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 TMA Action July 1, 2015   News and Insights from Texas Medical Association


INSIDE: Call for Two-Year ICD-10 Grace Period Gains National Support

Call for Two-Year ICD-10 Grace Period Gains National Support
OIG Focuses Fraud Efforts on Physician Compensation
All Mobile-Friendly CME Discounted 20 Percent This Month
Be Part of HIE Planning for Rural Texas

DSHS Issues Cyclospora Health Advisory
CDC Provides MERS Virus Evaluation Guidelines
HHSC Seeks Medicaid EHR Review Panel Members
This Month in Texas Medicine

Call for Two-Year ICD-10 Grace Period Gains National Support

Physician leaders from three states have joined the Texas Medical Association in asking the federal government to help doctors dodge disaster by adopting a two-year, penalty-free grace period to shift to the new ICD-10 medical billing and coding system. The four largest state medical associations — from Texas, California, Florida, and New York — sent a letter to Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS), which will roll out the mandatory shift to ICD-10 on Oct. 1.

David Henkes, MD, of San Antonio, chair of the Texas Delegation to the AMA House of Delegates, signed on behalf of TMA. 

And CMS leaders are listening. Last week, the agency arranged a conference call for physicians and staff from the four states to further explain their request. TMA President Tom Garcia, MD, and Asa Lockhart, MD, vice chair of the Texas Delegation to the American Medical Association House of Delegates, represented Texas on the call.

The letter supports the AMA house's recent passage of a resolution calling for CMS to establish the two-year ICD-10 grace period

"The Oct. 1 mandatory implementation of the ICD-10 coding system is a looming disaster," the letter to Mr. Slavitt explains. 

Dr. Henkes and the other letter authors call for

  • A two-year period during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system; 
  • A two-year period in which physicians will not be subject to special Medicare-payment audits due to ICD-10 coding mistakes; 
  • A two-year period during which physician payments will not be reduced or withheld based on ICD-10 coding mistakes; and 
  • Advance payments in the event of claims delay. 

The problem with ICD-10, physicians say, is the alarming size of the change: ICD-9, adopted in the 1970s, has 13,500 codes, while ICD-10 has 69,000. The codes are very specific. And omitting a detail could lead to a penalty. Physicians have been preparing for years to make the transition by training themselves and their office staffs, learning the new codes, and ensuring their electronic health records (EHRs) system can accommodate the huge change. 

Many describe it as an expensive government-mandated headache. "Even those practices that are most prepared for this transition tell us they worry about the confusion and reduced productivity they expect to accompany ICD-10," the letter says. "The quite realistic prospect of reams of denied and significantly delayed claims raises the specter of financial disaster or bankruptcy for many small practices." 

If physicians or their staffs miscode or are not specific enough, their practice could face penalties or payment delays for care they already provided. Physicians want the grace period to smoothly transition to the new system without penalty for simple mistakes. 

"We believe that two years of transition time, on-the-job learning by physicians — plus our continued ICD-10 educational activities — will result in a much less disastrous transition to this overwhelmingly complicated new coding system," say the doctors. 

Short of that, physicians fear disruptions and delays in patient care. They point to recent government tests assessing ICD-10 readiness of all the players involved, which revealed errors. Claim acceptance rates ranged from 76 percent to 89 percent in the CMS "end-to-end" ICD-10 tests. The rest of the claims were rejected for myriad reasons. 

Doctors add that even if one of the other links in the code-reporting chain, like EHR vendors, isn't ready by October, physicians and their patients will suffer. And the government's demands are not fairly distributed; for example, EHR, practice management, and billing companies do not have to complete software upgrades until Oct. 1 — the same day doctors must start reporting via the new system. That leaves physician practices no time to adapt to software changes before they must report patient records via ICD-10 codes. 

Physicians expect disruptions in patient care and reduced productivity that could cost their practices hundreds of thousands of dollars and extend patient waiting times. TMA and the other participating state medical societies are asking physician members to write Congress to ask senators and representatives to push CMS to stop or postpone the ICD-10 implementation or — at the very least — to enact the grace period.

TMA also joined with the medical societies from California, Florida, and New York in a letter asking the leaders of the U.S. Congress to stop the Oct. 1 implementation of the ICD-10 coding system or require CMS to establish a two-year, penalty-free grace period for physicians. 

"We remain steadfast in our belief that the ICD-10 coding system offers no real advantages to physicians and our patients — and certainly no advantages to justify the time and expense the entire health care system has invested in this transition," TMA and the medical societies wrote, pushing them to pass HR 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Houston). 

"If these requests are not achievable, we strongly encourage you to pass legislation such as HR 2652, the Protecting Patients and Physicians Against Coding Act, by Congressman Gary Palmer (R-Alabama) and others, or simply join our call for CMS to implement a two-year ICD-10 grace period," the letter states. 

In addition, health professionals have until July 10 to take an ICD-10 readiness survey from the Workgroup for Electronic Data Interchange (WEDI). Results will help to determine how well the health care industry is progressing toward the Oct. 1 implementation deadline. WEDI will evaluate and compile the results into a report for the industry.

Action, July 1, 2015

OIG Focuses Fraud Efforts on Physician Compensation

A recent U.S. Office of Inspector General (OIG) fraud alert warns that physician compensation arrangements may result in significant liability. 

"Physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide," the alert states. "Although many compensation arrangements are legitimate, a compensation arrangement may violate the anti-kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of federal health care program business. OIG encourages physicians to carefully consider the terms and conditions of medical directorships and other compensation arrangements before entering into them."

OIG recently reached settlements with 12 physicians who entered into "questionable medical directorship and office staff arrangements."

In the alert, OIG adds that "those who commit fraud involving federal health care programs are subject to possible criminal, civil, and administrative sanctions." OIG has more information on physician relationships:  

Action, July 1, 2015

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All Mobile-Friendly CME Discounted 20 Percent This Month

Need continuing medical education (CME)? Now's the perfect time to visit the TMA Education Center! 

For the entire month of July, you can take an additional 20 percent off all mobile-friendly CME courses, which can be completed anywhere, anytime, and on any device. This includes PDF publications, on-demand webinars, and podcasts. Dozens of courses are eligible for the discount, including popular programs covering ethics, risk management, coding, and practice operations. 

To take advantage of the sale, visit the TMA Education Center and enter the coupon code MOBILE20 at checkout to activate the discount.

Action, July 1, 2015

Be Part of HIE Planning for Rural Texas

Health information exchanges (HIEs) are active in several regions of Texas. Public HIEs received federal grant funds several years ago to build infrastructure that would allow physicians and other health professionals to share patient information. HIEs also have the ability to query a patient for health information outside a practice so physicians have relevant patient information at the point of care. 

Healthcare Access San Antonio (HASA) is a nonprofit HIE providing services in and around San Antonio. HASA has recently been commissioned by the Texas Health Services Authority to develop an HIE plan for West Texas and the Panhandle region. HASA wants to hear from physicians about their needs and interests to determine how to best serve them. 

Contact HASA Executive Director Gijs van Oort, or call (210) 918-1357 to provide input in planning for HIE infrastructure in rural Texas. 

Meanwhile, Gov. Greg Abbott last month signed House Bill 2641, the TMA-supported bill that gives important new liability protections for physicians using HIEs. The new law states: 

  • "Unless the health care provider acts with malice or gross negligence, a health care provider who provides patient information to a health information exchange is not liable for any damages, penalties, or other relief related to the obtainment, use, or disclosure of that information in violation of federal or state privacy laws by a health information exchange, another health care provider, or any other person." 
  • "Nothing in this section may be construed to create a cause of action or to create a standard of care, obligation, or duty that forms the basis for a cause of action."

Action, July 1, 2015

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DSHS Issues Cyclospora Health Advisory

The Texas Department of State Health Services (DSHS) issued a health advisory encouraging physicians to test patients for Cyclospora if they have diarrheal illness lasting more than a few days or diarrhea accompanied by severe anorexia or fatigue. 

DSHS reminds physicians it's important to promptly report confirmed cyclosporiasis cases to their local health department. DSHS received reports of more than 40 cases of Cyclospora infection in June.

According to the health advisory, diagnosis of cyclosporiasis requires submission of stool specimens for ova and parasite testing with additional specific orders for Cyclospora identification. A single negative stool specimen does not exclude the diagnosis; three specimens are optimal.

The alert notes that while "no common exposure source for this increase in cases has yet been identified, past outbreaks in the U.S. have been associated with consumption of imported fresh produce, including fresh cilantro, pre-packaged salad mix, raspberries, basil, snow peas, and mesclun lettuce."

Action, July 1, 2015

CDC Provides MERS Virus Evaluation Guidelines

The Centers for Disease Control and Prevention (CDC) hosted a call with doctors on June 11 to brief them with updated information and guidelines for evaluating Middle East respiratory syndrome (MERS) virus. 

The interim guidance doesn't include travel advisories, but concern about the virus has grown since the Republic of Korea reported to the World Health Organization an initial case of laboratory-confirmed MERS-CoV infection on May 20. CDC says it represents the first case in what is now the largest single outbreak of MERS coronavirus (MERS-CoV) outside of the Arabian Peninsula. 

CDC provided information to clinicians about the global situation and the current status of the MERS-CoV outbreak in Korea; updated guidance to health care professionals and state and local health departments regarding who should be evaluated and tested for MERS-CoV infection; and further guidance on "Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Possible MERS-CoV."

For more information, see CDC's guidance on MERS clinical features.

Action, July 1, 2015

Action Ad Summit 7.15         

HHSC Seeks Medicaid EHR Review Panel Members

The Texas Health and Human Services Commission (HHSC) is seeking candidates for the Texas Medicaid Electronic Health Record (EHR) Incentive Program Ad Hoc Review panel. Ideal candidates would be familiar with EHR systems and the EHR incentive program. 

Responsibilities include reading materials from the state, the auditing contractor, and eligible professionals or eligible hospitals. Panel members will participate in discussions and provide advisory recommendations to HHSC regarding all documents. Panelists will be appointed by the HHSC executive commissioner and will not be required to travel, as work will be conducted by web or telephone. All positions are voluntary and involve about five hours of participation each month. The term for serving on the panel is one year. 

Interested candidates should complete and submit an application

Action, July 1, 2015

This Month in Texas Medicine

The July issue of Texas Medicine features a cover story on Medicare mistakes TMA uncovered and helped to resolve, with key input from member physicians. In the issue, you'll also find information on new medical records rules adopted by the Texas Medical Board; growing numbers of subspecialists and the concern over adequate access to general care; failed legislation that would have required student athletes to have an EKG before participating in school athletics; TMA Practice Consulting's practice setup services; and Medicare's Quality and Resource Use Reports.

Click to launch the full edition in a new window.  

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Action, July 1, 2015

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Deadlines for Doctors

TMA's Deadlines for Doctors alerts you and your staff to upcoming state and federal compliance timelines and offers information on key health policy issues that impact your practice.  

ICD-10 Implementation Compliance   

First-Year Participants' Last Day to Begin 90-day Reporting Period of Meaningful Use for the 2015 Medicare and Medicaid EHR Incentive Programs

 TMA Education Center 

The TMA Education Center offers convenient, one-stop access to the continuing medical education Texas physicians need. TMA's practice management, cancer, and physician health courses are now easier than ever to find online.  

On-Demand Webinars

 Achieving ICD-10 Implementation Success    
ICD-10 Documentation and Auditing: Success Is in the Details
ICD-10 Starts With Physicians

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