Current Bulletin

  • Anthem Abandons Reduction for ‘Modifier 25’ Codes; Opens Door to New Dialogue With Physicians

    Anthem notified organized medicine on Feb. 23 that, after several meetings and discussions with state medical societies like the North Carolina Medical Society (NCMS), specialty societies and the AMA, it would not proceed with its reduction in payments for evaluation and management (E&M) codes. The new policy was slated to take effect March 1, but instead Anthem is notifying its contracted practices that the change will not be implemented.

    Significantly, the Executive Vice President and Chief Clinical Officer at Anthem, Craig E. Samitt, MD, MBA, acknowledged in his letter to the AMA that “the company believes making a meaningful impact on rising health care costs requires a different dialogue and engagement between payers and providers. As such, Anthem looks forward to pursuing an effective collaboration with the AMA to truly transform health care in our country to make it simpler, higher‐quality, affordable and accessible.” Read the letter.

    The NCMS along with other state and specialty societies and the AMA had strenuously voiced objections to this policy, which originally would have reduced payments for E&M codes by 50 percent. While this is a promising shift, organized medicine at both the state and national levels continues to advocate on behalf of our members on other Anthem policies such as the retrospective denial of payment for emergency room visits, restrictions on advanced imaging in hospital outpatient facilities and the denial of payment for monitored anesthesia care or general anesthesia for cataract surgery.

    The AMA and Anthem also jointly released a statement saying they will pursue opportunities for collaboration in the following areas:

    • Enhance consumer and patient health care literacy;
    • Develop/enhance and implement value-based payment models for primary and specialty care physicians;
    • Improve access to timely, actionable data to enhance patient care;
    • Streamline and/or eliminate low-value prior authorization requirements.

    Watch your NCMS Bulletin for updates on these discussions and other issues affecting your practice.

  • NCMS, Physicians Well-Represented on Medicaid Reform Subcommittees

    As the North Carolina Department of Health and Human Services works toward transformation of its Medicaid program to managed care, it has formed several subcommittees of the Medical Care Advisory Committee (MCAC) to look at the practical aspects of this change. North Carolina Medical Society (NCMS) staff along with NCMS members representing a variety of practices are included on the subcommittees to ensure the physician and physician assistant perspectives are well represented.

    The Credentialing subcommittee will review the credentialing approach; planning and preparing for a centralized credentialing organization and giving feedback on the transition for existing physicians and PAs to a new verification process. Conor Brockett, JD, NCMS vice president, legal and regulatory affairs and associate general counsel will serve on this subcommittee.

    The Managed Care Quality subcommittee will provide guidance on processes to promote evidence-based medicine, coordination of care and quality of care as well as discuss measure reporting and timeline. Kristen Spaduzzi, NCMS director of value-based health care, will sit on this subcommittee. She will also serve on the Provider Outreach and Engagement subcommittee.

    Other subcommittees include:

    • Network Adequacy, which will review network adequacy standards for primary, specialty and behavioral health providers including time and distance and appointment wait times; and
    • Beneficiary Engagement and Outreach, which will address methods to engage beneficiaries as well as communications and marketing strategies.

    Physicians on the committees include NCMS leaders such as Board member Michelle Jones, MD, and Genie Komives, MD, co-chair of the NCMS Foundation’s Kanof Institute for Physician Leadership Physician Advisory Committee.

    Review the subcommittees’ charges and membership.

  • Latest News in NCTracks Lawsuit

    The North Carolina Supreme Court has ruled the lawsuit filed by eight physician groups against the NC Department of Health and Human Services (NC DHHS) and CSRA for the disastrous implementation of the NCTracks Medicaid billing system cannot yet proceed to trial. The case of Abrons v. NC DHHS claimed that because the system was improperly designed and rushed into production, Medicaid providers were not correctly reimbursed for treating patients and incurred damages as a result.

    The case has been tied up on preliminary questions centering on whether superior court was the proper venue for initiating the lawsuit. In 2016, the North Carolina Court of Appeals agreed with the physicians, ruling that the case could proceed in superior court as originally filed.  But NC DHHS and CSRA appealed that ruling to the state’s highest court. The NCMS, in a coalition with the NC Academy of Family Physicians, NC Healthcare Association, NC Healthcare Facilities Association, and the American Medical Association, participated as amicus curiae in support of the physician-plaintiffs.

    But in its decision last week, the supreme court came to a different result, ruling that the physicians should have first sought relief directly from NC DHHS or the NC Office of Administrative Hearings (OAH), instead of proceeding straight to superior court. Justice Barbara Jackson, writing for the Court, stated that the physicians had not exhausted the appropriate administrative appeals and disagreed with their arguments that the appeals process was futile based on the extreme facts of this case. Justice Jackson did note, however, that by initiating the lawsuit when they did, the physicians could still return to the agency or OAH to press their claims and seek relief.  Read the ruling.

  • Thank You For Your Valuable Input on LEAD Conference

    Thank you to the many North Carolina Medical Society (NCMS) members who took just 60-seconds to complete our February Snapshot Survey on what would make our upcoming LEAD Health Care Conference, Oct. 18-19, the most beneficial gathering for NCMS members and their families.

    The survey results show that respondents continue to be bothered by documentation burdens; they would prefer sessions on balancing work and the rest of life and they prefer a more traditional presentation format. You may still weigh in on what educational sessions and activities you would like to see at the LEAD Conference by commenting at the end of this article. Check out the LEAD Health Care Conference website every now and then to see what has been added to the line up of educational sessions and social gatherings.

    The survey results will be presented to the NCMS Board of Directors at their upcoming meeting as they make decisions on educational content for the conference.

    Congratulations to the randomly selected winners of the Amazon gift cards from those completing our last two Snapshot surveys: Stephen Lang, MD; Scott Sledge, MD; Andrew McKnight, MD; Jugta Kahai, MD; John Bools, MD; Miranda Turner, MD; Juline Bryson, MD; Sarah Stout, PA-C; Michael Hirsch, MD; Tim Reeder, MD; Henry Unger, MD.

    Complete the March Snapshot survey on March 14 and you, too, will be eligible to win a $100 Amazon giftcard. Watch your email for the survey. It only has five questions and shouldn’t take more than 60 seconds to complete.

  • Population Health Collaborative Meets Thursday, March 15; Tomorrow is Registration Deadline

    The North Carolina Population Health Collaborative’s first meeting of 2018 will take place next Thursday, March 15, from 11:30 a.m. to 4 p.m. at the JB Duke Hotel, 230 Science Dr., Durham.  Download the full agenda (PDF).

    The NC Population Health Collaborative brings together a variety of stakeholders in the move to value in health care throughout the state. The Collaborative membership includes the state’s Accountable Care Organizations, which come together quarterly throughout the year to share insights and best practices in the pursuit of the Triple Aim of improved population health, better patient experience and lower cost. For more information, contact or call (919) 833-3836.

    Click here to learn more and register.

  • Make An Impact on Medicine In NC; Consider an NCMS Leadership Position

    If you or someone you know would like to be considered for service on the North Carolina Medical Society (NCMS) Board of Directors, as part of the NC AMA Delegation or on the NCMS Nominating and Leadership Development Committee, please complete this application at your earliest convenience. For details about each of these positions, please click here.

    Below is a list of the open seats as well as the counties included in each NCMS region, in case you are contemplating a regional position.  The nomination period will run through Aug. 18, 2018.

    Please direct questions to Evan Simmons,

    NCMS Board of Directors:

    • President-Elect (1-year term)
    • Region 1* Representative (3-year term)
    • At-Large Member (2 positions open) (3-year term)

    NC AMA Delegation (2-year term):

    • Delegate (3 positions open)
    • Alternate Delegate (2 positions open)

    Nominating and Leadership Development Committee (2-year term):

    • Region 1* (2 positions open)
    • Region 2**
    • Region 3***

    *Region 1 counties include:

    Beaufort, Bertie, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Halifax, Hertford, Hyde, Jones, Lenoir, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, Washington, Wayne, Wilson.

    **Region 2 counties include:

    Alamance, Caswell, Chatham, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Johnston, Lee, Montgomery, Orange, Person, Randolph, Rockingham, Stokes, Vance, Wake, Warren.

    ***Region 3 counties include:

    Anson, Bladen, Cabarrus, Cleveland, Cumberland, Gaston, Harnett, Hoke, Lincoln, Mecklenburg, Moore, Richmond, Robeson, Sampson Scotland, Stanly, Union.

    Region 4 counties include:

    Alleghany, Alexander, Ashe, Avery, Burke, Buncombe, Caldwell, Catawba, Cherokee, Clay, Graham, Haywood, Henderson, Iredell, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rowan, Rutherford, Surry, Swain, Transylvania, Watauga, Wilkes, Yadkin, Yancey.

  • Secure Your Place Now In An NCMS Leadership Development Program

    Two programs that are part of the North Carolina Medical Society (NCMS) Foundation’s Kanof Institute for Physician Leadership (KIPL) are now accepting applications. The Leadership College and Health Care Leadership and Management still have openings, but please apply soon. Spots are reserved for various North Carolina specialty and county medical societies. Since class sizes are kept small to ensure plenty of meaningful interaction between participants, classes fill up quickly.

    To learn more about each of these popular programs and to apply visit the KIPL website. Questions? Please contact Erin Grover at

  • NC Medicaid Authorizes Temporary Telephonic E/M Services for Influenza

    The North Carolina Division of Medical Assistance (DMA) is offering telephonic evaluation and management services (E/M) to Medicaid beneficiaries who are actively experiencing flu-like symptoms to help respond to the higher than normal number of influenza cases this flu season.

    This service is intended to help physicians and physician assistants assess established patients over the telephone to gather additional information. Telephonic E/M services are not to be billed if the patient needs to be seen within 24 hours for an office visit or next available appointment. In those circumstances, the telephone consultation shall be considered a part of the office visit.

    Dates of service for reporting of telephonic E/M codes coincide with the annual flu season. Claims for telephonic calls related to flu-like illness will be denied for dates of service after April 30, 2018. See NC DMA’s Special Bulletin for more information.

  • Video for Your Waiting Room — ‘New Medicare Cards Are Coming’

    Beginning April 1, the Centers for Medicare and Medicaid Services (CMS) will begin mailing Medicare cards with new numbers. [See previous Bulletin article on this.] Help inform your Medicare patients by playing the New Medicare Cards are coming! video in your waiting room. The video tells patients when and how they will receive the new card. This one-minute video is available on YouTube and in opened caption and 1080p formats. Visit the Provider webpage for the latest information on the new Medicare card.
  • Reminder: State Health Info Exchange Connection Deadline Begins In June

    State law (NCSL 2017-57) mandates all health care providers who receive any state funds for the provision of health care services (e.g. Medicaid, NC Health Choice, State Health Plan, etc.) to connect to and submit patient demographic and clinical data by certain dates in 2018 and 2019.

    Hospitals, physicians, physician assistants, and nurse practitioners who provide Medicaid services and who have an electronic health record system must be connected by this June. Physicians and providers who not be able to connect by the mandated deadline may be granted an extension if certain criteria are met. Extensions are not an exemption from the state’s connection requirements but provide additional time. See HealthConnex’s Extension Process page for additional information.

    The sooner you connect, the better. For more information, and to begin your connection process, visit, send email to, or call 919-754-6912.