2018 Announcements

The Centers for Medicare and Medicaid Services (CMS) has announced that physician practices/groups may now log into the CMS QPP website to check their 2018 eligibility for Medicare’s Merit-based Incentive Payment System (MIPS). After groups log in, they will be able to click into a details screen to see the eligibility status of every clinician in the group (based on their National Provider Identifier or NPI) to find out whether they need to participate during the 2018 performance year for MIPS.  Unfortunately, CMS will not be sending out letters to advise physicians of their eligibility status this year so checking on the QPP participation status look-up tool is the only way to determine or verify eligibility status.  Eligibility rules in 2018 are different than in 2017 so status this year may be different than last.  Also as is indicated in the look-up tool, exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group.  The look-up tool can be found at: https://qpp.cms.gov/participation-lookup.
 

Public Health Alert: Potential Measles Exposure at Newark Liberty International Airport

Contact A Health Care Provider If You Suspect Exposure

On March 12, 2018, an international traveler with a confirmed case of measles—a highly contagious disease—arrived in Terminal B at Newark Liberty International Airport from Brussels and departed for Memphis from Terminal C. The individual, a young child, was infectious on that day and may have traveled to other areas of the airport. If you were at the airport between 12:45 p.m. and 9:00 p.m, you may have been exposed to measles, and if infected could develop symptoms as late as April 2. If you develop symptoms of measles, the Department of Health recommends that you call a health care provider before going to a medical office or emergency department. Special arrangements can be made for evaluation while also protecting other patients and medical staff from possible infection. Measles symptoms include rash, high fever, cough, runny nose and red, watery eyes. It can cause serious complications such as pneumonia and encephalitis (swelling of the brain). Measles infection in a pregnant woman can lead to miscarriage, premature birth or a low-birth-weight baby. Measles is easily spread through the air when someone coughs or sneezes. People can also get sick when they come in contact with mucus or saliva from an infected person. New Jersey residents identified as potentially exposed on the ill individual’s flights will be notified by their local health department. If you have been exposed, you are at risk if you have not been vaccinated or have not had measles. "Two doses of measles vaccine are about 97 percent effective in preventing measles,” said Dr. Christina Tan, state epidemiologist.  “We urge everyone to check to make sure they and their family members are up-to-date on measles/mumps/rubella (MMR) vaccine and all other age-appropriate immunizations. Getting vaccinated not only protects you, it protects others around you who are too young to get the vaccine or can’t receive it for medical reasons. If you’re planning an international trip, the World Health Organization recommends that adults or adolescents unsure of their immune status get a dose of measles vaccine before traveling,” Dr. Tan added. Information on what to do if you’ve been exposed to measles is available on our website: www.state.nj.us/health/cd/documents/topics/measles/measles_exposure_guidance_public.pdf For more information about measles, contact your health care provider, or visit the New Jersey Department of Health website at www.state.nj.us/health/cd/topics/measles.shtml The U.S. Centers for Disease Control and Prevention’s website has additional information at www.cdc.gov/measles/ Follow the New Jersey Department of Health on Twitter @njdeptofhealth, Facebook /njdeptofhealth, Instagram @njdeptofhealth and Snapchat @njdoh.

  Out of Network Update

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NJ Department of Banking & Insurance: Program for Independent Claims Payment Arbritration (PIPCA)

Click this link to access the PIPCA application website

Out-of-Network" DOBI Bulletin 18-14 Guidelines On Out-of-Network

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Sussex County Medical Society Newsletter

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New Jersey Earned Sick Leave 

Click here to download the detaiils about the New Jersey earned sick leave law 
    Important: Postponement of new AmeriHealth New Jersey policy regarding CPT^® consultation codes 

Please be advised that AmeriHealth New Jersey will postpone the implementation of Claim Payment Policy #00.01.64: Consultation Codes, which outlines our reimbursement position on Current Procedural Terminology (CPT) consultation codes.

We previously communicated that this Claim Payment Policy would go into effect January 1, 2018, which would have aligned with reimbursement standards on certain CPT consultation codes set by the Centers for Medicare & Medicaid Services. However, the implementation of this policy will be postponed, and the Notification has been removed from our Medical Policy Portal.

Once the new implementation date is determined, we will post a new Notification on our Medical Policy Portal. We will also communicate this information in a future Partners in Health UpdateSM article. If you have any questions, email us at [email protected]. Be sure to include your name, contact number, and provider ID number in your email. CPT Copyright 2016 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Highlights of the 2018 Medicare Physician Fee Schedule (MPFS) Final Rule  Click here to download the MPFS

2018 Quality Payment Program Final Rule Highlights 

Click here to download the quality payment program document