Issue Background

Health System Reform

MESSAGE FROM CMS: Verifying Patient Coverage in a Health Insurance Marketplace Plan

It is the beginning of the New Year and you’ll be verifying your patient’s insurance status when they show up in your office. With the beginning of the Health Insurance Marketplace, also known as Health Insurance Exchange, over a million people will have a new insurance plan. In many cases, this will be the first time they have had insurance in years. Many of these people will have signed up for their plan within the past few days. They may not have received their card yet or they may be unaware of the need to carry their insurance information. You may find your office needing to verify their coverage.

How do you verify their coverage?

In New Jersey, call the plan phone number listed below to verify coverage. …

AmeriHealth New Jersey: 1-866-681-7368

Horizon Blue Cross Blue Shield of New Jersey: 1-888-266-1640

Health Republic Insurance of New Jersey: 1-888-990-5706


You can also download copies of fact sheets or educational material for your patients.


NJ-HITEC Reaches 6,000 Members and Over 1,000 Meaningful Users

NJ-HITEC has just reached their 6,000 member milestone and has assisted over 1,000 physicians to become Meaningful Users in their EHR systems. Read the full article from NJ-HITEC.


Federal Government Creates Public-Private Healthcare Fraud Partnership

This week the U.S. Attorney General and the Secretary of Health & Human Services announced the launch of a partnership between the federal and state governments, private healthcare insurance companies and other healthcare anti-fraud groups to prevent healthcare fraud. The effort is aimed to safeguard healthcare dollars.

The partnership will share information to improve detection of fraudulent healthcare billing. “A potential long- range goal of the partnership is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect healthcare fraud schemes.” [Press Release, U.S. Dept. of HHS (July 26, 2012)]. Read more.


MSNJ Objects to Proposal Requiring Electronic Submission of Lab Results

MSNJ has filed comments in opposition to a prompt pay rule proposal that would appear to require laboratories to prove electronic submission of the laboratory results to insurers before payment would be made. MSNJ appreciates the goal of electronic transmission of laboratory results for clinical purposes and supports that goal; however, the proposed rule could be interpreted to require submission of the lab results to insurers in order to be paid. We have raised our privacy and confidentiality concerns to the ACLU which has indicated that it will monitor developments on the rule.


CMS Revises Medical Staff Conditions of Participation

MSNJ recently joined with virtually all state medical societies and national specialty societies in comments expressing strong opposition to CMS’ proposed revisions to the medical staff and governing body conditions of participation.. See the January 13, 2012 issue of MSNJ e-News. Improvements to the rule finalized last month include:

• Removal of a mandatory requirement to include non-physician allied health professionals on medical staffs

• Inclusion of a requirement that the hospital’s governing body must include at least one medical staff member

Unfortunately, provisions that give multi-hospital systems the option to have a single governing body and allow podiatrists to hold leadership roles on the medical staff remain. The AMA has renewed its objections to these provisions and will continue to advocate on them. Read CMS’s summary of the rule.


MSNJ Joins the AMA’s Request for More Flexibility on EHR

This week, MSNJ joined the AMA and almost 100 other medical associations in comments seeking greater flexibility in Stage 2 of the electronic health record (EHR) “meaningful use” program. The comments addressed to CMS sought changes to the proposed Stage 2 criteria and penalty programs including: fewer measures in the required core set; opt-outs of a certain number of measures not relevant to the specialty; more exemptions from penalties; and an appeals process.


MSNJ Opposes Legislation Limiting Rights of Out-of-Network Physicians

Yesterday, MSNJ testified before the Assembly Financial Institutions & Insurance Committee on A. 2751, the “Healthcare Disclosure and Transparency Act.” The bill was scheduled for discussion only.

MSNJ believes that transparent, accurate coverage and payment information from payers to their subscribers is essential. We opposed A. 2751 because it will result in discounted in-network fee schedules being applied to out-of-network providers working in in-network facilities. This undercuts the rights of physicians to freely contract with patients as out-of-network providers. It will also undermine the rights of physicians to decline contracts in networks in which the fees are insufficient to support a practice. The bill “would remove any leverage at all in the market for physicians to negotiate fairly with insurers about payments to keep their practices afloat,” according to MSNJ’s CEO, Lawrence Downs.

MSNJ does not support excessive fees which are already regulated by the State of New Jersey and unethical. To the extent that A. 2751 is aimed at excessive fees, MSNJ recommends that the state establish a mechanism to vet such fees before a board of same-specialty physicians.


US House Passes Bill on Repeal of IPAB and Medical Liability Reform

This week, the United State House of Representatives passed H.R. 5, the “Preserving Access to Healthcare Act” by a vote of 223 to 181. This legislation combines two AMA and MSNJ supported bills: the “Medicare Decisions Accountability Act” (H.R. 452), and the “Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act” (also H.R. 5). The combined bill would repeal the Independent Payment Advisory Board (IPAB) and address a wide-range of medical liability reforms, including a $250,000 cap on non-economic damages. During floor debate, other amendments were also approved including:

  • One which would restore the application of antitrust laws to the business of health insurance by amending the McCarran-Ferguson Act (by voice vote);
  • One which address the crisis in access to emergency care by extending liability coverage to on-call and emergency room physicians under the Federal Tort Claims Act (by voice vote); and
  • One which would grant limited civil liability protection to health professionals that volunteer at federally declared disaster sites.

The House's passage of the bill is an encouraging first step, but these combined bills and amendments must be passed by the full Senate as well to become law. Read more about the IPAB repeal.