Action: Aug. 15, 2011

TMA Action Aug. 15, 2011  News and Insights from Texas Medical Association  

INSIDE: Revalidate Your Medicare Enrollment 

Revalidate Your Medicare Enrollment
TMA, AMA: Change Medicare Data Reporting
Risk Analysis Tool for Meaningful Use
HHSC Chooses Medicaid HMOs
Medicaid Obstetric Claims Change Delayed  

Join TEXPAC: Make a Difference
Plan to Attend TMA's Fall Conference
A Healthier Texas Helps Us All
This Month in Texas Medicine
Do You Twitter? Follow TMA 

Revalidate Your Medicare Enrollment

Physicians who signed up for the Medicare program before March 25, 2011, must revalidate their enrollment with TrailBlazer Health Enterprises over the next year-and-a-half. The health system reform bill Congress passed last year requires it to reduce Medicare fraud, waste, and abuse. Physicians who enrolled on or after March 25, 2011, do not need to revalidate. 

TrailBlazer will send notices to physicians between now and March 2013. Begin the revalidation process as soon as you get the notice. You have 60 days to complete the enrollment forms, or Medicare may deactivate your billing privileges. Do not submit a revalidation application unless you've received a revalidation request letter from TrailBlazer. The easiest and quickest way to revalidate your enrollment information is by using the Provider Enrollment, Chain, and Ownership System  (PECOS). After updating PECOS, be sure to sign the certification statement and mail it to TrailBlazer. 

The Centers for Medicare & Medicaid Services (CMS) began using new screening criteria  [PDF] in the Medicare provider/supplier enrollment process on March 1. CMS places new and revalidating providers and suppliers in one of three screening categories – limited, moderate, or high. CMS says each category represents the level of risk to the Medicare program for the particular category of provider/supplier, and the agency determines the degree of screening that TrailBlazer and other Medicare administrative contractors processing the enrollment applications will perform. Physicians are in the "limited" risk category.  

The Texas Medical Association's Payment Advocacy staff reminds physicians that they should keep their Medicare enrollment information up to date through PECOS. TMA will ask CMS officials for more information on the revalidation program when TMA staff meets with them in the fall. Action will publish more information on the process as soon as it is available.

For more information about provider revalidation, review the Medicare Learning Network's Special Edition Article #SE1126 [PDF], titled "Further Details on the Revalidation of Provider Enrollment Information." 

TMA, AMA: Change Medicare Data Reporting

Public reports on Medicare and private payer data must be valid, reliable, and actionable, the Texas Medical Association, the American Medical Association, and 80 other physician organizations told the Centers for Medicare & Medicaid Services (CMS) in comments on Medicare's proposed rules for reporting performance measurement data.  

The organizations applauded the inclusion of safeguards that protect patients and physicians in the rule, but said several critical issues must be resolved for physician measurement and public reporting to be effective. 

In their letter, the organizations called on CMS to make sure that physicians can review their data for accuracy and appeal any errors before the information becomes public. They also urged CMS to standardize the process for developing the public reports and the type of information they will include, not only across the Medicare system but for private insurance data, as well. 

The comment letter provides detailed recommendations to CMS on additional safeguards and ways to standardize the data collection to help in developing meaningful, actionable reports. 

"Physicians and patients must be able to trust the quality performance determinations presented in these reports, and not have to decipher conflicting reports that present different conclusions due to a lack of applying accurate, transparent, and consistent risk-adjustment and attribution methods," they wrote. "Without standardization of risk-adjustment and attribution methods, there inherently will be multiple and conflicting performance reports for the same physician. This will undermine the goals of public reports resulting in actionable determinations by patients and physicians, as well as improved quality of care."  


Risk Analysis Tool for Meaningful Use

One of the required meaningful use criteria is to conduct a security risk analysis. To help physicians carry out this objective and comply with the HIPAA Security Rule, the Office of the National Coordinator (ONC) has created a security risk analysis tool.   

Physicians who meaningfully use a certified electronic health record (EHR)may qualify for EHR incentives up to $44,000 under Medicare or up to $63,750 under Medicaid. Many of the meaningful use measures offer exclusions (see Do you qualify for Meaningful Use Exclusions?), but conducting a security risk assessment is a core requirement and there are no available exclusions.  

Use of ONC's Risk Analysis tool will provide an overall view of the state of security and provide suggestions for potential deficiencies. There are various methods of performing a risk analysis to guarantee compliance with the HIPAA Security Rule and meaningful use; however. there are several key elements that must be incorporated, regardless of what method you use in your practice. You must:   

  • Document scope of analysis; 
  • Collect data; 
  • Identify and document potential threats and vulnerabilities; 
  • Assess current security measures; 
  • Determine the likelihood of threat occurrence; 
  • Determine the potential impact of threat occurrence; 
  • Determine the level of risk; 
  • Finalize documentation; and 
  • Periodically review and updates to risk assessment. 

Texas regional extension centers (RECs) can help your practice with a security risk analysis through on-site technical consulting. Their services are designed to take your practice from its current state – whether you are starting with a paper-based system or looking to optimize your current EHR system – to meaningful use to qualify for the federal EHR incentives. The Texas RECs understand the unique challenges physicians face and will work with you to fully realize the benefits of EHRs in improving efficiencies and patient care. They serve as a direct pipeline to the national program with HIT adoption. 

Primary care physicians qualify for a grant that lowers the annual price of services to $300 per physician. Federal incentives for consulting and EHR use are unprecedented and will not last long. Visit TMA's REC Resource Center to learn more about the Texas RECs, available incentives, REC and incentive eligibility, and meaningful use. 

Still have a question? Contact the TMA Health Information Technology helpline at (800) 880-5720 or email HIT.   




HHSC Chooses Medicaid HMOs

The Texas Health and Human Services Commission (HHSC) has tentatively selected health plans for the HHSC Medicaid STAR, STAR+PLUS, and Children's Health Insurance Program (CHIP) managed care program for current and new HMO service areas. HHSC is negotiating contracts with the plans. The new contracts take effect in March 2012.   

The service areas [PDF] and health plans are: 

Bexar: STAR-Aetna, Community First, Superior Healthplan Network; STAR+PLUS-Amerigroup, Molina Healthcare of Texas, Superior Healthplan Network; CHIP-Aetna, Superior Healthplan Network, Community First.  

Dallas: STAR-Parkland Community Health Plans, Amerigroup, Molina Healthcare of Texas; STAR+PLUS; CHIP-Amerigroup, Parkland Community Health Plans, Molina Healthcare of Texas.   

El Paso: STAR-El Paso First, Superior Healthplan Network, Molina Healthcare of Texas; STAR+PLUS-Molina Healthcare of Texas, Amerigroup, CHIP-El Paso First, Superior Healthplan Network. (STAR+PLUS model will begin March 2012). 

Harris: STAR-Amerigroup, Texas Children's, Community Health, Molina Healthcare of Texas, United Healthcare Community Plan; STAR+PLUS-Molina Healthcare of Texas, Amerigroup, United Healthcare Community Plan; CHIP-Amerigroup, Community Health, Molina Healthcare of Texas, Texas Children's, United Healthcare Community Plan.   

Jefferson (new service area effective Sept. 1, 2011): STAR-Amerigroup, Texas Children's, Community Health, Molina Healthcare of Texas, United Healthcare Community Plan; STAR+PLUS- Amerigroup, Molina Healthcare of Texas, United Healthcare Community Plan; CHIP-Amerigroup, Community Health, Molina Healthcare of Texas, Texas Children's, United Healthcare Community Plan.   

Lubbock: STAR-Superior Healthplan Network, FirstCare, Amerigroup; STAR+PLUS, Amerigroup, Superior Healthplan Network; CHIP-FirstCare, Superior Healthplan Network (STAR+PLUS model to begin March 2012). 

Nueces: STAR-Superior Healthplan Network, Driscoll Children's, Christus; STAR+PLUS-Superior Healthplan Network, United Healthcare Community Plan; CHIP-Driscoll Children's, Superior Healthplan Network, Christus.   

Tarrant: STAR-Amerigroup, Aetna, Cook Children's; STAR+PLUS; CHIP-Aetna, Amerigroup, Cook Children's.   

Travis: STAR-Amerigroup, Superior Healthplan Network, Seton; STAR+PLUS-Amerigroup, United Healthcare Community Plan; CHIP-Seton, Superior Healthplan Network, Amerigroup. 

New Medicaid HMO Service Areas
Beginning in March 2012, HHSC will eliminate the Primary Care Case Management (PCCM) model in favor of the HMO model. HHSC is responding to cost-containment recommendations approved by the Texas Legislature. TMA is developing a webinar on the Medicaid HMO changes. It is tentatively planned for October. 

Hidalgo: STAR-United Healthcare Community Plan, Superior Healthplan Network, Molina Healthcare of Texas, Driscoll Children's; STAR+PLUS-Molina Healthcare of Texas, Superior Healthplan Network, Health Spring; CHIP.   

Medicaid Rural Service Areas   

  • West Texas: STAR-Amerigroup, Superior Healthplan Network, First Care; STAR+PLUS; CHIP.   
  • Central Texas: STAR-Amerigroup, Superior Healthplan Network, Scott & White; STAR+PLUS; CHIP. 
  • Northeast Texas:  STAR-Amerigroup, Superior Healthplan Network; STAR+PLUS; CHIP.   
  • Sept. 1, 2011: Expansion of HMO model to counties contiguous to current service areas. 
  • March 1, 2012: Conversion of PCCM to HMO model in all remaining rural and South Texas counties. 
  • March 1, 2012: Expansion of STAR+PLUS HMO model to Lubbock and El Paso.  


Medicaid Obstetric Claims Change Delayed 

Thanks to TMA and its organized medicine partners, the Medicaid program delayed the start of changes to claims for obstetric services for one month until Oct. 1. At that time, claims with delivery procedure codes 59409, 59410, 59514, 59515, 59612, 59614, 59620, or 59622 will require the U1, U2, or U3 modifier.

Claims for deliveries following labor induction before 39 weeks of gestation that are not considered medically necessary will be denied.

The changes are legislatively mandated efforts to reduce the incidence of elective inductions before the 39th week of gestation. While TMA supports efforts to reduce nonmedically necessary inductions, it has expressed concerns to the Texas Health and Human Services Commission (HHSC) about the pace of changes. The association, together with state obstetrical and gynecological societies, has requested that HHSC postpone implementation until at least Oct. 1 to give practices more time to modify their claims-billing systems to meet the new requirements. The change was scheduled originally for Sept. 1.

For more information, call the Texas Medicaid & Healthcare Partnership Contact Center at (800) 925-9126. 



Join TEXPAC: Make a Difference

The Texas Medical Association Political Action Committee (TEXPAC) is asking county medical society presidents to help recruit 25 percent of their membership to join TEXPAC before the 2012 elections and raise $160,000 by Sept. 30. 

"Will you rise to the challenge to ensure our political relevancy, effectiveness, and strength?" TEXPAC Board of Directors Chair Joe Todd, MD, asked in a letter to the presidents. "The 2012 post-redistricting election cycle will be both opportunity-rich and challenging," he wrote. "The results of the 2012 general election will set the tone and tenor of the Texas Legislature for the remainder of the decade. Voters will fill one U.S. Senate vacancy and 36 congressional seats, plus every state Senate, every state House, three Texas Supreme Court, and 41 appellate court seats. The old Chinese proverb (or is it a curse?) comes to mind: 'May you be blessed to live in interesting times.' Interesting times, indeed."Dr. Todd noted that last year, 15 percent of TMA members joined TEXPAC "and helped us elect more physician and alliance members than have ever served in the Texas Legislature at the same time. The results of their efforts were, in a pecan shell, effective."    

He said Sen. Robert Deuell, MD (R-Greenville), and Reps. Charles Schwertner, MD (R-Georgetown), Mark Shelton, MD (R-Fort Worth), and John Zerwas, MD (R-Simonton), and TMA Alliance member Rep. Susan King (R-Abilene) – along with more than 1,200 physician and alliance First Tuesday volunteers – "were instrumental in staving off disastrous policy decisions our legislature considered. Medicine successfully moved the ball forward on numerous fronts."   

For example, TMA:   

  • Defended clinical autonomy of physicians employed by hospitals; 
  • Fought off all proposed scope-of-practice expansions for nurse practitioners and other allied health professionals; 
  • Staved off severe cuts to physician fees in Medicaid and the Children's Health Insurance Program that likely would have driven physicians out of those programs;  
  • Won significant reforms of the Texas Medical Board disciplinary process to make it much fairer for physicians; and 
  • Protected hard-fought medical liability reforms.   

Read more about TMA’s legislative victories in TMA's 2011 Legislative Report Card.   

"Beyond these advances, much work remains," Dr. Todd said. "TEXPAC must redouble its efforts educating candidates on the business and practice of medicine. We must work hard to help reelect our friends in the legislature who went to bat for medicine this past session. We must evaluate each candidate's record and commitment to improving the delivery of health care in Texas so we can determine if he or she is the 'right candidate' to further medicine’s agenda. We must continue to put doctors, and their spouses, in the House and Senate, as we have done in each of the last three campaign cycles."     

Dr. Todd urges all Texas physicians to join TEXPAC or upgrade their membership, get involved in the political process at home, and educate their patients "about the patient-physician relationship and the forces seeking to undermine it." Visit TEXPAC online to learn about the issues and how to help. 

For more information, email Political Education Director  David Reynolds.   

The Texas Medical Association Political Action Committee (TEXPAC) is a bi-partisan political action committee of TMA and affiliated with the American Medical Association Political Action Committee (AMPAC) for congressional contribution purposes only. Its goal is to support and elect pro-medicine candidates on both the federal and state level. Voluntary contributions by individuals to TEXPAC should be written on personal checks. Any corporate funds or funds attributed to individuals or professional association (PAs) that would exceed legal contribution limits will be placed in the TEXPAC administrative account to support political education activities unless a refund is requested. Federal Election Law prohibits TEXPAC from soliciting donations from persons who are not either TMA members or TMA Executive/Administrative personnel and their families. All donations received other than from these persons will be returned. 

Contributions are not limited to the suggested amounts. TEXPAC will not favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions are subject to the prohibitions and limitations of the Federal Election Campaign Act. 

Contributions or gifts to TEXPAC or any CMS PAC are not deductible as charitable contributions or business expenses for Federal income tax purposes. 

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year. To satisfy this regulation, please include your occupation and employer information in the space provided. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, please call TEXPAC at (512) 370-1361. 


Plan to Attend TMA's Fall Conference 

TMA's 2011 Fall Conference features thought leaders providing insight into how physicians can prepare for upcoming challenges, take advantage of new opportunities, and avoid mistakes from the past. Join your colleagues from across the state as we move forward in this post-reform world. The tentative agenda follows. 

Friday, Oct. 21
7:30 am-10 pm
Business meetings at the Hyatt and the TMA building

5:30-6:30 pm
Distinguished Service Award Reception honoring Bohn Allen, MD (o
pen to all conference attendees and official guests)  

Saturday, Oct. 22
Business meetings continue at the Hyatt before and after the General Session. 

7:30-8:30 am
Networking Breakfast (o
pen to all conference attendees and official guests)  

8:45-11:45 am
General Session (continuing medical education)
Moderated by TMA President C. Bruce Malone, MD 

The headquarters hotel for the conference is Hyatt Regency Austin, 208 Barton Springs, (512) 477-1234, reservations: (800) 233-1234. The TMA room rate is $179 for single/double. For online reservations, visit the TMA website. Book your reservations at the Hyatt no later than Sept. 20. 

Mention that you are with TMA to receive the special discount room rate. Sleeping rooms are subject to a 15-percent occupancy rate tax. Local sales tax is 8.25 percent.

TMA will provide shuttle service between the Hyatt and TMA on Friday, Oct. 21. 

Free registration is one of the many benefits of your TMA membership. Nonmembers may attend for $125. Register online after Monday, Aug. 15, on the TMA website 

Onsite registration hours are: 

Friday, Oct. 21
8 am-6:30 pm
TMA Building

8 am-7 pm

Saturday, Oct. 22
6 am-noon

Gain insight into the mega-trends that physicians will face as a result of health system reform at TMA's Fall Conference. For more information, visit the TMA website or contact TMA Knowledge Center by phone at (800) 880-7955 or by email 


A Healthier Texas Helps Us All 

TMA's health improvement programs encourage Texans to play a more active role in their good health. Read about how Texans benefit from these programs in  Healthier Texans: Now and in the Future [PDF], the just released 2010 annual report of the TMA Foundation (TMAF), the philanthropic arm of TMA, which raises the funds to make these programs possible. 

The report also spotlights the hundreds of TMA and TMA Alliance members who volunteer their time and expertise to carry out TMA's award-winning programs in communities around the state. Their partnership with local schools, civic groups, and others demonstrates medicine's trusted leadership in "improving the health of all Texans." 

The vision and support of hundreds of generous donors to TMAF makes this work possible. To make sure Texans have continued access to these award-winning outreach efforts, visit TMAF to donate online or call (800) 880-1300, ext. 1664, or (512) 370-1664.   

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent. 

A practice management tip from
TMA Practice Consulting


This Month in Texas Medicine

The August issue of Texas Medicine details TMA's incredibly successful effort in the 2011 Texas Legislature to win passage of bills that help Texas physicians and patients, and block passage of those that would harm them. You'll also learn about public health bills that TMA backed, why many physicians think the federal government's proposed rules on accountable care organizations are a bad idea, and about the state attorney general's crackdown on physicians who purchase unapproved drugs or medical devices. 

Check out our new digital edition. 

Also, you can subscribe to RSS feeds for TMA Practice E-Tips, TMA news releases, Blogged Arteries, and Texas Medicine 



Texas Medicine RSS Feed

Don't want to wait for Texas Medicine to land in your mailbox? You can access it as an RSS feed, the same way you get the TMA Practice E-Tips RSS feed.  

E-Tips RSS Feed

 TMA Practice E-Tips, a valuable source of hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, and practice marketing, is available as an RSS feed on the TMA website. Once there, you can download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action. 


Do You Twitter? Follow TMA 

As part of its work to explore new communications technologies, TMA regularly publishes on Twitter, the hot, 140-character "micro-blogging" service.

If you Twitter, follow TMA to get practice management tips, news bits, and political chatter – and we'll follow you, too. If you don't know what we're talking about, click here to check it out.

What are TMA-member physicians saying on Twitter each day about health care, politics, science, and more? You don’t need a Twitter account to be part of the conversation. The TMA Member Physicians Daily comes out around 10 am each day. You can subscribe via e-mail or RSS feed. TMA’s own Twitter feeds reach more than 20,000 unique individuals online each week.  

This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to Blogged Arteries. You can hear the latest Podcast TMA episodes and read the most recent news from Action and Texas Medicine

TMA Seminars

Practice Management, Ext. 1421 

Recorded Web Seminars 

Avoiding RAC Audits
Communication Skills: Why Bother?
Evaluating Your Medicare Options
Prepared for ICD-10?
Meaningful Use
Medical Records-Consent for Treatment of Minors
Patient-Physician Relationship
Patient Satisfaction
Professional Courtesy: Waiving Copays, and Charity Care Requirements
 Revenue Cycle Management  

Physician Health and Rehabilitation, Ext. 1342

Family Systems: The Impact of Marriage and Family on Physicians
9/10         Amarillo
10/20       El Paso 

Challenging Behaviors, Recovery, and Physician Health Programs
9/16-17   San Antonio 

About Action

Action, the TMA newsletter, is e-mailed twice a month to bring you timely news and information that affects your practice.

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If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Larry BeSaw, Action editor.

Published: 8/22/2012 06:00:03 PM