested without complying with New York State law.
New York State Department of Health Counsel previously noted in a written opinion that release of records without obtaining appropriate consent violates New York State law. Such action could expose you to a claim of professional or medical misconduct.
Don’t fall into the “TRAP” set for the unwary by sending patient records prematurely. Take your time. Review Charts. Assume an audit is underway. Professional guidance is absolutely crucial.
Carriers will use these charts against you to extrapolate and demand tens of thousands of dollars or more in a refund demand. Making sure the carrier is following the appropriate peer review procedure and affording you due process under New York State law is paramount to avoid unlawful refund demands being made. Your Society provides valuable resources and access to representatives in this area that can help.
Oftentimes after a coding and billing expert reviews your medical records on your behalf, the carrier claims are proven to be unfounded.
Carriers may seek refunds going back six years, even though the law restricts them in most instances to a shorter review (two–year) period, or the carriers may not even be accurate in their coding assessments.
Companies may not have peers in your area of medical expertise look at your care. They could have “hired guns” in other specialties, whose only purpose is to find fault in order to obtain a refund.
Mississippi Case Supports an Equitable Defense
The Society’s ombudsman shared a case published in Mississippi (cited below) applicable to what certain third–party insurers are doing when they seek money back for a service that they already paid when they (1) knew that it was not covered or (2) when they paid it on a long–term historical basis and then said it should not have been paid at all and so seek a refund.
It’s akin to the estoppel argument frequently used in New York, called Restatement of Restitution Theory (the carrier positioned against physician has the lesser of “clean” hands as the carrier created the situation in the first place.)
In Mississippi, the United States District Court relied on the Restatement of Restitution as well as on respected commentator S. Williston’s treatise on contract law, and reached the decision that the health care provider did not need to repay the insurance company for ongoing, mistaken payments.
The Court wrote that the widely–recognized exception to the general rule is that restitution may not be had in cases in which the mistaken payment is made to an innocent third–party creditor, that is, one who had made no misrepresentations and had no knowledge of the mistake when (s)he accepted payment.
The insurance company created the situation and was in the best position to avoid it, so the insurance company had to bear the loss. The health care provider was “an innocent third–party creditor.” National Benefit Admin. v. Mississippi Methodist Hospital, 748 F. Supp. 459 (S.D. Miss. 1990).
The precedent cited above, although not binding to a New York Court, clearly states a valid defense theory to protect the more innocent party (doctor) from being forced to repay mistaken repeated payments made erroneously by insurance companies.
Based on the Restatement of the Law of Restitution, the rule states doctors shouldn’t have to repay overpayments that the insurance companies made by mistake, as long as the doctor made no misrepresentation concerning the mistake, and the doctor had no notice of the mistake when accepting payment.
This is fair policy because the insurance company is the one in the best position to have known the policy coverage, it created the mistake, and it was in the best position to have avoided or mitigated the error. The doctor provided the medical services, and was therefore a bona fide creditor.
In summary, these matters require careful consideration to assure fair review. Merely sending records at the request of carriers leads to substantial refund demands. Be guided accordingly.
Scott Einiger specializes in health care law and represents physicians in professional conduct investigations, the purchase, sale and integration of medical practices, insurance fraud investigations, transactional work, regulatory compliance, and managed care litigation. He helped initiate the mass arbitration lawsuit against Oxford representing fifteen medical societies and hundreds of aggrieved physicians. Mr. Einiger is Special Counsel to the New York County Medical Society and General Counsel to The American Academy of Psychoanalysis. He was also part of a comprehensive risk management/ quality assurance program designed to reduce liability risks for health care professionals and hospitals insured with the Medical Liability Mutual Insurance Company where he was counsel for 15 years.
The following is courtesy of James McNally, the Society’s Third–Party Insurance Help Program. If you have questions, call the Society at (212) 684–4681.
• CMS Releases 2019 Medicare Part B Premium and Deductible Figures: The Centers for Medicare and Medicaid Services (CMS) has announced that the standard Medicare Part B monthly premium for 2019 will be $135.50, an increase of $1.50 per month over last year.
The annual Medicare Part B deductible will increase to $185. After meeting this deductible, beneficiaries typically pay 20 percent of the Medicare–approved amount for covered services.
To read more on the 2019 data, click on the link here.
• Medicaid Reminder: Documentation Required for Medicare and Third–Party Insurance Primary Submissions: All crossover claims submitted from Medicare and other third–party billing should accurately reflect payments received from other insurers to allow correct calculation of Medicaid reimbursement amounts. The Explanation of Benefits and other documentation supporting Medicare and third–party reimbursement amounts must be kept for audit or inspection by the Department of Health, Office of the Medicaid Inspector General (OMIG), the Office of the State Comptroller (OSC) or other state or federal agencies responsible for audit functions.
Additionally, for any claim submitted to Medicaid with a zero–fill reimbursement from Medicare or a third–party insurer, the provider must retain evidence that the claim was initially billed to Medicare and/or the third–party insurer and was denied before seeking reimbursement from Medicaid. The exception to this policy in which providers may bill Medicaid directly without first receiving a denial for items that are statutorily not covered by the Medicare program. Providers are responsible for retaining the statutory exemption from Medicare for audit or inspection.
• Attention: All Medicaid Physicians — Claims Pending Review for Edit 02287: Effective October 25, 2018, an additional edit for Delay reason code 11 will be implemented.
eMedNY edit 02287 (Delay Reason Code 11 [Other Delay] Requires Manual Review) will pend for review for all claim types.
HIPAA reason code 29 (Adjustment Reason Code 29 with no Remittance Remark Code) will be reported on the 835 remittances. Claim status code 718 will be reported when the claim is pended for manual review. Claims will be manually reviewed and if denied, must be resubmitted as a paper claim with appropriate documentation to support the use of delay reason 11 to the following address:
PO Box 4601
Rensselaer, NY 12144–4601
Physicians should confirm that delay reason code 11 is appropriate when submitting these claims.
Please visit the eMedNY.org website Timely Billing Information section at the link here:
This will allow you to view slides from the most recent webinar on Timely Billing that includes common examples for the appropriate use of delay reason code 11 as well as other delay reasons used in Medicaid Claims processing.
General questions for claims submission should be directed to CSRA at (800) 343–9000. Questions on specific claims that are pended for review should be directed to the Bureau of Medical Review, Pended Claims Unit at (800) 342–3005 (option 3).
• UHC is Moving Single EOB Search to Link: This news from United HealthCare — “The Single Explanation of Benefits (EOB) Search tool gives you multiple options to quickly locate an EOB or remittance advice. To make it easier to access the tool, we’re moving it from UnitedHealthcareOnline.com to Link. You’ll be able to add the new Single EOB app to your Link dashboard starting February 22, 2019. To read more, click on the link here:”
• CMS Offering Web-Based Training on MIPS: The Centers for Medicare and Medicaid Services is offering web–based training courses on some of the components of the Merit Based Incentive Payment program (MIPS).
Quality Payment Program 2018 MIPS Improvement Activities Performance Category Web-Based Training Course — Revised.
A revised Quality Payment Program in 2018: Merit-based Incentive Payment System (MIPS) Improvement Activities Performance Category Web-Based Training Course is available through the Learning Management System at the link here. You must login or register to set up a permanent account. https://learner.mlnlms.com/Default.aspx
• How the category fits in the Quality Payment Program
• Steps to report data
• Basics of scoring
Quality Payment Program 2018 MIPS Cost Performance Category Web–Based Training Course — New
A new Quality Payment Program in 2018: Merit–based Incentive Payment System (MIPS) Cost Performance Category Web–Based Training Course is available through the Learning Management System at the link here. You must login or register to set up a permanent account. https://learner.mlnlms.com/Default.aspx
• Data sources used to calculate scores
• Cost score calculation methods
• Beneficiary attribution
• 2017 MIPS Final Scores and Payment Adjustments Information Have Been Revised:
As reported previously, the Centers for Medicare and Medicaid Services (CMS) had released information on the 2017 MIPS performance feedback results and who would be impacted by a payment adjustment/penalty in 2019. They have now announced that these results have been recently revised where this update may affect your score and, more importantly, whether you will be subject to a payment adjustment/penalty
Because of this change, physicians are urged to again access the QPP portal using your EIDM account to determine if there have been any changes to their scoring and potential payment adjustments/penalties. If CMS has now determined that you will be subject to a payment adjustment/penalty and you disagree with their findings, you should immediately file an appeal via the Targeted Review process. CMS has extended this deadline for MIPS participants to appeal their performance feedback (scoring) via a Targeted Review and this deadline is now October 15, 2018, at 8:00 PM Eastern time. You may do this by accessing the QPP Portal using your EIDM account and password at the link here. https://qpp.cms.gov/login
• Emblem Health/GHI Issues Restrictive Modifier 25 Policy with Evaluation and Management Services Reported with Procedures: Beginning October 30, 2018, Emblem Health will revise its current coding policy that will apply to GHI plans regarding E/M services billed with modifier 25 within 28 days of a previous face–to–face service. The E/M service will be denied when both of the following apply:
The E/M service (92002–92004, 92012–92014, 99201–99380, 99441–99499) is billed with modifier 25 on the same day as a procedure with a 0–day, 10–day, or 90–day postoperative period.
The patient has had a face–to–face service with the same provider for the same condition as the E/M service, and the 0–day, 10–day or 90–day procedure within the previous 28 days.
Face–to–face service codes included in this medical policy: 10021–36410, 36420–44680, 44800–69990, 90935–90993, 92002–92371, 92502–92504, 92511, 95831–95852, 96365–96379, 96405–96406, 96440, 96450, 96542–96999, 97597–97755, 97802–98943, 99100–99170, 99201–99285, 99291–99337, 99341–99357.
This policy change is, again, indicative of Emblem Health’s practice of delaying claim payments and will force the physician to file an appeal if they feel that there is a significant separate and distinct problem, not associated with a procedure performed or during the global period for a prior procedure.
If one exists, then the physician should appeal the determination by providing the appropriate documentation that substantiates the additional billing.
A contact was made with the New York State Department of Financial Services (NYSDFS) and their opinion was sought as to whether this policy change is in violation of present law and regulations. As more information is received, we will keep the membership apprised.
• NYSWCB Announced New TPAs for Workers’ Compensation, Volunteer Firefighter, and Volunteer Ambulance Claims: As of September 10, 2018, the Special Funds Conservation Committee (SFCC) will no longer be administering workers’ compensation, volunteer firefighter, and volunteer ambulance worker claims. These claims are being transferred to new third–party administrators (TPAs), who will assume all claims administration services.
Notifying Injured Workers: Injured workers have been notified of the name and contact information of their new TPA and have been advised to inform their legal representatives and medical providers of this change.
Medical Reporting and Billing: All requests for treatment authorization on and after September 10, 2018, must be sent to the correct TPA for the injured worker.
All medical bills received by SFCC in error during this period of transition will be forwarded to the proper TPA for resolution and payment.
Finding the New TPA: If you are providing medical treatment or legal representation for an injured worker who lists SFCC as their insurer on or after September 10, 2018, please inquire further, as the SFCC will no longer be the claims administrator at that time.
For information about the new TPA, the injured worker (or your office if you have previously submitted Form OC–400 or medical bills to the Workers’ Compensation Board for that person in that workers’ compensation case) may contact SFCC or the Workers’ Compensation Board.
Buffalo: (716) 686–5700
Dewitt: (315) 445–9405
New York City: (212) 883–3900
Please note, the distribution of claims amongst the new TPAs does not follow any identifiable pattern (such as injured worker last name or injury date) that can be shared ahead of or after the transfer; however, the SFCC and the Board can provide this information to you on a case–by–case basis upon your request.
• Medicaid Introduces New Edit to Validate Submitted Procedure Codes and Associated National Drug Codes (NDCs): Effective September 20, 2018, enhancements were added to the eMedNY System to validate submitted procedure codes and their associated NDCs. A new edit will ensure that the submitted NDC code reported on a professional claim is associated with the submitted procedure code. To read more, click on the link here. https://www.emedny.org/ProviderManuals/communications/new_edit_validate_submitted_procedure_codes_associated_ndcs.pdf Note: This document contains a link to a very helpful resource that lists all drugs and their associated NDC codes)
• New Medicare Card Replacement Initiative — MBI to be Returned on Eligibility Response: The eMedNY System is being enhanced to comply with CMS’ New Medicare Card Replacement Initiative. Effective 9/20/2018, the Eligibility Response for clients enrolled in both Medicare and Medicaid will return the new MBI (Medicare Beneficiary Identifier), if available, when using the following access methods for Eligibility verification:
— POS Devices
— 270/271 Transactions
Until 12/31/2019, if the MBI is not available for the client, the HICN (Health Insurance Claim Number) will be returned by the access methods noted above.
After 01/01/2020, only the MBI will be returned by the access methods noted above.
Providers who use ePACES to verify eligibility should inform their staff or agent(s) that on 9/20/2018 the ePACES Eligibility Response Medicare Information Section’s “Health Insurance Claim Number HIC” label will read “Medicare Identifier.”
Providers who use the POS device to verify eligibility should inform their staff or agent(s) that even though the HICN Tag will not change, the MBI will be displayed if available, as of 9/20/2018. As with other access methods for eligibility, if the MBI is not available, HICN will be displayed until 1/1/2020. The MBI is unique in that it contains only numbers and uppercase letters (no special characters) and will not contain the letters S, L, O. I. B. and Z.
If you have any questions, please contact the eMedNY Call Center at (800) 343–9000.
More information on the New Medicare Card Replacement Initiative is available at
• Reminder on Off–Cycle Medicare Enrollment Revalidations: Medicare has a long–standing requirement that physicians must revalidate their enrollment with the Medicare program normally every five years once the initial enrollment revalidation has been completed.
This is the normal process, but Medicare can initiate revalidation requests outside this time frame on an off–cycle basis in addition to this regular five–year cycle.
This off–cycle revalidation can be the result of:
— Random checks
— Information indicating local health care fraud problems
— National initiatives
If warranted, these off–cycle revalidations may be followed up by site visits.
As a corollary to the above, physicians are reminded that they must report the following reportable events to their Medicare contractor within 30 days of:
— A change of ownership;
— Any adverse legal action; or
— A change in practice location.
All other changes in enrollment must be reported within 90 days. Keep in mind that not responding to a revalidation request in a timely manner will result in deactivation of billing privileges.
• UHC To Retire Certain Fax Numbers Used of Prior Authorization Requests: United Healthcare will be retiring certain fax numbers for medical prior authorization requests and asking you to use the Prior Authorization and Notification tool on Link.
This is the website you already use to check eligibility and benefits, manage claims and update your demographic information. To read more, click on the link here. https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2018/Retiring-fax-numbers-article.pdf
• CMS Issuing Letters Requesting Your Input Related to Medicare Data Collection on the Post–operative Visits Project: Your office may soon receive a letter requesting that you provide data to the Centers for Medicare and Medicaid Services (CMS) related to the Medicare Data Collection on Post–operative Visits project. The recent 2019 Medicare Fee Schedule Proposed Rule addressed this item as follows.
CMS had devised a policy to convert all 10– and 90–day global codes to 0–day global codes beginning in 2018. Subsequently, Section 523 of MACRA prohibited CMS from implementing this policy and instead required the agency to gather information needed on surgical services from a representative sample of physicians. Reporting was to be required only for services related to codes reported annually by more than 100 practitioners and that were reported more than 10,000 times or had allowed charges in excess of $10 million annually.
Only practitioners who practiced in groups with 10 or more practitioners in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island were required to report. Practitioners who only practice in smaller practices or in other geographic areas were encouraged to report data, if feasible.
For 2019, CMS provided a first look at data received via its mandated reporting of CPT code 99024 for 10– and 90–day global procedure codes in these nine states for groups of 10 or more physicians. Congress mandated that CMS collect this data to determine whether patients were receiving all the services built into global payments.
Based on this first, high–level analysis, CMS says it will do additional surveying and analysis including more targeted surveys of individual physicians and procedures.
However, the agency says it is not making any recommendations to change payment for global surgical procedures for 2019! The letter you received is the result of this additional surveying and, as such and at the present time, is solely for data collection purposes.
For guidance on this issue, contact us through the Third–Party Insurance Help Program.
If you have questions on any of these issues, contact the Society’s Third–Party Insurance Help Program at (212) 684–4681.
New York State Workers’ Compensation Board Chair Clarissa M. Rodriguez today announced the Board has launched a first–in–the–nation initiative that allows injured workers and other participants to attend workers’ compensation hearings right from their homes or offices. The Board’s virtual hearings provide injured workers a way to move the claim process forward without the need to travel many miles for a hearing that may last only minutes, which is especially beneficial depending on the extent of their injuries.
The New York State Workers’ Compensation Board developed virtual hearings in partnership with the Office of Information Technology Services to give all parties involved the option of using a smart phone, tablet or computer to attend hearings. This is the first high definition, all access system for legal hearings in the nation, where multiple users in different locations log in once and then move from one hearing to another.
“This state–of–the–art, secure technology removes obstacles and stress for hard–working New Yorkers who were injured on the job, as well as for business owners and the professionals who participate in the system,” Board Chair Rodriquez said. “Virtual hearings allow injured workers to remain in their homes and other participants to attend from their workplaces. Our successful pilot and now statewide launch demonstrate New York's commitment to helping people hurt on the job.”
To participate in a virtual hearing, the party of interest needs only a smart phone, tablet or computer with a microphone and video camera, as well as a high–speed internet connection. All participants can see and hear each other on their respective screens. Additionally, workers’ compensation law judges can share claim documents with all involved parties. The system includes security.
The Board is also developing a mobile app, for future release, that parties may download and use to attend hearings.
“Virtual hearings save injured workers the burden of travel, which is particularly helpful for someone with impaired mobility, especially during the harsh winter months,” Chair Rodriguez said. “They make it easier for injured workers to receive benefits and for other parties, such as employers and attorneys, to participate in the workers’ compensation system.”
“The Office of Information Technology Services is pleased to partner with the Workers’ Compensation Board to deploy technology that makes it easier to serve injured workers across New York State,” said New York State Chief Information Officer Robert H. Samson. “Here in New York, we are harnessing the power of technology to deliver innovation that matters … for all New Yorkers, and virtual hearings are the latest example of this.”
Many workers’ compensation hearings last less than 10 minutes, but injured workers can still lose time from work and suffer inconvenience traveling to Board offices. Weather–related complications can also make these trips difficult. Virtual hearings are entirely optional though, and parties may now choose them over attending a hearing at a Board office. They can always choose to attend in–person if they prefer.
Virtual hearings were first tested in the Capital District Office in Menands in November 2017, then rolled out across the state. Since the beginning of the pilot, more than 33,000 hearings have included at least one party who appeared remotely, successfully connecting injured workers, law judges and representatives from all over New York and nationally. The Board has trained more than 780 participants on the system, including law judges and other staff, attorneys and legal representatives. Feedback has been overwhelmingly positive.
Todd L., an injured worker, said, "Once we got connected, we had great audio and visual and everything ran smoothly right up to the resolution. It was actually very convenient — given that the hearing was in New York and I was in Georgia — versus having to travel back to a central location in Albany.” (Privacy laws protect the identities of injured workers.)
Attorney Matt Mead said, “Virtual hearings save me travel time and as a result have saved my clients some fees because I don't have to bill them to get back and forth to the locations. I think it could be really useful to out–of–town witnesses. I deal with some employers who are out of the immediate area and would have to take time away from their businesses to travel. If they could appear virtually, that would be helpful to them.”
Virtual hearings are another successful element of the Board’s Business Process Re–engineering, which has been improving the overall health of workers’ compensation in New York since 2013. More information on virtual hearings, including instructional videos and other training materials, is at www.wcb.ny.gov/virtual-hearings.the-art Virtual Hearings
It’s no secret that employees violate security policies. Whether we’d like to admit it or not, there’s a good chance we have all violated a security policy once upon a time. Sometimes, employees violate policies to save time or make their job easier, and sometimes, they don’t even know they’re doing it. How do you ensure your employees are following your security policies? First, you must figure out why they’re breaking the rules, to begin with. Below we highlight findings made by Dark Reading as to why employees violate security policies.
Reason #1: “I didn’t know”
It’s an age–old excuse, but many times policies are violated due to ignorance. We often expect employees to know they’re “supposed to” exercise certain security measures, but the truth is, many of them don’t know what those measures are.
According to a study from February 2018, 52 percent of companies do have a cybersecurity policy in place, but what good is a policy if employees don’t know it exists? That same survey found that nearly half of entry–level employees don’t know if their company has a cybersecurity policy or not.
Reason #2: “It’s easier this way”
Despite nearly half of employees knowing a cybersecurity policy exists within their organization, many of them choose to act as if they don’t. We all know that the easy way isn’t always the safe way, but sometimes, employees choose convenience over following the rules to avoid a disruption in their work–flow.
Maybe a co–worker or third–party vendor needs access to a system they don’t have credentials for. Sure, the right thing to do would be see that they get their own credentials to access the system, but it’s much easier to just give them yours. What’s the harm if you change your password after? Of course, this is poor cybersecurity. Maybe you reused that password on various other systems, now you have given out the key to all your doors and violated your organization’s security policy (if it exists).
Reason #3: “I’m frustrated”
Sometimes even the best employees break the rules. Perhaps an employee has been trying to remote into the company’s server from home but is having trouble. If that employee needs to get their work done to meet a deadline, they may decide to do so locally on their computer, or if they’re having trouble with their internet connection, may go to a public location, such as a coffee shop, to use their free Wi–Fi for a better signal. There’s a good chance that employee knows this is against their company policy, but under stress, the employee decides to take their chances and roll the dice.
Reason #4: “I’m curious”
Your cybersecurity policy should outline that employees only access information required to perform their job function, but many times, that is not enough to stop an employee from snooping. We’re humans, we’re curious! Employees might be wondering which celebrity client may be requesting an appointment, or how much money their co–workers make. Although this is a violation of policy since the information isn’t required to perform necessary work–functions, curiosity often gets the best of an employee, causing them to break the rules.
Reason #5: “I was just trying to help”
In some instances, employees know the rules that are in place, but when asked to do something outside of the rules, they feel compelled to listen. For example, Business Email Compromise (BEC) Scams are huge in the cybercrime industry. If an employee gets an email from their boss requesting a wire–transfer for funds to deposit into the company holiday party fund, there is a good chance that employee will quickly complete the transfer of funds, despite the odd request falling outside of policy.
What can you do?
Knowing why employees violate security policies is extremely important and useful in helping your organization address those issues.
1. Make sure employees are aware of your organization’s security policies. If you are not properly communicating the rules and expectations for your employees, you cannot expect them to follow them.
2. Employees who violate policies due to the convenience in doing so may always look for an easier way to accomplish a task or avoid disrupting their work–flow. Ensuring that accounts, access provisioning, and approvals are a seamless process will help employees not feel the need to side–step the rules in order to accomplish their job–function.
3. Your organization must also be ready to hold policy–violators accountable for breaking the rules. Often, employees who break the rules, maybe out of frustration, know there is a workaround that is in violation of their organization’s security policy. Unfortunately, those individuals often recognize that their employer won’t reprimand them for their misconduct, so they move forward, feeling comfortable enough to break the policy. Make sure your employees know that will be repercussions for policy violations.
4. To help control policy–violators who are curious about information they shouldn’t be accessing, ensure your organization has proper access–controls in place. In addition, monitoring your employees’ cyber–behavior will not only help you identify inappropriate access (both internally and externally) but will also make your employees aware that you are enforcing the rules.
5. Cybercriminals are becoming more sophisticated in their attacks and will continue to find new ways to trick employees into falling for their scams. Employees who violate policies while trying to be helpful in scenarios such as a BEC Scam may act on a request quickly, before thoroughly thinking it through. Ensure that your employees have gone through security awareness training and receive continuous education on new threats and best practices. Spear–phishing, as seen in a BEC Scam, can be very convincing attempts by cybercriminals. While email filters may aid in sorting out malicious attempts, employees MUST know how to spot these attempts on their own to protect your organization.
The Doctors Company is the New York County Medical Society’s exclusively–endorsed professional liability insurer. We join many of the country’s most prestigious medical organizations that endorse or sponsor the nation’s largest physician–owned medical malpractice insurer.
NYCMS members gain a partner uniquely aligned with physicians for over 40 years — and that has always been guided by its mission to advance, protect, and reward the practice of good medicine. The Doctors Company insures 80,000 members, has $4.6 billion in assets and $2 billion in member surplus, and is rated A by A.M. Best Company and Fitch Ratings—giving the company the financial strength to protect New York physicians now and for many years to come.
Society members who join The Doctors Company will receive extensive benefits, including:
· Claims–free credit of up to 12 percent for eligible members.
· Five percent credit for members who participate in the Section 18 excess risk management program.
· Extensive patient safety tools and resources, including free on–demand and live CME.
· Aggressive defense.
Members of The Doctors Company are also eligible to participate in the Tribute® Plan, a breakthrough financial benefit that rewards members for their loyalty and for their commitment to superior patient care. The company has paid more than $50 million to retiring doctors to date.
For more information on your membership privileges with The Doctors Company, call (800) 421–2368 or visit thedoctors.com and tell them you are a member of the New York County Medical Society.
Congratulations to Society Trustee and Past President Scot B. Glasberg, MD, who received The Plastic Surgery Foundation Distinguished Service Award in October.
Established in 1984, recipients are nominated by The PSF President in recognition of a member or other individual who shows exceptional contribution of time and talent and is dedicated to an activity, committee or board. Scot B. Glasberg, MD, holds numerous positions within national, regional and local medical and specialty societies. He is a past president of American Society of Plastic Surgery, and also served as the Society’s vice president of Advocacy and Health Policy. Doctor Glasberg involves himself in research activities and his research has been published in numerous peer–reviewed journals and has included new techniques in breast reconstruction and the treatment and prevention of keloid and hypertrophic wound healing, as well as the assessment of pediatric craniofacial deformities. Dr. Glasberg travels to Albany, New York, and Washington, D.C., several times each year to speak about many healthcare and medicolegal issues, and he has testified before Congressional committees and panels of the FDA.
If you are retired or over age 72, you may qualify for life membership in the Society. Life membership must be applied for by the member. To inquire about applying, call Membership at (212) 684–4682, for information.
The following 40 candidates for membership have been presented to the Board of Directors of the Society.
Jason M. Abramowitz, MD
Surbhi Agrawal, MD
Natalie Alvarez, MD
Anuschka Bhatia, MD
Julia Belle Blanter, MD
Brian Chernak, MD
Michael Chung, MD
Manjil Chatterji, MD
Elizabeth Cody, MD
Nicholas J. Costable, MD
Christopher Lee Crogan, MD
Jason Gordon, MD
Rebecca Hellmann, DO
Sophia Hsien, MD
Chandra Marie Ivey, MD
Evan F. Joiner, MD
Pratistha Koirala, MD
Jennifer Kraut, MD
Jacob C. La Salle, MD
Jeffrey Lautin, MD
Bea Genevieve A. Leal, MD
Bradley H. Lee, MD
Brian Lefchak, MD
Scott Leikin, DO
Matthew James Linn, MD
Moustafa W. Mourad, MD
Yonina Murciano–Goroff, MD
Edmund Albert Nahm, MD
Sarah Corinne Noble, MD
Daniel J. O’Neill, MD
Monica Ortiz, MD
Alopi Patel, MD
Vishaal Prabhu, MD
Kristina M. Quirolgico, MD
Andre Robinson, MD
Jordan M. Ruby, MD
Ammar Navid Saigal, MD
Akhil Abraham Saji, MD
Emily J. Senay, MD
Janki Shah, DO
Jay Shah, MD
Ravi Shah, MD
Christine Hope Umandap, MD
Camari Wallace, MD
Robert F. Ward, MD
The following educational piece is from Alex Tomei , Vital Planning Group, LLC, the Society’s endorsed vendor for financial planning.
In retirement planning and employee benefits, traditional pension plans are much less common than they used to be. But for many small business owners, including doctors, they can still be used to defer hundreds of thousands of dollars of taxable income a year, and can be layered on top of other retirement planning strategies, such as a 401(k). With new tax laws in effect for 2018, pensions, also known as Defined Benefit (DB) Plans, are getting new life.
The Tax Cuts and Jobs Act (TCJA) of 2017 introduced valuable tax deductions for owners of pass–through business entities, meaning business entities where the income is taxed to the individual owner(s), not to the business itself. However, owners of service businesses, such as medical practices, must have income below $315,000, for a married couple, or $157,500 for a single taxpayer, to take full advantage of deduction. One effective way to reduce taxable income and qualify for the deduction may be establishing and funding a DB plan.
A DB plan requires the employer makes to make contributions for each eligible employee, according to a set formula. These contributions are tax–deductible to the employer and tax–free to the employee. When the employee starts taking withdrawals from the plan in retirement, the distributions will be treated as ordinary taxable income. While business owners often like the idea of contributing to a DB plan for themselves, it’s important to keep in mind that they will have to make contributions for their employees as well. The contribution is calculated to achieve a certain benefit by the time the employee retires, so it’s generally a much smaller amount for younger employees than it is for those closer to retirement. Generally, the contribution for high–income workers in their 30s and early 40s will be less than $100,000, but limits for older workers can rise quickly, to above $200,000 for those in their late 50s and above $300,000 for those in their late 60s.
The participants’ investments are managed collectively, usually with a guaranteed set return. In a cash balance DB plan, each employee’s share of the investments is tracked individually, so participants know each year how much they individually hold.
A DB Plan may be the next logical step for successful business owners who are already funding their 401(k) profit–sharing plans up to the contribution limits and want to further reduce their tax liability. DB plans are subject to ERISA requirements, which can be extensive and are among the more complicated retirement plans to administer. However, for those who hope to reduce their taxable income to qualify for the new tax deductions available under the TCJA, a DB plan can be doubly beneficial.
Securities, investment advisory and financial planning services through MML Investors Services, LLC. Member SIPC www.sipc.org . Vital Planning Group, LLC is not a subsidiary or affiliate of MML Investors Services, LLC, or its affiliated companies 6 Corporate Drive, Shelton, CT 06484, Tel: 203–513–6000. CRN202010–237390
Representatives do not provide tax and/or legal advice. Any discussion of taxes is for general informational purposes only, does not purport to be complete or cover every situation, and should not be construed as legal, tax or accounting advice. Clients should confer with their qualified legal, tax and accounting advisors as appropriate
With so many new Assemblymembers and Senators coming Albany next year, the need for physician grassroots involvement is greater than ever. With the Democrats taking control of the both the New York Senate in addition to the Assembly, there could be significant change in the approach to health care legislation. For example, many Democrats in their campaigns pushed
for many progressive changes, including single payer healthcare. While that bill has overwhelmingly passed the Assembly multiple times, it was known that it would not be taken up by the Senate. Furthermore, many candidates ran on the platform of legalizing recreational marijuana, something that Governor Cuomo has pledged to advance legislation. There will also likely be a big push to pass the Comprehensive Contraception Coverage Act.
MSSNYPAC has developed a number of tools to better assure physicians can proactively engage New York’s law makers. With some new faces in the legislature, it is a perfect time to engage them to assure they are familiar with the concerns of physicians and their patients. This is also an opportunity for PALs (Physician Advocacy Liaison Network) to expand their relationships with their own legislators and create new ones. Maximize your effectiveness as an advocate for your patients, medical practice, and profession through MSSNYPAC and the Physician Advocacy Liaison Network (PAL). For more information about the PAL, contact Carrie Harring at
You have rights when you deal with managed care plans.
- The Prompt Payment Law: YOU HAVE THE RIGHT to complain if a clean claim hasn’t been paid within 45 days.
- External Appeals: YOU HAVE THE RIGHT to file an external appeal if services have been denied under certain specific conditions.
- Fee Schedules: YOU HAVE THE RIGHT to get your fee schedule!
- Chart Requests: YOU HAVE THE RIGHT to get more information from the carrier first when you receive a chart request.
- Refund Demands: YOU HAVE THE RIGHT to get more information and appeal when carriers demand refunds.
Society members look forward to the Annual Medicare Update presentation by Jim McNally, NYCMS insurance consultant, as well as a January presentation by Jim Bavoso, Manager of Provider Outreach & Education for National Government Services.
Jim McNally describes changes that are expected in the coming year; Jim Bavoso, details those that are official once 2019 has arrived. As there’s a huge range of topics, the two presentations are quite different. We encourage everyone to attend both sessions — they’re both important, and they’re mutually complementary.
Both presentations will be held in the Corwin Hall at MEETH (Manhattan Eye, Ear and Throat Hospital), 210 East 64th Street, New York.
Thursday, December 20, 8:00 a.m. to 10:00 a.m.: Medicare Update with Jim McNally
Thursday, January 10, 8:00 a.m. to 10:00 a.m.: 2019 Medicare Update with Jim Bavoso
When an employee leaves a company, the usual routine employers follow is to post the job description that has been put together for the position, and then sift through the responses. But this is not the best approach to filling a position, nor the best way to ensure that the new employee is successful in the job and stays with the company.
Looking at the Job Itself
Before posting the job description, you need to take a close look at the job itself, what it involves and what skills are needed. Odds are that over time, the duties and responsibilities of the position have changed as the company has grown and may be substantially different from what the existing job description contains.
For example, you need to look at how the company has changed and the department where the job is located has changed since you last hired someone for the position. You also need to look at other people in the department as well and the makeup and skills of the current team, which may also be different. Look at how the person who last held the job spent most of his or her time.
Ask yourself what skills the job now requires, skills that the former employee may not have had but are now needed. Look ahead and attempt to determine what duties and responsibilities will be required of this job with the changes expected in the coming year.
Another thing to consider is the necessity of the job itself. As the company has changed, is the position itself really needed, or can the tasks of the job be spread among other people in the department and the resources required for the position used in other places? Another question to consider, with the rise of the gig economy, is whether you can outsource the duties of the job to independent contractors.
These are all questions about the job itself that should be considered even before looking at specific people to fill the position.
Making a Better Fit
Once you have answered these questions, you will know with much greater precision the skills and experience that are needed. It will enable you to find someone who is a good fit for the actual job as it is now, greatly increasing the probability that the person will be successful in the position and will stay with the company longer.
In its continuing effort to introduce members to services that will help their practice thrive, the New York County Medical Society is pleased to announce the addition of a key Business Partner to help your practice with services you use every day. Storage Quarters is a comprehensive, full service company specializing in document storage, records management, scanning records and imaging, secure document destruction, self storage and on–demand storage.
The company specializes in the protection and management of your information. Your business or personal possessions are your most important assets. Storage Quarters customizes information management solutions to suit your needs and always offer a cost–effective quote. Now, Storage Quarters is offering special savings to New York County Medical Society members.
With this new arrangement, Society members will receive discounts on:
- Initial pickup and transport of files (NO Charge as opposed to the $39.95 fee non-members pay);
- Discount on the minimum storage fee (20%) ;
- Discount on 1.2 cubic foot box storage (10%);
- Discount on destruction charges, (20% off) and more.
Storage Quarters has scanning, storage, shredding services, with a number of easy and professional options for physicians trying to determine how to work with paper files and material in their office.
Citi Waste is now an exclusive provider of medical waste management services offering deep discounts to New York County Medical Society members. Whether sharps, red–bag, chemo, pathology, hazardous, or pharmaceutical waste, Citiwaste will work with you to classify and segregate waste streams for best pricing.
In addition, Citi Waste will determine the appropriate service frequency and deliver the supplies you need to package wastes. Guaranteed savings with no fuel, stop, energy, or environmental fees. Medical waste manifests available online 24/7 at no charge. One provider for all your medical, hazardous, and pharmaceutical waste.
Protection for your business with complete regulatory compliance. Call David at (718) 372-3887 to learn more about how Citi Waste can save you money.
Gerald Friedman, MD. Doctor Friedman received his MD degree from University of Buffalo School of Medicine in 1957.
Thomas King Lammert, MD, died November 21, 2017. Doctor Lammert received his MD degree from St Louis University School of Medicine in 1948.
Ludwig Gerald Laufer, MD, died April 19, 2017. Doctor Laufer received his MD degree from Cornell University School of Medicine in 1948.
Harvey Alan Lincoff, MD, died November 25, 2017. Doctor Lincoff received his MD degree from University of Pittsburgh School of Medicine in 1948.
Carlos Amaury Lithgow, MD. Doctor Lithgow receive his MD degree from Santo Domingo in 1957.
Roger A. Mac Kinnon, MD. Doctor Mac Kinnon received his MD degree from Columbia University College of Physicians and Surgeons in 1950.
Robert M. Naiman, MD, died June 24, 2018. Doctor Naiman received his MD degree from George Washington University School of Medicine in 1946.
Robert Lloyd Segal, MD, died August 2, 2018. Doctor Segal received his MD degree from
University of Buffalo School of Medicine in 1947.
Eugene Sherman, MD, died March 6, 2018. Doctor Sherman received his MD degree from Chicago Medical School in 1954.
Lawrence Dubin, MD, died April 27, 2018. Doctor Dubin received his MD degree from Yale University School of Medicine in 1958.
Richard L. Rovit, MD, died, Apri,l 2018. Doctor Rovit received his MD degree from Jefferson Medical College in 1950.