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Slide Presentations from the November 18 Membership Meeting

November 23rd, 2015

ACOG_SMI slides

ACOG_SMI slides

SGR Replace: A New MACRA Primer for OB-Gyns

SGR Reform PPT

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ACOG’s We-Are-You-Video

November 23rd, 2015

http://www.acog.org/About-ACOG/ACOG-Departments/Junior-Fellows/ACOG-We-Are-You-Video

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Posted in ACOG Dist II, News and Events | Comments Off

Countdown to ICD-10: Is Your Practice Ready for Launch?

August 14th, 2015

Yes, ICD-10 is really going to happen. The launch is set for October 1, 2015, and if you’re not ready for implementation, the alarm bells should be going off.

Ideally, you will have everything in place by early September, giving you and your team time for testing and trial runs. However, if you have not taken all the necessary steps, you’ll need to prioritize your activities in the limited time before October 1.

Consider these five mission-critical steps for ICD-10 readiness:

  1. Make sure all (data) systems are a go. Specifically, ensure that your data systems are updated for ICD-10 capability. This means your vendor has delivered the most recent version and current user materials to guide you, and your staff has updated systems appropriately. Likewise, all systems involved in documentation, coding and billing should be updated.

Action: Verify with your EHR vendor that all software products and applications are ICD-10 compliant. Note that vendor resources are being stretched very thin with the nationwide rollout, so keep in touch with your vendor and get these updates scheduled.

  1. Master the codes that matter. You don’t need to master them all but you do need to master the codes for the top conditions you treat. Consult the ICD-10 code set to determine what and how you will need to document. For example, when coding for diabetes with the new code set, you’ll need to document the manifestation of the disease as well as insulin use and presence of coma.

The key is specificity. In fact, some experts are saying that the five most important words you can master under the new system are: “mild, moderate, severe, chronic and acute.”

Action: Select charts that correspond to your practice’s most frequent diagnosis codes. Then review each medical record and see if there is sufficient documentation to support appropriate ICD-10 codes. If clinical information is missing, make a list and begin addressing the lapses in those areas.

3.   Root out unspecified diagnosis codes. A good way to tell if you’re going to have trouble with ICD-10 is to see how much trouble you’re having with ICD-9. Hint: If you currently have a substantial number of claims denied as “not medically necessary” or have pre-authorizations for diagnostic tests denied because there is “no covered indication,” you’re probably suffering from diagnosis-code issues. The problem is only going to get worse in ICD-10.

Action: Run a report to find the frequency of unspecified codes (codes ending in .9). If you find a high percentage, start using specific ICD-9 diagnosis codes now to ease the transition to the more detailed and descriptive ICD-10 system.

4.   Revise forms and templates. Evaluate how the transition to ICD-10 will affect your EHR or paper records. Revise forms and electronic screens, including those for:

  • Pre-admission/Pre-certification
  • Authorization
  • Super Bills/Patient Encounters
  • Orders
  • Quality Reporting
  • Referrals
  • Inpatient and Outpatient Scheduling
  • Public Health Reporting

Action: Look for all forms and tools that document diagnosis code information.

5. Conduct a test launch. The Workgroup for Electronic Data Interchange (WEDI) suggests identifying the payers that process the highest percentage of your claims and testing ICD-10 readiness with them. Here, your clearinghouse or billing service may be able to provide assistance.

Note also that some payers are creating their own web-based, self-service testing opportunities. And, if you haven’t already, contact Medicare Administrative Contractors (MACs) and the Centers for Medicare & Medicaid Services (CMS) to register for ICD-10 testing during the remaining testing period.

Action: After you have completed ICD-10 testing, work with your payers to understand any errors that may have occurred and develop strategies to prevent payment snags once ICD-10 implementation is in full swing.

Prepare for Blast-Off!

As you complete implementation plans and prepare for go-live in October, don’t forget to establish a financial reserve that will see you through the inevitable payment delays.

If an outright cash reserve is unfeasible, experts recommend that practices establish a credit line that can cover at least three to six months of operating expenses.

Posted in Advocacy Matters, Bulletin Board, National Healthcare News | Comments Off

Osphena Speaker Program -June 25

May 26th, 2015

I am thrilled to invite the Suffolk County OBGYN Society physicians to the upcoming program we are having in your area.  Dr. Goldstein will be speaking about Osphena (ospemifene) as a treatment option for moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy due to menopause, on Thursday, June 25th at Insignia in Smithtown.  RSVPs are appreciated. Thank you.

Regards,

Felicia Rosenberg

Professional Sales Consultant

Shionogi, Inc.

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ANNUAL MEETING SET FOR MAY 13 @ WATERMILL CATERERS

April 28th, 2015

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Photos from 2015 Clinic Day

April 21st, 2015

Thanks to all the ATTENDEES, SPEAKERS and SPONSORS that made Clinic Day a great success.

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Suffolk Ob/Gyn Society Annual Clinic Day

March 31st, 2015

2015 Obstetrics and Gynecology Clinic Day  – April 15, 2015-

LOCATION: Watermill Caterers: 711 Smithtown Bypass, Smithtown, NY 11787 (631) 724-3242

TIME: 7:30 AM Sign-in and continental breakfast.  Programs begin at 8:15AM

Pre-registration is REQUIRED: To register contact:

Susan McGreevy

P: 631.670-2104 F: 631.670.2137 E: smcgreevy@nshs.edu


Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of the Suffolk Academy of Medicine and the Obstetrical & Gynecological Society of Suffolk County.  The Suffolk Academy of Medicine is accredited by MSSNY to provide Continuing Medical Education for physicians.

The Suffolk Academy of Medicine designates these live activities for a maximum of 4.5 AMA PRA Category 1 Credits™. Physicians should claim only credits commensurate with the extent of their participation in the activity.

Disclosure Statement

In compliance with the ACCME Standards for Commercial SupportSM of CME, all those in control of the CME content of activities provided by the Suffolk Academy of Medicine are expected to disclose all relevant financial relationships with any commercial interest that may have a direct relationship to the subject matter of their educational activity.  All commercial relationships that create a conflict within the faculty’s control of content must be resolved before the educational activity occurs.

Among the planners and speaker for this educational presentation only Dr. Daniel Keningsberg and Jennifer Hill have relationships with commercial supporters or commercial entities whose products or services relate to the content of the educational presentation.  Dr. Keningsberg is on the advisory board for Glycotrope (no products in the USA, Merck, (Investigator for product Elonva, not FDA approved); Auxogyn (Product Tester).  Dr. Jennifer Hill is an Advisor for Boston Scientific (One Day Meeting).  An appropriate mechanism has been implemented to resolve all conflicts of interest prior to the presentation.

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Senate Delays Vote on Bipartisan Bill on Medicare Doc Fees

March 27th, 2015

AP WASHINGTON — Mar 27, 2015, 3:22 AM ET

The Republican-run Senate has delayed giving final congressional approval to bipartisan legislation permanently blocking Medicare cuts for physicians until next month.

The GOP-led House approved the $214 billion bill Thursday, moving Congress close to resolving a problem that has long plagued it.

That 392-37 vote, plus President Barack Obama’s endorsement of the legislation, intensified pressure on the Senate to finish the measure.

But as the Senate worked into Friday’s pre-dawn hours on a separate budget-balancing plan, leaders decided to wait until after Congress’ two-week spring recess to finish the legislation. Senators from both parties have complained about parts of the measure.

By law, doctors are to receive 21 percent cuts in Medicare reimbursements April 1. The government can delay processing the payments until lawmakers return.

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Posted in Bulletin Board, National Healthcare News | Comments Off

FINAL BUDGET INCLUDES OUT – OF – NETWORK TRANSPARENCY AND COVERAGE REFORM PROVISIONS SOUGHT BY MSSNY, MEDICAL SPECIALTY SOCIETIES AND PHYSICIAN LEADERS

March 17th, 2015

DFS regulations to implement the Independent Dispute resolution program

DFS summary

The final Budget negotiated between the Governor and the Legislature contains provisions to provide greater transparency of a health insurer’s out‐of‐network coverage, broader availability of a patient’s right to go OON if the insurer’s existing network is insufficient, provisions to assure that OON benefits are more comprehensive, and provisions to address payments for emergency care and “surprise bills” by OON physicians.

MSSNY’s Division of Governmental Affairs would like to thank all physicians who worked on this proposal including particularly those from State, County, Regional, and Medical Specialty Societies. A special thank you to Michael Brisman, MD (Nassau County) Thomas Lee, MD (Westchester County), MSSNY President Sam Unterricht and MSSNY President‐ Elect Andrew Kleinman for their daily and often hourly “hands on” work on the language of this proposal.

The provisions will do the following to enhance network adequacy and expand out‐of‐network coverage availability for patients, and expand rights of physicians to have flexibility as to which plans they can choose to participate with:

  • Require health insurers to describe its OON coverage in a manner that is based upon the % of the “usual and customary cost” of OON health care services, including examples of anticipated out of pocket costs for frequently billed OON health care services, and an internet site that enables patients to determine what out of pocket costs they can reasonably expect to face based upon the OON coverage provided by the insurer;
  • Define “Usual and customary cost” as the 80th percentile “of all charges for the particular health care service performed by a provider in the same or similar specialty and provided in the same geographical area as reported in a benchmarking database maintained by a nonprofit organization specified by the superintendent.” This would appear to imply FAIR Health. Importantly, efforts by the insurance industry to sunset this definition in 2016 was defeated.
  • Require health insurers issuing a “comprehensive group or group remittance health insurance policy or contract that covers out‐of‐network health care services” to “make available” coverage for at least 80% of the usual and customary cost of each out‐of‐network health care service . Importantly, efforts to exempt these products from state “premium prior approval” requirements were defeated. The coverage baseline was increased from what had originally been proposed (70% UCR) to 80% of UCR.
  • Enables the superintendent to require insurer offering of 80% UCR OON coverage to a group market in a region if no coverage is available
  • Require all health insurance products, not just HMOs, to have adequate networks;
  • Afford patients enrolled in all health insurance products the right, currently available only to those enrolled in HMOs, to receive treatment from a specialist appropriately qualified to treat a patient’s particular condition at no additional cost to the patient, if the network of such insurance product fails to include such appropriately qualified specialist.
  • Establish a new patient external appeal right to go OON if the insurer network is insufficient to meet health care needs of enrollee.

The bill would also make all bills for emergency care and other “surprise bills” for care by non‐participating physicians (taking assignment) subject to an independent dispute resolution (IDR) process after an insurer made an initial “reasonable payment” for such care, and efforts to informally settle the payment dispute were unsuccessful. Either the physician or insurer could bring the claim to the IDR process. To encourage reasonableness on both sides, the IDR entity would be required to choose between the plan’s payment or the non‐participating physician’s fee (“baseball arbitration”). Only in the rare instances where the reviewer believed that a settlement is reasonably likely or both the physician fee and insurer payment represent unreasonable extremes, the reviewer can give the parties ten business days to negotiate a fee without consequence if one or neither party wished to participate in such a re‐negotiation. Claims for certain CPT codes under $600 would be exempted from the IDR altogether. A physician of the same or similar specialty as the physician providing treatment will be required to be involved in the review of the fee. To the extent practicable, the physician shall be licensed to practice in this state. As part of the IDR entity’s review, they would be required to consider:

  • Whether there is a “gross disparity” between the fee charged by the physician as compared to what they usually charge in other non‐par situations;
  • Whether there is a “gross disparity” between the fee charged by the physician as compared to other fees paid to similarly qualified non‐par physicians in the same region;
  • The non‐par physician’s usual charge for comparable services;
  • individual patient characteristics
  • the level of training, education and experience of the physician;
  • the circumstances and complexity of the case, including the time and place of the services; and
  • The usual and customary cost of the service.

All decisions by the IDR entity, including those involving claims which the reviewer requests the parties to renegotiate, would be required within 30 days of the submission of the dispute.

The IDR is a loser pays process unless the alternative negotiation is invoked by the reviewer in which case if an alternative payment is agreed to each party divides the cost of dispute resolution equally.

Given that one of the major goals of the legislation is to reduce the incidence of “surprise” medical bills, to better assure patients are made aware of situations where they may end up receiving treatment by an out‐of‐network physician, the bill would also impose substantial new disclosure requirements on physicians and hospitals,

including:

  • The plans in which the physician participates and the hospitals where the physician is privileged;
  • The anticipated fee a non‐par physician will charge the patient for scheduled services must be provided upon request;
  • The identity and contact information of other health care providers who may be involved in the patient’s care when a non‐emergency service is scheduled, including anesthesiology, laboratory, pathology, radiology or assistant surgeon; With regard to scheduled services that will be provided in a hospital, the identity and contactinformation of other physicians involved in the patient’s treatment whose services will be arranged by the treating physician.

Similar additional disclosure requirements are also imposed on health insurers and hospitals including:

  • Hospitals are required to post on their website certain standard charges for items and services provided by the hospital and the plans in which the hospital is a participating provider.
  • Hospitals are required to post on their website and provide to a patient in advance on non‐emergent hospital services in registration or admission the names and contact information for physician groups with which the hospital has contracted to provide anesthesia, pathology or radiology; and the name of the physicians employed by the hospital and whose services may be provided at the hospital and the health care plans in which they participate; and a statement which informs patient that a physician who provides service in the hospital may not participate with the same insurer that the hospital participates with and that the patient should check with their physician.
  • Insurers are required to update their websites regarding physician participation status with plans or hospitals within 15 days of a change.

An out‐of‐network workgroup is created comprised of two physicians, two insurer reps and three consumers, co-chaired by superintendent and commissioner of health. The workgroup is required to make recommendations regarding an alternative rate methodology taking into consideration a number of factors including current physician charges, trends in medical care and the actual costs of medical care, regional differences, current methodologies and levels of reimbursement paid by insurers, HMOs, Medicare and Medicaid, in‐network rates, the impact that different rate methodologies would have on customers and premium costs by region. The workgroup must also make recommendations regarding the availability and adequacy of coverage taking into account the extent to which OON coverage is available in each rating region, the extent to which a significant level of OON benefits is available in each rating region including the prevalence of coverage based on UCR cost as well as other set rating methodologies such as Medicare. The report is due 1/1/16.

The new law is effective one year after it is signed into law (April 1, 2015) and shall apply to policies renewed on and after that date. The new disclosure requirements will go into effect one year after enactment(April 1, 2015), and the IDR provisions will apply to health services provided after April 1, 2015 .

Posted in Bulletin Board, News from the NYS Legislature | Comments Off

Study Ties Oral Contraceptive Use To Increased Risk For Crohn’s Disease.

March 16th, 2015

The Telegraph (UK) (3/16, Barrett) reports that a study conducted by gastroenterologists at Harvard University suggests that “women who take the contraceptive pill could triple their chances of developing Crohn’s disease.” The study of 230,000 women in the US also revealed that the risk for Crohn’s “was three times higher for women who had used the Pill for at least five years.”

Posted in Bulletin Board, Clinical Updates in OB/GYN | Comments Off