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Physician Advocate Volume 8, Issue 2


Inside: ‘MSNJ Docs in the News,’ Practice Management Feature: Payer Policies and Denials, New Jersey Academy of Ophthalmology Elects New President: Brenda Pagán-Durán, M.D., ‘Corner Office,’ Photos and Event Recaps

Corner Office MSNJ CEO & General Counsel

Lawrence Downs, Esq. Get connected to MSNJ!


Dear MSNJ member: As you may know, legislation was recently introduced to effectively end collaborative agreement requirements for Advance Practice Nurses (APN’s) to practice with a physician. Presumably this legislation is seeking to address the coming shortage of physicians by expanding the ability of nurses to act as physicians. Your state medical society has been actively working with a coalition of state and national physician organizations to defeat this unprecedented expansion of nursing practice Page 2

in New Jersey. Not because the organization is against nurses, but because we believe this proposed policy will work against team based care. We are asking you, our members to help educate your patients, policy makers, and community groups about this issue.

and treat patients. Nurses spend just 500 – 720 hours depending on their training program. Healthcare delivery is a team sport. Coordinated care occurs where physicians and other healthcare professionals work collaboratively in the best interests of a patient. This legislation embodies the antithesis of team work and collaboration.

APN’s are a vital part of medical care teams. Our opposition to the legislation If enacted the legislation would is not an indictment of the create care centers where valuable work of these patients healthcare Healthcare delivery would practitioners. is a team sport. never have Our access to a opposition physician. rests on the Our state health policy must fact that nursing care, even encourage interdisciplinary at the highest quality, is not a teams that ensure access to one for one replacement for physician care. physician care.

The training of a medical doctor (or doctor of osteopathic medicine) and an APN cannot be compared. Physicians undertake 4 year of medical school. The nurse practitioner does 2-4 years of postgraduate training. Then there is something called residency.

Our state needs to solve the coming shortages of both physicians and nurses. Creating incentives for team based care is much more difficult than simply creating “new doctors” by legislative fiat. Our healthcare is too important to take the easy fix.

Physicians spend 3-7 years in residency training to become really good at taking care of patients. Nurses do no residency training at all. Physicians train 12,000 to 16,000 hours to be able to safely evaluate, diagnose

Help support a strong healthcare system. Join your colleagues at your county and state medical society by applying for membership today.

Medical Society of New Jersey’s Physician Advocate Magazine

Payer Policies and Denials – A step in the management of your practice’s revenue cycle By Laura S. Tarlow MBA, CMPE We all get them – claims denials.

While all practices get some level of claims denials, better performing practices ask: (1) why do these denials occur; (2) is there a pattern to these denials; (3) which denials can be appealed; (4) what caused the non-appealable denials; (5) what can the practice control to reduce the denial rate; (6) how can the practice remove from the claims process those denials that can’t be appealed; and (7) what is a good denial management program to achieve better outcomes? To actually manage your practice’s denial rate, you need to understand the underlying payer rules, identify the role providers and office personnel have within the claims process, identify tools to assist the practice with denial management, and use all of this knowledge to design, communicate, and implement better processes. By using a fact-based approach towards managing your denials, you can start to move your practice towards the 4% denial benchmark MGMA found for better performing medical practices in their 2011 study.1 Consider that the inverse of achieving a 4% denial rate, is having a 96% clean claim rate which translates to lower claims processing costs and faster cash payments.

What are the most frequent denials? Medically unnecessary • Lack of information or request for medical record • Lack of medical necessity for the visit/procedure Coverage • Services not covered benefit • Service bundled or inclusive to main procedure • Coverage terminated or not insured Payer Provider Process rule • Requires prior authorizations / certification • No referral on file • Benefits exhausted Incorrect coding information • Missing or invalid CPT / ICD9 code(s) • Wrong place of service • Lack of modifier

Incorrect patient identifier information • Subscriber number or Insured group number missing • DOB doesn’t match • invalid Name misspelled Coordination of benefits • Other insurance is primary • Missing EOB • Member has not updated insurer with other insurance information Office Process issues • Timely filing • Duplicate claim • Credentialing - Provider not on file

What are the underlying rules behind payer definitions of clean claims?

Warren Buffet says “the first rule is not to lose. The second rule is not to forget the first rule.” With medical claims processing to “not lose” is to file a clean claim the first time, every time and to accomplish that you need to know the rules. Our rules derive from: CMS national carrier determinations (NCDs), local carrier determinations (LCDs), National Correct Coding Initiative Edits (NCCI) and payer policies. We’ll explore how these form the foundation that drives the definitions of clean claims, particularly for the top four categories of denials in the above table. 1) National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) Many of the denials for medical necessity or non-covered services can be traced back to the information found in either the National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs). Through the determinations, CMS defines under what

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Continued from page 3 circumstances services are considered medically necessary and under what conditions they are covered for reimbursement. These policies are predicated upon evidenced based research and may include input from the public as well as from medical specialty organizations. As to why it is so important for every practice to be versed in the NCDs and LCDs relevant to your practice, we only need to read Medicare’s comments characterizing the NCDs as representing “… the formal instruction to our claims processing contractors regarding how to process claims (when to pay, when not to pay, pay only when certain clinical conditions are met).”2 With this as background, you can understand why time is well spent to learn about the NCDs and LCDs that pertain to your practice. Some may ask why bother to follow this recommendation if your practice sees very few Medicare patients? One key reason is your commercial payer contracts may include a phase that states in the absence of specific payer policies, the payer will rely upon Medicare policies (e.g. NCD/ LCDs). Secondly, the commercial payer policies are often derived from the Medicare determinations. The structure of both the NCD and LCD policies include: 1. Indication and limitations of coverage and or medical necessity – this is the key section identifying the patient conditions or tests or medical decision making steps required to support the medical necessity of the professional service; 2. coding information that identifies the CPT codes and the medical necessity supporting ICD-9 diagnosis codes; 3. utilization guidelines – this provides insight to criteria that could force a review or audit of your charts; 4. general information providing specific documentation requirements, if any 5. sources of information upon which the NCD/LCD is based – typically articles from your peers and/or your professional association; and 6. a history of the NCD/LCD as to when it was revised and the key component of each revision. A worthwhile exercise would be to read one of your charts, section by section, while comparing it section by section to the NCD/LCD. What you want to see is that every aspect of the NCD/LCD is covered in your chart in a clear, succinct, legible (if a paper chart) and in a very obvious manner. An organized medical record facilitates the extraction process by the coder to follow the guidelines provided in the NCD/LCD. Another critical reason to evaluate your charting against the NCD/LCD is this is what the government auditors will do – they rely upon the NCD/LCD and NCCI edits to guide their decision on whether or not you were correctly paid! See Exhibit A as examples of our RAC auditors (DHC) applying NCCI edits to their review. Medicare publishes their national policies on their website at: This site also provides access to local determinations. In addition you can access our NJ Medicare carrier, Novitas, Local Carrier Determination (LCD) at: A great exercise is to select the search by title tab of the Novitas LCD website and literally read each LCD title to determine which are appropriate for your practice3. Apply the information contained in the policies to: • • • • •

re-confirm that your charge capture form is current for both CPT codes and acceptable ICD-9 codes; verify that your medical record forms or EHR screens provide prompts for items you are required to document; confirm that the procedure or test screening directions are current for your clinical staff; check to see that your financial policies are updated to reflect how your practice handles payment of non-covered services (including whether or not you need to implement an Advance Beneficiary Notice); and, re-confirm that your office staff correctly applies the documentation and coding rules to ensure a clean claim submission.

Commercial and governmental payers have two or three types of policies upon which claims may be paid or denied: 1. medical coverage, 2. reimbursement policies, and 3. administrative policies. While the Medicare NCD/LCDs policies are typically the foundation for the commercial payers medical coverage policies, commercial payers may adopt unique policies. Reimbursement and administrative policies usually don’t address the medical necessity or medical reasonableness of a service but provide guidance on general coding rules (e.g. bilateral, surgical assist, global days, etc.) and billing process rules such as balance billing or defining the appeals process. Some commercial payers incorporate all of the above aspects into one policy. One key difference from Medicare is the payer policies define whether or not a pre-certification process is required. Commercial payer policies are located on their website and may be augmented with bulletins. The same exercise listed above for Medicare policies should occur with payer policies as to translating the policies into actionable items for the practice. Larger practices or multi-specially practices can engage services which report on a daily basis changes in payer, reimbursement and administrative policies relevant to your practice. One such

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Medical Society of New Jersey’s Physician Advocate Magazine

company is Experian4. It provides crisp summaries of the payer policy changes with links to the payer details. 2) National Correct Coding Initiative Edits (NCCI) The NCCI edits are to promote correct coding and thus proper payment for services. There are two types of edits – those that look at procedure-to-procedure coding and those that define sets of codes as medically unlikely to be reported together. The procedure-toprocedure edits define which pairs of codes cannot be reported together on the same beneficiary on the same day of service (generally one service is inclusive to the other); or if multiple procedure reporting on the same visit is allowed, then edits identify it is acceptable and which allowed modifiers are to be used to support the reported combination. The medically unlikely edits (MUEs) look at code sets and define the number or quantity of which cannot be reported on the same day, e.g. allow only one initial critical care code per day. They also address unlikely medical situations such as men having female procedures. As you can gather from this description of the edits, it is a mathematical test of the combination of the numerical CPT codes and modifiers. Before further elaboration on the importance of the mathematical aspects of the NCCI edits, you should be aware that there is an extensive NCCI manual5 from which the code combination rules are derived. More information on the NCCI chapters will be provided further below. Why spend time learning more about some of the basics of the NCCI edits? Because with the correct application of the edits, it will stop wasteful time on denials that will never get paid or stop wasteful time on rescinded payments for claims incorrectly paid. It’s much more productive and costs you far less to process a clean claim the first time and every time. Consider that billing companies make their greatest profit on clean claims that collectors never have to touch. The volume of the NCCI edits is in the thousands, well beyond a level that any coder could possibly memorize. The volume of quarterly NCCI edit changes is equally mind boggling. Frank Cohen of the Frank Cohen Group6, an industry expert and frequent MGMA contributor, routinely analyzes the quarterly updates to identify rules changes. On one of his recent MGMA posts about the July 2012 update, he noted that there were 532 CPT codes with modifier changes with 531 going from the ability to apply a modifier to no modifier allowed. This means that starting July 1, 2012 there are 531 codes now considered inclusive to other codes and cannot be reported together (unbundled) on the same encounter. If you do submit a claim with two codes that should not be reported together, at best you are correctly paid for the primary procedure with a denial on the second procedure; and at worse the entire claim is denied forcing the practice to appeal for the payment of the allowed primary service. [Should we add future alleged overpayment and recoupment requests. An audit trigger for inappropriate coding and billing?]Denials due to NCCI edits are not allowed to be billed to patients and Advance Beneficiary Notices are not allowed to be used with this type of denial. A word of caution: if the NCCI edits support the use of the -59 modifier, meaning a distinct procedural service on the same date of service, you may pass the computer mathematical edits with the correct combination of CPT and ICD9 codes, but the underlying assumption by CMS in paying that claim is that your medical record documentation contains the detail to support the reported separate and distinct combination of CPT and ICD-9 codes. In other words, your medical record documentation should drive the codes entered on the claim. Coding is complex and made that much more difficult with the quarterly update of the NCCI edits and changing payer policies. Employing certified Coders is one positive step practices can take. The second is to arm the coder with tools to assist them with these complex rules. With quarterly changes in the NCCI edits and code pairings, the better coding tools are the on-line services rather than code books which quickly become outdated after publication. These on-line subscription tools will not only tell you if the code pairing is allowed but will point the coder to the underlying NCD or LCD. Additionally the better on-line services provide links to CMS Medlearn Articles, CMS transmittals and CMS processing manuals. Other coding tools include AMA’s CPT Assistant, your specialty’s coding publications and webinars, and coding update webinars by MSNJ. Coders require continuing education to maintain their certification. Building educational time into the coder’s job is a win-win for the practice. If you make this investment – specify the expected return such as the coder’s responsibility to summarize key findings, update charge submission forms, update EHR screen edits, update pre-certification requirements, etc. Knowing the importance of the NCCI edits, every office should assign one person to read the NCCI Policy Manual chapters on a quarterly basis. The purpose of the manual is to explain the rationale behind the edits. It is divided into chapters that correspond to sections of the CPT manual. It is highly recommended that at a minimum someone within the practice is assigned to read at least three of the chapters: (1) Chapter one - General Correct Coding Policies, (2) the chapter for your specific specialty, and (3) chapter twelve for evaluation and management services. If your office performs diagnosis testing or radiological procedures – those chapters should be read as well. These are well written in understandable terms, often with helpful vignettes. CMS also publishes a brochure on how to use the NCCI edits to properly submit claims.4 One excellent section of this brochure explains how to take the Excel table of the NCCI edit code pairs and easily filter it for the CPT codes relevant to your practice. An excerpt from the brochure is in Exhibit B which demonstrates the application of the code pair rules.

Claims Clearinghouses, Your billing software and CCI edits

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New Jersey Academy of Ophthalmology Elects New President: Brenda Pagán-Durán, M.D. By: Beverly Lynch, Executive Director, NJAO


he New Jersey Academy of Ophthalmology (NJAO), representing over 300 board certified Ophthalmologists across New Jersey , has recently elected a new president – Dr. Brenda PagánDurán. Dr. Pagán-Durán takes over the NJAO at a vital time when advocacy is of the utmost importance. “As in previous years, advocacy is the most important component of the New Jersey Academy of Ophthalmology. With the beginning of a new 215th administration in Trenton in January, we can expect to see a significant amount of changes in our political landscape. I am confident that our team of association management, lobbyists, legal counsel and coding experts will help us monitor the many state and national bills that will be introduced this year,” said Dr. Pagán-Durán.

Dr. Brenda Pagán-Durán is a Clinical Assistant Professor at the Veterans Affairs Medical Center in East Orange, NJ, where she previously acted as Chief of Ophthalmology from July 2004 to June 2007. Dr. PagánDurán is also a Clinical Assistant Professor at UMDNJ’s Institute of Ophthalmology and Visual Science in Newark, NJ.

Dr. Brenda Pagán-Durán

NJAO’s newly established Ambassador Program works to establish important relationships with legislators throughout the State and educate these individuals on issues facing ophthalmology as well as critical health care concerns. New Jersey Academy of Ophthalmology advocates and educates both its members and the public in order to enable ophthalmologists to provide the highest quality of health care. The NJAO annual meetings are a forum in which physicians unite in order to discuss critical legislative issues as well as educate the Eye MD community on developing technologies and practices in the field. The NJAO website ( is

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an excellent resource for members and patients, with tools that allow patients to search for ophthalmologists in their local area as well as other important consumer information.

In addition to her Presidency and position on the Board of Governors for NJAO, Dr. Pagán-Durán is a member of the Pan-American Association of Ophthalmology, the American Academy of Ophthalmology, the American Medical Association, and the Harvard Club of New Jersey’s Executive Committee.

Dr. Pagán-Durán graduated from Harvard University, cum laude, with a bachelor’s degree in Biology. She later graduated from medical school with honors from the University of Puerto Rico, School of Medicine in San Juan, Puerto Rico. Dr. Pagán-Durán performed her residency training in ophthalmology at UMDNJ Medical School in Newark, NJ. Dr. Brenda Pagán-Durán and husband of fifteen years, Robert Howard, have three children: Briana, Natalia, and Robert Nicolás. For more information on NJAO, please contact Beverly Lynch, Executive Director, at 609-392-1201.

Medical Society of New Jersey’s Physician Advocate Magazine

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fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an effective way to begin earning up to $44,000 in Medicare incentive payments. athenahealth helped Dr. Eubanks go from paper to payment in just six months. With guidance every step of the way and proven, cloud-based services.  Best in KLAS EHR*  Free coaching and attestation

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Visit or call 800.981.5085 *ambulatory segment for practices with 11-75 physicians ** If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act Medicare reimbursement payments only. Additional terms, conditions, and limitations apply. This discount offer is available to any medical practice that: (1) is comprised of physicians who are all members of the Medical Society of New Jersey; (2) signs an initial contract for athenaOneSM; (3) if it qualifies for the free implementation offer, pays a deposit of $1,150 per MD, which will be credited back to that practice after it goes live on all contracted services; (4) uses athenahealth’s online implementation process if it has six or less providers; and (5) goes live on athenaCollector® within six months of the effective date of the contract. This promotion may not be combined with any other promotional offer and may be modified or canceled at any time at athenahealth’s sole discretion. Additional terms, conditions, and limitations apply.

Cloud-based practice management, EHR and care coordination services

Medical Society of New Jersey’s Physician Advocate Magazine

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Continued from page 5 Another valuable tool to assist you with the correct application of the NCCI edits is housed within your practice management billing software. Usually you have the option to turn on or off the NCCI edits. Prior to electronic submission of claims, the NCCI edit scrubber will test the code pairs and modifiers. The report will show you which fail, which require further review and which pass. Sometimes the volume of the claims identified as requiring further review is of such high volume and yields few code modifications that offices react by turning off the edit test or scrubber. Clearly the downside is without the edit test, you lose the opportunity to identify claims that will fail the edits and thus will have costly time addressing the denials. Furthermore, for those in the “recommend to review” category – you lose the opportunity to question and verify that the supporting documentation is in place should the denial result in a request from the payer for more information. A second stage tool is available to you is through your claims clearinghouse. Often these companies provide denial management tools beyond the initial code pairing/modifier tests. These clearinghouses provide rapid testing that allow you to correct any claims errors before it is sent to the payer. Not surprisingly because it’s their primary business, clearinghouse reports and ease of use usually excel over the tools built into your practice management billing software. There are practices that prefer, where possible, to submit claims directly from the practice to the payer which can produce faster payment of your claims. Under this claims flow, you are completely reliant upon your billing software’s CCI edit tools. What you gain in cash flow from direct submissions to payers, may be lost in higher rejections if your billing software built-in claims edits are turned off.

Additional Clues for Clean Claim Submissions – The CMS Physician Fee Schedule Indicators

CMS provides a fee schedule look-up that allows you to see, in table format, key claims submission guidelines. These guidelines let the practice know: • if the CPT is active for the current year; • if a technical component is allowed to be added (modifier -26) to the professional fee; • by CPT code the days considered within the global period; • if the CPT can be submitted with other procedures (multiple procedures); • if the CPT allows for bilateral procedures; and, • if a surgical assist or co-surgeon are allowed to be billed with the submitted codes.

This is valuable information which can assist your office in tendering a clean claim or conversely avoiding an unnecessary denial. This constructive information can be of assistance when you receive an incorrect denial, one in which the table shows that you were correct with the claim submission. In other words, the table will help to support your appeal for claims incorrectly denied. Please see Exhibit C for a sample of this Medicare physician Fee schedule tool with the indicators. A worthwhile assignment is for your practice to generate a table of your frequently used codes to guide you with your correct claims submissions.

Application of Payer Policies to Eliminate Denials

Number one, start with education – know the policies that are specific to your practice. Build and maintain the library. Some payers, such as United Healthcare, have monthly electronic bulletins. Others may send notices that new policies may be found on their websites. Assign a point person in the office who is expected to read the policies, identify any changes, seek additional information from the payer if necessary, and most important – create a one to two paragraph summary of the key change along with any new steps that providers and office personnel need to take to avoid denials for those services. The Practice Administrator needs to know: what changed, who needs to know, what they need to know, and then modifies the tools (e.g. charge encounter forms, EHR screens, etc.) to assist everyone in the practice to implement these changes and then monitors the adoption of the changes. Significant policy changes may require a staff meeting with the physicians in attendance to work through complex changes. Those meetings will provide an educational component as well as an outline of the resultant workflow modifications so that everyone can be on the same page with documentation and charge submission requirements. Education may also extend to your patients if a payer deems a procedure as non-covered and, in that situation, an ABN is allowed.


Lee Iacocca once said “Start with good people, lay out the rules, communicate with your employees, motivate them and reward them. If you do all those things effectively, you can’t miss.” The NCCI edit, national/local coverage determinations, and payer policies are the ground rules. Lay out the rules by converting the policies into action items with assignments for every team member in your office as to their role in correctly applying the rules. • Translate those rules into coding guidelines: which codes can or cannot be reported together, which require modifiers or never should have a modifier, under what circumstances can special modifiers be applied, what diagnosis are expected to support the medical necessity, define the global period and what event starts that period, when can a procedure be reported with a surgical as-

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sist, when are bilateral or multiple levels/units acceptable to be reported, what are acceptable places of service, when is a technical component allowed, the number of events within a prescribed time period, and audit to those guidelines insuring that providers understand the payer requirements and that documentation clearly reflects the requirements in the policy. • Translate the rules into which services require pre-certification, what criteria must be met to be certified, and where in the chart to find that information. • Translate the rules into better forms for charge capture and medical record documentation with prompts on minimum reporting requirements. • Translate the rules to define when a denial is appealable and most importantly what policy rules support the appeal. • Translate the rules into collection policies relative to adjustments for non-payable services or those inclusive to the main procedure. • Translate the rules into financial policies – when is an advance beneficiary notice required and when does the procedure become a self-pay event. • Translate the rules into denial reporting to identify avoidable denials caused by the practice’s incorrect application of the rules. Taking these steps will help your practice to reduce and hopefully eliminate avoidable denials. This allows your team to spend productive time on claims that are payable! Control your destiny through a better understanding of the coding rules as defined by the government and payer policies. And equally important, this is just one step in many steps towards developing your denial management program. The next set of articles will expand upon the components of a denial management program with Excel tools. About the author: Laura Tarlow, MBA CMPE is a consultant for MSNJ. She has over thirty years of experience serving in executive level positions in hospital administration, physician practice management and managing a full service billing and practice management company. She has authored papers and lectured on practice management for national and state organizations.

Download Laura Tarlow’s full article with footnotes and exhibits at

MSNJ Docs in the News Is there an MSNJ member physician you’d like to see recognized? E-mail with the information and look for the mention in the next edition of Physician Advocate. Congratulations to MSNJ member Dr. Richard S. Rhee of Monmouth County - his photograph has been selected as the winner of MSNJ's 2013 photo contest! Dr. Rhee has won free state dues for 2013 and will be featured on the cover of the calendar, out soon to the entire membership. Thank you to all who participated in the contest! All 12 featured photographs are on MSNJ’s Facebook page at MedicalSocietyofNJ.

Congratulations to MSNJ President Mary F. Campagnolo, MD, MBA, who completed a century (100 miles) for Bike MS: City to Shore on September 29th as team, MSNJ Heroes and Healers, reaching her goal of $1,000 benefiting Multiple Sclerosis! Medical Society of New Jersey’s Physician Advocate Magazine

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A S P E N | AT L A N TA | B I R M I N G H A M | B O S T O N | L O S A N G E L E S | N E W Y O R K | S A N D I E G O | S A N F R A N C I S C O

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MSNJ Docs in the News (continued) MSNJ Congratulates 72 Physician Members Selected for Comprehensive Primary Care Initiative (CPCI) MSNJ is proud of the 72 primary care physician members selected for the Center for Medicare & Medicaid Innovation’s Comprehensive Primary Care Initiative (CPCI) public-private partnership. New Jersey was selected as only one of seven of the demonstration states earlier this year. The CPC initiative is a multi-payer program where Medicare will work with the state and commercial health insurance plans, offering bonus payments to primary care physicians who can better coordinate care for their Medicare patients. • • • • • • • • • • • • • • • • • • • • • • • •

Anthony Miccio, MD Charles Choe, DO Suma Ghanta, MD Karen Peters, DO Melissa Bauer-Sheldon, DO Kenneth Panitch, MD Alexander Biener, MD Neil J Perilstein, MD Tariq A Rizvi, MD Michael Carlucci, MD, JD Deepak K Jain, MD Christina C Wang-Epstein, MD, PhD Thomas A Schwartzer, MD, PhD Ahmad John Haddad, MD Victoria Triola, MD Katherine Schneebaum, MD Philip Guiliano, MD Paul William Madonia, MD Dario Alberto Lecusay, Jr. MD Rachel Brooke Kanner Liebman, DO Dennis Earl Novak, MD Jan S Glowacki, MD Danielle J Nardone, DO Dominic C Pamintuan, MD

• • • • • • • • • • • • • • • • • • • • • • • •

Denise H Hayward, MD Roger M Thompson, MD James M Chapman, MD Caryn M Giacona, MD Vishal V Patel, MD Thomas Rafael Ortiz, MD Paul Peter Madura, MD Harvey R Gross, MD Joseph Winston, MD David Bechtel, MD Iliya D Mitev, MD Suzanne Holdcraft, MD John A Fritz, DO Michael P Basista, MD Michael P Basista, MD Jeanne Tomaino, MD Frieda S Goldman, MD David Isralowitz, MD Orlando Franklin Mills, MD Brendan J Mulholland, MD Mary Lynn Krisza, MD Lizette A Marza, MD Marianne Roosels, MD Richard Lawrence Corson, MD

• • • • • • • • • • • • • • • • • • • • • • • •

Martin Edward Klein, MD Soumen Samaddar, MD David Ethan Swee, MD Robert Clifford Like, MD Susan B Profeta, MD Susan Cantor, MD Epifanio Calcara, MD Joyce R Talavera, MD Christopher L DeMasi, DO Nicole A Henry-Dindial, MD Claudia A Wagner, MD John F Tabachnick, MD Kathleen H Leistikow, MD Maurice A Ferrante, MD Carole F Lytle, MD Sharon R Stoch, MD Stephen K Bobella, MD Lisa F Brodkin, MD Alan I Fine, MD Wayne R Braendle, MD Louis A Friedman, DO Lauren M Maza, MD Mary T O'Donnell, MD Seth Webber, MD

MSNJ Society News MSNJ's New Website Has Launched! MSNJ is proud to announce that the all-new website (still at, database and online community has launched! Log in today by resetting your password from the homepage. We will continue to post help guides and webinar videos to the website and we encourage all members to explore all the new site offers.

Medical Society of New Jersey’s Physician Advocate Magazine

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Medical Society of New Jersey’s Physician Advocate Magazine

MSNJ Event Recaps Thanks to all who participated in MSNJ's

Medical Liability Reform Policy Forum,

hosted on September 27 at Forsgate Country Club and sponsored by the New Jersey Lawsuit Reform Alliance (NJLRA). Approximately 80 physicians, administrators, consultants and members of the legal and business communities came out to the free event, as part of MSNJ's new Policy & Strategy Seminar series. MSNJ would like to thank the NJLRA for their support of the event, and our speakers for their valuable contributions: • Robert L. Ignasiak, Esq., Senior Vice President of Medical Protective • Marcus Rayner, Executive Director of New Jersey Lawsuit Reform Alliance (NJLRA) • John Z. Jackson, Esq., Partner, McElroy, Deutsch, Mulvaney & Carpenter, LLP • Tim Martin, MSNJ Lobbyist of MBI-GluckShaw • Gary S. Schaer, New Jersey Assemblyman

MSNJ's Sixth Annual Golf Outing was held

on Tuesday, October 23 at Mercer Oaks Golf Course. More than 60 people came out to golf and support the MSNJ Foundation.

IS Ensuring faster physician payment The American Medical Association is proud to work with the Medical Society of New Jersey to educate physician practices on how to streamline their claims process. Getting billing information quicker—and paid faster— is a prescription for efficiency. The AMA and the MSNJ support physicians in your practice, in the state house and in the courthouse. Working together with the MSNJ, the AMA will continue to make a difference.

Be a part of it.

First place was awarded to Investors Bank, second place to the NJ Carpenters Fund, and third place to Larry Downs' foursome. The closest to the pin contest winner was Dr. Arif Hashmi. Longest drives for men and women were awarded to John Gannon and Julie Lynch. IOMPHNJ and MSNJ would like to thank our event sponsors and participants who help make this event a success every year. Turn to page 14-15 for some golf outing photos visit for more!

© 2012 American Medical Association. All rights reserved.

Medical Society of New Jersey’s Physician Advocate Magazine

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Medical Society of New Jersey’s Physician Advocate Magazine

MSNJ’s 2012 Annual Golf Outing October 23, 2012 Mercer Oaks Golf Course

Medical Society of New Jersey’s Physician Advocate Magazine

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Inaction vs IN ACTION We understand the difference The Litigation Center of the American Medical Association and the State Medical Societies fights to protect doctors and uphold the highest standards of patient care. In courtrooms across America, we are achieving legal victories that preserve the rights of physicians, promote public health and protect the integrity of the profession. Whether we are challenging managed care organizations’ payment practices or preserving the autonomy of the hospital medical staff, one thing remains constant: The Litigation Center is an active force fighting for physicians’ rights. Learn more on how The Litigation Center can help you: Membership in the American Medical Association and the Medical Society of New Jersey makes the work of The Litigation Center possible. Join or renew your memberships today.

The Litigation Center is proud to have Lawrence Downs, Medical Society of New Jersey CEO, serve on its executive committee.

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Fall 2012  

Fall 2012 Physician Advocate

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