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November 14, 2018

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Dear Colleagues,

Several of our committees are meeting this month and we will be sharing updates as they become available. The following is a recap from Dr. D’Angelo, our Insurance Committee Chair, of what his committee has been working on over the past few months. I would like to thank them and our  consultants, Hoda Henein and Arnie Tannen, for their great work in helping us address and resolve insurance issues for our members.

Dr D Angelo Tannen 1 Hoda Henein
Dr. Nicholas D'Angelo Arnie Tannen Hoda Henein
  • After meeting with the DOH, a "glitch," which was causing podiatry services to be denied when applied to the Medicare deductible, has been corrected. Many thanks to Harold Iselin in arranging and participating in this very productive meeting. 
  • After meeting with Fidelis healthcare to discuss the denials of L3000 services, it became apparent that Fidelis was using the Milliman criteria as the basis for coverage. Presently, the committee is attempting to access these criteria through the assistance of the APMA. Again, many thanks to Arnie Tannen for arranging and participating in this very productive meeting. Also, many thanks to Dr. Paul Kesselman and Mr. Dan Kline for supporting the committee’s efforts at this meeting. 
  • After much effort and communications with Health Care Partners, the burden of pre-authorizations has been lifted. The effective date of these changes have yet to be determined. All podiatrists should continue as they were until this date is communicated. Many thanks to our insurance consultant, Arnie Tannen, and our coding consultant, Hoda Henein, for their collaborative efforts on this issue. 
  • Most recently, it was discovered, through a member complaint, that Molina Health Care was denying all podiatry services for non-diabetics and patients over 21 years of age. Many thanks to our lobbyist, Harold Iselin, for communicating with this plan on our behalf. The committee is optimistic that this policy will be reversed in the near future. 
  • After communicating with Emblem HIP about the delay of HIP capitation monthly payments to podiatrists, it was determined that an internal systems issue was the cause. Many thanks to our insurance consultant, Arnie Tannen, for his assistance in contacting and effectively communicating our concerns. Although a lag in payments still exist, all podiatrists should have received a good portion of outstanding payments.
  • New pre-authorization requirements for Wellcare have been recently imposed for many podiatry services. We strongly advise members to check for any requirements prior to rendering services to these patients.
  • Dr. Kesselman, from the Insurance Committee, reports that through the efforts of the APMA, CPT code A5513 can be billed in cases where computerized technology is being utilized to create the cast for the devices.
  • Finally, Dr. Keating, Dr. Kesselman, Dr. Santi, Mr. Kline and Dr. D'Angelo recently attended the annual CAC/PIAC meeting in Baltimore, on November 10th and 11th. You still have time to avoid any MIPS penalties in 2018 and 2019 with some extremely simple reporting. Find out how by watching a 9 minute webinar found on the APMA website. An EHR program is not required in order to successfully report and avoid penalties or for obtaining a bonus.

As we enter the Holiday Season, I know that many of our members are involved in volunteer efforts of providing podiatry services to those less fortunate in their communities. NYSPMA would like to highlight these initiatives and efforts in the coming weeks. Please let us know if you are involved in such programs by emailing Executive Director Dan Kline at dkline@nyspma.org so we can share it with our members. Thank you all for the incredible work that you do each and every day.

Have a wonderful rest of your week.

Patricia

NY18 Clinical Conference Registration Now Open

NYSPMA member registrants, please carefully read the following:

MEMBER ID NUMBERWhen registering for the conference, you will be asked to provide your member ID number. Your APMA and NYSPMA ID numbers are the same. When registering for NY18 use your APMA/NYSPMA number (and not the old 999xxxx number). The ID number is located on your invoices and on your online member profile on the website. Or you can call 212-996-4400 or email nsaari@nyspma.org to get your ID number.

CECH LETTER: Attendees will receive a survey linked to their CECH letters no later than March 1, 2018.  Any members not in good standing will be required to make their dues payment in order for their letter to be released.

Register Here On-Line
Eligible members who register before the December 8th deadline attend at no additional cost.

Young Member Forum at NY18

Dr. Andrew Pasvelescu and the Young Members Committee would like to announce that the Young Member Forum will be Saturday, January 20, 2018, from 3:30-5:30p.m. at NY18 following the complications seminar with a reception to follow. Topics will include malpractice, legal, and coding issues. There will also be a financial management lecture and a presentation on process of qualifying and getting board certifications post residencies.

Call For Board & HOD Nominations

It is time to make known any interest in running for the NYSPMA Board of Trustees, and/or as a Delegate to the 2019 APMA House of Delegates.

 The following seats are open for the 2018-2019 year: 

  • NYSPMA Trustee, three (3) three-year terms
  • APMA Delegates 2019 (# of seats available to be determined by membership tally). 

Interviews will be held at the Clinical Conference in NYC in January 2018, so if you are planning to run for any of these positions, this would be an ideal opportunity to be interviewed by the Nominating Committee. Elections take place at the NYSPMA House of Delegates in 2018. 

Please send a letter of intent along with a current CV by email to Dan Kline, Executive Director, dkline@nyspma.org.

CPR Billing and Coding Tip of the Week

To assist you and your staff in keeping up to date with insurance, billing and coding changes, we have added this new Tip of the Week feature. Each week, we will be providing a “tip” to help you navigate the increasing complexity of reimbursement and compliance. We encourage you to visit our Billing and Coding Portal.

CMS Responds to Concerns Regarding Custom Fabricated Diabetic Inserts

The Centers for Medicare and Medicaid Services (CMS) has proposed a change to the DMEPOS Quality Standards that addresses the concern regarding the recent DME MAC/PDAC interpretation of the term “molded to patient model” when used to describe custom fabricated diabetic shoe inserts. The proposed change to the quality standards allows for the creation of a digital positive model of the patient’s foot using CAD/CAM technology that is then used to direct mill a custom fabricated insert based on the digital model.

In July, 2017, the DME MACs and PDAC issued a joint bulletin that stated that in order to meet the definition of “molded to patient model” contained in the descriptor for A5513, diabetic inserts must be fabricated over a physical model of the patient’s foot. The bulletin went on to state that digital or virtual models that were used to direct mill custom inserts are not considered a positive model and inserts fabricated using this technique do not meet the code requirements of A5513 and therefore, must be billed as A9270, a statutorily non-covered HCPCS code. On September 28, 2017, AOPA and the American Podiatric Medical Association (APMA) submitted a joint letter to CMS expressing their concern over this bulletin as it represented a significant threat to the use of advanced technology to provide better clinical service. In addition to working directly with the APMA, AOPA worked closely with the O&P Alliance, Representative Wenstrup’s (R-OH) office, his staff, and the House VA Subcommittee on Health to make sure that this issue remained at the forefront of the discussion.

On November 2, 2017, CMS announced a proposed change to the DMEPOS Quality standards that would include the use of digital or virtual models to direct mill custom diabetic inserts as an acceptable method to meet the definition of “molded to patient model” contained in the code language for A5513. CMS will hold an Open Door Forum call on November 28, 2017 at 2:00 pm EST to allow experts to discuss the proposed changes to the DMEPOS Quality Standards and will accept comments on the proposed changes through December 11, 2017. Comments on the proposed changes may be sent to CMS via e-mail at ReducingProviderBurden@cms.hhs.gov

CMS has indicated that it intends to finalize the proposed changes by January 1, 2018.

Legal Tip - Paid Family Leave

Andrew Feldman 0088It’s the Law Effective January 1, 2018

by Andrew Feldman
General Counsel, New York State Podiatric Medical Association

Employers, including all podiatry practices, are required to provide paid time off for employees with family emergencies and obligations. This law applies to all podiatry practices, regardless of the size or type. There are no exceptions or exemptions.

Coverage for the program is provided through the podiatrists’ workers compensation disability benefits insurer. Every podiatrist should be in contact with his or her insurer to set up a paid family leave program.

The intent of the law was for employees to completely fund the program through a payroll deduction system. Although employers have the option to pay for the program themselves, instead of using the employee payroll deduction, that would probably not be the best choice. The law guarantees employees the following:

  1. Wage replacement for 8 weeks in 2018, increasing to 12 weeks by 2021.
  2. Job protection upon return from paid family leave.
  3. Continuation of health insurance while out on paid family leave.

Job protection is defined as returning to the same job or a job comparable to the one the employee held prior to taking leave.  Employers can require that employees continue to pay their health insurance premium contributions.

An employer may not discriminate or retaliate against an employee for taking or inquiring about paid family leave. Employers must also insure that there employees are aware of the paid family leave program and that their policies comply with the law.

Podiatrists should probably include paid family leave information in the employee handbook or any similar employee materials that are distributed. Additionally, by January 1, 2018, podiatrists will be required to display a poster regarding paid family leave coverage in their place of business, similar to the poster required for workers’ compensation or disability benefits coverage. Your insurance carrier should supply the poster to you. 

This is a critical obligation for a podiatrist’s practice, and an employee benefit. There are consequences for failing to implement the paid family leave program, and noncompliance can lead to costly claims.

If you need help setting up your paid family leave program, you can call the New York State office governing this at (844) 337-6303 or go to www.ny.gov/paidfamilyleave.

NYSPMA Job Board

For most, seeking a new career takes a lot of time and patience. Job hunting has turned into a science. Avoid wasting your time and patience by using the right resources to find your next career. The NYSPMA Job Board is the best channel to find open positions in our industry. Recruiters posting on the NYSPMA Job Board are looking for quality candidates that stand out from the rest. Be sure to upload your resume and start searching the open positions posted on the NYSPMA Job Board today. Click here to get started!

NYSPMA: Connect on Facebook & Twitter

NYSPMA has a Facebook page and is now on Twitter. These pages provide both consumer foot health information and Association announcements and updates. We are always looking for great news stories to share on our pages. If you’ve recently been quoted in the media, received an award, launched a new project or have relevant news to share, please email lsales@nyspma.org

Poster for Your Office
: We have developed an 8 1/2 x 11 Full Color Poster/Flyer that can be displayed in your office to encourage your patients to visit our site to stay up to date on the latest foot health news and get updates on diabetes, bunions, heel pain...and more.

Upcoming Events

December 5, 2017
7:00-9:00PM

Suffolk Division Meeting

Insignia Steak House, 610 Smithtown Bypass, Smithtown, NY 11787

December 7, 2017
7:00PM

Annual Downstate Meeting

Hosted by the Kings Division

Terrace On The Park, 52-11 111th Street, Flushing, NY 11368

December 11, 2017
6:30-9:00PM

Mid-Hudson Division Meeting

Sapore Steakhouse, 1108 Main St., Fishkill, NY, 12524

December 11, 2017
7:00PM

New York Division Dinner Meeting

Blu on Park, 116 East 60th Street, New York, NY 10022

December 14, 2017
7:00-9:00PM

Queens Division Holiday Dinner

Morton's Steakhouse, 777 Northern Blvd, Great Neck, NY 11020

December 19, 2017
6:30-9:00PM

Northeastern Division Meeting

TBA

December 21, 2017
7:30PM

Queens Division Dinner Meeting

Crabtrees Restaurant, 226 Jericho Turnpike, Floral Park, NY

January 19-21, 2018

NY18 Clinical Conference

Marriott Marquis Hotel, 1535 Broadway, New York, NY 10036

February 20, 2018
7:00-9:00PM

Suffolk Division Meeting

TBA

April 10, 2018
7:00-9:00PM

Suffolk Division Meeting

TBA

April 12, 2018
7:00-9:00PM

Queens Division Dinner Meeting

Trattoria 35 Restaurant, 213-15 35th Ave., Bayside, NY 11361

May 8, 2018
7:00-9:00PM

Suffolk Division Meeting

TBA