Doctors join together for video on surprise billing; MMS comments on medical deferred action

News and announcements

Doctors join together for video on surprise billing, call on peers to act 

Long Island orthopedic surgeon Dr. Daniel Choi and several other physicians from across the country produced a short video providing education and insight on surprise billing, and calling for colleagues from across the country to rally and support bills aimed at eliminating surprise bills. Please watch and share the video, which can be seen by clicking the button below. As you know, the Massachusetts Medical Society will be active in our advocacy efforts in support of legislation that addresses surprise billing when Congress returns.

Mass. Medical Society comments on medical deferred action 

U.S. Citizenship and Immigration Services recently informed immigrants in the country to receive medical care that the agency will no longer consider what is known as medical deferred action. This policy struck home for some 20 pediatric patients receiving life-saving care in Massachusetts hospitals. Massachusetts Medical Society president Dr. Maryanne Bombaugh offered comments on the matter.

September is National Preparedness Month! 

National Preparedness Month provides an opportunity to raise awareness of the important work we all do to ensure our communities are safe, healthy, and ready for emergencies. The Massachusetts Department of Public Health (DPH) Office of Preparedness and Emergency Management (OPEM) is sponsoring a statewide campaign to encourage Massachusetts residents, families and communities to make plans and prepare for public health and medical emergencies, threats, and disasters.

This year’s Know Plan Prepare campaign emphasizes being informed, planning ahead and being prepared; a prepared community is a resilient community.

OPEM offers a number of preparedness materials available to order including tote bags and a secure document bag. Whether it’s through your own volunteerism or within your practice, encouraging community members and your patients to assemble a preparedness kit is fundamental for emergency preparedness. Key things to include in a kit are copies of important papers like insurance documents, Social Security cards, and prescriptions; being prepared is essential in order to grab and go when there are weather emergencies, power outages, and other events.

Also available is A Personal Planning Tool for Individuals Who Have Access and Functional Needs; an 8-page booklet that provides space for people to record their personal needs in the categories of communication, medical needs/maintaining health, independence, service/support, and transportation. This resource is available in print and as fillable pdf.

DPH maintains one central web page at http://www.mass.gov/knowplanprepare to provide information, tips and links for the public. The web page also provides resources to support local, regional and state preparedness initiatives for you to use with your community or organization. DPH will also be tweeting daily using the Department’s Twitter page.

Proposed policy, payment, and quality provisions changes to the 2020 Medicare Physician Fee Schedule 

On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a draft rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020.

The calendar year (CY) 2020 PFS proposed rule is one of several proposed rules that reflect a broader administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.

Public comments on the proposed rules are due by September 27, 2019.

For a fact sheet on the CY 2020 Physician Fee Schedule proposed rule, please click the button below. 

Payer watch

MassHealth Important Update

Ensure you are complaint with the Ordering, Referring and Prescribing (ORP) Requirements*

With the new Ordering, Referring and Prescribing (ORP) Requirements, it is imperative that all your claims include the information as specified in All Provider Bulletin 274 to prevent future denials.

The information in this bulletin is intended to continue to help billing providers prepare their processes and systems for compliance with ORP requirements and reduce the serious financial impact on their practices once claim denials take effect.

To better understand where changes need to be made providers can reference their 835 electronic remittance advices for their CARCs and RARCs edits related to ORP.

If you are not the person in your practice responsible for claims billing, please get this message to those responsible before the edits are turned on and claims are denied.

Below are reasons for denials:

• POSC version of the remittance advice 1080 Ordering Provider Required 1081- NPI required for Ordering

• Provider 1200 – Referring Provider Required 1201 – NPI of Provider Required - HDR

• 1202—NPI of Referring Provider Required 2—HDR²

• 1204—NPI of Referring Provider Required 2—DTL²

*Ordering, Referring, and Prescribing Requirements

Section 6401(b) of the Affordable Care Act includes requirements related to ordering, referring, and prescribing (ORP) providers. If MassHealth requires a service to be ordered, referred, or prescribed, then ACA Section 6401(b) requires that

1. The billing provider include the ORP provider’s NPI on the claim; and
2. The ORP provider be actively enrolled with MassHealth as a fully participating provider or as a nonbilling provider and be an authorized ORP provider, as described on page 2 of this bulletin.

Section 6401(b) applies to all claims submitted by providers for payment by the MassHealth agency, including claims for secondary coverage and Medicare Crossover claims. It does not apply to claims submitted to managed care entities.

To learn more about the ORP requirements please visit:
https://www.mass.gov/the-aca-orp-requirements-for-masshealth-providers

MassHealth All Provider Bulletin 274 can be found at: https://www.mass.gov/files/documents/2018/02/08/all-274.pdf

If you have any questions, and for all your payers update, contact us today at PPRC (781) 434-7702 or email us at pprc@mms.org.

Benefit buzz

Legal Advisory Plan - Why you should enroll

When you receive a Board of Registration in Medicine (Board) investigation or complaint, it is recommended that an attorney delivers a well-crafted response to the Board. If you have to attend an informal Board conference about your situation, it is advised that an attorney represents you in person.

Your malpractice insurance may not cover these legal activities or perhaps only a portion. Your out-of-pocket expenses could cost you thousands of dollars.

Take advantage of the MMS Legal Advisory Plan, a members-only affordable legal service, for a nominal fee of $70/year – a fraction of typical legal fees. Enroll or renew for coverage through July 2020 now. Additional discounts for groups of five or more. Questions? Email lap@massmed.org or call (781) 434-7311.

Member verdicts:

"The Plan is a bargain. Our practice has contacted the attorneys a few times and resolved the Board matters quickly."

"The LAP newsletters were very helpful in helping me be aware of situations to avoid that could impact my medical practice and license."

The PHYSICIAN PRACTICE RESOURCE CENTER (PPRC) serves individual physicians and group practices of all sizes by providing expert knowledge and resources, advocacy, timely and critical information, and ongoing practice support. Our goal is to ensure that you have the information and resources you need to maintain a thriving practice of any size. In today’s challenging environment, practicing medicine is complicated. We make it easier. We provide physician practices a powerful support and resource network so that you can operate successfully and focus on what matters most.

Feel free to contact us today at PPRC (781) 434-7702 or email us at pprc@mms.org.

MMS Individual Claims Consultation Days: Spaces are limited!

The Massachusetts Medical Society is hosting in-person Insurance Claims Consultation Days (ICC). ICC days are designed to allow MMS member physicians and/or their practice staff to schedule 30-minute appointments with health plans to focus on adjudication of troublesome claims.

Available:

• Lakeville ICC Day September 19, 2019

Representatives from health plans will be on-site to review claims with you to facilitate claims processing.  Schedule your appointment at massmed.org/ICC2019 .

The following health plans are participating: Allways Health Partners, Blue Cross Blue Shield of Massachusetts, Fallonhealth, Harvard Pilgrim HealthCare, Health New England, MassHealth, Medicare, Tufts Health Plan, UnitedHealthcare, and Unicare.

Educational programs and events

CME education programs & events  

Featured Online Physician Burnout CME Courses

• Restoring the Art of Medicine: The Power of Physician Wellness – The 2019 Annual Education Program
• Future of Care: A Call to Collaboration – The 2019 Shattuck Lecture
• MedPEP, Medical Professionals Empowerment Program (20 episodes)
• Restoring Well-Being to the Medical Profession
• Running on Empty? Physicians’ Path to Enjoying Life and Medicine More

Featuring Live CME Activities

CME Essentials Workshop
Thursday, October 3, 2019 9:30 a.m. – 2:30 p.m. 

16th Annual Public Health Leadership Forum: Maximizing the Political Determinants of Health
Thursday, October 24, 2019 1:00 p.m. – 5:00 p.m.

Upcoming events and trainings

September 7-8: Enhanced Recovery After Surgery: Providing Evidence-Based Care in the Multidisciplinary Setting Course and Workshops (MMS Headquarters)   Dedicated to addressing topics related to understanding all components of ERAS, including preoperative, intraoperative, and postoperative Phases, the course and workshops consider evidence-based best practices for each component according to the various levels of care across different medical specialties. Participants will learn the value and implications of ERAS as a relatively new holistic approach to patient care.

September 8-10: Schwartz Center’s Compassion in Action Healthcare Conference (Westin Boston Waterfront)
This unique conference brings together clinicians, health system leaders, and others who are committed to making compassion a priority in their organizations and communities. Through interactive experiential sessions with experts from diverse care settings and communities, this conference will provide cutting-edge programs, strategies, and tools to help health care professionals across all roles and disciplines create and sustain cultures of compassion.

October 16: Forum about Giving Back: A Pathway to Happiness, Purpose and Fulfillment
The keynote speaker, Sanjiv Chopra, MD, an internationally known thought leader, author and speaker will share the “Happiness Formula” and the traits of happy individuals when living with purpose. Maryanne Bombaugh, MD, president of MMS, will discuss the rewards of improving the lives of patients when optimizing their social determinants of health. This free unique event is on October 16, 2019 at the MMS headquarters in Waltham. It is hosted by the MMS Committee on Senior Volunteer Physicians.

Questions? Email ckoh@mms.org or call (781) 434-7312.

Quote of the week

"It certainly is incredibly frustrating and upsetting to the public health community that we may lose measles elimination status, because we do have a safe and effective vaccine.”

—  Dr. Nancy Messonnier, director of the US Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, on the potential of the U.S. losing its measles elimination status. (CNN)

Tweet of the week

@stephmsolis
Covering state politics, immigration, gaming and more for @masslivenews. Past: USA TODAY Network. Long live Zardulu. (RTs not endorsements).

What’s new in health care

Check out the most clicked-on stories from this week's MMS Media Watch. Sign up for daily Massachusetts media roundups by email. Some publications are fully accessible only to their subscribers.

What we know about EEE as Mass. sees first fatality this year (WBUR)

The disease can be hard to spot because its initial symptoms are common to many illnesses: high fever, headache and chills. Brown explains that "because this is a disease that invades the central nervous system, that can progress relatively rapidly to changes in level of consciousness, leading to seizures, coma and about a 40% fatality rate." And, EEE is a virus without known treatment, so Brown says public health officials are focused on preventing mosquito bites. "What we want to do and what we're trying to help people understand is that taking steps to avoid mosquito bites is really the way to avoid EEE," she says. Namely, she recommends rescheduling outdoor events planned between dusk and dawn for places with highest risk.

Mass. doctor arrested in NY with massive cache of guns, other weapons (WHDH)

A Massachusetts doctor is facing criminal charges after officials say he was recently arrested in New York and caught with a massive cache of guns, ammunition, and body armor, among an array of other weapons. Dr. Matthew J. Bonanno's medical license was suspended Tuesday when the Massachusetts Board of Medicine gathered for an emergency meeting and deemed him an immediate and serious threat to the public's health, safety, and welfare following his arrest in New York for illegally possessing a semi-automatic firearm. A subsequent search of the 47-year-old car yielded five loaded assault rifles with high-capacity magazines, 1,600 rounds of ammunition, three handguns, 29 high-capacity loaded magazines, a stun gun, handcuffs, face masks, smoke grenades, military knives, brass knuckles, pepper spray fogger, scopes, binoculars, a ballistic helmet, and heavy ballistic body armor, officials said.

UMass research links fried food to rise in colon cancer risk (MassLive)

"People with colonic inflammation or colon cancer should be aware of this research," Jianan Zhang, the lead author and a postdoctorate student at UMass Amherst, said in a news release. He worked with Guodong Zhang, an associate professor, and Eric Decker, head of the Department of Food Science, to study the health effects of eating fried foods. The research team used a sample of canola oil to cook falafel at 325 F in a commercial fryer at an Amherst restaurant. Decker, who is an expert in lipid chemistry, analyzed the chemical reactions the oil went through during the frying process.

Deadly Powassan tick virus confirmed in Mass. resident (WCVB)

A Maynard resident was recently diagnosed with the Powassan virus, a deadly tick-borne illness, according to Town Administrator Greg Johnson and the Maynard Public Health Division. According to the Centers for Disease Control and Prevention, Powassan virus is rare but often severe. The virus can cause encephalitis, a potentially fatal swelling of the brain, or meningitis, inflammation of the membranes surrounding the brain and spinal cord that can be life-threatening. Massachusetts had 22 cases between 2009 and 2018, the third-highest total in the country.