Summer 2010
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, e-mail rural@texmed.org.
CMS Delays Pecos Enrollment Deadline
The Centers for Medicare & Medicaid Services (CMS) says it will not begin rejecting Medicare claims for physicians and other providers not enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS) as scheduled on July 6. Instead, CMS says it is working with providers to address concerns about the PECOS enrollment system to ensure that Medicare beneficiaries continue to receive the health care services and items they need.
More than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, but some physicians and providers have encountered problems with the system. CMS says it is continuing to update and streamline the process.
For the time being, CMS will not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6.
CMS issued an interim final regulation on May 5 implementing provisions of the Affordable Care Act that permit only a Medicare-enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies, and certain items and services under Medicare Part B. The new law applies to orders, referrals, and certifications made on or after July 1.
The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.
While the regulation will be effective July 6, CMS will not implement automatic rejections of claims submitted by providers who have attempted to enroll in PECOS. Until the automatic rejections are operational, claims will continue to be reviewed and paid as they have historically been reviewed and paid.
Not sure if you're enrolled in PECOS? There are two ways to verify PECOS enrollment:
- Go to the Medicare provider/supplier enrollment website. The file contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and nonphysician practitioners who are of a type/specialty eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS that contain an NPI).
- Call the TrailBlazer Health Enterprises interactive voice response (IVR) system. Follow these steps to obtain PECOS information via the IVR system.
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TMA Opposes Medicaid Fee Cuts
Due to an estimated $18 billion budget shortfall for 2012-2013, the Texas Health and Human Services Commission (HHSC) is considering a 1-percent, across-the-board cut in Medicaid and Children's Health Insurance Program physician payments to answer the state's projected budget gap. HHSC proposed the rate reduction in response to instructions from the Legislative Budget Board that all state agencies identify ways to reduce spending by five percent.
At a June HHSC hearing on the proposed fee reductions, several TMA members testified in opposition. TMA and 16 state specialty societies also sent a joint letter to the governor, lieutenant governor, and house speaker to convey organized medicine's concerns about the impact the rate cuts would likely have on patients' ability to get the care they need. TMA called on the leadership to work with organized medicine to identify targeted savings in lieu of cuts.
Currently, only 42 percent of physicians accept Medicaid; another cut could further reduce Texas physician participation and make it even more difficult for Medicaid patients to find a physician. Such a cut could actually cost the state budget more than it saves.
In May 2010, all state agencies also were asked to identify options for reducing their 2012-2013 budgets by an additional 10 percent. Hearings on possible cuts will be held later this summer. TMA will testify at each hearing about the importance of maintaining a robust primary and subspecialty physician network for Medicaid and CHIP patients as well as the importance of preventive health care.
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Rural Provisions in HSR Act
This report (PDF) from the RUPRI Center for Rural Health Policy Analysis outlines the provisions in the Patient Protection and Affordable Care Act that are important to rural health care delivery. The report provides a rural roadmap of the act and includes a brief introduction, highlights of the legislation as it affects rural interests, and detailed tables presented in the order of the sections of the law.
TMA also has developed the Health System Reform Action Center to help physicians keep track of the new law's impact – good and bad -- on your patients and your practice. The resource center includes an overview of the law as well as information by practice type – small practice, group practice, or academic. New content is added regularly.
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Rural Grants Available From TDRA
Visit the Texas Department of Rural Affairs (TDRA) website for more information about the many grant opportunities offered by TDRA. TDRA, formerly known as ORCA, is a state agency that works to strengthen rural communities by focusing on rural issues, monitoring governmental actions that affect rural Texas, and coordinating rural programs among state agencies.
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Rural Health Open Door Forum July 20
The next Rural Health Open Door Forum, sponsored by the Centers for Medicare & Medicaid Services, will be Tuesday, July 20, from 1 to 2 pm CDT. If you wish to participate, dial (800) 837-1935 and enter the conference ID-- 83092839.
The forums address addresses Rural Health Clinic Community Access Hospital and Federally Qualified Health Center (FQHC) issues, as well as some other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings.
Save the Dates!
- TMA Fall Conference 2010: Oct. 15-16, Austin
- TMA Winter Conference 2011: Jan. 28-29, Austin
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Last Published: 7/14/2010
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