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Volume 13:01-15 (January 2013)

The Joint Commission is putting hospital leaders on notice that
boarding in the emergency department requires a hospital-wide solution

In performance standards that went into effect January 1, the Joint Commission is requiring hospitals to set specific goals to improve patient flow, which include ensuring the availability of patient beds and maintaining proper throughput in laboratories, operating rooms, inpatient units, telemetry, radiology, and the postanesthesia care unit. The Joint Commission is also calling on hospitals to ensure the efficiency of nonclinical services such as housekeeping and transportation and to maintain access to case management and social work.

The standards specifically name the medical staff, the chief executive officer, and other senior hospital managers as having a responsibility to take action when patient flow goals are not met.

The updated patient flow standards also include some brand new elements, though the new requirements won’t go into effect until January 1, 2014. Under the new rules, hospitals must measure and set goals for curbing the boarding of patients in the ED. The new requirement defines boarding as the "practice of holding patients in the emergency department or another temporary location after the decision to admit or transfer has been made." Boarding goals should be based on patient acuity and best practice, the Joint Commission wrote, but it recommended that boarding times should not exceed 4 hours.

Hospitals won’t be scored on the 4-hour guideline during their surveys. The expectation is that hospitals will set their own time limits for boarding and they will be scored based on their own goals. Joint Commission surveyors, however, will question hospital leaders about what conditions require boarding times beyond 4 hours.

The Joint Commission also set new rules for boarding related to behavioral health emergencies. A new requirement, which also takes effect on January 1, 2014, calls on hospital leaders to work with behavioral health providers in the community on better care coordination for these patients.

Additionally, the Joint Commission released a new requirement that hospitals provide patients who are awaiting care for emotional illness or substance abuse with a safe, monitored location. Hospitals are also required to provide training to clinical and nonclinical staff on caring for these patients, including medication protocols and de-escalation techniques. These requirements took effect on January 1, 2013.




Doctors Across New York (DANY) Physician Practice Support and
Physician Loan Repayment Programs Cycle III applications are now available.


Physician Practice Support provides up to $100,000 in funding over a two year period to applicants who can identify a licensed physician that has completed training and will commit to a two year service obligation in an underserved region within New York State.

Physician Loan Repayment provides up to $150,000 in funding over a five year period for physicians who commit to a five year service obligation in an underserved region.

Application materials can be found on the Department of Health website at: www.health.ny.gov/professionals/doctors/graduate_medical_education/doctors_across_ny/

Applications will be accepted continuously from January 2, 2013 through March 29, 2013, or until the funds are exhausted. Submit applications electronically only (in PDF) to This e-mail address is being protected from spambots. You need JavaScript enabled to view it – if impossible contact the Department at the numbers listed below.

Contact: It is preferred that questions be directed to the email address: This e-mail address is being protected from spambots. You need JavaScript enabled to view it For other inquiries please contact Helen Crane at (518) 473-3513 (Physician Practice Support), Caleb Wistar or Martha Fennell at (518) 473-7019 (Physician Loan Repayment) or for any assistance or clarification that may be necessary. An applicant conference will not be held for these programs.

Office of Primary Care
NYS Department of Health
Corning Tower, Room 1695
Albany, New York 12247
(518) 473-3513 or 473-7019
email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it



Audit Spurs Improvements At Health Department's Bureau of Narcotic Enforcement
DiNapoli Calls for More Consistent Statewide Approach

 

The State Health Department's Bureau of Narcotic Enforcement tightened processes for combating abuse of prescriptions for controlled substances during an audit by the State Comptroller's office that ultimately found hundreds of thousands of prescriptions that may have been abused, poor controls over unused prescription forms and significant variations in bureau drug investigation practices across the state.

"The abuse of prescription medications has reached epidemic proportions and the costs to society are enormous," DiNapoli said. "Attorney General Schneiderman deserves credit for spearheading a statewide electronic prescription drug database, I-STOP, that will help to crack down on prescription drug abuse. I commend Governor Cuomo and his team for introducing legislation and making leadership changes that are moving the Bureau of Narcotic Enforcement in a positive direction. The bureau needs to aggressively pursue new ways to prevent, detect, investigate and prosecute illegal prescription activities."

The bureau is the state Department of Health's (DOH) lead office charged with combating the illegal use and trafficking of controlled substances in New York.

DiNapoli's auditors examined 28.5 million prescriptions dispensed over a 15-month period and found more than 325,000 prescriptions for controlled substances, filled more than 565,000 times, contained errors or inconsistencies in critical information.

Zolpidem (a drug sometimes marketed as Ambien), Oxycodone (a pain medication commonly marketed as OxyContin), and Hydrocodone (a pain medication sometimes marketed as Vicodin) accounted for nearly half of the drugs acquired with these prescriptions.

Auditors found:

• More than 130,000 instances where data showed that the prescriptions used to obtain controlled substances contained an invalid Drug Enforcement Administration registration number that did not match the prescriber;
• Almost 180,000 instances where prescription numbers appeared more than once in the data, having been filled at different locations or with inconsistent information about the prescriber or the drug dispensed;
• More than 90,000 prescriptions were refilled more than 157,000 times beyond their authorized refill quantities. This included almost 12,000 prescriptions for Schedule II controlled substances that were refilled more than 17,000 times even though these types of medications are not allowed to be refilled at all because they are the most dangerous and highly addictive drugs allowed to be prescribed in New York; and
• 135 instances where prescriptions had been written by practitioners whose licenses had been revoked, suspended, surrendered or otherwise inactivated.

DOH contends that many of these questionable prescriptions were likely attributable to data entry errors. The bureau was able to identify what it believes are the likely causes of about 50,000 discrepancies.

Auditors also found the bureau's five regional offices did not have a consistent approach for what they investigated, which resulted in inconsistent outcomes. For example, the Syracuse office accounted for half of the bureau's completed cases that resulted in criminal charges, while the Buffalo office produced less than 10 percent. In contrast, the Buffalo and Rochester offices together generated about 80 percent of the cases that resulted in civil penalties and administrative warnings, while the New York City office had none.

Auditors determined that the bureau relies heavily on external tips and sources as the starting point for the majority of its cases and much less on data mining techniques that can be more effective in identifying suspicious activity. In response to the audit, the new director of the bureau has recently implemented new data mining strategies and officials say they plan to assign additional resources to conduct these analytic techniques. The bureau's full response is included in the audit.

Additionally, auditors found that returned and unused prescription forms were not always properly secured and accounted for. Auditors examined a box that had not been properly inventoried and kept inside a locked cabinet as required and found 2,034 prescriptions that had not been logged in, including 1,500 pieces of blank electronic medical record paper which could easily be made into counterfeit forms. Over 4,000 returned forms maintained by a DOH contractor that were supposedly destroyed showed up in the bureau's records as being used to obtain controlled substances.

Auditors recommended the bureau:

• Increase its use of advanced analytical techniques to pinpoint possible cases of drug diversion;
• Pursue crimes with a consistent and coordinated approach across the state; and
• Secure and account for unused prescription forms.

Albany Phone: (518) 474-4015 Fax: (518) 473-8940
NYC Phone: (212) 681-4840 Fax: (212) 681-7677
Internet: www.osc.state.ny.us
E-Mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Follow us on Twitter: @NYSComptroller

Medicaid to Cease Support of the OMNI 3750 POS
Card Swipe Terminals on March 31, 2013

 

Medicaid is discontinuing support of the OMNI 3750 Point of Service (POS) device effective March 31, 2013. Providers who do not participate in the Medicaid Cardswipe Program and who currently use the Omni 3750 POS Device to verify Medicaid eligibility or request Dispensing Validation System (DVS) prior approval must make plans to switch to one of the following real-time methods prior to the March 31, 2013 date.

• Electronic Provider Assisted Claim Entry System (ePACES)
• eMedNY Simple Object Access Protocol (SOAP)*
• Several large clearinghouses and service bureaus support real-time connections to eMedNY (If you require DVS, verify DVS availability with the clearinghouse prior to contracting.)

*Does not support DVS transactions

Providers should visit www.emedny.org to determine which alternate method best meets their needs.

All providers participating in the Cardswipe Program who have 3750 terminals will soon receive a separate letter from the New York State Office of the Medicaid Inspector General on the status of their involvement in the Cardswipe Program.

Questions and requests for technical assistance on transitioning to an alternate access method may be forwarded via e-mail to This e-mail address is being protected from spambots. You need JavaScript enabled to view it or providers may contact the eMedNY Call Center at (800) 343-9000.

 


Instructions for Beneficiaries Enrolled in
Medicare Managed Care Plans

 

Billing guidelines previously published in the November 2009 and January 2010 Medicaid Update instructed providers to use Claim Filing Indicator Code 16 to bill Patient Responsibility amounts to Medicaid following payment from a Medicare Advantage Plan.

Since these instructions were issued, claims have been submitted to Medicaid using Claim Filing Indicator Code 16 for Medicaid beneficiaries who were not enrolled in a Medicare Advantage plan.

Therefore, effective December 1, 2012, all claims indicating Medicare Advantage plan coverage (Claim Filing Indicator Code 16), must have an active Medicare Advantage Plan in the eMedNY system for the date of service, or the claim will be denied. The denial message will read “Pyr 16 Invalid- Client Not Enrol In MCARE Advant.”

If a claim is denied, non-pharmacy providers must rebill the claim eliminating Indicator Code 16. Pharmacy providers must rebill their NCPDP D.O claims without the indicator code that denotes Medicare Advantage plan coverage.

Questions? Please contact the eMedNY Call Center at (800) 343-9000.

 

Changes In Medicaid Billing
for Vaccine Administration


There are changes in billing for Vaccine Administration for dates of services on and after January 1, 2013.  

Attention Practitioner Providers: additional billing information for vaccine administrations

As a result of NCCI editing, claims may be denied Edit 00715 (Procedure conflicts with prior service) when an office visit (E&M and preventative medicine codes) and a vaccine administration service is billed on the same day of service.

NCCI will allow payment for both services when a separately identifiable office visit was performed that meets a higher complexity level of care than a service represented by CPT code 99211.
For payment to be made for both services, the office visit must be billed with Modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Providers must maintain documentation in the medical record to support use of an appropriate modifier.

Questions: Medicaid billing assistance: CSC, 1-800-343-9000.

2012 e-news archives
2011 e-news archives
2010 e-news archives

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