New Jersey - Volume XII, Number 8 - August, 2003

STATE ENACTS PHYSICIAN PROFILING LAW

The recently enacted New Jersey Health Care Consumer Information Act directs the State Board of Medical Examiners (�Board�) to collect and maintain information that will provide a public profile of every physician and podiatrist licensed by the State. The individual profiles will be maintained in a database that can be accessed free of charge by members of the public, effective June 2004. Information to be disseminated includes medical education, license status, practice locations, and a 10-year history of Board disciplinary actions, criminal convictions, hospital privileges actions related to competence, misconduct or impairment, and medical malpractice judgments and awards involving payment to the complainant (and categorizing the physician as average, below average or above average compared to the claims experience of his or her same-specialty peers). Nonspecific qualifying language will be provided related to some of the information to indicate that the information provided is not �comprehensive.� Explanatory language will accompany the medical malpractice profile, in part to indicate that settlements and dollar amounts paid do not necessarily mean that malpractice occurred. A physician may request that additional positive information be included in the profile, such as faculty appointments, board certification, insurance program participation, and practice information. The initial profile and any updates will be provided to the licensee, prior to publication, for review and correction of factual inaccuracies. Physicians and podiatrists should exercise extreme care in reviewing the information to be published and correct inaccuracies within the timeframe provided. The law contemplates future development of public profiles of dentists, advanced practice nurses, physician assistants, optometrists, physical therapists and chiropractors.

MEDICAL BOARD PROPOSES CHAPERONE RULE

The New Jersey State Board of Medical Examiners (�Board�) has proposed a new rule that will require licensees in an office setting to advise patients of their right to have a chaperone present during specified medical examinations, i.e., breast and pelvic examinations of females, and genitalia and rectal exams of males or females. The Board determined that, in response to several years of complaints involving inappropriate examinations, and patients� reluctance to request a chaperone, the Board should require that patients receive notice of the chaperone option. A physician can determine not to provide care for the immediate problem presented if unable to provide a chaperone acceptable to the patient or if the patient refuses a chaperone and the licensee believes that one is necessary, so long as the patient is informed of the risks of not receiving immediate care. The rule does not discuss who can be offered as a chaperone or to what extent a licensee must go to make an �acceptable� chaperone available before declining care.

HIPAA TRANSACTIONS & CODE SETS COMPLIANCE GUIDANCE ISSUED

The Centers for Medicare & Medicaid Services (�CMS�), which enforces the provisions of the Health Insurance Portability & Accountability Act (�HIPAA�) that require the use of standard transactions and code sets for electronic claim filing, has issued guidance outlining its enforcement approach following the October 16, 2003 deadline for utilizing the uniform standards. Recognizing that these transactions require the participation of both provider and payor, and that noncompliance by one may put the other in jeopardy (such as a payor�s inability to test the transactions with the provider), during the period immediately following the compliance date CMS plans to assess both entities� good faith efforts to come into compliance with the standards and determine whether reasonable cause for noncompliance exists and how much time should be allowed for curing the noncompliance. Penalties will issue where CMS sees that sufficient compliance efforts were not or are not being taken.  

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