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For Quickscans from the past two months, visit the News Archive.

From the President...Scott Mankowitz, MD

I just got back from the NJACEP board retreat and I'm really excited about the coming year. We discussed different ways to offer greater benefit to our membership, how to expand our reach by combining with other like-minded groups and how to integrate social media to keep us better connected and more interactive.

Advocacy is front and center in our agenda. Our biggest struggle right now is the fight over out-of-network reimbursement. As many of you know, insurance companies make pricing agreements with various doctors and hospitals to cover their members. These "in-network" rates are usually much lower than the reasonable and customary fees that doctors charge. When the insurer pays only part of a doctor's bill, the doctor is required to collect the rest of the money directly from the patient, a process known as "balance billing". In California, balance billing recently became illegal, which means that all doctors have to accept the in-network rate regardless of whether they contracted with the insurer or not.

Could this sort of law come to New Jersey? If so, it would completely eliminate physicians' ability to negotiate prices with insurers. It would dramatically decrease reimbursement for all kinds of doctors. The insurance industry is well-funded and has extensive lobbying and public relations efforts to see this measure pass into law. NJACEP has joined a coalition with 22 other physician groups to help steer public discussion away from the anti-doctor sentiment and towards fair payment for services.

This is easily the most important issue of our day. It directly affects our livelihoods, and those of all our colleagues. We have to fight it. We have to put forward a lot of effort. And it's going to cost a lot of money. I urge everyone to give generously to our PAC. We've made it easier than ever to contribute. Click on www.njstatpac.org.

Medicare Update: Contractor Advisory Committee
June 6th, 2010 

The latest meeting of the New Jersey Contractor Advisory Committee (CAC) took place at the Holiday Inn in East Windsor on June 6th, 2010. Seven Local Coverage Determinations (LCDs) were discussed.

1) Cardiovascular Nuclear Med
2) Dynamic electrocardiography
3) OVA -1 assay
4) Continuous glucose monitoring
5) Injectable Collagenase Clsotridium Histolyticum for Dupuytren's
    contracture
6) Loss of Heterozygosity based topographic genotyping- non coverage.
7) Sleep Disorder - some revisions of the current policy

They, as well as other active LCDs, can be found at;
https://www.highmarkmedicareservices.com/websch/MedPolSearchResults.do?option=medpoltitlesearch&status=active

Draft LCDs are generally placed on the site as the time for CAC meetings approach. Any physician can comment on the draft LCDs while the comment period is open.

We were reminded at this CAC meeting that as CAC members we serve as advisors, it is not a parliamentary process and the final decisions are made by the carrier medical directors.

The Comprehensive Error Rate Testing (CERT) program continues. New Jersey still ranks high although the percentage has decreased. One item that seems to be driving this high rate is illegible or missing signatures on charts and orders. This impacts labs that get orders from physician offices. Our MAC (J12) has a large number of national labs.

RAC audits are ongoing. Most of what is currently being done is data mining efforts. There is anticipation that chart reviews may start soon. The RAC for our MAC (J12) is Diversified Collection Servcies. The items that our RAC will be reviewing/auditing can be found on their web site.

http://www.Dcsrac.com

The RAC must have approval of CMS and post their plans for review before they begin any new reviews. One new area for review in the near future will be one day hospital stays.

Physicians were reminded to check their specialty designation with CMS or Highmark Medicare. With the discontinuation of consultation codes it is important for physicians to have the correct specialty designation to avoid nonpayment of bills. Evaluations (consultations) done in the hospital should be billed under the ED codes or the initial hospital day codes depending on whether the patient is admitted or not. Current policy is same specialty/same patient/ same day will result in denied payments.

All specialty societies have the potential for a representative at these meetings. Many seem to lack representation at the meetings I have attended.

The next meeting is scheduled for October 13th, 2010.

Mark Meredith, MD, FACEP, MMM
CAC Member-Emergency Medicine 

Women's Health Caucus Testimony with NJ-ACEP's Dr. Shelley Greenman

On June 7, NJ-ACEP Board member Shelley Greenman, MD, delivered outstanding testimony before the inaugural hearing of the New Jersey Women's Legislative Caucus. The Caucus' focus for this first hearing was on Access to Women's Health Care.

Dr. Greenman was the second speaker, and the legislators listened intently. She was asked numerous questions by the legislators, and Dr. Greenman responded appropriately. She submitted lengthy testimony (attached), but condensed her remarks for the hearing. Approximately 15 legislators attended the meeting.

She was interviewed by WHYY radio, and the TV cameras were rolling.

You can listen to the entire hearing by going to:

http://www.njleg.state.nj.us/media/archive_audio.asp?SESSION=2010

And scroll all the way down to "Women's Legislative Caucus." Dr. Greenman is the second speaker.

Thanks to Dr. Greenman for spending the day in Trenton, representing NJ-ACEP so wonderfully and increasing the visibility of the profession and the College. She spent an enormous amount of time crafting her remarks and talking with her colleagues about the issue.

NJ-ACEP's own Al Sacchetti, MD, FACEP, was recently honored with the 2010 National Emergency Medical Services for Children (EMSC) Heroes Policy Leader of Distinction Award. It was presented on May 27 at their annual conference in Bethesda, Maryland. The nomination was prepared by the NJ Office of Emergency Medical Services. Our warmest congratulations go to Dr. Sacchetti!

(from left to right): OEMS-NJ Director Karen Halupke, Tim Seplaki, OEMS-NJ; Kathy Lutz, OEMS-NJ; Dr. Sacchetti; Eric Hicken, OEMS-NJ; and Nancy Kelly-Goodstein, OEMS-NJ.

New Jersey Life Health + Beauty magazine has opened nominations for its Doctors Who Make a Difference Honor Award

In the April/May 2011 issue, the magazine will be honoring doctors and other medical personnel (such as nurses, therapists, alternative practitioners) who have made a positive impact in the medical community and in the towns where they practice. Candidates include those who:

• have pioneered research, developed a new procedure/device, or advocated for legislation that has improved the quality of health care for the state's residents;

• have received national recognition for their endeavors and by doing so have elevated the stature of NJ's medical community;

• should be recognized for their philanthropic work or who have founded organizations that have made a significant contribution to the state or beyond;

• have published a landmark or practice-changing book or article;

• have otherwise gone above and beyond in his/her practice of medicine.

Nomination deadline: August 27. Visit www.njlhb.com for nomination form.

© 2003 NJACEP