President's Report
Important Dates
From the Statehouse
From the Legal Counsel
New Member Benefit
From the Third Party Payer Consultant
Asset Protection: Most Common
Planning Mistakes and Oversights
President's Report...Gregory
Borah, MD
The NJSPS has joined 21 other plastic surgery societies and
health organizations in strong opposition to the US Senate's
proposed "BoTax" provision in the Senate health system reform
bill: Sec. 9017, Excise Tax on Elective Cosmetic Medical
Procedures included in the "Patient Protection and Affordable
Care Act." This tax discriminates against women and the middle
class and state experience has demonstrated that it is a failed
policy, one that will not result in the projected revenue.
Furthermore, we believe that this new tax invites the Internal
Revenue Service (IRS) into the exam room violating patient
privacy.
The points we are making to our Senators include these important
facts:
Discriminates Against Women and the Middle Class
Contrary to popular belief, cosmetic surgery is not an
exclusive luxury of the very wealthy. Eighty six percent
(86%) of cosmetic surgery patients are working women and this
five percent tax discriminates against these women. In the
first research of its kind, conducted with people planning to
have cosmetic surgery within the next two years, 60% of
respondents reported a household income of $30,000-$90,000 a
year. Most importantly, 40% of the 60% reported income of
$30,000-$60,000. Only 10% of respondents reported household
income over $90,000. These data clearly refute the suggestion
that elective surgery taxes are "luxury" taxes affecting a
privileged few.
Physicians as Tax Collectors
This provision places physicians in the role of tax collector
and holds physicians liable should an individual fail or refuse
to pay the tax. The provision mandates implementation in less
than six weeks (1/1/2010), placing an incredible burden on
physician offices.
Violates Patient Privacy
Presumably enforcement of this provision will include IRS audits
of medical practices to determine whether procedures were
elective and/or cosmetic. To date, enforcement of whether these
procedures are deductible medical expenses focuses on
individuals and the burden of proof is on them. The proposed tax
provision makes the physician a tax collector and holds him/her
liable for the taxable amount. Therefore, the provision invites
the IRS into the exam room, possibly violating HIPAA patient
privacy to review personal medical records and determine whether
a procedure meets the definition.
Arbitrary and Difficult to Administer
This bill inserts the federal government directly into the
physician-patient relationship - specifically, the Internal
Revenue Service will become an arbiter of what is cosmetic and
what is medically necessary, a completely inappropriate
proposition. As evidenced by the recent failed experience in
New Jersey, the line between "cosmetic" and "reconstructive"
surgery is not always clear, particularly when that
determination is made by persons other than trained medical
professionals. The implementation of this subjectively imposed
tax will require an inordinate amount of time to interpret and
administer with questionable return.
I and the NJSPS urge you to contact both Senators Lautenburg and
Mendenez and their staff to defeat this unreasonable and
burdensome provision from the final Senate version of Health
System Reform.
Important Dates
NJ Chapter American
College of Surgeons
2009 Annual Meeting
December 5, 2009
Woodbridge Renaissance
Hotel & Conference Center
www.nj-acs.org
2010 Annual
Meeting
April 17, 2010
The Westin Princeton
2011 Annual
Meeting
April 16, 2011
The Westin Princeton
More details to
come!
From the Statehouse....Beverly
J. Lynch
I
have been working closely with the ASPS, Allergan and others on
the proposed federal tax on cosmetic surgery. We are utilizing
our excellent contacts and resources developed over the past few
years in our efforts to repeal the New Jersey tax, specifically
Assemblyman Joe Cryan (D-Union), who has authored an op-ed piece
for the national media, and signed a letter to the United States
Senate, which discourages the use of this tax to raise
revenue. Additionally, we have begun talks with the republican
leadership and new administration on renewing our repeal efforts
here in New Jersey.
Lame Duck Session in Full Swing
With just a few weeks left in the 212th legislative session, the
New Jersey physician community is rallying in support of the
Assignment of Benefits legislation and working hard to make sure
wrongful death legislation "dies" on January 11. Any bills that
aren't on the Governor's desk by midnight, January 11, will be
thrown away, and the new two-year legislative session convenes
on January 12, 2010.
For information on these, or any other legislative initiatives,
please email me at
BLYNCH@BLYNCHASSOCIATES.COM.
New legislative leaders were elected to serve the Assembly -
Assemblywoman Sheila Oliver (D-Essex), and Assemblyman Joseph
Cryan (D-Union) as majority leader. Assemblyman Alex DeCroce
(R-Morris) remains as the head of the Assembly minority.
Senator Stephen Sweeney (D-Gloucester) defeated current Senate
President Richard Codey (D-Essex) to lead the upper house.
Senator Barbara Buono (D-Middlesex) will leave her chair of the
Senate Appropriations Committee to become Sweeney's majority
leader. Senator Tom Kean, Jr., (R-Union) remains as the
Republican leader of the Senate. Expect new committee chairs
and committee appointments to be announced soon.
Christie Announces Transition Health Subcommittee Members
Governor-Elect Chris Christie has recently announced the members
of the Healthcare Transition team, which will include:
David Knowlton, Chairman
President / CEO, New Jersey Health Care Quality Institute
Dr. Alan Carr
Comprehensive Pain Management
Kevin Barry, MD
Anesthesiology, Morristown Memorial Hospital
Stewart Berkowitz, MD
Jersey Shore Brachytherapy
Judy Burgis
Senior Vice-President for Corporate Services, Robert Wood
Johnson University Hospital
Joseph Clemente, MD
President / CEO, Medical Health Center
Annette Catino
President / CEO, QualCare Alliance Networks, Inc.
Robert Hariri, MD PhD
CEO, Celgene Cellular Therapeutics
Patricia Kelmar
Associate State Director - Advocacy, AARP New Jersey
Mark Manigan, Esq.
Health Law Practice Group, Brach Eichler LLC
William McDonald
President / CEO, St Joseph's Healthcare System
Gary Puma
President / CEO, Springpoint Senior Living
Christopher Rinn
Director - Emergency Medical Services, Jersey City Medical
Center
Brent Saunders
President, Consumer Health Care and Senior Vice President,
Schering-Plough
John Sheridan
President / CEO, Cooper Hospital
James Orsini, MD
Essex Oncology Of North Jersey
Ryan Graham
Senior Sales Director of Employee Benefits, Fairview Insurance
Loretta Brickman
Co-Owner, BD Consulting & Public Relations
Appointments for all cabinet and subcabinet positions will be
announced over the coming weeks. Stay tuned!
Legal Report...Kern
Augustine Conroy & Schoppmann, P.C.
Appellate Division Upholds Trial Court Decision in Garcia v.
Health Net
In an unpublished decision, the Appellate Division held that
Wayne Surgical Center and its physician owners did not violate
the Insurance Fraud Prevention Act by failing to disclose that
Wayne Surgical did not collect co-insurance (apparently
referring to co-payment). In its ruling, the court noted that
there is no statute, regulation or regulatory directive from any
licensing agency barring the waiver of a contractual right to
collect co-insurance. Watch for anticipated action by the
Department of Banking and Insurance to address this decision.
NJ Pure Accused of Violating Trade Practices Act
The Commissioner of Banking and Insurance has Ordered NJ Pure to
Show Cause why its Certificate of Authority should not be
suspended or revoked, why it should not be fined, and why it
should not be ordered to cease and desist from disseminating
advertising and marketing materials which are allegedly untrue,
deceptive, misleading, and in violation of the NJ Insurance
Trade Practices Act.
Red Flags Rule Delayed Again
The FTC has announced yet another delay (to June 1, 2010) in the
enforcement of the Red Flags Rule, which requires a written
identity theft prevention program.
CMS Releases 2010 Physician Fee Schedule; Announces
Revalidation Effort
In addition to a scheduled reduction in the Medicare payment
rate to physicians, which awaits legislative action to remedy,
the 2010 Medicare Physician Fee Schedule will end payment for
nearly all consultation codes but will increase payment for
evaluation & management services. Also included is an
accreditation requirement, effective January 1, 2012, for
suppliers of the technical component of MRI, CT, PET and nuclear
medicine. CMS also is undertaking aggressive efforts to
determine if Part B suppliers have provided accurate and updated
enrollment information to CMS. Failure to timely respond to
correspondence from CMS regarding revalidation could result in
non-payment of claims, suspension of billing privileges, and a
one-year bar on re-enrollment.
NJ Regulatory Activity
NJ's Dept of Banking & Insurance has adopted a rule requiring
all carriers to issue health insurance ID cards containing basic
information needed for providers to bill and collect for
services. NJ's State Board of Medical Examiners has jointly
proposed a rule with the Board of Pharmacy, providing for
collaborative practice agreements between a physician and a
pharmacist for management of patients' drug related therapy. A
NJ Dept of Health & Senior Services' rule proposal would permit
clinical laboratories to operate collection stations in
physician offices, but only where the lab does not pay rent,
share employees or provide other goods or services to the
physician. A lab's patient service center intended to be open
to the general public could not be located in a physician
office.
Federal Agency Activity
Penalties for HIPAA violations will significantly increase under
a new HHS rule, which also eliminates the "lack of knowledge"
defense for HIPAA violations. The FDA has issued guidance for
clinical investigators regarding protecting human subjects and
ensuring the integrity of clinical trial data. The FTC has new
guidance governing advertisements that include endorsements and
testimonials. The IRS will conduct audits over the next 3 years
focusing on worker misclassification, i.e., employee versus
independent contractor status. The U.S. Citizenship &
Immigration Service begins a new workplace inspection initiative
focusing on the employment of H-1B foreign workers.
For more information on any of the above items, visit
www.drlaw.com.
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.
From the Third Party Payer
Consultant....James McNally, CPC
2010 Medicare Physician Payment Changes
The 2010 Medicare Final Rule was published on November 25, 2009
and is anticipated to take effect on January 1, 2010.
Due to the ongoing controversies and activities in Congress and
the Administration on "health care reform", these provisions are
provided for your information but MAY be subject to change.
Key provisions of the final rule include:
-
21.2%
reduction in Conversion Factor (another freeze is
anticipated but, again, it is dependent on congressional
action).
-
The
consultation codes will no longer be allowed under Medicare.
They will be paid as visits dependent on the place of
service and patient type (new versus established).
-
Imaging
accreditation requirements.
-
PQRI/E-Prescribing
changes
The Centers for Medicare & Medicaid Services (CMS) have issued a
corrected 2010 Medicare Physician Fee Schedule. The 2010
Medicare Physician Fee Schedule is now posted to the Highmark
Medicare Services web site and can be accessed by selecting Fee
Schedules or clicking on the link here.
https://www.highmarkmedicareservices.com/partb/reimbursement/index.html
Keep in mind that these fees have been calculated using the
proposed reduction in the fee schedule. As such, and dependent
on any actions that Congress takes between now and the end of
the year, these fees may change.
2010 Annual Participation Enrollment Program Extension
Due to recent and potential revisions that were made to the 2010
Medicare Physician Fee Schedule (MPFS), the Centers for Medicare
& Medicaid Services (CMS) has extended the 2010 Annual
Participation Enrollment Program end date from December 31,
2009, to January 31, 2010.
As a result, the
enrollment period will now run from November 13, 2009, through
January 31, 2010.
The effective date for any Participation status change during
the extension, however, remains January 1, 2010; and will be in
force for the entire year.
Contractors will accept and process any Participation elections
or withdrawals, made during the extended enrollment period that
are received or post-marked on or before January 31, 2010.
The Participation Agreement (CMS-Form 460) will be made
available on the CD-ROM that is sent out annually by your
Medicare contractor during the Annual Participation Enrollment
period. Your contractor will also make the Participation
Agreement available to you by placing it on their Websites with
Participation enrollment (and termination) instructions.
For guidance on this issue, contact us through the Third Party
Insurance Help Program.
HMS Initiates
Faster Way to Send Medical Documentation for an Electronic Claim
Beginning November 2, 2009, you will be able to fax medical
documentation for Highmark Medicare Services (HMS) Part B
Electronic Claims!
When medical documentation is needed to process your Part B
electronic claim, you will be able to fax this information to
Highmark Medicare Services any time prior to claim submission,
including the same day.
On
November 2, please look for the new "Fax Cover Sheet for
Submitting Medical Documentation for Electronic Claims" on the
home page of the EDI Center of the Web site, under the Reference
Materials section or in the Electronic Billing Guide.
Go
to either of the web sites below:
http://www.highmarkmedicareservices.com/edi/index.html
http://www.highmarkmedicareservices.com/edi/guide/chapter11.html
Alternatives Now
Available to Access PQRI Feedback Reports
In
the past, the only option for accessing PQRI Feedback Reports
was via a secure Web Site after first registering in the Center
for Medicare & Medicaid Services (CMS) security system known as
the Individuals Authorized Access to CMS Computer Services (IACS).
As
many physicians can attest, there was much confusion and many
problems associated with this process.
As
a result, CMS is introducing an alternative process whereby
individual physicians can request their feedback reports based
on their National Provider Identifier (NPI) by telephone.
As
of October 19, 2009, individual physicians are able to call
their carrier or MAC provider contact center to request feedback
reports for their individual NPI.
Please note that requests for feedback reports based on Tax
Identification Numbers (TINs) or by groups will still be
required to access their PQRI Feedback Reports via a secure Web
Site after first registering in IACS.
To
read more, go to:
Highmark Medicare Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0922.pdf
As reported
previously, it is anticipated that incentive payments for the
2008 Physician Quality Reporting Initiative (PQRI) will be made
in October 2009 and 2007 PQRI re-run payments will be made in
November 2009.
The incentive payments and feedback reports for 2009 will be
available in 2010.
For guidance on this issue, contact us through the Third
Party Insurance Help Program.
ICD 10 Code
Translator Now Available from AAPC
The American Academy of Professional Coders (AAPC) has
released its ICD-10-CM online code conversion tool, which is now
available online at
www.aapc.com/icd-10/codes.
This valuable tool allows users to convert (or "map") ICD-9-CM
codes to ICD-10-CM codes (and vice versa) based on the General
Equivalency Mapping (GEM) files published by the Centers for
Medicare and Medicaid Services (CMS).
The tool is free and available to the general public with no
access code or password required.
Developed by the AAPC, this tool is expected to be a huge
resource to medical coders and health care professionals as they
begin to transition to the new ICD-10 system to its ultimate
implementation date on October 1, 2013.
Highmark Medicare
Services Announces Important Information Regarding Upcoming Par
B Provider Enrollment Activities
Over the course of the upcoming months there are several
Provider Enrollment activities taking place under the direction
of the Centers for Medicare & Medicaid Services (CMS) and
Highmark Medicare Services.
As
a result, HMS has published an article is to highlight those
activities and outline potential impacts.
Please read the article at the web site link here carefully. It
is critical that communications from HMS be answered in a timely
manner. Otherwise, there could be severe consequences for your
practice.
Go
to: http://www.highmarkmedicareservices.com/bulletins/partb/news10262009.html
For guidance on this issue, contact us through the Third Party
Insurance Help Program.
FTC Delays Red
Flag Rules Again
The Federal Trade Commission announced on Friday, October 30,
2009 that the Red Flags rule is delayed again until June 1,
2010.
The AMA has been urging the FTC and Congress that physicians are
not "creditors" and should not be subject to the rule.
For more information on the FTC's decision go to:
http://www2.ftc.gov/opa/2009/10/redflags.shtm
For guidance on this issue, contact us through the Third Party
Insurance Help Program.
Attention Highmark
Medicare Services PC-ACE Pro32 Customers:
New PC-ACE Pro32 Version 2.16 Upgrade Available via Internet
Download
PC-ACE Pro32 is a software program that enables electronic
billing for both Medicare Part A and Part B claims in a HIPAA-compliant
format. To provide the most up-to-date information within PC-ACE
Pro32, the software program is updated quarterly. The most
current upgrade, which is PC-ACE Pro32 version 2.16, was
released on October 27, 2009. The Centers for Medicare &
Medicaid Services (CMS) require you to upgrade your software
program within 90 days of availability, so please take time now
to upgrade immediately.
This Internet download is available free of charge for all new
and existing PC-ACE Pro32 customers from the Highmark Medicare
Services (HMS) web site. Download instructions were mailed to
existing PC-ACE Pro32 customers on the release date. If
ordering via CD-ROM, there is a service fee of $25 for postage
and handling for each quarterly update totaling $100 annually,
billed annually.
You are strongly encouraged to download this program via the
Internet when enrolling or upgrading.
The PC-ACE Pro32 Release Newsletter can be viewed on our Web
site at:
http://www.highmarkmedicareservices.com/edi/pc-ace/qtrly-pcace-newsletters.html
If
you would like more information about PC-ACE Pro32 or would like
to enroll to begin using this software program, please visit the
HMS web site at:
http://www.highmarkmedicareservices.com/edi/index.html
If
you have questions or require additional assistance, please
contact an HMS EDI Analyst at 1-866-488-0546.
Physicians Must
Enroll in Medicare PECOS System if Ordering or Referring
Physicians
As
reported previously, Medicare will be activating a new policy
requiring physicians who order or refer services to be enrolled
in the Provider Enrollment, Chain and Ownership System (PECOS)
database. As of this point, physicians are given warning or
informational notes on their claim Remittances.
Claims will deny if the physician who refers a
patient to the billing physician is not enrolled in PECOS by
January (when the new policy is fully implemented).
While there are major flaws in this new policy - the billing
physician has no control over whether the referring physician is
in PECOS; it is recommended that your practice do the following.
First, check the PECOS system itself to determine if your
enrollment information has been loaded to the PECOS system.
More importantly
(and in order to preclude any denials in the future when the
edits go live and deny), physicians who enrolled in Medicare
prior to 2003 need to re-enroll through PECOS before
January 2010.
Right now, the AMA and other groups are urging CMS to delay the
policy because it could bog down the enrollment system and
present significant workflow challenges for physicians and other
health care practitioners.
To
read more about how to enroll via PECOS, go to the link here:
http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp
For guidance on this issue, contact us through the Third Party
Insurance Help Program.
Asset Protection: Most Common
Planning Mistakes and Oversights
ALast
month I reviewed asset protection strategies for your primary
home. As I mentioned, the greatest common denominator among the
different areas of asset protection is ownership: who owns what
and how. Your choice of ownership is where most mistakes occur.
The most common types of ownership for vacation/Second homes are
Joint Tenancy with Right of Survivorship (JTWROS) and Tenants in
Common (TIC). In the event of a lawsuit neither of these types
of ownership would afford you much, if any, protection from
creditors.
A better strategy would be to have your vacation home owned in a
limited liability structure, such as a Limited Liability Company
(LLC) or a Family Limited Partnership (FLP), or something called
a Qualified Personal Residence Trust (QPRT). Both of these types
of ownership will not only protect your home from potential
lawsuits but also provide you with a vehicle to transfer your
home in a tax efficient manner thereby lowering potential estate
taxes.
There are many pros and cons to LLC/FLP ownership but assuming
that they are set up, funded, and administered correctly they
definitely are a viable alternative to provide very strong
protection from creditors. They also provide you with a vehicle
to gift portions of the value of your home, over time, to your
children on a discounted basis.
Next month we will discuss how a QPRT works. Until then, if you
have any questions, please feel free to call me at (877)
972-7900 or e-mail me at
dvargo@varbeco.com.
David J. Vargo, CFP®, CMFC
President, Varbeco Wealth Management, LLC
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