January 2010
The
- FOUNDED 1921-
Career
and Fellowship Fair
On January 6th, 2010 the NYSPMR will
be holding its career and fellowship fair starting at 6pm
in The Hospital for Special Surgery (70th and York Ave, New York City) 2nd
Floor Conference Center. Representatives
will be present to provide you with information and answer your questions about
various job and fellowship opportunities. We would like to thank Dr. Paul Rai
and Dr. David Lee for their efforts in organizing the fair. For further
information please contact Dr. Lee at lee.davidw@gmail.com
NYSPMR Monthly
Lecture Series and CME
The next CME-accredited lecture/dinner program
will be on
We would like to express our gratitude for the
Hospital for Special Surgery for providing our CME accreditation this year as
well as allowing us the use of their conference center for the past 5 years.
Please visit their website for further educational activities offered through
HSS. http://www.hss.org/cme.asp
·
If you have questions or concerns regarding the
content or presentation of a session please contact Dismayra Martinez, PA, MA, Coordinator
of Professional Education at The Hospital for Special Surgery 212.606.1613 martinezd@hss.edu or Danielle McPherson at
212.606.1812 mcphersond@hss.edu
Upcoming
NYSPMR Workshops
·
Spinal Cord Stimulator: With special thanks to Dr. Phalgun Nori, the NYSPMR together with Medtronic, Inc. are pleased to announce a-hands
on workshop on spinal cord stimulators on February 10 at
·
Legal medicine workshop series: with Dr.
Alan Lambert, Esq. March 10,
·
Musculoskeletal Ultrasound: Thanks to the
efforts of Dr. David Cheng, we are pleased to announce a hands-on workshop that
will be held in Spring 2010. Further details to follow.
·
We would like to thank Dr. Tamar Kessel and
Dr. Kevin Sperber for our recently successful hands-on work shop on Cervical
Dystonia. Plans are underway for
additional workshops to include management of Upper Extremity Spasticity using Botulinum Toxin. Further details to follow.
Social Events occur regularly at nearby
venues following the conclusion of the lectures. Please join us in these events to get to know
your fellow physiatrist
NYSPMR Resident
Bowl –
We will be requesting a team of 4 residents from
each program to join in the fun, and see who will win it all this year.
Congratulations to SUNY at Stony Brook for winning last year. If Attendings
wish to submit their own multiple-choice style questions to test residents’
knowledge at the bowl, please submit them to Dr. Ruth Alejandro at alejanjr1@netzero.net
NYSPMR Resident
Night –
Submissions of original research abstracts or
case reports (which have not been previously published or presented) are now
being accepted and reviewed. To be considered for presentation please email
your original abstract to Susan.Stickevers@va.gov
News from the NYSPMR Legislative Committee
Update from Marty Schaum, Esq.,
who has represented the interests of the society in
The Society will be closely monitoring the
activities of the physical therapy lobby as it pursues legislation permitting
physical therapists to have direct access to workers’ compensation
patients. During the last legislative
session our opposition to this initiative was articulated and the same
arguments will be advanced in 2010. At
the same time we must remain vigilant concerning all efforts to intrude upon
the medical province.
On the
issue of medical malpractice insurance an important hearing was held by a
special Senate subcommittee in December and attention was paid to the advent
and growth of Risk Retention Groups (RRGs).
It is possible that you have been solicited by an RRG and, if so, it is
important to remember that these groups are not backed by the New York State
Insurance Department so that if an individual RRG should become insolvent in
the future there is no State insurance fund to offer you coverage. This possibility should be weighed against
the attractiveness of the low premium offered to you. The Senate hearing was asked to impose
greater control over RRGs and it will be interesting to watch this issue
unfold.
The
State elections to be held in 2010 will also be extremely important as those
elected will redraw election district boundaries in the 2011 reapportionment
process. If one party controls both
Senate and Assembly it can redraw lines to strongly favor one party over another. Since this is a vital issue for both
Republicans and Democrats in power the political game will be quite vigorously
played in
·
The NYSPMR has joined with the NYS Coalition of
Specialty Care Physicians. This is an important new development to help with
our lobbying efforts in
Save the date:
Coding Changes in
Electrodiagnostic Medicine
Members should be aware of the changes that will
be imposed in 2010, including a more complete definition of traditional nerve
conduction studies. Providers who use
preconfigured electrode arrays will need to be ready for these changes. The NYSPMR will seek to bring you a brief
summary of the upcoming coding and billing changes in the upcoming year once
they have been released.
Medical Student Workshops: NYSPMR is committed to promoting medical students
education and to help expose them to our field. We will now be participating in
board review courses for Touro College of Osteopathic
Medicine. I would like to thank Dr. Van de Walle, Dr. Jessica Au, Dr. Andrew
Toy and Dr. Annemarie Gallagher for spearheading this endeavor and invite those
also interested in participating to contact nysocietyofpmr@gmail.com
Membership
Information:
The New York Society of Physical Medicine and
Rehabilitation (NYSPMR) is a non-profit educational organization dedicated to
the advancement of the specialty of Physical Medicine and Rehabilitation
(PM&R). Please help support our educational, networking and legislative
opportunities by becoming a member and paying yearly dues. If you are
interested in becoming a member please contact: NYSPMR, c/o Valerie Davis, New York County Medical Society, 12 East
41st Street, 15th Floor, New York, NY 10017, Tel #: (212) 684-4670, ext. 220, Fax
#: (212) 684-4741,Email: vdavis@nycms.org
or
visit our website at www.nyspmr.org
Inspirational Words of the Month “The only limit to our realization of
tomorrow will be our doubts of today.” -
HAPPY HOLIDAYS AND A HAPPY NEW YEAR FROM THE
NYSPMR!!
2009-2010 Officers
President: Michelle Stern, MD
President Elect: Susan Stickevers, MD
Co-Vice Presidents:
Treasurer:
Executive Committee Chair:
Program Chair: Paulinder Rai, DO
Resident Section
Co-President: Laura Manfield, DO and David Cheng,
MD
Co-Vice President: Seth Schran, MD and Tamar
Kessel, MD
Secretary:
Members at large: James Chang, MD, David Lee, MD,
and Sheetal Deo, DO, Sagar Parikh. MD
Dr. Lambert is the Special Health Law Counsel to the New York
Society of Physical Medicine & Rehabilitation. His latest article is on: Surviving
Third Party Payer Audits and Investigations. If there are any further topics
that our members wished to be addressed in future newsletters or workshops,
please contact Dr. Lambert at 212-905-1513 or email: lambert@butzel.com, www.attorney-for-physicians.com.
Surviving Third Party Payer Audits and Investigations
Unfortunately, with increasing frequency, physicians and other
licensed health care providers have been subjected to third party payer audits,
investigations and demands for repayment. On the government payer front,
This article will address some of the red flags as well as steps that may be
taken with the advice and counsel of your individual attorney when you find
your medical practice under audit or investigation by a third party payer.
• Audits and investigations are frequently the result of a
complaint received by the third party payer. Disgruntled patients, employees
(former), and competitors are common sources of complaints. Perform a risk
management review of your treatment, and compliance review of your coding and
billing, before you consider placing a patient in collection or initiating
other potentially adversarial conduct with the patient. Unfortunately, too many
audits and investigations are initiated as a result of a retaliatory complaint
by the patient to the third party payer. An audit can also be triggered when a patient
calls up a third party payer seeking clarification of information they did not
understand on an explanation of benefits (EOB). Make sure your patients
understand the services provided and the related billing for same. Remember
that your relationships with employees can be transient and the separation from
employment may not always occur on the best of terms. Therefore, do not allow
employees access to sensitive information that could be misrepresented by them
to make a bad faith report.
• Audits and investigations may also be triggered by internal
third party payer data. Third party payers commonly prepare comparative
performance reports which compare you to your peers in terms of multiple
variables such as the volume of diagnostic tests ordered, procedures performed,
billing (CPT) codes used, cost of treatment per diagnosis and quality of
outcomes. If you fall outside of the norm for your peers, you can be subjected
to an audit. Frequently, the third party payers are unaware of, or fail to
adjust for, differences in your patient population or case mix from that of
your peers. With proper legal representation, data can be prepared that places
your practice in proper perspective and justifies the services provided.
• Requests by third party payers for a copy of more than one
medical record at a time could be a red flag that you are the subject of an
audit. Another red flag is a letter that comes from a “special investigation”
unit of the third party payer. The special investigation unit of a third party
payer commonly addresses issues of suspected fraud.
• Respond to medical record requests in timely fashion. Delay
can create suspicion on the part of the third party payer. It is important to
be sure that the release of copies of medical records to the third party payer
is in compliance with applicable state and federal law including applicable law
on patient confidentiality. When you receive a request for medical records, do
not alter the medical records. If you must make an addition to a medical record,
this should be done in a separate note which is dated and timed to correctly
identify when the note was written. Since even correctly dated and timed
additions to medical records can raise risk management issues, it is best to
review the matter with an attorney before making such additions. Remember that
medical record fraud, or even the appearance of same, can convert an otherwise
defensible or manageable case into a career ending fraud case.
• Be careful about attempting to defend yourself during an
audit or investigation by answering the questions of an investigator or
submitting written statements without the advice of an attorney. Don’t assume
that the audit or investigation is all a terrible misunderstanding which can be
clarified by showing good will on your part. Your statements, whether
verbal or written, can subsequently be used against you. However, with the
advice of an attorney, useful information such as medical literature justifying
your approach to treatment and data justifying your volume of diagnostic tests
ordered, procedures performed, and billing (CPT) codes used can be submitted.
The submission of the aforementioned information may lead to an audit or
investigation being closed out without any action being taken against you.
• In general, don’t offer to make repayments without a written
settlement agreement which addresses issues needed to protect your interest
such as the reason for repayment, your right to continue to be a provider for
the third party payer, and whether the matter has been, or will be, reported to
government agencies such as state licensing authorities, state insurance
departments, and the state/ federal criminal authorities.
• To reduce the risk of audits, investigations and
prosecutions, consider implementing a compliance study of your practice to
identify and correct problems relating to medical record documentation, billing
and other practice issues. It is important that your medical records justify
the medical necessity of the services provided. As part of a compliance plan,
certified professional coders can be useful consultants.
The information contained in this article is presented for educational purposes
only and does not constitute legal advice. You should consult with your
individual attorney prior to acting on any of the educational information
provided herein.
