New Member Benefit
Please Join Us in Seattle
From the Statehouse
From the Legal Counsel
Medical Society of New Jersey Webinar
Office of the Governor
Varbeco Wealth Management
Important Dates
New Member Benefit - The Third Party
Insurance Help Program
Consistent with our commitment to being a true resource for
plastic surgeons, the New Jersey Society of Plastic Surgeons is
pleased to offer its members unlimited, free consulting
assistance for problems or questions they encounter relating to
third party payer matters beginning November 1, 2009. Assistance
is not limited to Medicare issues, but includes all insurers,
public and private.
The Third Party Insurance Help Program is expected to be
one of the Society's' most popular member benefits and has
helped hundreds of other physician specialists and their staff
to become more efficient and effective in their billing
practices.
Please obtain a copy of the Fax Back form Society website
www.njsocietyofplasticsurg.org.
If you have any related pertinent documents, such as denial
letters, EOB forms, etc, send form, along with a copy of these
materials by paper "snail mail" to
New Jersey Society of Plastic Surgeons
202 West State Street
Trenton, NJ 08608
Or fax to (609) 392-2664
In most cases, you will be contacted with a response within 24
hours of the time your inquiry is received.
Please note that only Society members in good standing are
eligible to take advantage of this service, and membership
status will be verified for all inquiries.
Please Join Us in Seattle
NJ Society of
Plastic Surgeons
You're Invited
Please join the
officers and members of the
New Jersey Society of Plastic Surgeons
at a Cocktail
Reception
Sheraton
Seattle Hotel
Queen Anne Room
Saturday, October 24th
6:30p - 8:30p
Please RSVP by email to
chiggins@blynchassociates.com
From the Statehouse...Beverly
Lynch
Recently, I met with Mark Anderson, the State's new Medicaid
Inspector General. He was joined at the meeting by Mark
Moskovitz, First Assistant Medicaid Inspector General.
Previously, Mr. Moskovitz was the Compliance Officer for St.
Barnabas Health Care.
The Office of the Medicaid Inspector General was established in
March, 2007, by statute (the "Medicaid Program Integrity and
Protection Act") and is charged with detecting, preventing, and
investigating Medicaid fraud and abuse, recovering improperly
expended Medicaid funds, enforcing Medicaid rules and
regulations, auditing cost reports and claims, and reviewing
quality of care given to Medicaid beneficiaries. Additionally,
the Office of the Medicaid Inspector General refers criminal
prosecutions to the Attorney General's office, reports findings
of audits, and reviews and issues recommendations for corrective
or remedial actions to the Governor, President of the Senate,
and Speaker of the General Assembly, and conducts educational
programs for Medicaid providers, vendors, contractors and
beneficiaries.
We would urge you to find out more about the Inspector General's
mission at their website:
http://www.nj.gov/njomig/
The website also provides information on reporting fraud and has
an anti-fraud poster you can download and print/display.
HOSPITAL ERRORS LEGISLATION SIGNED INTO LAW
A bill which will require the Department of Health and Senior
Services (DHSS) to publicly report certain preventable patient
safety errors at New Jersey's hospitals was signed into law on
August 31, 2009. The new law, S-2471, will require DHSS to
include in the annual New Jersey Hospital Performance Report
certain patient safety indicators and preventable medical errors
on a hospital by hospital basis. DHSS will be required to report
information on 14 pre established patient safety indicators,
including: foreign body left after medical procedure;
postoperative hemorrhage or hematoma; postoperative sepsis;
accidental puncture or laceration; or surgery performed on the
wrong side, wrong body part, or wrong patient. The patient
safety indicators listed in the bill were developed by the
federal Agency for Healthcare Research and Quality or are listed
by the Centers for Medicare and Medicaid Services (CMS) as
"never" events that are not eligible for payment under Medicare
or Medicaid.
The bill also prohibits hospitals from charging a patient or
third party payer for certain medical errors or hospital
acquired conditions which are ineligible for reimbursement under
the CMS established medical error guidelines. The original
version of the bill included prohibitions on physicians charging
for certain medical errors, but physicians were amended out of
the final version.
The Departments of Health and Senior Services will work with the
Department of Banking and Insurance to collaborate on the
standards for hospitals and third party payers to implement the
provisions of the new law.
For more information, please contact Beverly Lynch.
Legal Report...Kern
Augustine Conroy & Schoppmann, P.C.
Federal Data Breach Regulations Require Modification of HIPAA
Policies
As of September 23, 2009, federal regulations under the Health
Information Technology for Economic & Clinical Health (HITECH)
Act require that health care providers notify individuals
affected by a breach of unsecured protected health information
(PHI). Providers must ensure that business associates, such as
billing companies, notify them of a breach, which the provider
is then responsible for reporting. A breach is defined as any
unauthorized acquisition, access, use or disclosure of PHI which
compromises the privacy of the PHI. A breach would not include
occurrences where PHI was not available to an unauthorized
individual long enough for it to be retained. A record of the
breach and the action taken, including the required notification
of affected individuals, must be created and mailed to the U.S.
Dept of Health & Human Services (HHS) annually. Breaches
affecting more than 500 individuals require the provider to
notify HHS immediately and inform the media of the breach.
Enforcement of these regulations begins on February 22, 2010.
However, providers are advised to modify their HIPAA policies as
soon as possible. Note that providers can avoid a data breach
notification by securing PHI. If PHI is secured and a breach
occurs, notification is not required. HHS will issue final
guidelines on the acceptable methods for securing PHI. New
Jersey's data breach notification regulations have yet to be
adopted in final form. For more information about the HITECH
requirements, visit www.drlaw.com.
Stark Changes Effective October 1st
As reported one year ago, certain changes in the Stark
self-referral regulations take effect on October 1, 2009.
Specifically, percentage-based lease payments involving
referrals of Stark services, including any lease formula tied to
revenue raised, earned, billed or collected, related to the
services performed or business generated in the leased space or
through use of the leased equipment, are prohibited. "Per-click"
or unit-based space and equipment lease arrangements are also
prohibited, to the extent the charges reflect services provided
to patients referred between the lessor and lessee. The
definition of "entity" changes so that both the person or entity
furnishing Stark services and the person or entity billing for
those services is considered a Stark entity. As a result, except
in rural areas, physician ownership of entities providing
services to a hospital, where the hospital bills for those
services, need to be restructured.
On-Line Registration for H1N1 Vaccination Shipments
Physicians and other health care providers can now apply for
approval to receive H1N1 flu vaccine shipments and serve as
vaccination sites this fall by registering online. The state
recommends priority be given to pediatricians, obstetricians,
and primary care physicians serving children and pregnant women.
Providers who want to serve as vaccinators but not as "ship-to"
sites should work with their LINC (Local Information Network &
Communications System) agencies to obtain the vaccine. The state
has entered into an agreement with insurers to cover the H1N1
vaccine, as well as arranging for the provision of free vaccines
for the uninsured at public health clinics. To register and for
more information on eligibility and enrollment requirements, go
to:
www.nj.gov/health/flu/providerinfo.shtml.
Medical Society of New Jersey
Webinar
Security Breach Notification
October 28, 2009
Webinar begins at 12 p.m.
This event is free to MSNJ members and members of the following
participating New Jersey
specialty societies:
NJ
Society of Plastic Surgeons
NJ Academy of Otolaryngology-(Head and Neck Surgery)
Orthopaedic Surgeons of NJ
NJ Academy of Ophthalmology
NJ State Society of Anesthesiologists
Oncology Society of NJ
NJ Chapter American College of Cardiology
NJ Gastroenterological & Endoscopy Society
NJ Rheumatology Association
Neurological Association of NJ
$50 fee for
non-members.
MSNJ Member
Registration / Non-Member Registration
Note that non-MSNJ members who wish to register for the webinar
must first establish an account with MSNJ and establish a
password before registering. Once an account is established,
follow the Member Registration link.
A
new interim final regulation went into effect on September 23
(although penalties will not be assessed until February 2010)
that requires covered entities to make notifications of certain
security breaches to the affected individuals and to the
Secretary of Health & Human Services. Learn whether your
practice is covered and what you need to do to be compliant with
this new regulatory requirement.
Presenter:
Helen Oscislawski
Fox Rothschild LLP
Helen is widely recognized for her experience with and
understanding of laws affecting the use and disclosure of health
information, including HIPAA privacy and security requirements
and recent changes to such laws resulting from the enactment of
the Health Information Technology for Economic and Clinical (HITECH)
Act. She currently represents several RHIOs in New Jersey and
advises on EHR subsidy arrangements and licensing agreements for
HIT, among other things. Helen was appointed by Governor Corzine
to the New Jersey Health Information Technology Commission to
sit as a member with "demonstrated expertise in privacy [and
security] laws." She is editor of the HIPAA, HITECH & HIT Blog
that provides cutting-edge legal and practical developments that
health care providers and businesses must consider with regard
to the handling and sharing of health information, including
through the use of electronic health records. Helen frequently
presents at live seminars and through webinars on topics related
to privacy and security to the health care community.
Office of the Governor
GOVERNOR CORZINE
ANNOUNCES LANDMARK FLU VACCINE COVERAGE
Health Insurers
agree to pay providers
for H1N1 influenza vaccination administration
Meeting his commitment to ensure provider coverage of H1N1
vaccines, Governor Jon S. Corzine announced a cooperative effort
with New Jersey's major health insurers that put the state and
its citizens at the forefront of handling a possible resurgence
of the H1N1 influenza this fall. The Governor and New Jersey
Department of Banking and Insurance (DOBI) Commissioner Neil N.
Jasey have secured an unprecedented commitment for coverage of
New Jersey citizens by medical providers licensed to administer
the H1N1 vaccination as well as coverage of other H1N1 influenza
medications.
While the federal government will pay the cost to produce the
H1N1 influenza vaccination currently under development, payment
to administer the vaccine has remained an open issue. Today's
agreement closes the gap in New Jersey for distribution of the
H1N1 vaccination once it becomes available. The highlights of
the agreement include:
-
Coverage of
vaccine administration whether or not the plan provides it,
including cases where the insured has exhausted his or her
annual wellness allowance, which is ordinarily subject to a
fixed dollar limit.
-
Reimburse any
member provider for vaccine administration, including OB-GYNs
and specialists, whether or not the provider is the
insured's Primary Care Physician.
-
Waive any
restrictions on multiple flu shots (including restrictions
emanating from exhausting a wellness allowance).
-
Coverage of
anti-viral medications (e.g. Tamiflu and Relenza) and the
relaxation of certain restrictions on their use so that
doctors can provide the medications consistent with evolving
federal guidance.
-
Carriers will
review their claims processing systems and institute
measures, such as manual overrides, to prevent coverage
denials and related paperwork burdens and other delays in
the above situations.
Joining this multi-point agreement are: Aetna, AmeriGroup,
AmeriHealth, CIGNA, HealthNet, Horizon Blue Cross Blue Shield of
New Jersey, UnitedHealthCare, and University Health Plans.
The H1N1 vaccine health insurance coverage agreement announced
today follows last week's unveiling of Governor Corzine's plan
to prepare for any possible H1N1 influenza emergency and places
New Jersey citizens ahead of nationwide emergency preparedness
efforts.
Anyone with questions or problems regarding H1N1 vaccine
coverage under New Jersey plans should contact the Department at
1-800-446-7467 (SHOP), 609-292-7272 or at
www.njdobi.org.
For more information on H1N1 influenza in New Jersey visit the
state's Web site at:
http://nj.gov/health
To
access federal information on H1N1 influenza go to
www.flu.gov.
Varbeco Wealth Management
I recently had the opportunity to make a presentation to the
NJSPS Board of Directors regarding the services that my company
- Varbeco Wealth Management -- could provide to help enhance the
membership benefits available to you.
Varbeco is an independent financial planning and wealth
management company that specializes in working with physicians.
As owner and president, I have been helping physicians reach and
exceed their financial goals since 1990. These goals typically
encompass advice and strategies on building your wealth which
includes investment and retirement planning; protecting your
wealth from lawsuits, taxes, and a declining investment market;
and transferring your wealth to your children and heirs.
Beginning this month, I will contribute to your newsletter
articles that will deal with various planning topics pertinent
to a physician's financial wellbeing. I am also available to
provide advice and answer questions on a one on one basis. Feel
free to call or e-mail me.
I
look forward to forward to becoming an independent and unbiased
financial resource for the NJSPS membership.
Asset Protection:
Most common planning mistakes and oversights
I
have the opportunity to meet with many physicians over the
course of a year. Over the next few months, I would like to
share with you some of the observations that I have made as a
result of those meetings with a focus on the most common
planning mistakes and oversights that relate to asset
protection.
When I mention asset protection, typically the first thing that
comes to mind are lawsuits and in particular, malpractice
lawsuits. But malpractice suits are just one of the potential
threats to your assets that you need to plan to protect
yourselves from. Three others are: the expense of a long term
illness; estate taxes; and a sideways or declining investment
market.
Malpractice suits are always top of mind but they have not
really been an issue for New Jersey doctors yet. New Jersey
physician's personal assets have not been attacked as a result
of a malpractice claim. All the cases that we know of have
settled within the limits of your malpractice insurance policy.
Physicians in some of our surrounding states, in particular New
York and Pennsylvania, have not been so lucky. It is much more
likely to have your assets attacked as a result of a
non-malpractice lawsuit. I have seen a number of cases where a
claimant has come after you personally as a result of an auto
accident or a home-related injury. Many physicians have
insufficient protection from a non-malpractice lawsuit.
To
help shield your assets, I strongly urge you to maximize the
liability limits on your auto, home, boat, and umbrella
insurance policies. Maximum limits will vary by provider but on
average I recommend the following minimums: Auto policy-
$500,000; Homeowner's- $1,000,000; Umbrella- $2,000,000.
Next month we will review recommended ownership strategies for
your primary residence and vacation home. If you have any
questions please contact me at (877) 972-7900 or
dvargo@varbeco.com.
David J. Vargo, CFP®, CMFC
President, Varbeco Wealth Management, LLC
Important Dates
2010 Annual
Meeting
April 17, 2010
The Westin Princeton
2011 Annual
Meeting
April 16, 2011
The Westin Princeton
More details to
come!
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