Rural Texas Physician is a quarterly electronic newsletter catering to physicians in the many rural areas of Texas caring for patients and their communities. TMA’s grassroots membership is the strength of the association. For general inquiries or newsletter comments, email email@example.com.
Medicaid Primary Care Rate Increase
Primary care physicians who treat Medicaid patients will receive fee increases for 2013 and 2014 under the Patient Protection and Affordable Care Act, but only if they sign an attestation form confirming they’re eligible for the raise, state officials say.
Although the state received the final federal rules too late to begin the higher payments on Jan. 1, the Texas Medicaid & Healthcare Partnership (TMHP) will make retroactive payments to that date. The state anticipates beginning payments in September.
Under federal rules, physicians will qualify for the rate increase if:
- They practice family medicine, general internal medicine, pediatrics, or a subspecialty within those designations recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties; and
- They are board certified in an eligible specialty or subspecialty designation and practice in primary care, or more than 60 percent of the services they provide are primary care services eligible for the rate increase. Specifically, the increase will apply to evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461, 90471, 90472, 90473, and 90474. Preventive care codes for new and established patients also will be included in the increase even though Medicare does not cover them.
New physicians with no history of Medicaid billings can attest that 60 percent of their Medicaid billing will be for primary care services, the Texas Health and Human Services Commission (HHSC) said.
HHSC has not yet set a deadline for filing the attestation form but says it will continue to keep physicians informed of the timeline. However, TMA encourages physicians to complete and return the form as soon as possible. For more information, call the TMHP Contact Center at (800) 925-9126.
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TMA Calculates Impact of Medicare Fee Cut
Medicare payments to physicians dropped two percent on April 1 because of the federal budget sequester. TMA’s Payment Advocacy Department analyzed the impact of the fee reduction and compiled a list of answers to questions you may have.
See an example of how the fee cut would affect payment for a service with a Medicare fee schedule amount of $100.
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Frequently Asked Questions
Q: Can I pass on the 2-percent cut to my patients and collect it from them?
Q: When will the Centers for Medicare & Medicaid Services (CMS) post an updated 2013 fee schedule based on the 2-percent cut?
A: CMS will not post an updated 2013 fee schedule. The fee schedule you use for 2013 will remain the same.
Q: Will CMS apply the fee reduction to claims processed starting April 1? What if I have a claim from March that hasn’t been paid yet?
A: CMS will apply the cut to claims with a date of service of April 1or later. CMS will pay claims from January through March at the posted fee schedule amount without a 2-percent reduction.
Q: Will this cut also impact my payment from Medicare Advantage plans?
A: Possibly. It depends on your contract. If you are out of network with a plan and its pays claims based on the 2013 Medicare Fee Schedule, you will see the 2-percent cut reflected on your payment.
Q: If I’m a Medicare-enrolled physician who is non-par and doesn’t accept assignment, do I need to calculate the 2-percent cut off what I collect from the patient?
A: No. You will continue collecting the same amount as you did before. Your patients will see the cut taken on the amount Medicare reimburses them; thus you may receive questions from them.
Q: Will CMS hold claims like it does when the fee schedule undergoes changes?
Q: How is the 2-percent reduction identified on the electronic remittance advice (ERA) and the standard paper remittance (SPR)?
A: The Claim Adjustment Reason Code (CARC) 223 is used to report the sequestration reduction on the ERA and SPR.
Q: What is the verbiage for CARC 223?
A: “Adjustment code for mandated federal, state, or local law/regulation that is not already covered by another code and is mandated before a new code can be created.”
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Meaningful-Use Audits Start
Meaningful-use audits are under way in Texas, and TMA is receiving calls from members seeking assistance. Figliozzi and Company is the designated contractor performing the audits on behalf of the Centers for Medicare & Medicaid Services (CMS).
The company offers some guidance for audited practices. Be sure to answer all questions to the best of your ability. One of the documentation requirements is an audit trail from the electronic health record (EHR) software demonstrating that drug formulary or drug allergy checks were enabled for the entire reporting period. Not all EHR vendors have this capability. If that is the case, you can make a statement attesting that your drug formulary checks were enabled for the entire reporting period and that your EHR vendor does not have functionality to provide proof.
The deadline for the initial request of documentation is two weeks. If the auditors consider your answers deficient, they will make a second request with a one-week deadline. Figliozzi will extend the deadline upon request, but your second-year payment may be delayed until the audit is finalized. Once the audit ends, you will receive an audit determination letter from Figliozzi. If the auditors find you ineligible for the incentive payment, you can appeal.
Be sure to maintain, for at least six years, documentation supporting the meaningful-use measures, calculations, and data submitted during attestation. CMS prepared EHR Incentive Programs Supporting Documentation for Audits to help practices better understand the documentation needed in an audit.
To help physicians with the EHR incentive program complexities, the Office of the National Coordinator for Health Information Technology established regional extension centers (RECs) to provide onsite health information technology (HIT) consulting in physician practices. For questions about eligibility and REC services, visit the REC Resource Center on the TMA website.
For more information about meaningful use or other HIT issues, contact TMA’s HIT Department by telephone at (800) 880-5720 or by email, or visit the TMA EHR Incentive Program Resource Center.
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Proposed GME Funding in the 83rd Legislative Session
Several proposals this legislative session\ aim to increase GME capacity. In the current proposed budget, the Senate proposed $11.45 million (+$5.9m; 105 percent over current funding) and the House proposed $14.1 million (+$8.5m; 152 percent over current funding) for the Family Medicine Residency Program.
Senate Bill 143 has two new programs targeted at medical schools, with the objective of preparing more primary care physicians. The bill would establish the Resident Physician Expansion Grant Program to produce new residency positions; establish the Graduate Medical Education Planning Grant Program to encourage the creation of new residency programs in hospitals without current programs; establish an incentive program for medical schools that produce more primary care physicians; establish an incentive program for medical schools that develop new methods to produce more primary care physicians for the state; and allow physicians who treat Medicaid patients or Texas Women’s Health Program patients to participate in the Physician Education Loan Repayment Program.
TMA testified in favor of the bill.
Additionally, House Bill 576/Senate Bill 256 would require increased reporting on medical school graduates for the purposes of identifying the number of graduates going on to enter practice in primary care specialties.
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Bill Would Change Conrad 30 Program
Four senators filed legislation in March to expand and revise the Conrad 30 visa program. The bill, the Conrad State 30 and Physician Access Act by Sens. Amy Klobuchar (D-Minn.), Jerry Moran (R-Kan.), Susan Collins (R-Maine), and Heidi Heitkamp (D-N.D.), changes H-1b visa and green card requirements. The Association of American Medical Colleges (AAMC), American Medical Association, and American Hospital Association support the bill.
The Conrad program allows states to request up to 30 J-1 visa waivers a year to allow international medical graduates who participated in U.S. residency training programs under J-1 visas (educational exchange visas) to remain in the state to practice in underserved areas. Without the waiver, the physicians would have to return to their home countries and wait two years before applying for immigration to the United States through routine channels.
The bill removes the current sunset date for the Conrad 30 program of Sept. 30, 2015. It would change the employment requirements for physicians, providing for more flexibility.
The Texas Department of State Health Services administers the Texas Conrad 30 program.
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Doom No More
TMA’s Calendar of Doom is now Deadlines for Doctors: Do This Now.
It is still loaded with the key dates you need to know to stay abreast of all the upcoming state and federal regulations and key health policy issues that impact you and your practice. It is still filled with the outstanding TMA information resources, tools, and educational programs you need stay in compliance. It is still a great way for you to plan ahead for those insurance company demands and health information technology carrots and sticks.
But your TMA Council on Practice Management Services wanted to give the calendar a new name, one that wasn't so negative and ominous. Council member Susan Blue, MD, of Fort Worth, came up with Deadlines for Doctors.
Bookmark www.texmed.org/deadlines and visit it regularly, or subscribe to the RSS feed.
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TexMed 2013: Remembering the Patient
With the increasing complexities of modern technology, coupled with the spiraling labyrinth of rules and regulations, physicians can find themselves scattered to the edge of distraction. TMA is working to help physicians remain focused on the mission of medicine — the patient.
Join us for TexMed 2013 at the Grand Hyatt San Antonio and the Henry B. Gonzalez Convention Center on May 17-18 as we remember the patient. Online registration is closed, but you can still register at the conference.
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Rural Health Open Door Forum
The Rural Health Open Door Forum, sponsored by the Centers for Medicare & Medicaid Services, addresses rural health clinic (RHC), community access hospital (CAH) and federally qualified health center (FQHC) issues, as well as questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings. For more information, visit the CMS Web site.
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Empower Yourself: Join the Discussion
Become an avid reader and contributor to TMA’s MeAndMyDoctor blog. The blog is a place where you and your patients can have a candid discussion about today’s health care system. It’s a perfect way to educate your patients and colleagues about health care issues important to you. Check it out www.MeAndMyDoctor.com.
Get involved today. Here are four simple things you can do right now:
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