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Retiring Physician?  Some Things To Consider Before Hanging Up Your Stethoscope

January 14, 2019 | No Comments
Posted by Beth Christian

If you are a physician approaching retirement, you may be thinking about the activities which await you once you cease your practice activities for good.  You may be dreaming of lying on a beach with a cool drink, traveling the world, or doing good by providing services as part of a medical mission or medical response team.  While many individuals in the workforce can retire after providing their employer with a few weeks’ notice, as a physician you’ll need to give yourself more time to make that transition.  Careful planning for your retirement exit will ensure smooth sailing as you move toward a post-retirement life.  Here are some things to consider:

  • If you are part of a multi-physician practice, you’ll need to determine how much notice you will give to your professional colleagues and will need to work through reassignment of clinical, governance and other responsibilities. If you are a solo practitioner, you will need to determine how you will notify the individual employees of your practice and how items such as unused vacation or sick time and employee benefits (if any) will be handled.
  • If you have an employment agreement with your practice, are an employee of a health care system, or are employed by a captive professional practice, you will need to review the notice requirements under your employment contract.
  • Since you will be providing professional services through the date of your retirement, you will need to determine how to bill for these services following your departure from practice, particularly if you have historically done your billing in-house.
  • There are legal requirements for patient notification regarding the manner in which patients can obtain copies of their medical records, as well as a newspaper notice requirement of the cessation of practice.
  • As a licensee of the New Jersey Board of Medical Examiners, you will need to determine what type of license to maintain post-retirement. It is possible to obtain either a retired active, reduced fee license or a retired inactive, no fee license.  Each of these has separate requirements and limitations that should be reviewed.
  • You should carefully review any third party payor and vendor agreements, as well as space and equipment leases for your practice, as well as for contract termination and notice provisions. You should review your current professional memberships and subscriptions (including cable and streaming service subscriptions).  All of these subscriptions have a monthly cost.  If you practice with colleagues, they may feel that the associated costs are no longer necessary.  If you are closing a solo practice, you may not want to pay for these costs once you are no longer actively working.
  • You should schedule a call or meeting with your insurance broker to review the various options that may be available with regard to professional liability insurance and any other types of insurance that you maintain.
  • If you do not plan on obtaining another direct patient care position, you should notify the NPPES that you will no longer be utilizing your NPI number once you are satisfied that you have received all claims payments.
  • You will need to notify the New Jersey Controlled Dangerous Substance Unit and the federal Drug Enforcement Administration. These agencies will provide you with instructions regarding the destruction of prescription pads and other matters involving your CDS and DEA registration.
  • If you will not be engaging in any practice activities, you should notify the hospitals and other health care facilities where you have Medical Staff privileges that you will be retiring.
  • If you are employed by a captive P.C., you will need to follow up and confirm that the P.C. has a new physician shareholder to assure that you are no longer responsible for the medical decisions of the captive P.C.
  • If your practice entity is not going to continue as an ongoing concern with other practitioners, you should take steps to dissolve your practice entity once you are satisfied that your practice activities have been wrapped up and all claims payments have been received. In addition, you will also need to have your accountant prepare and file a final tax return before your practice entity is dissolved.

The number of steps that a physician needs to take before retiring can appear somewhat daunting.  Enlisting the help of an attorney, an accountant, and other professionals who have helped physicians through the process should allow you to sleep more peacefully at night and ensure that you will take all the steps needed to launch a successful retirement.

 

January 7, 2019 Regulatory Developments

January 8, 2019 | No Comments
Posted by Anjali Baxi

Here are the most recent health care related regulatory developments as published in the New Jersey Register on January 7, 2019:

  • On January 7, 2019, at 51 N.J.R. 17(a), the Department of Human Services, Division Of Medical Assistance And Health Services, issued a proposed rule amending N.J.A.C. 10:66, Independent Clinic Services, addressing the payment methodology for covered services provided in an ambulatory surgical center (ASC). The proposed amendments memorialize the New Jersey Medicaid/NJ FamilyCare program’s compliance with Federal rules regarding ASC reimbursement at 42 CFR Part 416, Subpart F: “Coverage, Scope of ASC Services, and Prospective Payment System for ASC Services Furnished on or After January 1, 2008.”
  • On January 7, 2019, at 51 N.J.R. 28(a), the Department of Community Affairs, Division of Law and Public Safety, Board of Medical Examiners proposed rules to require licensed athletic trainers to complete one credit of continuing education in topics concerning prescription opioid drugs every biennial renewal period. These topics would have to include the risks and signs of opioid abuse, addiction, and diversion. The proposal would amend N.J.A.C. 13:35-10.21.
  • On January 7, 2019, at 51 N.J.R. 83(a), the Department of Health, Public Health Services Branch, Division of Family Services, Maternal and Child Health Service, Child and Adolescent Health Program, readopted N.J.A.C. 8:51A with amendments to address lead screening in children under the age of 6. The only Federal regulation governing lead screening applies to children enrolled in Medicaid, which requires children to be screened at 12 and 14 months, or between 36 and 72 months in the case of a child who has not been previously screened. The readopted rules are as protective as Federal recommendations regarding childhood lead screening. Accordingly, N.J.A.C. 8:51A would continue to govern lead screening for non-Medicaid enrolled children in New Jersey.  The goal is to have all children undergo lead screening.

Pharmaceuticals

December 19, 2018 | No Comments
Posted by Frank Ciesla

As you can see from the following link (https://www.washingtontimes.com/news/2018/dec/18/elizabeth-warren-us-govt-ought-make-generic-drugs/), Elizabeth Warren is proposing that the government now go into the manufacture of pharmaceuticals.  I have proposed in two prior blogs (http://njhealthcareblog.com/2018/05/17/pharmaceutical-pricing/; and http://njhealthcareblog.com/2018/11/08/pharmaceutical-pricing-update-to-may-17-2018-blog/) that we take a much more direct and simpler approach…that is that we legislatively impose the Most Favored Nation’s treatment on the drug industry.  This makes a lot more sense than creating another government bureaucracy.  The government’s track record in the medical field, as shown by their inability to provide care to veterans under the Veterans Administration is not at all encouraging and there is no reason to believe that their endeavor in the pharmaceutical field will be any better.

 

December 2018 Regulatory Developments

December 18, 2018 | No Comments
Posted by Anjali Baxi

Here are the most recent health care related regulatory developments as published in the New Jersey Register in December 2018:

  • On December 3, 2018, at 50 N.J.R. 2434(a), the Department of Health published a notice acknowledging the receipt of the petition for rulemaking submitted by Laura I. Thevenot, Chief Executive Officer, American Society for Radiation Oncology (ASTRO), Arlington, Virginia, requesting that the Department add ASTRO as an approved accrediting body for radiation oncology. The Department reviewed the petition and determined that additional time is needed to deliberate about this petition. Time is needed to further evaluate the standards for certification of the American Society for Radiation Oncology and compare them with the standards of the American College of Radiology and the American College of Radiation Oncology. The Department has asked the American Society for Radiation Oncology for additional information and has sought input from stakeholders. The matter will be deliberated on for a period of no more than 90 days.
  • On December 17, 2018, at 50 N.J.R. 2547(a), the Department of Law and Public Safety, Division of Consumer Affairs, New Jersey Board of Nursing published proposed amendments to Board of Nursing rules as a response to the ruling of New Jersey Supreme Court in In re Eastwick College LPN-to Rn Bridge Program, 225 N.J. 533 (2016) regarding the unreasonable interpretation of N.J.A.C. 13:37-1.3(c) 2. The amendment proposes to amend N.J.A.C. 13:37-1.3 to clearly require that 75% of graduates of a nursing education program with provisional accreditation who take the examination in a calendar year must pass the examination the first time they take it. The Board also proposes to amend the regulations to revise standards for nursing education programs with provisional accreditation.
  • On December 17, 2018, at N.J.R. 2549(a), the Department of Law and Public Safety, Division of Consumer Affairs Charitable Registrations Unit, the proposes to amend N.J.A.C. 13:48-4.3 and 5.3 to state that charitable organizations exempt from tax under Section 501 of the Internal Revenue Code must continue to report certain information to the Division, regardless of whether the IRS’s new reporting policy excuses an organization from reporting the information to the IRS. The proposed amendments require that, for charitable organizations that do not provide a list of contributors as part of their IRS filings, the annual financial reports filed by such organizations with the State of New Jersey must include a list of every contributor who, during the previous year, gave the organizations, directly or indirectly, money, securities, or any other type of property totaling $ 5,000 or more. The amendments permit separate and independent gifts of less than $ 1,000 to be disregarded. Charitable organizations will be required to provide the name and address of each contributor, the total amount given by each contributor, and a description of noncash property given.Docs #3491369-v1

NJ DOBI Issues Out of Network Guidance

December 11, 2018 | No Comments
Posted by Anjali Baxi

On Tuesday November 20, 2018, the Department of Banking and Insurance (“DOBI”) published Bulletin 18-14 (“Bulletin”) to help carriers, health care providers and other interested parties meet their obligations under the Out of Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Act”), which was enacted on June 1, 2018 and became effective on August 20, 2018.

The 29-page Bulletin serves as agency guidance until DOBI proposes regulations for the implementation of the Act. The bulk of the document contains procedures for claims processing and arbitration for out of network (“OON”) services provided on an inadvertent or urgent basis covered under the Act.  There is a short mention of OON billing and cost-sharing waivers, which reiterates the requirements under the Act and the Federal law on co-pay waivers.  The Bulletin also provides some guidance on the carrier disclosure requirements, including a customizable disclosure form as an attachment.  Links to the Bulletin and Attachments can be found below.

Much of the Bulletin focuses on the claims processing/negotiation process prior to arbitration and the arbitration process itself. The Bulletin provides language that must be included in the EOB informing the OON health care provider of its right to reject the payment and negotiate with the carrier, including specific time frames for notice of rejection of payment to be eligible for arbitration.

The Bulletin further provides the conditions under which the OON health care provider may request to enter into binding arbitration: (1) the difference between the carrier and OON health care provider’s final offer is $1,000 or higher; (2) the applicable preauthorization or notice requirements of the health benefits plan were complied with; (3) the matter does not involve a dispute as to whether a treatment or service is medically necessary, experimental or investigational, or cosmetic; or (4) the carrier should have authorized the service to be performed by an OON health care provider through an in-plan exception because the carrier’s network lacks a provider who is accessible and possesses the requisite skill and expertise to perform the needed services.

Until August 30, 2019, DOBI will utilize its current vendor MAXIMUS to administer the OON Arbitration System. Thereafter, a vendor will be engaged through DOBI’s procurement process.  Currently MAXIMUS will be accepting OON Arbitration Applications on https://njpicpa.maximus.com/njportal/. Fee information is available on the website.

The deadlines for rejection of initial and final notice of offers of payment and for filing the arbitration application are paramount. For example, MAXIMUS will reject any application that it receives in excess of the 30 days after the provider’s receipt of the carrier’s notification of its final offer of the allowed amount/allowed charge. The Bulletin spells out the evidentiary format and the deadlines for MAXIMUS to issue a decision and for the carrier to make payment, if applicable.

The Bulletin emphasizes its expectation that the OON health care provider will only bill the covered person for the cost-sharing liability for the services once, regardless of whether an increased payment was made by the carrier through negotiation or arbitration.

The links to the Bulletin 18-14 and Attachments are as follows:

Bulletin 18-14 :https://www.state.nj.us/dobi/bulletins/blt18_14.pdf

Arbitration Process Grid: https://www.state.nj.us/dobi/division_insurance/oonarbitration/processgrid.pdf

Arbitration Application: https://www.state.nj.us/dobi/division_insurance/oonarbitration/requestform.pdf

Disclosures to Covered Persons Regarding Out of Network Treatment. https://www.state.nj.us/dobi/division_insurance/oonarbitration/disclosures.pdf

 

November 2018 Regulatory Developments

November 28, 2018 | No Comments
Posted by Anjali Baxi

 

Here are the most recent health care related regulatory developments as published in the New Jersey Register in November 2018:

  • On November 5, 2018, at 50 N.J.R. 2239(b), the Department of Human Services, Division of Family Development published a public notice the Division of Family Development shall increase the rate of the personal needs allowance from $ 110.00 to $ 112.00 effective January 1, 2018, for SSI recipients and Work First New Jersey/General Assistance recipients living in residential health care facilities and for SSI recipients living in boarding homes. This increase is based on the total 2018 Federal Social Security cost-of-living increase. (Amends N.J.A.C. 10:123-3.4(a)).
  • On November 19, 2018, at 50 N.J.R. 2281(a), the Department of Community Affairs published a proposal to readopt the existing rules concerning requests for government records were scheduled to expire on October 17, 2018. The Department proposed that the rules be readopted without change. Comments due January 18, 2019.
  • On November 19, 2018, at 50 N.J.R. 2328(b), the Department of Human Services, Division of Medical Assistance and Health Services readopted rules for the Medicaid Only eligibility for aged, blind and disabled individuals. The DHS adopted the subchapter (N.J.A.C. 10:71) before the expiration while it works on changes to reflect the Federal requirements under the Affordable Care Act. Those changes will be published under a separate rulemaking. The readopted rules will continue to be in effect for seven years.
  • On November 19, 2018, at 50 N.J.R.2329 (a), the Department of Insurance, New Jersey Individual Health Coverage Program Board readopted rules Individual Health Coverage Program Plan of Operations. The mission of the Board administer the New Jersey Individual Health Coverage Program in a manner aimed at increasing access to coverage, protecting consumers, educating key stakeholders and other interested persons, and promoting carrier participation in the market. This includes establishment and modification of standard plans for marketing to individuals and establishing and administering the assessment mechanism. It also includes the regulation of individual health coverage carriers in conjunction with the Department of Banking and Insurance.
  • On November 19, 2018, at 50 N.J.R. 2334(a), the Department of Banking and Insurance, Small Employer Health Benefits Program Board adopted amendments to the Small Employer Health Benefits Plan at N.J.A.C. 11:21 Appendix Exhibits F, G, W, Y, HH, and II.

October 15, 2018 Regulatory Developments

November 13, 2018 | No Comments
Posted by Anjali Baxi

Here are the most recent health care related regulatory developments as published in the New Jersey Register on October 15, 2018:

  • On October 15, 2018, at 50 N.J.R. 2138(a), the Department of Law and Public Safety. Division of Consumer Affairs, proposed new rules and amendments to the rules for the Prescription Monitoring Program (PMP) (N.J.S.A. 45:1-45 et seq.), to expand delegate access to include athletic trainers and medical scribes employed by a hospital’s emergency department, modifies the conditions under which a prescriber is required to look up a patient’s PMP records, and provides for electronic health systems to access prescription monitoring information, so that PMP information can be directly integrated into electronic medical records, making access more user friendly.
  • On October 15, 2018, 50 N.J.R 2150(a), published a recodification of N.J.A.C. 13:49 as N.J.A.C. 8:70.   The Office of the Chief State Medical Examiner (Office) was created as an independent agency within the Department of Health. All functions, powers, and duties of the Office of the State Medical Examiner in the Department of Law and Public Safety (OSME) to the new Office and abolished the OSME.
  • On October 15, 2018, 50 N.J.R 2153(a), the Department of Law and Public Safety. Division of Consumer Affairs, Board of Medical Examiners adopted amendments to the requirements for the dispensing of drugs and special limitations applicable to the dispensing of drugs for a fee. (N.J.A.C. 13:35-7.5).
  • On October 15, 2018, 50 N.J.R 2153(b), the Department of Law and Public Safety. Division of Consumer Affairs, Orthotics and Prosthetics Board of Examiners, adopted amendments to the rules governing the scope of practice and licensure rules for orthotists, orthotist assistants, prosthetists, prosthetist assistants. (N.J.A.C. 13:44H-2.1, 2.2, and 3.5)
  • On October 15, 2018, 50 N.J.R 2177(a), the Department of Health received a petition for rulemaking from Laura I. Thevenot, Chief Executive Officer, American Society for Radiation Oncology (ASTRO), Arlington, Virginia, requesting that the Department add ASTRO as an approved accrediting body for radiation oncology.

Pharmaceutical Pricing: Update to May 17, 2018 Blog

November 8, 2018 | No Comments
Posted by Frank Ciesla

In light of the recent midterm election, we will soon have a split federal government, with the Democrats controlling the House and the Republicans controlling  the Senate and the White House.  In the area of health care, while little may get done, there is an area that appears to be of joint interest to both.  Both the President and many Democratic elected officials have suggested that we need to control drug prices.  Prior to the election, the Administration indicated that it was considering negotiating drug prices on behalf of certain governmental programs and considering European prices as a guide.

As mentioned in my previous blog of May 17, 2018 (http://njhealthcareblog.com/2018/05/17/pharmaceutical-pricing/), we should go much further than this for a whole host of reasons. I think it is appropriate for the United States, as the major buyer of pharmaceuticals, to enact the Most Favored Nation approach, under which no company could sell pharmaceuticals in the United States at a price higher than the lowest price they are sold anywhere else in the world.

What does that accomplish? Americans would not be encouraged, as we can see from the literature, to purchase drugs in Canada or Mexico, or as what is being hinted at currently in the literature, having employer plans encourage their employees to purchase drugs outside of the United States.  If the price of the drugs would be the same, or lower than they would be in Canada or Mexico (or from any other place that you would order them on the Internet), then there is no need to risk purchasing drugs outside of the American secure system of providing effective quality drugs.

In addition, contrary to the approach being considered of negotiating rates for pharmaceuticals, this approach would eliminate a number of problems.

There would be little opportunity under this approach for influencing the negotiations by political contributions, either requested by elected officials or voluntarily provided to elected officials to impact the negotiations.

There would also be no need for developing a specialized purchasing program for small business enterprises, to the extent that they can even exist in this expensive field of pharmaceuticals, minority enterprises or women owned enterprises. All types of purveyors of pharmaceuticals would be subject to the statutory limitation.

In a way, it would also accomplish the objective of having the rest of the world bear their fair share of common expenses.  It is clear that the American consumer is bearing the burden of pharmaceutical research and development, with the prices that they have to pay for drugs.  However, not only do the consumers in the United States benefit from research and development, but consumers throughout the world benefit as well.

Under a Most Favored Nation approach, all we would need is a government agency to enforce this simple pricing rule: whether or not the pharmaceuticals are being sold in the United States at a price no higher than they are being sold anywhere in the world.  This would lead to less regulation, as the government would not need to be involved with negotiating prices for individual drugs.

 

October 1, 2018 Regulatory Developments

October 18, 2018 | No Comments
Posted by Anjali Baxi

Here are the most recent health care related regulatory developments as published in the New Jersey Register on October 1, 2018:

  • On October 1, 2018, at 50 N.J.R. 2043(a), the State Board of Optometrists issued proposed rules to amend the continuing education requirements to require continuing education on prescription hydrocodone or opioids in general.
  • On October 1, 2018, at 50 N.J.R. 2044(a), the State Board of Physical Therapists proposed rules that sets forth new standards for wound debridement and general supervision requirements of licensed physical therapist assistants.

September 2018 Regulatory Developments

October 15, 2018 | No Comments
Posted by Anjali Baxi

 

Here are the most recent health care related regulatory developments as published in the New Jersey Register in September 2018:

  • On September 4, 2018, at 50 N.J.R. 1926(a), the Department of Banking and Insurance proposed a rule readoption with amendments regarding the standards and practices for the regulation of dental plan organizations (DPOs) and the provision of dental services on other than a pure fee-for-service basis by insurers, DPOs, and dental service corporations (DSCs). Included in the this readoption is new provision that would require that any employee dental plans offered as alternate coverage through an insurance contract intended to be sold as a pediatric dental plan to satisfy the EHB requirement of the ACA and fulfill certain requirements set forth in the proposed rules.
  • On September 4, 2018, at 50 N.J.R. 1931(a), the State Board of Medical Examiners proposed rules to amend the continuing education requirements to require physicians and physician assistants to complete one credit of continuing education in topics concerning prescription opioid drugs every biennial renewal period. These topics would have to include responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion.
  • On September 4, 2018, at 50 N.J.R. 1932(a), the Division of Consumer Affairs proposed rules to increase Controlled Dangerous Substance (CDS) registration fees after 21 years. All registrations fees are proposed to be doubled. Under the proposed rules, the initial and annual registration fee for dispensers and practitioners, it would change from $20 to $40.
  • On September 17, 2018, at 50 N.J.R. l987(a), State Board of Massage and Bodywork Therapy issued proposed amendments to existing rules regarding licensure to require applicants to complete a course of study of at least 500 hours in massage and bodywork therapies and to pass a written examination. The Board would no longer allow licensure based on passing a written examination.
  • On September 17, 2018, at 50 N.J.R. 1992(b), Department of Human Services, Division of Medical Assistance and Human Services, adopted amendments and new rules regarding home care services. There is a new provision regarding the transfer of beneficiary care to a different service provider. (N.J.A.C. 10:60-3.10).
  • On September 17, 2018, at 50 N.J.R. 2030(a), the Department of Health cancelled a call for pediatric intensive beds, citing that there is no current need. The notice stated that the Department issued approval for 22 new beds in response to 2017 pediatric intensive bed call. The next scheduled call is September 2, 2019.
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