In this edition:
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NCSEPS’ Initiative Resolves Coding, Billing Issues with BCBSNC and CEC
NCSEPS leadership, along with NCSEPS and NCMS staff, and other concerned physicians recently held several meetings with Blue Cross Blue Shield of NC (BCBSNC) to address concerns over erroneous processing of claims. We estimate that this will be worth thousands of dollars to each NC ophthalmology practice that treats BCBSNC patients.
BCBSNC has acknowledged that there were errors in its processing of claims and is working to correct the errors moving forward AND adjusting claims retroactive to 5/1/16.
Ophthalmology practices in NC noticed that after 5/1/16, certain codes and services were no longer being processed or paid by BCBSNC as they had in the past. The new and established eye codes (920XX) and the refraction code (92015) were affected by the change implemented by BCBSNC. BCBSNC maintains that notices were sent of this change on 2/1/16, in compliance with the 90 day notice requirement, indicating that Community Eye Care (CEC) would be processing all claims made with the eye codes after 5/1/16.
Significant confusion resulted, as customary billing practices were suddenly met with denials and unusual bundling on BCBSNC claims. This applied to BCBSNC commercial plans as well as Medigap (BCBSNC secondary to Medicare) and State Health Plan secondary to Medicare. Several of the issues have been resolved, and others are still in discussion. NCSEPS physicians and NCSEPS and NCMS staff are continuing to work with BCBSNC to ensure that our physicians are fairly compensated for the services provided to BCBSNC patients.
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Ophthalmologists Fight to Protect Patient Safety in NC
New state legislation that threatens patient safety has sparked a fire among NC's ophthalmology community. The bill, HB 36, would allow optometrists to perform surgical laser and scalpel procedures on and around the eyes. Ophthalmologists are working to educate legislators on the significant differences in education and training between ophthalmologists and optometrists, and have expressed concerns about the risk to patient safety that the legislation presents.
Since the joint NCSEPS, AAO and NCMS campaign opposing the bill launched, some legislators have withdrawn their support for the bill. In a strategy meeting with NCSEPS and AAO physician leaders, Dr. Kurt Heitman, AAO Secretary for State Affairs advised, "Be truthful. Be factual."
Here are the talking points:
- HB 36 is not in the best interests of North Carolinians and poses a significant threat to patient safety.
- Our state's medical community opposes HB 36 because it would allow optometrists – who are not medical doctors, and are not trained surgeons – to perform delicate surgery on the eye and surrounding tissues.
- Performing surgery of any kind without the proper level of medical education and clinical training would put patients at risk.
- Patient safety must always come first, and HB 36 would lower our high standards of patient safety.
The NCSEPS urges ophthalmologists to continue contacting your state legislators in opposition to HB 36. We have seen organized optometry move quickly to advance similar proposals in other states. This type of legislation was proposed and derailed in six states and Puerto Rico in 2016. A quick and passionate response by ophthalmologists and concerned citizens is necessary to further increase the growing opposition to the bill.
Take Action Now:
- Use the “Who Represents Me” tool on the NC General Assembly website to search for your representative in the NC House by zip code. To locate representatives by county, click here.
- Call and email to voice your opposition to this dangerous bill. Expand your contacts to include legislators who represent your home, your primary business location, and any satellite offices where you practice.
- Report feedback that your receive to the NCSEPS by email to ncoph@ncmedsoc.org.
- Support us in this effort with an online contribution to the NCSEPS Advocacy Fund.
Meetings with Legislators – Request a meeting with your legislators. Our NCSEPS staff and lobbying team can assist you with scheduling, advocacy training and talking points, and by providing key insights. Please let us know (ncoph@ncmedsoc.org) when you have meetings scheduled so that we can coordinate. Clinic and ASC visits are also a great way to introduce legislators to the world of medical-surgical eye care.
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Many members have already traveled to Raleigh to speak with legislators. If you’re able to come to Raleigh any Tuesday, Wednesday or Thursday, our lobbying team will provide assistance with scheduling meetings, reviewing the talking points and providing key insights. Please look at your calendar and let us know when you can make it to Raleigh by email to ncoph@ncmedsoc.org.
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Pictured: Dr. Sara Stoneburner (Greensboro), Dr. Jamie Bryan (Chapel Hill) and the NCSEPS lobbying team at the NC General Assembly on Feb. 8, 2017.
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Dr. Greg Murphy Tapped to Chair Key Health Committees in NC House
Rep. Greg Murphy, MD (R-Pitt Co.) – the only physician in the state legislature – will chair two key health committees in the 2017 session of the North Carolina House of Representatives. House Speaker Tim Moore (R-Cleveland Co.) has appointed Dr. Murphy to chair the House Health Committee as well as the House Appropriations Committee on Health and Human Services.
The 2017 legislative session is just beginning, and we anticipate several topics of interest to be considered by the General Assembly. A priority issue, of course, will be implementation of Medicaid reform that was passed by the General Assembly in 2015. In 2016, the state applied to CMS for approval of a plan to capitate payment on health services. CMS has yet to announce a decision with regard to the state’s waiver application.
Other issues that are likely to surface include a bill to expand optometrists’ scope of practice into surgery (including YAG and SLT lasers), legislation to address the opioid crisis, legislation to eliminate physician supervision of advanced-practice nurses, access to mental health care, and legislation addressing step therapy, among others. We are not aware of any efforts to dial back the medical liability relief that was won in 2011, but this remains a key area of concern and, as such, we continuously monitor for any movement on this issue at the legislature.
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NC Welcomes Dr. Mandy Cohen as NC DHHS Secretary
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Dr. Mandy Cohen, former Chief Operating Officer and Chief of Staff for CMS in Washington, started her new position as Secretary of NC Department of Health and Human Services this week. Dr. Cohen was tapped by Governor Roy Cooper to lead the agency’s 15,000 employees and oversee an annual budget of $20 billion.
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Prior to her role as COO at CMS, Dr. Cohen held positions in the Center for Consumer Information and Insurance Oversight (CCIIO) at CMS and the CMS Innovation Center. She received her medical degree from Yale School of Medicine, a Master’s in Public Health from the Harvard School of Public Health, and trained in Internal Medicine at Massachusetts General Hospital.
Dr. Cohen is married to Sam Cohen, a health care regulatory lawyer, and has two daughters.
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Enhance Your Leadership Skills, Apply for NCSEPS Endorsement
Effective physician leaders are needed to deliver great health care in our state. The NCSEPS wants you to be a strong leader and we’re partnering with the NC Medical Society to ensure that NCSEPS members have access to leadership development opportunities with the NCMS' Leadership College and Health Care Leadership & Management Programs. The NCSEPS will consider endorsement requests from NCSEPS members in good standing. To be considered for NCSEPS endorsement, please email your endorsement request along with a copy of your CV to ncoph@ncmedsoc.org by March 31, 2017.
Leadership College - The Leadership College Program provides you with the tools to handle the rapidly changing health care environment and call-to-action as a physician leader. The Leadership College Class of 2018 will convene in Fall 2017. Participation requirements include four in-person meetings, periodic phone meetings, and completion of an individual or group project. 2017/18 meeting dates (subject to change): Sep. 15, 2017, Jan. 26-27, 2018, May 18-20, 2018, June 2018 (TBD) and Sept. 14, 2018.
Prior Leadership College Scholars:
- Chad Brasington, MD (Burlington), Class of 2008
- Sandya Cohen, MD (Greensboro), Class of 2014
- George Cooper, MD, FACS (Fayetteville), Class of 2005
- Sharon Fekrat, MD (Durham), Class of 2003
- Darrell Hester, MD (Wilmington), Class of 2010
- Ami Shah, MD (Durham), Class of 2015
- Brian Smith, MD (Asheville), Class of 2005
Health Care Leadership & Management (HCLM) – The HCLM Program provides a critical framework for physicians based on economics, finance and leadership development. With this framework, graduates are provided the necessary vocabulary for the business realm and are equipped to take on greater leadership positions in their career. Participation requirements include four in-person meetings, optional on-site visits, periodic phone meetings, and completion of a team project. 2017/18 meeting dates (subject to change): Oct. 13-15, 2017, Jan. 14, 2018, April 13-15, 2018, and June 22-24, 2018.
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Prior Authorization Got You Down? NCMS Advocates for Reform
The NC Medical Society announced on January 25, that it is part of a coalition of 15 other health care organizations led by the American Medical Association (AMA) urging health plans, benefit managers and others to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.
Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved by applying the principles’ common-sense concepts grouped in five broad categories:
- Clinical validity,
- Continuity of care,
- Transparency and fairness,
- Timely access and administrative efficiency, and
- Alternatives and exemptions.
Read the 21 principles guiding the coalition’s efforts.
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Nominate a Physician for the
2017 NC DOCTOR OF THE YEAR Award Today
ncdoctorsday.org | The nomination period ends March 1.
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ICYMI: The Latest Developments in Medicaid Transformation
A recording of the NCMS’ recent Webinar about Medicaid reform developments is now available. The presentation covers the latest developments with regard to Medicaid transformation in North Carolina, including the NCMS’ partnership to create Carolina Complete Health, a provider-led Medicaid health plan. Access the presentation here: https://attendee.gotowebinar.com/recording/2673678407429429505
Carolina Complete Health is an innovative partnership between the NCMS, the North Carolina Community Health Center Association (NCCHCA) and Centene Corporation and offers an unprecedented opportunity for physicians and other providers to have a say in how to best serve Medicaid patients and how to minimize bureaucracy while achieving cost efficiencies. The plan focuses on the NCMS’ longstanding principles for Medicaid: patient-centered, physician-led, value driven and homegrown.
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CMS Quality Payment Program Webinar Available
On November 15, 2016, the Centers for Medicare and Medicaid Services presented a webinar on its Quality Payment Program Final Rule that resulted from the passage of MACRA. The webinar provides answers to many questions related to the rule and provides guidance going forward. Access the video presentation online.
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AAO Mid-Year Forum & Congressional Advocacy Day 2017: April 26-29
Registration is now open for the American Academy of Ophthalmology's 2017 Mid-Year Forum. During this annual forum in Washington, D.C., Academy members and other ophthalmic leaders gather to discuss critical issues facing ophthalmology. The event also includes Congressional Advocacy Day, April 26 to 27, and the spring meeting of the Academy Council, April 28 to 29. Congressional Advocacy Day is free to attend. Registration is open until April 11.
Benefits of attendance:
- Provide valuable contributions to Academy policy development.
- Help build and strengthen our relationships with members of the U.S. House and Senate.
- Learn more about Academy activities and initiatives.
- Return to your state, subspecialty or specialized interest society armed with the latest information.
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Save the date! NCSEPS Annual Meeting, Sept. 22-24
- Dates: September 22-24, 2017
- Location: The Omni Homestead Resort in Hot Springs, Virginia. For reservations, call (888) 796-5838 (option 1) and reference NCSEPS.
- Exhibiting Opportunities: Please help ensure a successful meeting by sharing the Exhibitor Prospectus with the product and service representatives that call on your practice.
- Questions? Contact Nancy Lowe, nlowe@ncmedsoc.org, or 919-833-3836 ext. 111.
About the Homestead Resort
Experience the Southern hospitality and elegant charm that have made The Omni Homestead Resort a premier destination for 23 U.S. presidents dating back to the 18th century. With more than 2,000 acres of timeless comforts and modern amenities all under one roof, the Hot Springs, Virginia accommodations are the perfect getaway for business and leisure traveling.
Whether visiting in the winter or summer, The Omni Homestead Resort offers plenty of indoor and outdoor activities to keep all guests happy. Two major hot springs flow onto the property, offering guests the opportunity to take in the mineral waters just as President Thomas Jefferson did in 1818. Its two-acre water park, fueled by crystal clear springs, features two water slides, a lazy river, a water play zone and a sandy beach for the kids, along with a cozy whirlpool and private cabanas with exclusive services. Golfers can challenge themselves on nationally ranked golf courses. Guests can step into the Spa at the Homestead for an exhilarating rejuvenation like no other.
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