We’re On the Move
The Society will be settling in new quarters as of August 1, 2017. Look for us at 261 West 35 Street, Ste. 504, New York, NY 10001. Same main number and e–mail.
This feature of MM “NEWS” introduces you to Society leaders as they explain their vision of organized medicine’s activities. This month, read Society President Michael T. Goldstein’s message.
Apathy is Not the Answer
The last decade has wrought radical changes in healthcare, drastically changing the physician’s role and activities in healthcare delivery. We have seen an explosion of EMR in healthcare, resulting in physicians becoming more data–input clerks with less time for effective physician patient interaction. The technology of the EMR is mostly keyboard–based while all of our other devices are more interactive and touch–pad based making the EMR process slower and more cumbersome than necessary. The choice of what needs to be entered is determined by others. The process of examining and treating a patient has become a structured task where all the boxes have to be filled out for both completeness and proper coding. None of this has anything to do with diagnosing and treating patients.
As a medical student I was taught that by sitting down with a patient, observing them and taking a proper history focused on their complaints, physicians can make the diagnosis in the overwhelming majority of cases. The exam then either confirms the diagnosis, picks up other conditions, or results in a new diagnosis. This methodology of physician patient interaction results in a positive interaction, reduces the needs for unnecessary testing and prompter diagnosis and treatment. The medical record is a documentation of that interaction but it is the professional evaluation of the patient by the physician that is key. In our new world it is the documentation rather than the professional component that dominates. Physicians providing the proper care can have billing downcoded, lose a medical liability suit and be the subject of professional discipline by the Office of Professional Medical Conduct. How did this all happen?
The answer is apathy and acceptance of anything, no matter how absurd, that is imposed on us. Physicians have failed to unite to fight for their rights as professionals and to prevent outside interference from hampering their ability to advocate for their patients. Sometimes medical leaders have been too passive in allowing this to happen. Some medical organizations have polarized rather than united physicians. However, in this State there are effective organizations that do advocate for their members. Our State medical society and specialty societies have been working hard and together to advocate for all the physicians in the State. Unfortunately the unwillingness of the majority of physicians to support the organizations that advocate for them, including medical societies and PACs, has been a significant impairment to our success.
The consequences of this apathy have reduced the quality of life for the average physician and has resulted in what some call “physician burnout.” Career satisfaction is at an all–time low and getting worse. Yet nobody listens, and more and more burdens are being imposed on us.
The new game is quality metrics. Doctors have to fill in the boxes and perform in a way that our overseers demand. If we do so we will be rewarded; if not, we will have our fees reduced. This is supposed to be “budget neutral,” meaning for every winner there will be a loser. It is as if we are becoming trained animals. Perhaps even less, for the trained animal is either rewarded or punished for inpidual behavior. In the budget–neutral model, the well–trained physician is rewarded and the poorly– trained physician is punished in proportion to reward given the one better trained. Why are doctors allowing this to happen?
Physicians need to wake up and start fighting for their rights as professionals to restore their dignity and take control of their work environment. It is not too late, but there is little time left for apathy. Physicians need to support those organizations that advocate on their behalf with dollars and numbers. Ineffective leaders of organized medicine need to be replaced and quality leaders need support. Employed physicians in hostile work environments need to consider unionizing. Independent physicians need our support for legislation giving them collective bargaining rights, and they need to join or form collaborative joint ventures that give them the power they need to survive.
The New York County Medical Society has been a leader in advancing the causes of the physician community in our county and has spearheaded actions for all physicians in this State. For those that are active members in our Society, we need your continued support. But we also need those who are not members to join with us in the battle to enable physicians to be physicians, not data entry clerks, who are fairly compensated for their professional services.
Time is running out join the battle for the survival of our profession.
From the Board Room
At its meetings on April 17 and May 20, 2017, the Board of Directors of the Society did the following:
• arranged for new office space at 261 West 35 Street;
• reviewed resolutions prior to the 2017 meeting of the MSSNY House of Delegates; and
• heard a presentation on union representation for doctors.
The next meeting of the Board is September 12, 2017
RESOLVED, MSSNY House of Delegates
The Society brought a number of resolutions to fruition successfully at the 2017 meeting of the Medical Society of the State of New York’s House of Delegates. Among the highlights:
•Percentage–Based Billing Services Arrangement: That MSSNY work for repeal of
the New York State law barring percentage–based payment arrangements between
physicians and their billing agents; and work with other allied organizations to oppose efforts by state government officials to demand refunds from physicians based upon allegations that claims were submitted to Medicaid using percentage–based arrangements between physicians and their billing agents. Legislation has been introduced, and the Society has been alerting Manhattan legislators of the problem.
•Changing MSSNY Goals on Medical Liability: That MSSNY work to lower medical liability premiums as a way to address the medical liability issues in the State by different means.
• Insurers Withhold Key Financial Information from Out–Of–Network Physicians: That MSSNY seek legislation or regulation requiring important information contained in a Claim Remittance or Explanation of Medical Benefits be sent to all treating physicians., and that insurers be prohibited from using the term “co–insurance” to refer to the obligation of inpidual policy holders and suggest insurers to use a more applicable term such as “patient’s responsibility.”
• Violation of HIPAA Electronic Transaction Standards by Insurer Failure to Upload ICD–10 Revisions: That MSSNY survey its members asking whether they have experienced claim denials, claims re–submission, or appeals because the insurer (federal, state or commercial) failed to upload the October 1, 2016, version of ICD–10 in a timely fashion; and to present information on ICD–10 improper claim denials to the Centers for Medicare and Medicaid Services (CMS) and its Office of Ehealth Standards & Services, to determine whether the insurers’ failure to properly update their claims processing systems has constituted a violation of the HIPAA Electronic Transaction Standards and should trigger disciplinary or corrective actions to prevent these occurrences in the future.
• Discrimination against Patients in Medicare Advantage Organizations: That MSSNY, on behalf of the patients of New York, object to the behavior of the Medicare Advantage Plans that disregard the law (42 CFR 422.101 (a)) that requires all Medicare Advantage Plans to meet or exceed the benefits covered by Medicare Part B in the geographic area and request that CMS enforce this law and hold Medicare Advantage Plans financially responsible for the required coverage.
• MOC Should Not Contribute to Physician Burnout: A resolution asking that the American Medical Association (AMA), and partner specialty societies that nominate candidates to bodies concerned with maintenance of certification (MOC) nominate only those candidates who agree that MOC should be accomplished only through open–book examinations or other innovative methods that meet with widespread approval by physicians, was refered to MSSNY Council for further review.
The New York County Medical Society congratulates Malcolm D. Reid, MD, MPP, its past president, for a successful year as President of the Medical Society of the State of New York (MSSNY) during the April 21 – 23, 2017 meeting of the House of Delegates of MSSNY. Doctor Zebulon Taintor also concluded his successful two–year term as president of the First District Branch of the Medical Society of the State of New York. Doctor Paul N. Orloff was elected secretary of the First District Branch during the FDB Annual Meeting on April 21. Joshua M. Cohen, MD, MPH was elected alternate delegate to the American Medical Association.
Thanks to the Society’s Delegation for its hard work during the meeting:
William B. Rosenblatt, MD, Chair
Anthony A. Clemendor, MD, Vice Chair
Michael Goldstein, MD, JD, Presidential Chair
Stuart Orsher, MD, JD, Chair Emeritus
Robert B. Goldberg, DO, MSSNY Past President
Malcolm D. Reid, MD, MPP, MSSNY President
Joshua M. Cohen, MD, MPH, MSSNY Council, Manhattan and The Bronx
Michael Borecky, MD
Mimi Buchness, MD
Erick Eiting, MD
Scot B. Glasberg, MD
Peter Lombardo, MD
Marlin Mattson, MD
Paul N. Orloff, MD
Edward W. Powers, III, MD
Gabrielle Shapiro, MD
Zebulon Taintor, MD
Naheed Van de Walle, MD,
Brian Gelbman, MD, New York State Society of Thoracic Surgery
Lana Kang, MD, New York State Society for Surgery of the Hand
Emerald Lin, MD, New York State Society of Physical Medicine and Rehabilitation
Thomas Sterry, MD, New York State Society of Plastic Surgeons
Monica Pozzuoli, MD, Weill–Cornell Medical College
Robert Viviano, DO, Resident/Fellow Section
Elected!
The following members were elected at the Society’s Annual Meeting on June 22, 2017, as Scot B. Glasberg, MD, took the gavel and become the 178th President of the New York County Medical Society. The slate elected at the meeting follows:
Naheed Van de Walle, MD, President–Elect
Mimi Buchness, MD, Vice President
Jessica J. Krant, MD, MPH, Secretary
Arthur Cooper, MD, Assistant Secretary
Ami Shah, MD, Treasurer
Jill R. Baron, MD, Assistant Treasurer
Ksenija Belsley, MD, Board of Medical Ethics (Two–Year Term)
Erick Eiting, MD, Board of Medical Ethics (Two–Year Term)
Milton Haynes, MD, Board of Medical Ethics (Two–Year Term)
Steven Y. Lee, MD, Board of Medical Ethics (Two–Year Term)
Michael T. Goldstein, MD, JD, Trustee (Five–year term)
Board Members At Large
Loren Wissner Greene, MD
Keyvan Jahanbakhsh, MD
Keith LaScalea, MD
Patricia McLaughlin, MD
Mark Milstein, MD
Bijan Safai, MD
Gabrielle Shapiro, MD
Robert Sporter, MD
Thomas Sterry, MD
Delegates to the Medical Society of the State of New York (MSSNY)
Mimi Buchness, MD
Anthony A. Clemendor, MD
Joshua M. Cohen, MD
Milton Haynes, MD
Paul Orloff, MD
Naheed Van de Walle, MD
Alternate Delegates to MSSNY
Ksenija Belsley, MD
Arthur Cooper, MD
Erick Eiting, MD
Dennis Gage, MD
Stuart Gitlow, MD
Loren Wissner Greene, MD
Heskel M. Haddad, MD
Steven Lee, MD
Patricia McLaughlin, MD
Anthony Rossi, MD
Bijan Safai, MD
Robert Sporter, MD
Thomas Sterry, MD
Physicians Must Attest Pain Management CME By July 1, 2017
DOH Attestation Process for Pain Management CME Must Be Completed by July 1, 2017.
The New York State Department of Health has announced the attestation process for prescribers required to complete Pain Management CME. Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics. A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application. Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):
1. Log into the HCS here.
2. Under “My Content” click on “All Applications”
3. Click on “N”
4. Scroll down to NEAT (Narcotic Education Attestation Tracker) and double click to open the application. You may also click on the “+” sign to add this application under “My Applications” on the left side of the Home screen.
Complete the steps to ATTEST to the completion of the education requirement. A full set of instructions can be found here.
Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll–free at (866) 811–7957. They may then complete the form and return it by mail to the address provided in the form. The Bureau of Narcotic Enforcement has also released a Frequently Asked Questions (FAQs) on the prescriber mandate.
A copy of the FAQs can be found here . In certain limited circumstances, the New York State Department of Health may grant an exemption to the required course work or training to an inpidual prescriber who clearly demonstrates to the department that there is no need to complete such training. Exemptions will be granted only in very limited circumstances, and not solely on the basis of economic hardship, technological limitations, prescribing volume, practice area, specialty, or board certification. Prescribers may apply for an exemption through the Health Commerce System. Further information may be obtained by contacting BNE at (866) 811–7957 or This email address is being protected from spambots. You need JavaScript enabled to view it..
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here. These modules are being offered free of charge to all MSSNY members. Physicians who are new users to the MSSNY CME site will be required to register as a new user. As a new user, physicians and non-physicians will be required to enter fields that include: position; name (the name should be what you want to appear on the CME certificate); email address; and then create a password. MSSNY members, who encounter a payment page or have difficulty registering, please email This email address is being protected from spambots. You need JavaScript enabled to view it. for technical support. Directions for creating a new account/or logging in can be found here. Non–MSSNY physicians will be charged $50 per module.
The MSSNY CME is a new site and technical assistance is available from MSSNY at This email address is being protected from spambots. You need JavaScript enabled to view it.
CMS To Conduct EHR Meaningful Use Incentive Payment Audits
The following report is from James McNally, CPC, for our members.
Physicians should be aware that the federal government will be conducting audits of physician Electronic Health Record Meaningful Use (EHR MU) incentive payments that were awarded to physicians who adopted EHR MU certified systems.
This is the result of the release of a report from the U.S. Department of Health and Human Services’ Office of the Inspector General (HHS OIG) that showed, out of 100 randomly chosen physicians who earned bonuses from 2011 to 2014, 14 percent did not meet the meaningful use criteria.
The HHS OIG is urging the Centers for Medicare and Medicaid Services (CMS) to undertake meaningful use audits to assess whether these payments were proper and, if not, to recover the monies paid. (NOTE: As many will recall, in the past these types of audits were conducted by Figliozzi & Company and any communication from this entity should be handled expeditiously).
Physicians who received these payments should carefully review their MU documentation and ensure that it is in order. To that end, it is recommended that you review the CMS resource documents at the links here.
EHR Incentive Programs Audits Overview
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Audit_Overview_FactSheet.pdf
EHR Incentive Programs Supporting Documentation for Audits
https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/ehr_supportingdocumentation_audits.pdf
Stage 2 EHR Incentive Programs Supporting Documentation for Audits
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_AuditGuidance.pdf
For guidance on this issue, contact us through the Third–Party Insurance Help Program, at (212) 684–4681, or 4670.
McNally’s Corner
The following is courtesy of James McNally, the Society’s Third–Party Insurance Help Program.
CMS Releases Lookup Tool to Help Clinicians Determine their MIPS Participation Status: The Centers for Medicare and Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians need to take part in MIPS, the Merit–based Incentive Payment System. MIPS is an important part of the new Quality Payment Program. In late April through May 2017, practices will get a letter from the Medicare Administrative Contractor that processes Medicare Part B claims. This letter will tell the participation status of each MIPS clinician associated with the Taxpayer Identification Number or TIN in a practice. To download a zipped file showing you what this mailing will look like, click on the link here.
http://tinyurl.com/lkeswby
Clinicians should participate in MIPS for the 2017 transition year if they bill more than $30,000 in Medicare Part B allowed charges a year AND provide care for more than 100 Part B–enrolled Medicare beneficiaries a year. If you choose not to participate at all in the MIPS Program, you will be subject to a four percent penalty in 2019.
If you bill less than $30,000 in Medicare Part B allowed charges or provide care for less than 100 Part B–enrolled Medicare beneficiaries in a year, you are exempt from MIPS and will not incur the four percent penalty.
The Quality Payment Program intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate formula and streamlines the “Legacy Programs” Physician Quality Reporting System (PQRS), the Value–based Payment Modifier (VM), and the Medicare Electronic Health Records (EHR) Incentive Program.
In addition, clinicians can now use an interactive tool on the CMS Quality Payment Program website to determine if they should participate in 2017. To determine your status, enter your national provider identifier (NPI) into the entry field on the tool which can be found on the Quality Payment Program website at the link below. Information will then be provided on whether or not you should participate in MIPS this year and where to find resources.
NK"https://qpp.cms.gov/learn/eligibility"https://qpp.cms.gov/learn/eligibility
Participation Criteria
You will participate in MIPS in 2017 if you:
—Bill Medicare Part B more than $30,000 a year AND
—See more than 100 Medicare patients a year.
You must also be a:
—Physician
—Physician assistant
—Nurse practitioner
—Clinical nurse specialist
—Certified nurse practitioner
If you are new to Medicare in 2017, you do not participate in MIPS. You may also be exempt if you qualify for one of the special rules for certain types of clinicians, or are participating in an Advanced Alternative Payment Model (APM). To learn more, review the MIPS Participation Fact Sheet at the link here. https://qpp.cms.gov/docs/QPP_MIPS_Participation_Fact_Sheet.pdf
If you are not in the program in 2017, you can participate voluntarily and you will not be subject to payment adjustments.
NGS Announces Prepayment Audits of Exam Code CPT 99214: The National Government Services (NGS) Medical Review department routinely analyzes regional and national data to identify patterns of claims submission and payments that could suggest actual or potential problems. A recent analysis of data indicated CPT code 99214 continues to be one of the top contributors to the CERT error rate, and it has the highest CERT projected errors within the E&M services. In view of the findings, NGS Medical Review will be conducting service–specific prepayment reviews on the CPT code 99214 targeting E&M services for JK Part B Providers. To read more, click on the link here. http://tinyurl.com/m6fpmcp
Reminder to Medicare Advantage Physicians on Coinsurance and Deductible Payment Changes for QMBs: Pursuant to 2016 changes to Social Services Law*, the New York State Department of Health has revised the Medicaid reimbursement methodology for claims containing Medicare Part C (Medicare Advantage or Medicare managed care) co–payment and/or co–insurance liabilities. Retroactive to July 1, 2016, Medicaid will no longer reimburse the full Medicare Part C copay or coinsurance amount.
The 2016 change to Social Services Law regarding Medicaid payment of Medicare Part C copay or coinsurance will:
—Be implemented on or about May 25, 2017 by NYS Medicaid;
—Reimburse 85 percent of the copay or the coinsurance;
—Affect both institutional and professional claims, as well as pharmacy claims for drugs and supplies when submitted via an NCPDP transaction or as a professional claim; and
—Will be retroactive to July 1, 2016.
At the time of implementation, providers will be informed via eMedNY, and eMedNY will begin reprocessing claims retroactively to July 1, 2016, using the new methodology. There will be no change to the reimbursement of the Medicare Part C deductible. Medicaid will continue to reimburse the full deductible. There will be no change to Medicare Part C inpatient claims.
Providers exempt from the 85 Percent Part C reimbursement: There is no change to the current reimbursement methodology of Medicare Part C copayment and coinsurance amounts for ambulance providers and psychologists. Medicaid will continue to reimburse these providers the full Medicare Part C copayment and coinsurance amounts. Note: The provider is required to accept the Medicare Part C health plan payment and any Medicaid payment as payment in full for the service. The member may not be billed for any Medicare Part C copayment or coinsurance amount that is not reimbursed by Medicaid. Refer to the Centers for Medicare and Medicaid Services (CMS) publication, Prohibition on Balance Billing Dually Eligible Inpiduals Enrolled in the Qualified Medicare Beneficiary (QMB) Program at: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1128.pdf.
* A new subparagraph (iv) was added to paragraph (d) of subpision 1 of Section 367-a of the Social Services Law.
Remittance Advice Will Display the Local Coverage Determination or National Coverage Determination Number for Service Denial: You can find out which LCD or NCD number applies to a service denial for Part B claims processed on or after 5/25/2017, by reviewing the Medicare Provider Remittance Advice; it will contain the applicable LCD or NCD number. There is no need to call to obtain the number.
When a service denies based on an LCD or NCD, the ERA will display the LCD or NCD number in the following field:
LoopSegment/QualifierDescription
2110 REF 0K Healthcare Policy Identification
When a service denies based on an LCD or NCD, the LCD or NCD number will display on the SPR next to the label ‘HCPI’ (Healthcare Policy Identifier). In the example below, the service denied based on NCD 30.3. This will also be visible when you view the remittance via NGSConnex.
NGSConnex.com and NGSMedicare.com Browser Compatibility: The NGSConnex.com self–service portal and NGSMedicare.com websites are accessible from several different web browsers; however, only certain browsers are supported. If your browser is out–of–date you will not be able to access either NGSConnex.com or NGSMedicare.com without updating or making security setting changes. If your browser is not current you will receive notification that you need to update your browser. The notification will include simple, step–by–step instructions, please follow the instructions provided in the notification or you can use the instructions provided below:
NGSConnex Users: For an optimal NGSConnex experience it is best to upgrade your browser to one of the supported browsers below and NOT make the security setting changes. If you elect to use an unsupported browser, information may fail to display or may not display correctly in the various mega tabs.
NGSConnex.com and NGSMedicare.com Supported Browsers
Microsoft Internet Explorer version 11 or Edge
Google Chrome version 45.0 and above
Mozilla Firefox version 31.0 and above
Apple Safari version 9 and above
If you would like to continue to use your current browser you must make security setting changes to ensure you have TLS 1.1 and TLS 1.2 security settings enabled within your browser settings. Click on the following link for detailed instructions on how to update your current browser settings.
How to update my browser security settings
For guidance on all these issues, contact us through the Third–Party Insurance Help Program at (212) 684–4681.
Why Every Healthcare Practice Needs Revenue Cycle Management Now
The following White Paper is from PracticeBuilders. For more information, call (800) 679–1200, and tell them you are a Society member.
Healthcare practices across America are drowning in administrative paperwork and the increasing complexity of collecting insurance reimbursements and patient–responsible balances. As a result, a great deal of money is being left on the table. Every practice needs an effective revenue cycle management (RCM) solution; a unique communications platform with a direct account representative acting as a lifeline extension of the practice, a staff of certified professional coders and billers plus intense follow–up protocols for capturing accounts receivable.
With cash flows declining, profit margins tightening, and patient debt mounting rapidly, it’s become more important than ever to maintain a steady stream of income for your practice or organization. Fortunately, there are many new opportunities to significantly improve your revenue cycle management (RCM).
Today, every healthcare organization needs successful processes and programs to ensure their financial health. Healthcare RCM is a financial process that manages the administrative and clinical functions associated with claims processing, payment, and revenue generation. The process encompasses the identification, management, and collection of patient service revenues. Without this key financial process in place, many healthcare practices are finding that they cannot pay their bills and it’s increasingly difficult to keep their doors open to patients.
RCM is Critical to Your Success
Whether you are a multi–location, multi–disciplinary group practice or a solo practice with one doctor and one nurse, RCM is one of the most critical processes that you must master to be successful.
RCM combines claims processing, patient/payer payments and revenue generation. Simply put, it is your financial circulatory system — complete with all the administrative and clinical arteries that contribute to the capture, management and collection of patient service revenue for the life of every patient account.
Understanding the Healthcare Revenue Cycle
RCM begins when a patient engages medical services and ends when all claims and patient payments have been collected. However, the life of a patient’s account is not as straightforward as it seems.
When a new patient makes an appointment, your administrative staff must handle the scheduling, verify insurance eligibility and establish a new patient account. Pre–registration is the foundation for optimizing your healthcare RCM process. During pre–registration, your staff creates a patient account that details medical history and insurance coverage. They also create a claims submission immediately after treatment.
The healthcare provider or coder identifies the treatments received using the proper ICD–10 code. ICD-10 codes specify exactly what the patient’s complaint is. ICD–10 was designed to ensure accurate coding and enable doctors to bill to the highest level if those codes dictated a complicated visit or procedure. To prevent a claims denial, the coder must choose the most appropriate code. They then send the claim to either a private or government payer for reimbursement.
Healthcare practices are usually reimbursed for their services based on the patient’s coverage and payer contracts. Insurance companies may deny claims for all kinds of reasons — improper coding, incomplete patient accounts or details missing from the patient’s chart. When services are not covered nor reimbursed by insurance, healthcare practices must collect the unpaid balances from patients. The revenue cycle ends when all balances are collected and the account is closed.
Healthcare revenue cycle management is unique among businesses because bills and insurance claims often bounce between providers and payers for several months until every issue gets resolved. When the patient finally gets a bill, he or she does not always have the funds available immediately to pay.
Breaking Down the Revenue Cycle
Medical billing is an interaction between you, the healthcare provider, and an insurance company or payer. To operate most effectively, this interaction or billing cycle needs RCM. Here are the steps in the typical revenue management cycle:
•Charge capture: Render medical services with billable charges.
•Claim submission: Submit claims of billable fees to insurance payers.
•Coding: Properly code diagnoses and procedures.
•Patient collections: Determine patient balances and collect payments.
•Pre–registration: Collect preregistration information, such as insurance coverage, before a patient arrives for procedures.
•Registration: Collect subsequent patient information during registration to establish a medical record number and meet various regulatory, financial and clinical requirements.
•Remittance processing: Apply or reject payments.
•Third party: Collect payments from third-party insurers.
Obstacles to Practice Success
Many healthcare providers overlook critical back-office tasks associated with claims reimbursements when they should be overseeing payment posting, statement processing, collection efforts and claims denials. With ever–changing healthcare regulations, ICD updates and new reimbursement models, maintaining stable healthcare revenue cycle management policies becomes more challenging.
Perhaps the biggest RCM challenge is finding a foolproof way to collect patient payments at the point–of–service or sooner — instead of months later. Unfortunately, collecting at the point–of–service has become more challenging, too, as patients are forced to shoulder higher deductibles at a time when reimbursements are declining, creating a financial double–whammy for patients who now find themselves responsible for the higher unpaid balances, too.
As a health care provider, you walk a fine line to ensure that you collect your debts without pressuring patients so much that they seek care elsewhere.
The Technology Driving RCM
RCM includes technology that tracks claims, ensures payment collection and addresses issues like denied claims. RCM tools allow health care providers doing the billing to follow the process and identify any issues quickly, allowing for the steady stream of revenue.
RCM uses medical billing software that lets you track patient care from registration and appointment scheduling right up to the final payment on a balance due. RCM technical services currently include:
• Electronic Patient Eligibility Checks: Prior to the patient entering your office, we check for a patient’s insurance eligibility. This helps reduce claim submission errors and improves reimbursement processes.
•Claims Submission: Minimizing rejections and delays is the primary goal when making electronic submissions. The RCM platform provides appropriate tracking of claims activity.
• Electronic Remittance & Payment Posting: Explanation of Benefits (EOB) received electronically helps to save time, increase staff productivity and minimize the chance of errors.
•Analytics & Data Reporting: Identifying trends, claims monitoring and root cause analyses are key components to managing revenue streams. RCM analytical solutions are comprised of CRM dashboards, standard reports and technological tools. Therefore, the focus becomes streamlined on the operational, financial and clinical performance of the practice.
•Accounts Receivable: 30 percent reduction in average total A/R days due to specialized checks and balances methodology. The RCM solution performs thorough follow–ups with claim submissions up to 90 days of an aging claim.
•Credentialing: Proper credentialing is a requirement for establishing claims reimbursement and it’s a key component of the revenue cycle process. RCM ensures timely and efficient credentialing with all the necessary payers, keeping you aligned with fair compensation standards.
The Simple Goal of RCM
Healthcare revenue cycle management continues to evolve and keep pace with rapid changes in the American healthcare ecosystem. The latest is the move away from fee–based care toward value–based care.
As a healthcare professional, you should always be aware of your practice revenue cycle so you can not only provide appropriate care, but receive appropriate reimbursement, as well. The ultimate goal of healthcare RCM is to ensure that you get paid the full amount for services rendered as soon as possible.
An RCM Solution for Medical Practices
One possible solution: Revenue Builders by Practice Builders. It’s a complete, RCM program that has been specifically designed for medical practices. What sets it apart from other RCMs is:
• A unique communication platform with a direct account representative acting as a lifeline extension of your practice
• Ongoing education that shares new payer initiatives and industry changes
• A staff comprised of 100% certified professional coders (CPC) and billers
• Intense follow–up protocols obsessed with accounts receivable
As the nation’s leader in healthcare practice success since 1979, Practice Builders has worked with over 16,000 health practices and has a unique understanding of the financial challenges you face every day.
Solve your revenue cycle management needs with a single phone call to Practice Builders at (800) 679–1200.
Email us at This email address is being protected from spambots. You need JavaScript enabled to view it..
Visit us at www.PracticeBuilders.com.
Find us on Facebook, YouTube, Twitter, LinkedIn and Yelp.
Want to Score with MACRA? Perform a HIPAA Risk Assessment
The following article is by Art Gross, and is provided courtesy of HIPAA Secure NOW! the Society’s endorsed HIPAA training and security benefit. Check out www.HIPAASecureNow.com
Congress may be poised to roll back the Affordable Care Act, but HIPAA and MACRA, the Center for Medicare & Medicaid’s (CMS) new model for reimbursements, are as certain to remain as death and taxes. Moreover, MACRA and HIPAA go hand in hand. Physicians cannot participate in MACRA, which went into effect on January 1, 2017, without performing a security risk assessment (SRA) and making sure patient health information is protected. However, even if a physician is not participating, HIPAA compliance, including the essential SRA, is still a legal requirement.
MACRA is one of those rare laws that passed with bipartisan support from Republicans and Democrats in Congress, which ensures that it will continue under the current administration. Under MACRA, medical reimbursements are directly tied to the Triple Aim of providing better care, at lower costs and improving health, all in an effort to move to value-based care.
Fees and reimbursements paid to physicians will be scored based on performance and quality metrics care, using the Merit-based Incentive Payment System (MIPS). To achieve 25% of the MIPS score, for example, medical practices must use a certified EHR system with a set of measures that show how it’s used in their day-to-day practice, and with a particular emphasis on increased interoperability between their EHR and electronic information exchange with patients.
Based upon their MACRA performance scores in 2017, physicians can expect to see their payments vary by +/- 4% beginning in 2019. By 2022 payments will vary by +/- 9%.
Before medical practices participate in MIPS they will need to prove that patient health information contained in there EHR and elsewhere in their practice is protected by performing a security risk assessment (SRA). Failure to protect ePHI (electronic protected health information) with the proper IT security controls will result in zero scores, which could have a material impact on the MACRA fee adjustment, and overall Medicare reimbursement.
Yet, many medical practices are guilty of doing a “check the box” SRA and not taking the actual steps to prevent a security breach. It’s not uncommon for practices to have patient information scattered around the network and not even know which servers, files, laptops and mobile devices house patient information.
To start on the path to MACRA and MIPS scoring and increased reimbursements, medical practices must perform an SRA and identify vulnerabilities in protecting patient information. Here are the key elements to identify and close the ePHI security gaps:
—Identify and document all ePHI repositories.
Medical practices often operate under the assumption that all patient data is stored in their EHRs. But patient information can also reside in emails, Excel spreadsheets, Word documents, PDFs with scanned explanations of benefits, or even ultrasounds and MRIs. The SRA should determine exactly where all ePHI is stored.
—Identify and document potential threats and vulnerabilities for each repository.
Make sure backup and disaster recovery procedures are in place, as well as procedures for dealing with lost or stolen laptops containing ePHI.
—Train employees and create access policies.
Train employees to recognize phishing scams, phone scams, follow rules for accessing public wi–fi, social media posting, and other risky behaviors in order to avoid breaches. Review employee policies to ensure they access only the patient records they need to perform their jobs. Make sure that procedures are in place to prevent terminated employees from accessing ePHI.
—Encrypt data.
Encrypt patient data to not only protect against attacks but to help alleviate any potential penalties as regulators will take into account whether a firm took all reasonable steps to protect the data.
—Determine the likeliness of a threat.
Once the location of patient information is determined and potential vulnerabilities are identified, the probability of an actual breach should be ranked as high, medium, or low. It may be more likely, for instance, that an unprotected ground floor office could be broken into than one located in a high-rise with round-the-clock security. Then again, it could be easy for employees to lose cell phones or other devices containing patient information and so that threat might be ranked as “highly likely.”
—Develop a breach response plan
Have a response plan in case a breach does occur. Specify who will be on the response team, what actions the team will take to address the breach, and how the practice will prevent another breach from occurring. The SRA will make sure a plan exists and all employees are trained in how to respond.
Invest the time and devote the resources to perform a comprehensive risk assessment or hire a HIPAA expert to assist. Medical practices must achieve HIPAA compliance and patient data security to begin scoring MACRA points and maximizing reimbursements.
This Just In . . . Great New Members
The following 41 candidates for membership have been presented to the Board of Directors of the Society.
Shawn Anthony, MD
Allison Bean, MD
Jennifer L. Berkowitz, MD
Billie Jane Borden, MD
Sonya Brar, MD
Clarisse Elaine Cadang, MD
Julissa Cruz, MD
Beatriz Cruz–Alvarez, MD
Azza Elemam, MD
Julia L. Frydman, MD
Senem Salar–Gomcelli, MD
Jeremy Grubin, MD
Kwane O. A. Gyasi, MD
Margaret A. Harvey, DO
Jamie Elizabeth Huntly, MD
Kiki L. Hurt, MD
Danuta A. Jankowska, MD
Durga Jonnalagadda, MD
Stuart Kloda, MD
Ching Yin–Lam, MD
Christina Lee, MD
Jiabin Liu, MD
Sarah W. MacArthur, MD
Kenneth W. McKinley, MD
Manish Mammen, MD
Ahmadreza Moradi, MD
Olatunde Ola, MD
Tanuj Palvia, MD
Alan H. Pearl, MD
Arash Ronaghy, MD
Bryan J. Rudolph, MD
Alana E. Sigmund, MD
Lori A. Schwartz, MD
Aldo Alejandrino Recinos Soto, MD
Sheri Spirt, MD
Laurence J. Sprung, MD
Elizabeth Sharp, MD
Scott Statman, MD
Douglas Unis, MD
Douglas S. Wetmore, MD
Amy P. Wu, MD
Hats Off
Congratulations to Society and Medical Society of the State of New York Past President Robert B. Goldberg, DO, who was elected to the Council on Medical Education of the American Medical Association during the AMA’s Annual Meeting in Chicago. Doctor Goldberg is Director of Strategic Medical Initiatives at the Touro University of Osteopathic Medicine He is board certified in Physical Medicine and Rehabilitation Medicine, and is a graduate of the Philadelphia College of Osteopathic Medicine. Doctor Goldberg especially expressed gratitude to his campaign manager, Joshua M. Cohen, MD, MPH, Society Trustee and MSSNY Councilor.
Hats off to member Robert R. Walther, MD, FACP, who was recognized in May with the 2017 Jerry Gliklich, MD Award for Exemplary Clinical Care, presented by the Society of Practitioners and reserved for those members of the Medical Staff who have made sustained major contributions to the quality of patient care at New York–Presbyterian/Columbia University Medical Center. Doctor Walther is Professor of Dermatology, Columbia University College of Physicians and Surgeons, and a past president of the New York State Society of Dermatology and Dermatological Surgery.
If you or someone you know deserves a salute, send it to the Society’s Cheryl Malone at This email address is being protected from spambots. You need JavaScript enabled to view it. or fax to (2120 684–4741.
6 Ways to Reduce your Taxable Income
The following is provided by Vital Planning Group, the Society’s endorsed financial planners. Contact Vital’s Edward Alferoff at (212) 578—3003, or contact This email address is being protected from spambots. You need JavaScript enabled to view it.
Here are some things to think about before you file your returns.
401(k) Contributions
For the 2016 tax year, the IRS has approved 401(k) and 403(b) contributions of up to a whopping $18,000 a year for those ages 49 and under. Those 50 and over get the option to add an additional $6,000 to their retirement accounts, giving them the ability to reduce their taxable income by up to $24,000 with just 401(k) contributions alone. By maxing out your 401(k) contributions, you not only work toward preparing a more secure future for yourself, you work to minimize your 2016 taxable income by as much as possible.
IRA Contributions
IRA contributions can be used on top of 401(k) and/or 403(b) contributions to further reduce your taxable income. For those under age 50, a traditional IRA can be used to reduce taxable income by up to $5,500. Those over age 50, they qualify for a traditional IRA contribution of up to $6,500.
SEP IRA
Sole proprietor and small business owners may consider opening and funding a SEP IRA. If funded by the earlier of your tax filing date or 4/15 you will reduce your taxable 2016 income dollar for dollar. Contribution limits are 25% of business profit not exceeding $53,000.
Bonus: IRA contributions for the prior year can be made through April 15 of the current year, so there's still time to reduce your 2015 taxable income by making a qualifying traditional IRA contribution.
Business Tax Deductions
Estimates show that as much as 30 percent of American jobs are held by the self–employed and those they hire. In order to minimize your taxable income as much as possible, it's important to take full advantage of the tax deductions available to self–employed inpiduals if you own your own business, no matter how small.
If you're self–employed, talk to a qualified CPA who specializes in preparing taxes for self–employed inpiduals to see if you can reduce your taxable income with deductions for things like your home office, Internet and phone expenses, travel expenses and health care premiums. Learning how to take full advantage of the tax deductions available for your specific tax situation can be a smart way to reduce your taxable income and increase the amount of money you save and invest each and every year.
Charitable Contributions
With charitable contributions, you can tag team your efforts by reducing your taxable income and making the world a better place. According to the IRS website, it's possible to deduct giving amounts of up to 50 percent of one's adjusted gross income when donating to a qualified organization. Bonus: You can give either cash or property items and take the fair market value of the property item as a reduction of your taxable income.
Medical Expenses
Opening an account such as HSA (health savings account) or an FSA (flexible spending account) can be a great way to reduce your taxable income, provided you have upcoming medical expenses that will accrue during the year. A variety of medical expenses qualify for use with an HSA or FSA, such as impending surgeries, prescription medicines, doctor visit copays or dental expenses.
Both HSAs and FSAs can help you to reduce your taxable income. However, there are some
differences between the two accounts you'll want to consider:
HSAs are only available to those who have a high–deductible health plan, whereas the FSAs have no eligibility requirements.
HSA contributions are capped at $3,350 per inpidual and $6,750 per family annually, and FSA
contributions are capped at $2,550 per year for both inpiduals and families.
HSA contribution amounts can be changed at any time during the year, whereas FSA contribution amounts can only be adjusted during open enrollment periods or with a qualified change in family status or employment.
Whichever type of account you choose; there are significant savings to be had when choosing to
reduce your taxable income this way.
Interest Payments
According to the IRS, five types of interest payments can be deducted from your taxable income if you file using the long (1040-A) form:
—Interest paid on your home mortgage
—Interest paid on student loans
—Interest paid on your business loans
—Interest paid on money borrowed to purchase an investment property
—Interest on investment income (limited to your net investment income)
Talk with your certified public accountant about what types of interest payments you may have that can be used to reduce your taxable income.
You can implement all these strategies now for your 2017 filings! Get ahead of the game this year! Feel free to contact Vital Planning Group, LLC for any help in establishing retirement accounts or consulting us on tax minimization strategies.
We do not provide legal or accounting advice. Source: US News/Money 02/19/17 Written by: Deacon Hayes
Document Shredding Cuts Risks and Costs
The following is courtesy of Storage Quarters, the Society’s endorsed shredding and storage member benefit. To learn more about discounts for Society members, contact (516) 794–7300.
There is no question that to reduce the risk of a data breach and to comply with data protection laws, companies must destroy sensitive materials when it is no longer needed. Some small businesses think it is less expensive and easier to do it themselves, but unforeseen costs including money, time, and security all become apparent. Most staff cannot be bothered with using a shredder which are usually slow and jam easily, so papers are often tossed casually in the garbage.
When using a professional shredding company your sensitive material is removed and handled by trained professionals. Also, a Certificate of Destruction is essential if a business is asked to provide evidence that their confidential information was securely destroyed. Using an in–house shredder provides no real proof. Compared to the cost of outsourcing secure shredding services, an office shredder can be an unexpected financial drain, with ongoing maintenance, repair and replacement. Employees also have to take time away from their work to shred documents and increase the risk of a costly security breach.
It can be tempting to retain and store every document your company may ever need ,but this approach is never cost effective. This becomes even more wasteful as the amount of information your business generates continues to grow. Just as you need to identify and store important files, you also need to identify those that don’t need storage and can be destroyed. Physical destruction is the only 100% secure way to permanently destroy confidential data on a hard drive which cannot be done with store bought shredders.
Once you have considered using a professional document destruction company, price should only be part of your decision. It is just as important to understand the cost of a security breach to your business and to feel confident that the company you choose has the experience to help protect your business, customers and employees. Make sure the company has expertise in the industry and their employees have undergone training and background checks. They must have a secure chain of custody for shredding your confidential documents on and off–site the premises. Have the company you choose provide references and proof that there are no security breaches in their history. These factors will help when evaluating the right security and budgetary fit for your business.
Besides the environmental impact, it is not a good idea for any business to simply throw away old documents. There are federal and state regulations that mandate the secure destruction of many types of information; social security numbers, medical records and other industry specific data. There is also your own companies secure data to consider. Any information that your business or your customers might consider confidential cannot pass through your existing recycling program. Secure, locked shredding consoles may be another option for your business. Your employees dispose of sensitive material in special locked bins. The shredding service picks up the bins on a regular basis in a secure vehicle to a secure shredding facility. The documents are then shredded beyond recognition It then goes to a pulping mill for recycling. These factors all help determine the best plan for your business when deciding on your document destruction needs.
By Liz Geller, Marketing Director , (516) 794-7300, This email address is being protected from spambots. You need JavaScript enabled to view it.
Published in HIA Hauppauge Industrial Association Newsletter -
https://www.hia-li.org/membership/business-benefits/the-hia-li-reporter-newspaper/
Message From MSSNY on MLMIC
The following is from MSSNY President Charles Rothberg, MD.
Dear Fellow Physician:
Recent media reports, such as “Revenue Drops and Losses Grow for State’s Second-Largest Malpractice Carrier,” continue to generate widespread concerns regarding the medical professional liability insurance (MPLI) marketplace. We at MSSNY are quite pleased to report that our trusted partner and longstanding endorsed professional liability insurer, MLMIC, stands apart and above the fray.
MLMIC’s stability, especially in today’s marketplace, is notably reassuring. In fact, MLMIC remains the leading provider of medical professional liability insurance in the State of New York, in terms of both longevity and fiscal strength. For example, MLMIC has entered into a definitive agreement to be acquired by National Indemnity Company, one of the Berkshire Hathaway group of insurance companies.
As it has for more than 40 years, MLMIC continues to provide exceptional coverage, an unyielding defense, strong risk management programs, and high-quality legal counsel to the physicians of the State of New York.
Both we and MLMIC remain deeply committed to doing whatever we can to protect you and your practice. As always, should you have any questions or be in need of further information, please do not hesitate to contact our offices and/or reach out to MLMIC directly at mlmic.com or (888) 412-2012.
Sincerely,
Dr. Charles Rothberg
MSSNY President
Give the Gift of Knowledge to Your Family!
Kaplan Test Prep (www.kaptest.com) is a premier provider of educational and career services for inpiduals, schools and businesses. Established in 1938, Kaplan is the world leader in the test prep industry. With a comprehensive menu of online offerings as well as a complete array of print books and digital products, Kaplan offers preparation for more than 100 standardized tests, including entrance exams for secondary school, college and graduate school, as well as professional licensing exams for attorneys, physicians and nurses. Kaplan also provides private tutoring and graduate admissions consulting services.
To help students reach their academic goals and own Test Day, we offer a variety of course options that meet their inpidual learning preferences and scheduling needs, which include, depending on the exam:
Our In Person courses allow students to prepare with an expert teacher in a structured classroom setting, along with fellow test preppers. This remains one of our most popular class options.
Our One–on–One Tutoring programs, both in person and live online, is more than a tutor and a curriculum. It’s a robust educational journey with an exam master as personal guide.
Our Live Online courses are held in state–of–the–art virtual classrooms, which allow students to participate in real-time, featuring a live video instructor and teaching assistants, in a way that replicates the physical classroom experience. Students can interact with their teacher and other classmates using audio, instant chat, whiteboard, polling, and screen-sharing functionality.
Our Self Paced courses allow students to go at their own pace and on their own schedule with a personalized path through the curriculum, available 24/7. The courses integrate focused content review, test-taking strategies, and the practice students need to achieve their target score.
For college students, Kaplan offers a wide variety of specialised prep programs to meet the varying needs of our wide audience. With us, students excel at their LSAT, MCAT, PCAT, ACT, SAT, GMAT, GRE, DAT, OAT exams to start their next chapter in academic success. From books to inpidualized one-on-one mentoring, Kaplan prepares you for your next hurdle, backed with years of learning science to optimize the process.
In addition to our pre–med and grad courses, Kaplan also provides state–of–the–art licensure preparation for various health programs. USMLE prep, our flagship in this arena boasts excellent question banks, high yield lectures, on– demand, live and live online courses to meet the different needs of our students. In addition to USMLE, Kaplan also provides licensure prep for COMLEX, NAPLEX, PANCE, NBDE, NCLEX & BAR.
For more information about all of our courses and offerings (there are a lot more than just the above!), visit www.kaptest.com or call 800–KAPTEST. Members use code NYMS10.
We can't wait to get you started! We look forward to helping you and your family members succeed!
Remembering Margaret Lewin, MD
The Society mourns the loss of past president Margaret Lewin, (Passoja) MD (2007– 2008), a long–time member and leader. Doctor Lewin, who was board certified in internal medicine, medical oncology and hematology, served in numerous capacities for organized medicine including as President of the New York County Society of Internal Medicine.
She was a Clinical Assistant Professor at Cornell University Medical College, and affiliated with New York Hospital and the Hospital for Special Surgery. Doctor Lewin’s educational background before medical school includes a masters degree in mathematics from Rensselaer Polytechnic Institute, and bachelor of science in Aeronautics, Astronautics, and the Engineering Sciences from Purdue University. She graduated from the Case Western University School of Medicine.
She was a well–respected physician in the New York Physicians medical group; and was known as a kind, profoundly intelligent woman who dedicated her life to the service of others — patients, family, and the less fortunate across the globe. Doctor Lewin was a frequent physician volunteer for medical missions through Himalayan Healthcare to Nepal, Upper Mustang, and Bhutan, among others.
She was described by colleagues at the Society as “courageous both as a physician and a person,” and as “a great mentor for female physicians and a well respected internist who cared for her patients,” and “as an extraordinary human being and physician.”
In tribute to her, the Society’s President Michael Goldstein noted that “The best way that we can show our respect and appreciation for her is to carry on in our mission as advocates for our patients and profession.”
The Society sends its condolences to Doctor Lewin’s husband, Dr. Dann Passoja, and son Erik Passoja and family.
In Memoriam
Sidney S. Feuerstein, MD, died June 14, 2017. Doctor Feuerstein received his MD degree from Yale University School of Medicine in 1945.
Margaret Lewin, MD, died March 30, 2017. Doctor Lewin, who was a past president of the New York County Medical Society, received her MD degree from the Case Western University School of Medicine in 1977.
Henry S. Lodge, Jr., MD, died March 10, 2017. Doctor Lodge received his MD degree from Columbia University College of Physicians and Surgeons in 1985.
R. A. Rees Pritchett, MD, died March 27, 2017. Doctor Pritchett received his MD degree from Cornell University School of Medicine in 1948.
George S. Radnay, MD, died April 22, 2017. Doctor Radnay received his MD degree from Semmelweiss Medical School in Hungary in 1955.
Raymond Adrian Raskin, MD, died April 8, 2017. Doctor Raskin received his MD degree from New York University School of Medicine in 1946.
William Clinton Robbins, MD, died June 4, 2016. Doctor Robbins receive his MD degree from Cornell University School of Medicine in 1945.
Richard Charles Troutman, MD, died April 5, 2017. Doctor Troutman received his MD degree from Ohio State University School of Medicine in 1945.
Frances P. Stavola, MD, died May 30, 2017. Doctor Stavola received his MD degree from Medical College of Pennsylvania in 1950.
John C. Whitsell, MD. Doctor Whitsell received his MD degree from Washington University School of Medicine in 1954.
Walter Adam Wichern, MD, died March 27, 2017. Doctor Wichern received his MD degree from Harvard Medical School in 1945.
