SAVE THE DATE!

DADE COUNTY MEDICAL ASSOCIATION

PRESIDENTIAL INSTALLATION – 7:00 P.M.

BARBARA MONTFORD, M.D.

Will Be Installed As The First African American Female President of

The Dade County Medical Association

JW MARRIOTT

1109 Brickell Avenue

Miami, Florida  33131

$250 per person.  

Seminar for Women Physicians

                      August 5, 2016

OVER 100 PHYSICIAN PRACTICES IN MIAMI-DADE COUNTY

HAVE RECEIVED UPWARDS OF 30% OF THEIR WORKERS’ COMPENSATION PREMIUM BACK

THANKS TO THEIR MEMBERSHIP IN THE DADE COUNTY MEDICAL ASSOCIATION!

ARE YOU ONE OF THEM?

Workers Compensation insurance rates are set by the State of Florida; all companies charge the same rate.   You have nothing to lose and potentially 30% of your premium to gain by taking advantage of this DCMA program for members.    To date this program has returned a dividend for 12 straight years, with over $5 million over the past five years to DCMA and other county medical association members:  $600,000 of that to DCMA members.

The difference with the DCMA program through AmTrust North America is you receive a dividend. What is the $$$$$$ amount of return on workers’ compensation premium you could receive?  Below are random samples of the $$$$$$ several physicians received. (Physician or practice initials only are used to ensure privacy).

Doctors FCA received $11,605.16
        Doctors LF&G received $3,361.39    

                     Doctors MPS received $2,323.89              

                              Doctors ORN received $1,821.43

                                    

This plan offers premium refunds for favorable claim experience – as much as 30%!  The plan is written by AmTrust North America – an AmTrust Financial Company.   (“A” rated!).

How to participate:

·        Contact  Bill Gompers @ 888 777-7173 or Tom Murphy @ 800-966-2120; at Danna-Gracey, Inc  - It’s that simple!

Changes in the law for Physician Assistants - HB 375

May 3, 2016

Dear Physicians – Note the changes to the law as it relates to Physician Assistants (PA).   Effective date is July 1, 2016.  Thanks.  Patricia

Physician Assistants

Effective Date: July 1, 2016

Governor Scott signed HB 375 into law on Monday, March 28, 2016.  It relates to Physician Assistants (PA) and includes the following changes to the law: 

·       At renewal, PA must acknowledge that he/she has completed a minimum of ten (10) hours continuing medical education in the specialty practice in which the PA has prescriptive privileges. A signed affidavit is no longer required. 

·       PA may perform services delegated by the supervising physician in the PA’s practice in accordance with his/her education and training unless expressly prohibited under Chapter 458, Florida Statutes or the rules adopted by the Board of Medicine or Chapter 459, Florida Statutes or the rules adopted by the Board of Osteopathic Medicine.

·       Prescriptions may be written in paper or electronic form but must comply with sections 456.0392(1) and 456.42(1), Florida Statutes.

·       Changes to requirements for licensure:

o   No longer need two letters of recommendation;

o   No longer required to submit a sworn, notarized statement regarding criminal history; and  

o   Deletes obsolete provisions related to administering a licensure examination for certain foreign-trained PA applicants.

These changes effect PA’s that practice with allopathic physicians and osteopathic physicians. 

To read the entire bill, go to  http://www.flhealthsource.gov/2016-bills     

Click on 375 Physician Assistants.

Patricia C. Handler

Executive Vice President  

Dade County Medical Association

1501 NW North River Drive - 2nd floor

Miami, Florida   33125

305 324-8717

305 325-1316 – fax

E-mail: Phandler@miamimed.com

Visit us online: www.miamimed.com

Visit our DCMA Blog: http://miamimedblog.blogspot.com  

Visit our Facebook Page: https://www.facebook.com/pages/Dade-County-Medical-Association

One day your life will flash before your eyes.

              Make sure it’s worth watching.   

                              

  

             

Medicare ICD-10 Coding Flexibility – How It Works

Medicare ICD-10 Coding Flexibility – How It Works

By Seth Flam, DO

HealthFusion/MediTouch

http://healthfusion.com/

Early in July, at the urging of the AMA and other physician organizations, CMS agreed to offer flexibility with regard to ICD-10 coding during the first year of implementation: October 1, 2015 – September 30, 2016. In our July 6 blog post (http://healthfusion.com/blog/2015/claims-clearinghouse/icd10/ama-12-month-icd-10-grace-period-accepted-cms/), we outlined the new rule – and a key component of that rule centers on claim denial “flexibility:”

Claim denials – For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 coding. This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes.

Breaking down “specificity” and what the “same family of codes” means

ICD-10-CM is composed of codes with three, four, five, six or seven characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity. A three-character code is to be used only if it is not further subdivided, most codes are more than three characters, but the first three characters are key to understanding the “same family of codes” flexibility rule.

Discover the anatomy of an ankle sprain code, for example

Your patient presents for a subsequent visit for a Right Ankle Sprain and you determine that the Right Deltoid Ligament was recently sprained.

General Description: Sprain of the Deltoid Ligament of the Right Ankle – Subsequent Visit:

S93.421.D (ICD-10 Code) – Sprain of Deltoid Ligament of Right Ankle, Subsequent Encounter

Family or category:

XXX – S93 – Dislocation and sprain of joints and ligaments at ankle, foot and toe level

Add More Specificity to Identify the Ankle:

XXX.X – S93.4 – Sprain of ankle is distinguished from other parts of the anatomy and other types of injury – not foot or toe and from dislocation

Add More Specificity to Identify Which Ankle Ligament:

XXX.XX – S93.42 – Sprain of Deltoid Ligament of the Ankle

Add More Specificity to Identify Which Side (lateralization):

XXX.XXX – S93.421 – Sprain of Deltoid Ligament of the Right Ankle

Add More Specificity to Identify Encounter Type:

XXX.XXX.X – S93.421.D – Sprain of Deltoid Ligament of the Right Ankle – Subsequent Encounter

In the example captioned above, the family or category of code is the first three places of the code. For this code the user must code to the full seven digits including the encounter type, which can be either:

1. Initial Encounter

2. Subsequent Encounter

3. Sequela

If the user had to manually build the code from the three-digit family code to the final seven-digit code, it would be almost impossible for anyone to succeed. In this case, because only a seven-digit code is allowed, most advanced EHR products will never allow the user to submit a code for an ankle sprain that is less than the required seven-digit code.

The anatomy of an ICD-10 code

Now that we understand the anatomy of an ICD-10 code, we can better understand the CMS flexibility rule.

Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.

What other choices are available for Ankle Sprain that are the in same family or category of codes?

Below, in Table 1, is a list of Ankle Sprain codes that all are in the same family as defined by the first three digits of the ICD-10 code. Per the CMS flexibility rule, a provider would not be denied payment if one of those codes were used, even though the most appropriate code was the one we worked with in our anatomy of a code example above:

S93.421.D (ICD-10 Code) - Sprain of Deltoid Ligament of Right Ankle, Subsequent Encounter

It is unlikely that a provider will go through the trouble of coding to the specificity outlined above and then purposely choose the incorrect ligament or ankle. If that’s the case then how might the flexibility rule help a provider? The answer is in the unspecified codes.

Many EHRs may match an ICD-9 code with an ICD-10 code based on a file published on the CMS website called the GEMS (General Equivalence Mappings) file. The data in that file attempts to try to find an ICD-10 code that matches an ICD-9 code.

Example: IDC-9 to ICD-10 for Ankle Sprain

If your patient’s current diagnosis is Other Ankle Sprain with an ICD-9 Code of 845.09 then the GEMS file may return an equally non-specific code such as:

S93499A: Sprain of other Ligament of Unspecified Ankle, Initial Encounter.

You may choose this code even though we know that the more appropriate code for our sample patient is:

S93.421.D: Sprain of Deltoid Ligament of Right Ankle, Subsequent Encounter

If you choose S93499A: Sprain of other ligament of unspecified ankle, initial encounter instead of the more specific code CMS will not be able to deny the claim in the first year of ICD-10 even though there is a more specific code that better describes the patient’s diagnosis. CMS won’t be able to deny the code because the less specific code is from the same family as the more appropriate and specific code. Because many EHR vendors will assist physicians with mapping based on the GEMS file, the fact that physicians may use a less specific GEMS file match may reduce denials.

For a list of FAQs regarding the flexibility rule please read this CMS communication: (https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf).

Table of Ankle Sprain Codes

S93492S Sprain Of Other Ligament Of Left Ankle, Sequela	S93492D Sprain Of Other Ligament Of Left Ankle, Subsequent Encounter	S93492A Sprain Of Other Ligament Of Left Ankle, Initial Encounter
S93491S Sprain Of Other Ligament Of Right Ankle, Sequela	S93491A Sprain Of Other Ligament Of Right Ankle, Initial Encounter	S93491D Sprain Of Other Ligament Of Right Ankle, Subs Encntr
S93429D Sprain Of Deltoid Ligament Of Unspecified Ankle, Subs Encntr	S93429A Sprain Of Deltoid Ligament Of Unspecified Ankle, Init Encntr	S93429S Sprain Of Deltoid Ligament Of Unspecified Ankle, Sequela
S93422S Sprain Of Deltoid Ligament Of Left Ankle, Sequela	S93421S Sprain Of Deltoid Ligament Of Right Ankle, Sequela	S93422A Sprain Of Deltoid Ligament Of Left Ankle, Initial Encounter
S93422D Sprain Of Deltoid Ligament Of Left Ankle, Subs Encntr	S93421A Sprain Of Deltoid Ligament Of Right Ankle, Initial Encounter	S93421D Sprain Of Deltoid Ligament Of Right Ankle, Subs Encntr
S93419A Sprain Of Calcaneofibular Ligament Of Unsp Ankle, Init	S93419D Sprain Of Calcaneofibular Ligament Of Unsp Ankle, Subs	S93419S Sprain Of Calcaneofibular Ligament Of Unsp Ankle, Sequela
S93411S Sprain Of Calcaneofibular Ligament Of Right Ankle, Sequela	S93412D Sprain Of Calcaneofibular Ligament Of Left Ankle, Subs	S93412A Sprain Of Calcaneofibular Ligament Of Left Ankle, Init
S93411D Sprain Of Calcaneofibular Ligament Of Right Ankle, Subs	S93411A Sprain Of Calcaneofibular Ligament Of Right Ankle, Init	S93412S Sprain Of Calcaneofibular Ligament Of Left Ankle, Sequela
S93439A Sprain Of Tibiofibular Ligament Of Unsp Ankle, Init Encntr	S93439D Sprain Of Tibiofibular Ligament Of Unsp Ankle, Subs Encntr	S93439S Sprain Of Tibiofibular Ligament Of Unsp Ankle, Sequela
S93432D Sprain Of Tibiofibular Ligament Of Left Ankle, Subs Encntr	S93432A Sprain Of Tibiofibular Ligament Of Left Ankle, Init Encntr	S93431S Sprain Of Tibiofibular Ligament Of Right Ankle, Sequela
S93431D Sprain Of Tibiofibular Ligament Of Right Ankle, Subs Encntr	S93431A Sprain Of Tibiofibular Ligament Of Right Ankle, Init Encntr	S93432S Sprain Of Tibiofibular Ligament Of Left Ankle, Sequela
S93499S Sprain Of Other Ligament Of Unspecified Ankle, Sequela	S93499D Sprain Of Other Ligament Of Unspecified Ankle, Subs Encntr	S93499A Sprain Of Other Ligament Of Unspecified Ankle, Init Encntr
S93401D Sprain Of Unspecified Ligament Of Right Ankle, Subs Encntr	S93401A Sprain Of Unspecified Ligament Of Right Ankle, Init Encntr	S93402D Sprain Of Unspecified Ligament Of Left Ankle, Subs Encntr
S93402A Sprain Of Unspecified Ligament Of Left Ankle, Init Encntr	S93401S Sprain Of Unspecified Ligament Of Right Ankle, Sequela	S93409S Sprain Of Unspecified Ligament Of Unspecified Ankle, Sequela
S93409A Sprain Of Unsp Ligament Of Unspecified Ankle, Init Encntr	S93409D Sprain Of Unsp Ligament Of Unspecified Ankle, Subs Encntr	S93402S Sprain Of Unspecified Ligament Of Left Ankle, Sequela

Subscribe to the HealthFusion Blog (http://healthfusion.com/blog/)

About the author: Dr. Flam is one of the founders of HealthFusion and serves as the company's CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR. More information about Dr. Flam can be found at www.SethFlam.com

2015 MU Changes

Changes to Meaningful Use Stage 1 & Stage 2—What Do They Mean to Your Practice?

By Dr. Seth Flam, board certified in Family Practice and co-founder and CEO of HealthFusion

CMS has released a proposed rule that would dramatically change the Meaningful Use program, starting in 2015. Here are the 5 most important proposed changes to the rule and ramifications of these proposed changes:

1. Reduced Reporting Period in 2015 – The EHR reporting period that was targeted to be a full year in 2015 would be reduced to a 90-day (not calendar quarter) period based on the calendar year.

2. The Most Difficult Patient Engagement Measures are Relaxed – The Exchange of Secure Messages with patients, where the previous threshold for Meaningful Use Stage 2 was 5 percent, is now reduced to just having the capability to exchange secure messages with patients. Essentially, having an EHR Certified to the 2014 Stage 2 standards will get you a passing grade on this measure.

In addition, the Patient Action to View, Download, or Transmit Health Information measure where the previous threshold was 5 percent threshold for Stage 2, now only requires that just 1 patient seen by the provider during the EHR reporting period views, downloads, or transmits his or her health information to a third party.

3. Simplifies the Attestation Process by Removing Measures that are Redundant, Duplicative, or had already reached a very high performance level (“topped out.”) – CMS identified a set of measures that met the Redundant, Duplicative or Topped Out criteria and now proposes that providers no longer need to attest to those measures. See the table below.

In addition, Stage 1 and Stage 2 providers will attest to the same measures, but by using new exception rules for Stage 1 providers and different thresholds than their Stage 2 counterparts, Stage 1 did not become more difficult.

4. Structural Requirements the Concept of Core and Menu – Because of the restructuring of measures, the concept of core and menu will be deprecated in favor of choices within certain objectives; for example: the Public Health Objective. Now for Stage 1 providers, three current menu objectives would now be required and for Stage 2 one current hospital menu objective would now be a required objective. These objectives are as follows:

•             Stage 1 Menu: Perform Medication Reconciliation

•             Stage 1 Menu: Patient Specific Educational Resources

•             Stage 1 Menu: Public Health Reporting Objectives (multiple options)

•             Stage 2 Menu Eligible Hospitals and CAHs Only: Electronic Prescribing

The new reporting structure is outlined in the tables below:

 

5. 2015 Will Be a Backloaded Year – This proposed rule will have a 2-month comment period and therefore we don’t expect the final rule until the third quarter. After the final rule is published, EHR vendors will need to update their Meaningful Use Report Cards and the measurement period options in their software. While there may be a few 90-day reporting options available, we expect another year where most providers will be reporting on the last quarter of the year.

Wondering what changes are proposed with regard to perhaps the most difficult Stage 2 measure – the Electronic Exchange of PHRs via Direct?? See future blog posts at HealthFusion.com/blog

Dr. Seth Flam is one of the founders of HealthFusion and serves as the company's CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR.

5 Things About MU Stage 3

5 Things You Need to Know About the Meaningful Use Stage 3 Proposed Rule

By Dr. Seth Flam, board certified in Family Practice and co-founder and CEO of HealthFusion

The proposed rule for Meaningful Use Stage 3 was announced on Friday, March 20, 2015, and is now available for comment by stakeholders. CMS will rule on comments and the rule will probably be finalized early in the third quarter of this year. Then the ONC will prepare testing information by the late third quarter/fourth quarter and EHR vendors will start building the necessary modules.

 Here are 5 things you need to know about the Stage 3 proposed rule:

 1.            2017 will now be a Flex Year – Meaningful Use Stage 3 was originally slated to begin in 2017 for providers that had completed Stage 2; now 2017 is a flex year. This means that providers who would have progressed from Stage 2 to Stage 3 in 2017 now have the option to stay in Stage 2 an additional year. Only providers who use an EHR certified to the 2015 ONC standards will be allowed to attest to Stage 3.

2.            Every provider will attest for Meaningful Use Stage 3 in 2018 even if 2018 is the provider’s first reporting year – In order to simplify the Meaningful Use program, all providers will be in the same stage. This will allow group practices to focus on a single set of measures for all providers.

3.            Meaningful Use Stage 3 is the final stage of Meaningful Use – However, CMS is clear that because they expect technology and care standards to evolve over time they will consider (and we expect) that there will be future rulemaking related to Meaningful Use Stage 3 somewhere down the line.

4.            All providers will report for one calendar year – in an effort to continue to align Meaningful Use with other government reporting programs such as PQRS, all providers will report for a full year based on the calendar with one exception. Medicaid first year providers will still be allowed to report for based on a 90-day period measurement period. In the past CMS has shortened measurement periods based on provider feedback and we expect that to be true about this year. This year (2015) was slated to be a full year for most providers but we expect it to be scaled back to a quarterly measurement period because of the continued side effects of the poor implementation of Stage 2 last year. For 2017 and beyond we expect the implementation will be smoother and we don’t foresee more flexibility on measurement periods beginning next year.

 

CURRENT STAGE OF MEANINGFUL USE CRITERIA

BY FIRST PAYMENT YEAR

PROPOSED STAGE OF MEANINGFUL USE CRITERIA BY FIRST YEAR

 

5.            There are 8 objectives and some objectives have more than one measure – the total number of measures that providers will be required to report is 16.

For an overview of the Meaningful Use Stage 3 Proposed Rule and its impact on practices, register now for a webinar on April 28: Meaningful Use Stage 3: What the Future Holds.

 

Dr. Seth Flam is one of the founders of HealthFusion and serves as the company's CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR.