Advocacy

This section is devoted to the monitoring of legislative and regulatory activities and the initiation of grassroots lobbying efforts. The New York State Chapter relies upon its Government Relations Committee and its close association with the Medical Society of the State of New York and other New York State Speciality Society in order to accomplish these activities.

Please check this section frequently for up-to-date information.

CMS to Cover New Technologyfor Medicare Patients with Heart Valve Damage

The Centers for Medicare & Medicaid Services (CMS) will now cover transcatheter aortic valve replacement (TAVR) for Medicare patients under certain conditions. The coverage decision announced on May 1, 2012 by CMS Acting Administrator Marilyn Tavenner offers important new technology to some of Medicare’s sickest patients.
“We are pleased with this decision and the increased access to treatment options it will provide,” said Acting Administrator Tavenner. “This decision is particularly important as it highlights cooperative efforts among CMS, the Food and Drug Administration (FDA), the Agency for Healthcare Research and Quality, medical specialty societies, and the medical device industry.”

This final national coverage decision is one of the first coverage decisions completed under a mutual memorandum of understanding between CMS and the FDA, a joint effort aimed at getting sometimes lifesaving, new technology to patients sooner. Since this technology is still relatively new, it is important that these procedures are performed by highly trained professionals in optimally equipped facilities. Therefore, this decision uses “coverage with evidence development,” which, as a condition of coverage, will require certain provider, facility, and data collection criteria to be met. Such requirements are important to ensure beneficiaries receive the safest and most appropriate care.

The decision can be found at: www.cms.gov/medicare-coverage-database/details/nca-details.aspx?NCAId=257&ver=4&NcaName=Transcatheter+Aortic+Valve+Replacement+(TAVR)&bc=ACAAAAAAAAAA&

Medicaid Services(CMS) will now cover transcatheter aortic valve replacement(TAVR) for Medicare patients under certain conditions. The coverage decision announced on May 1, 2012 by CMS Acting Administrator Marilyn Tavenner offers important new technology to some of Medicare’s sickest patients.

Congress Reaches Final Deal on Medicare Physician Payment Concerns

The House and Senate have reached a final deal regarding the impending 27.4% reduction in physician fees. This agreement, which is expected to be signed by the President, will allow Medicare to continue paying physicians at current rates; thereby avoiding the 27.4% reduction in fees set to start on March 1, 2012. This change moves the scheduled March 1 cut back 10 months bringing us to a January 1, 2013 deadline for the implementation of any proposed reductions in fees.

Update on State Budget Process

Governor Cuomo amended his budget proposal on March 3rd to incorporate the recommendations of the Medicaid Redesign Team (MRT). Included among those recommendations is meaningful reform of medical liability including the $250,000 cap on pain and suffering, an indemnity fund for neurologically impaired infants, certificate of merit reform, disclosure of the medical expert’s identity and requirements for deposition of such expert, and peer review protection.

Over the weekend, the Senate and Assembly introduced individual budget proposals on which they intend to vote tomorrow. Importantly, the NYS Senate embraced the MRT/Governor’s recommendations on tort reform in their entirety. The Assembly rejected the MRT/Governor’s proposals. The Assembly did include: (1) creation of an OB patient safety workgroup charged with establishing initiatives and guidance to general hospitals on ways to reduce NI injuries and charged with creating an assessment program by July 1, 2011; and (2) creation of a neurological impairment fund managed by a nine person Board charged with: (a) certifying general hospitals which have implemented an OB patient safety assessment program approved by the workgroup; (b) establishing a mechanism to mitigate or subsidize costs related to medical malpractice premiums related to obstetrical services at a general hospital; (c) developing rules around the dispersal of funds; and (d) establishing eligibility rules for obtaining benefits through the fund by qualified hospitals.

It is imperative that you work to support the Governor and NYS Senate to assure that the meaningful liability reform provisions remain in the final budget enacted this year.

Please take the following steps:

Go to the MSSNY Grassroots Action Center at http://capwiz.com/mssny/state/main/?state=NY to send a letter in support of medical liability reform to your elected representatives.

Call your representatives to weigh in to support medical liability reform as proposed in the Governor’s amended budget and the Senate’s one House budget bill.

Meet with your representatives in their District offices. County medical societies are encouraged to facilitate District Office meetings before the end of March.

Speak to your patients, business and hospital leaders in your community, and your local media to make your case for reform.

Keep your Division of Governmental Affairs apprised of feedback you receive from your representatives.

The time is now to take action to secure meaningful medical liability reform!


P.O. Box Address Change in 5010

P.O. Boxes No Longer Permitted in Billing Provider Address in 5010
Transactions Jan. 1

Do you use a P.O. Box or lock box address as you billing provider address to receive payments? If you submit claims electronically, you will be required use only a street address or physical location as the billing provider address. Continuing to report a P.O. Box in the billing provider address field will cause your claims to reject.

Under the Health Insurance Portability and Accountability Act (HIPAA), all physicians and other health care providers that submit claims electronically are required to transition to the Version 5010 transactions by Jan. 1. One of many data reporting changes in the Version 5010 transactions is the requirement to report only a street address or physical location as the billing provider address.

Practices that wish to continue having payments sent to a P.O. Box or lock box will report this address in the “pay-to” address field.

You may need to work with your practice management system vendor, billing service, or clearinghouse to have this address change made for your claims. Talk to them today to find out if a change is needed and when it will be done. This work needs to be done prior to Jan. 1 to prevent claims rejections and interruptions in your cash flow.

Visit www.ama-assn.org/go/5010 or www.cms.gov/Versions5010andD0 for more information on data reporting changes in the Version 5010 transactions and to prepare your practice for the Jan. 1 deadline


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