Important Dates
New Member Benefit
From the Third Party Payer Consultant
From the Legal Counsel
Asset Protection: Most Common
Planning Mistakes and Oversights
23rd Annual Ellis Island Medal of
Honor Ceremony Honors Reza Momeni, MD, of Summit Medical Group
Important Dates
2010 Annual
Meeting
April 17, 2010
The Westin Princeton
2011 Annual
Meeting
April 16, 2011
The Westin Princeton
More details to
come!
New Member Benefit - The Third Party
Insurance Help Program
NJSPS members are
using this new member benefit - and loving
the results!!!! Try it yourself .....
"Dear Mr. McNally,
I can't thank you enough for your help in this matter. It makes
things so much more clear right now and I have something to go
by in the future. Thank you again and I am sure we will be in
touch."
-an NJSPS member
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
Highmark Medicare Services Announces Important Information
Regarding Upcoming Part 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.
CMS Revises 8551 and 8558 Enrollment Application Forms
The Centers for Medicare & Medicaid Services (CMS) has issued
revised Medicare enrollment applications for physicians,
non-physician practitioners and other suppliers (except DMEPOS
suppliers) using the CMS-855B and/or the CMS-8551 to enroll or
make a change in their enrollment information.
While Medicare contractors will continue to accept the 02/2008
version of the Medicare enrollment application through November
30, 2009, physicians, non-physician practitioners, and other
suppliers should begin to use the new Medicare enrollment
applications (i.e., "(02/2008) (EF 07/2009)") immediately.
Initially, these applications will be available only from the
CMS provider enrollment website.
For more information on what has been revised, go to:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0924.pdf
You may also use the on-line PECOS system to enroll or make
changes to your Medicare enrollment application.
BC/BS Laptop Loss May Compromise Personal Physician Data
The AMA has informed the physician community that a file
containing identifying information for every physician in the
country contracted with a Blues-affiliated insurance plan was on
a laptop computer stolen from a BlueCross/BlueShield Association
employee. It is not yet known whether any identity theft has
resulted from the data breach.
The file included the name, address, tax identification number
and national provider identifier number for about 850,000
doctors. Some 16% to 22% of those physicians listed - as many as
187,000 - used their Social Security numbers as a tax ID or NPI
number.
The AMA has met with BlueCross/BlueShield Association to express
our concerns and learn what steps are being taken to protect
physicians in the wake of this information breach.
Based on information provided by BlueCross/BlueShield
Association, the AMA posted the following message to physicians.
Subject: Blue Cross and Blue Shield Association Data Breach
Alert
From: AMA President J. James Rohack, MD
You may have heard reports about a data breach at the Blue Cross
and Blue Shield Association (BCBSA) involving provider
identifiers. We are working with BCBSA to recommend steps that
it can take to help mitigate the risk of identity theft
resulting from this data breach.
The breach involved a data set containing names, addresses,
taxpayer ID numbers, and NPI numbers of physicians and other
health care professionals. The data is used in performing
internal matching analyses to compare BCBS provider networks to
the networks of other health plans for employer groups. Since
some practitioners use their Social Security number as their
taxpayer ID number, BCBSA is taking steps to protect these
physicians.
It is important to understand that the identifying information
was not the intended target of the theft. The data set was
stored on a laptop that was stolen from a car, which was one of
several cars in the immediate vicinity that were vandalized.
There is no reason to believe that the thief intends to use the
data to commit identity theft. However, as a precaution, BCBSA
is offering credit monitoring services to those providers whose
Social Security number was exposed.
Local BCBS Plans in each area are in the process of sending out
notifications to affected physicians. If you receive a letter
from your local BCBS Plan offering credit monitoring services,
we encourage you to take advantage of those services that BCBSA
is providing through Experian.
Utilizing these services will help BCBSA monitor trends to see
if identity theft may be occurring as a result of the breach and
could help locate the source of any such identity theft. If you
have not been notified directly or if the letter you receive
does not include the offer of such services, then it was
determined that your Social Security number was not exposed.
We also encourage all physicians to be vigilant in protecting
themselves from those who may try to use their identity as a
physician to submit fraudulent prescriptions or fraudulent
claims. If you receive any suspicious calls or reports
erroneously suggesting that you have ordered or prescribed
certain goods or services, you should follow up promptly, and
notify your local BCBS plan immediately if you confirm that your
identity has indeed been stolen.
If you have questions about the data breach, please contact your
local BCBS Plan at their regular customer service number. AMA
staff will continue to be in contact with BCBSA and will provide
further information as it becomes available.
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:
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.
Legal Report...Kern
Augustine Conroy & Schoppmann, P.C.
DOJ Aggressively Prosecutes Alleged Kickback & Stark Law
Violations
The US Department of Justice (DOJ) has obtained settlements or
verdicts in several recent cases resulting in the recovery of
millions of dollars in penalties from physicians, healthcare
facilities, and the pharmaceutical industry. In one case, the
DOJ recovered $8.3 million dollars from UMDNJ to settle
allegations that it paid kickbacks to cardiologists and
submitted false claims to the Medicare program. The
cardiologists involved settled with the US Attorney's office,
were sued civilly, were criminally indicted or remain under
investigation. Recently, Covenant Medical Center in Iowa agreed
to pay $4.5 million to resolve allegations that it violated the
Stark Law by engaging in inappropriate financial relationships
with physicians who allegedly were compensated for their
services at a rate significantly greater than fair market value.
In another recent settlement, both a California hospital and its
CEO paid significant sums to resolve allegations that the CEO
personally negotiated financial arrangements with physicians,
and directed improper payments to them, in violation of the
Stark Law. Given the heightened focus by the DOJ on potential
anti-kickback and Stark Law violations, physicians are strongly
encouraged to examine all financial relationships pertaining to
their practice for compliance with the law.
OIG 2010 Fiscal Year Work Plan Impacts Physician Practices
The Office of Inspector General (OIG) recently released its 2010
Fiscal Year Work Plan, outlining the areas where the OIG will
focus its investigative efforts. In 2010, the OIG will review a
broad spectrum of services and program activities including: (a)
Part B billing for physician services provided to Medicare
hospice beneficiaries; (b) Medicare incentive payments to health
care professionals under the 2009 E-Prescribing Program; (c)
Medicare payments for Part B imaging services; (d) outpatient
physical therapy services; (e) Medicare payments for E&M
services during global surgery periods; and (f) payments for
services ordered or referred by excluded providers. A copy of
the work plan is available at
www.drlaw.com.
PIP Carrier's Lawsuit Dismissed
In an October 2009 decision in New Jersey Manufacturers
Insurance Co. v. Bergen Ambulatory Surgery Center, the New
Jersey Appellate Division affirmed a trial Court's Order
dismissing a summary action filed by NJM in a PIP case. The suit
sought extensive discovery from the surgery center, representing
essentially all billing and payment information over a one-year
period. NJM contended this discovery was necessary to determine
if fees not included in the PIP fee schedule were "usual,
customary and reasonable." The Appellate Division agreed with
the trial Court's holding that such matters are properly decided
in the PIP arbitration system, and not in the Courts.
2009 NJ Hospital Performance Report Released
The NJ Dept of Health & Senior Services has released the 2009
Hospital Performance Report which, for the first time, contains
hospital-specific information on medical errors. Earlier this
year, legislation was enacted requiring hospitals to publicly
report medical errors using specific "patient safety indicators"
developed by the federal Agency for Healthcare Research &
Quality and requiring patient safety updates in each year's
hospital performance report. NJ is one of the few states that
allow the public to see this data. Statewide, New Jersey
performed better than, or as well as, other US hospitals in 10
of 12 patient safety measures. However, results vary widely
among hospitals and among the patient safety indicators for each
hospital. The report is available at
www.drlaw.com.
Asset Protection: Most Common
Planning Mistakes and Oversights
As
a financial planner whose practice specializes in working with
physicians, I get the opportunity to meet with many doctors
throughout the course of a year. This month I will continue 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.
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 your primary residence
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. The best option for your primary home
is Tenants by the Entireties. This is a type of joint ownership
that is only available for a husband and wife. Each spouse if
protected from the creditors of the other. This type of
ownership has become the default ownership when purchasing a
home in NJ. So if have purchased your home in the last 5 years
or so you might already own your home this way.
The second best ownership option, and this is a distant second,
is to own your home individually by the non-doctor spouse.
Assuming that your spouse is not also in a career that is prone
to lawsuits this strategy could work. However, individual
ownership offers you no protection whatsoever if your spouse
gets sued (car accident, etc.). If you choose this route I would
strongly urge you to maximize your liability limits on your
Auto, Home, and Umbrella policies.
Next month we will explore ownership asset protection strategies
for your vacation home. If you have any questions or would like
additional information please contact me at (877) 972-7900 or
dvargo@varbeco.com.
David J. Vargo, CFP®, CMFC
President, Varbeco Wealth Management, LLC
23rd Annual Ellis Island Medal
of Honor Ceremony Honors
Reza Momeni, MD, of Summit Medical Group
Ceremony Paid
Tribute to American Citizens of Diverse Ethnic Origins Whose
Influence and Achievements Inspire and Touch the Lives of People
Everywhere
The National Ethnic Coalition of Organizations (NECO) presented
the 23rd Annual Ellis Island Medals of Honor on Ellis Island,
Saturday, May 9, 2009 at 6 p.m. The ceremony was followed by the
annual Gala Awards Dinner in the historic Great Hall.
Among the recipients of the distinguished award this year was
Reza Momeni, MD, plastic and reconstructive surgeon with the
Plastic Surgery Center at Summit Medical Group. Dr. Momeni was
born in Iran and traveled with his parents on UN Missions to
Afghanistan and Pakistan. As a young boy, he became interested
in other cultures in general and in international humanitarian
efforts in particular. He carried this enthusiasm for helping
others throughout his life and into his professional career as a
Plastic Reconstructive Surgeon.
At
the age of 15, along with his family, he immigrated to the U.S.,
where he went on to graduate, magna cum laude, from Haverford
College, and summa cum laude from the Medical College of
Pennsylvania (now Drexel University School of Medicine), both in
greater Philadelphia. During Dr. Momeni's residency training at
Yale University, he became actively involved in international
missions with the goal of providing free cleft surgery to
children in poor or developing countries.
To
date, he has traveled to Brazil, Columbia, Philippines, and
China with numerous non-profit organizations, namely Smile
Train, Healing the Children, and Changing Children's Lives. Dr.
Momeni's upcoming plans include a mission to Ecuador and a trip
to Nicaragua. Along with the dedicated members of these
traveling teams, several hundred children have received much
needed surgeries at no cost.
Each year since 1986, NECO - whose mission is to honor our
diverse Past, to advocate for positive change in the Present,
and to build strong leaders for the Future - has honored our
nation's diverse past by sponsoring the Ellis Island Medals of
Honor. The Ellis Island Medals of Honor annually pays tribute to
the ancestry groups that comprise America's unique cultural
mosaic. The Medals are presented on Ellis Island, in a dramatic
ceremony, to American citizens of diverse origins for their
outstanding contributions to their communities, their nation and
the world.
According to Nasser J. Kazeminy, Chairman of NECO, "NECO is
about investing in the power of caring, whereas people from all
cultures and walks of life stand together arm in arm to make a
real difference in our world through shared compassion and
philanthropy - not just for now, but to also inspire future
generations who will continue to preserve and build upon the
legacy that each of our cultures has contributed. With our
Medalists, we will see America - at its best. We will see every
color, every race from so many walks of life - together -
celebrating - the magic that is America. Our Medalists'
influence and achievements truly inspire and touch the lives of
people everywhere."
Past Ellis lsland Medal of Honor recipients include six
Presidents of the United States, Nobel Prize winners, athletes,
leaders of industry, artists and others whose work has made a
lasting impact on humanity. They are awarded annually to
outstanding American citizens, from all walks of life, who have
distinguished themselves through their significant contributions
to this country. The Ellis lsland Medal of Honor ranks among the
nation's most prestigious awards. The U.S. Senate and House of
Representatives have officially recognized the Ellis lsland
Medals of Honor, and each year the recipients are listed in the
Congressional Record. To date, more than 1,500 American citizens
have received Ellis lsland Medals of Honor. One other Summit
Medical Group physician, William A. Tansey, Ill, MD,
cardiologist, was a recipient of the Ellis lsland Medal of
Honor.
For further information about NECO and the Ellis lsland Medals
of Honor, please visit:
www.neco.org.
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