Action: April 1, 2011

TMA Action April 1, 2011
News and Insights from Texas Medical Association


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E-Prescribe in 2011 or Face 2012 Penalties
Nelson Seeks to Restore Medicaid Fee Cuts
The Truth About The $505 Medicare Fee
United to Release Doctor Ratings June 1
BCBS, AMA Set Webinars on v5010 Standards
Advanced Imaging Needs Accreditation
CMS May Drop Lab Signature Rule

Study: Texas Practices Are Good for Economy
AMPAC Campaign School Grooms Politicos
DSHS Changes Newborn Screening Reports
Make Your Plans for Houston in May
TMF Seeks Diabetes Program Partners
This Month in Texas Medicine
Do You Twitter? Follow TMA  

E-Prescribe in 2011 or Face 2012 Penalties

This is no April fool's joke: Medicare is going to cut your fees 1 percent in 2012 if you don't e-prescribe 10 times by June 30, 2011.  

In November, the Centers for Medicare & Medicaid Services (CMS) announced that, beginning in calendar year 2012, physicians who are not successful electronic prescribers based on claims submitted between Jan. 1, 2011, and June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. There also is an incentive available for physicians participating in the e-prescribing program.      
















Important 2011 e-prescribing deadlines!

  • June 30, 2011 – e-prescribe and report G-Code G8553 at least 10 times to prevent 2012 1-percent penalty.  
  • Dec. 31, 2011 – e-prescribe and report G-Code G8553 at least 25 times to earn a 1-percent bonus on 2011 Medicare part B allowable charges.
  • Dec. 31, 2011 – e-prescribe and report G-Code G8553 at least 25 times to prevent 2013 1.5-percent penalty.

Penalty Prevention
Physicians can avoid the 2012 e-prescribing penalty by complying with one of the following:

  1. Report G-Code G8553 for at least 10 unique e-prescribing events for patients in the denominator of the allowable measure (see denominator listing below).
  2. A physician is exempt from the 2012 penalties if there are not at least 100 cases containing an encounter code in the measure denominator (see denominator listing below). No G-code is needed as CMS will know of an exemption through claims. 

Denominator Codes
Bill under one of the following denominator codes (CPT or HCPCS): 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109.

Electronically generated prescriptions not associated with one of these denominator codes do not count toward the minimum 25 e-prescriptions needed for the bonus or the 10 needed to prevent the penalty. If you do not have at least 100 cases with one of these encounter codes, you are exempt from the penalty.  

Hardship Codes
Hardship codes exist for physicians not able to e-prescribe because of insufficient Internet access or insufficient pharmacies that accept e-prescribing. If that is the case, the G-code should be reported at least one time before June 30, 2011, to prevent the e-prescribing penalties in 2012.

G8642: The physician practices in a rural area without sufficient high-speed Internet access and requests a hardship exemption from the application of the payment.

G8643: The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.

You do not need to use an electronic health record (EHR) to implement e-prescribing in a practice; standalone e-prescribing systems are available.  Physicians considering installing e-prescribing software may view the SureScripts' certified products page for help with selection. Physicians should expect to pay approximately $50 per month for this type of software.   

Detailed program information is available on the TMA website

There is additional information on the CMS "How to Get Started" webpage.

Regional extension centers have been established to specifically help physicians work through the details of EHR adoption and meaningful use achievement required for EHR incentive programs through Medicare and Medicaid. Primary care physicians are eligible for onsite services for only $300 per year (per physician) because of federal grants. Specialists may call to receive customized pricing based on service needs. More information is available on the TMA website. 

For more information on e-prescribing or other health information technology needs, contact TMA's Health Information Technology Department at


Nelson Seeks to Restore Medicaid Fee Cuts

A proposed 10-percent cut in Medicaid physician payment rates could shrink to 3 percent if lawmakers approve a recommendation from the Texas Health and Human Services Commission (HHSC).

In mid-March, Sen. Jane Nelson (R-Lewisville), chair of the Senate Finance Subcommittee for Medicaid, asked Tom Suehs, HHSC executive commissioner, to develop a list of top funding priorities. Leading Commissioner Suehs' recommendations was a proposal to restore 7 percent of the proposed 10-percent cut in physician payments for both Medicaid and the Children's Health Insurance Program.

Senator Nelson's subcommittee designated that recommendation as a top-level priority, along with proposals to:

  • Stop paying coinsurance for patients who receive coverage from both Medicaid and Medicare (dual eligibles) if the coinsurance would exceed the Medicaid rate;  
  • Restore 5 percent of the proposed 10-percent cut to hospitals and other providers;  
  • Reduce funding for labs and durable medical equipment providers by 20 percent, with the goal of mitigating those cuts by half if funds become available;  
  • Approve continuation of the Women's Health Program, pending passage of legislation to extend program beyond 2011; and  
    Fund Medicaid caseload growth.  
 If lawmakers vote to restore the 7 percent for Medicaid physician fees, the resulting 3-percent payment cut would apply to both child and adult Medicaid services. 

Meanwhile, the full proposed 10-percent cut was still in the 2012-13 budget bill voted out of the House Appropriations Committee on March 24. House Bill 1 includes total spending of $164.5 billion, a cut of $23 billion from the 2010-11 budget. The full House is scheduled to begin debating HB 1 on April 1.

The Truth About The $505 Medicare Fee

Despite what you may have heard, the new $505 fee for enrolling in Medicare applies only to what the Centers for Medicare & Medicaid Services (CMS) calls "institutional providers." It doesnot apply to physicians and nonphysician practitioner organizations.

 CMS defines "institutional providers" as:

  • Community mental health centers,
  • Comprehensive outpatient rehabilitation facilities,
  • Critical access hospitals,
  • End-stage renal disease treatment facilities,
  • Federally qualified health centers,
  • Histocompatibility laboratories,
  • Home health agencies,
  • Hospices,
  • Hospitals,
  • Indian Health Services facilities,  
  • Organ procurement organizations,
  • Outpatient physical therapy/occupational therapy/speech pathology services,
  • Religious nonmedical health care institutions,
  • Rural health clinics, and  
  • Skilled nursing facilities.   

Institutional providers applying to participate in the Medicare program must first submit a completed CMS-855 application through the website.  




United to Release Doctor Ratings June 1

UnitedHealthcare says it will not publicize the ratings of physicians under its Premium Designation program until June 1 to give physicians time to question their ranking. The ratings were to be released March 30.

United says the designation results and assessment reports are available online.  It urges physicians to check their designation because some designations may have changed due to updated group affiliation information.

Physicians may ask the company to reconsider their ranking any time, United says, but the request must be filed before May 1 to impact the rating listed on the United website.

TMA has developed a toolkit physicians can use to challenge their ratings by United or any other health care plan..  

According to United, the Premium Designation program "uses clinical information from health care claims to assist physicians in their continuous practice improvement and to help consumers make more informed and personally appropriate choices for their medical care." It evaluates physicians in 21 specialties and is based on claims paid between Jan. 1, 2006, and March 31, 2009.


BCBS, AMA Set Webinars on v5010 Standards

Blue Cross and Blue Shield of Texas will conduct five 60-minute webinars on the ANSI v5010 electronic standards under the Health Insurance Portability and Accountability Act (HIPAA) for physicians and their staff in April. They will be at 1 pm on April 21, 22, 26, and 29, and at 2 pm on April 28. A 30-minute question-and-answer session will follow each presentation.

To register for the webinars, log on to the BCBSTX website and sign up now for the most convenient time and date. BCBSTX says space is limited and recommends group attendance.

The American Medical Association also plans webinars on the changeover April 4-8. They will cover:

  • Testing for large and small practices and facilities,  
  • Testing with Medicare fee-for-service, and   
  • Testing with commercial payers and clearinghouses.   

The U.S. Department of Health and Human Services requires all "covered entities" (physicians, clearinghouses, insurers, and others with access to digital personal health care data) to convert to the new ANSI 5010 transaction set by Jan. 1, 2012. These are the electronic transactions used to transmit patient, physician, and provider data among those covered entities. 

The switch from Version 4010/4010A1 to Version 5010 is part of the ICD-10 conversion in 2013. It involves updated codes and transactions standards that will cover improvements to electronic claims, insurance eligibility verification, claim status inquiries, requests for authorizations, and electronic remittance data. Unlike Version 4010, Version 5010 accommodates the ICD-10 code structure. The changeover will require equipment upgrades and comprehensive staff training. ICD-9 contains more than 17,000 codes, but ICD-10 will have more than 141,000 codes and will accommodate a host of new diagnoses and procedures. The format is new, with seven alpha-numeric codes instead of five numeric digits. You cannot learn ICD-10 overnight, or even in a few weeks or months. But easing yourself and your staff into a comprehensive understanding of ICD-10 will put your practice on solid footing when the new coding system takes effect.

TMA and the American Academy of Professional Coders offer training options to help physician practices make a smooth transition from using ICD-9 codes to using ICD-10   

Advanced Imaging Needs Accreditation

Physicians, non-physician practitioners, and independent diagnostic testing facilities must be accredited by one of the three Centers for Medicare & Medicaid Services (CMS)-approved national accreditation organizations and must update their Medicare provider enrollment information by Jan. 1, 2012, to be eligible to bill Medicare for the technical component of certain diagnostic imaging procedures. That’s the word from TrailBlazer Health Enterprises.

The three approved organizations are:

  • The American College of Radiology,  
  • The Intersocietal Accreditation Commission, and   
  • The Joint Commission.   

The 2008 Medicare Improvements for Patients and Providers Act says advanced diagnostic imaging procedures are diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine imaging, such as positron emission tomography. The TrailBlazer notice [PDF] about the accreditation requirement lists the CPT codes involved.

CMS posted a 20-page slideshow about the accreditation requirement on its website. Pay special attention to the information about compliance on slide 7, on what the accreditation agencies expect from you and the length of the approval process on slides 12-14, and on accreditation costs on slide 18.

Once physicians have received their accreditation, they will need to update their CMS and TrailBlazer enrollment application. The new version of the enrollment application will be available in July. TMA will post information about the new enrollment application on the TMA website once CMS posts it on its website.

CMS May Drop Lab Signature Rule

Centers for Medicare & Medicaid Services (CMS) Director Donald Berwick, MD, wrote Congress in March that the agency is looking into whether it could publish a regulation in time to rescind completely its requirement that physicians sign diagnostic laboratory requisitions. Earlier this year, CMS said it would delay enforcement of the rule until April 1.

In a mid-March letter to U.S. Rep. Michael Burgess, MD (R-Lewisville), Dr. Berwick said CMS officials "have publicly expressed their support for rescinding the requirement.”

Representative Burgess was among a bipartisan group of House and Senate members who urged Congress to delay enforcing the requirement until 2012 because of the "the myriad potential harmful consequences of this policy on Medicare beneficiaries' timely access to laboratory testing."

The lawmakers also told CMS that the requirement could harm Medicare patients because care might be delayed. "Under this new policy, laboratories will face a difficult decision when they receive a patient specimen with an unsigned requisition," the letter said. "Laboratories will have to decide not to provide their needed services and therefore be unable to provide a physician the information necessary to make health care decisions, or to provide the services without guarantee of payment, then work to obtain signatures in order to submit claims to Medicare."

Long-term care facilities were especially upset with the requirement because physicians often order lab tests for their patients in the facilities over the telephone. They argued the requirement would slow the process.     




Study: Texas Practices Are Good for Economy

Physicians' medical practices have a tremendous positive impact on Texas' economy, according to a new study by TMA and the American Medical Association. In 2009, Texas' medical practices contributed billions of dollars in economic activity and supported nearly a quarter of a million jobs. Office-based physicians play a vital role in the state's economy by providing jobs, purchasing goods and services, and generating tax revenue.

"Texas physicians not only save lives, we create jobs too," said TMA President Susan Rudd Bailey, MD. "Doctors' offices are significant contributors to the Texas economy." 

In the four major areas the study highlights, the 42,613 Texas physicians have significant economic impact:

  • Jobs: Physicians support almost 250,000 jobs in Texas (the average office-based Texas physician supports 5.8 jobs in the economy, including his or her own);  
  • Output: Physicians contribute $63.6 billion in economic output or sales revenue, representing 5.6 percent of the total gross domestic product in Texas;  
  • Wages and benefits: Physicians in Texas generate $39.4 billion in wages and benefits; and  
  • Taxes: Physicians generate nearly $2.1 billion in state and local tax revenue in Texas.   

"Physicians improve the health of their patients and also the economic health of their local communities and the state," said Dr. Bailey. "Texans benefit directly when the state creates a positive practice environment for doctors, and attracts and keeps physicians here."

The number of jobs that Texas physicians support is about the same as the total number of new jobs the Texas Workforce Commission reports that the state has added in the economic recovery of the past year.

Nationwide, physicians' medical practices support 4 million jobs, contribute $1.4 trillion in economic output/sales revenue, generate $833.1 billion in wages and benefits, and contribute $62.9 billion in state and local tax revenue.

AMA and TMA commissioned The Lewin Group to conduct the study, The State-Level Economic Impact of Office-Based Physicians Report. Three primary data sources were used to evaluate the economic impact of physician offices: the AMA masterfile of physicians, the Medical Group Managers' Association Cost Survey, and the IMPLAN economic impact modeling system.

The study examined the economic impact of office-based physicians – physicians' medical practices, whether solo or group – that care for patients. The study's authors define the direct output of an industry as the total sales revenue produced by that industry in any given year, or, for office-based physicians, the total value of medical and nonmedical revenues generated by office-based physician practices (from the cost of providing patient care to revenue from parking fees). They define jobs as the combination of physicians, support staff, and nonphysician health care providers. The value of direct wages and benefits includes compensation and benefits paid to physicians, nonphysician staff, medical practice owners, and any other staff on payroll. The taxes figure combines taxation on medical practice employee income, proprietor income, indirect business interactions, households, and corporations. Tax revenues are included from physician offices (direct) and from other affected industries (indirect) to determine the "total" tax revenues supported by the medical practices.

AMPAC Campaign School Grooms Politicos

American Medical Association members interested in getting involved in politics and working for medicine-friendly candidates can get an up-close look at the inner workings of a campaign at the annual AMA Political Action Committee (AMPAC) Campaign School, April 13-17, in Pentagon City, Va.

AMPAC pays for all costs for AMA members except transportation to the Washington, D.C., metro area.

For more information or an application, contact Political Education Programs Manager Jim Wilson at (202) 789-7465 or

The school is organized around a simulated congressional campaign, where participants are put on campaign "staff" teams and attend daily lectures on campaign strategy, media advertising, and political fundraising. Each team participates in nightly exercises such as creating a campaign strategy, taping a radio commercial, and writing a political fundraising letter. Graduates have gone on to become advisers and strategists for political campaigns across the country. Others have run for – and won – elective office.


DSHS Changes Newborn Screening Reports

The Newborn Screening Program of the Texas Department of State Health Services (DSHS) has changed the system for reporting the results of screenings [PDF]. The changes involve the reference range statement, reports of revised results, and reports of multiple abnormal results for a single disorder.

Call (888) 963-7111, ext. 7333, if you need additional information.


Make Your Plans for Houston in May

Take advantage of your TMA membership by attending TexMed 2011, May 13-14, at the George R. Brown Convention Center and Hyatt Regency Houston.

"Caring for Patients in a Time of Change" is the theme of the conference, which offers more than 100 hours of clinical and business continuing medical education (CME), an exhibit hall with some 100 exhibits, and a chance to learn how to enhance patient care, stay abreast of clinical updates, discuss key issues with experts in the field, and help set TMA policy on issues that are important to you and your patients. Attendance at TexMed is free for TMA members.

See into The Future of Medicine Under the New Health System  with Jeff Goldsmith, PhD, at the General Session. Dr. Goldsmith is president of Health Futures and one of the nation's foremost health industry analysts, specializing in corporate strategy, trend analysis, health policy, and emerging technologies. He has worked across the health system advising senior management and boards including hospitals, health plans, physician groups, pharmaceutical companies, and biotechnology and health manufacturing companies, as well as in distribution sectors.

Some of the key points he will cover in his General Session presentation include:

  • An update on what's happening in Washington.  
  • Market consolidation ― what's happening? 
  • What can we expect in the next five to 10 years?  
  • The importance of health information technology.  
  • Manpower issues – providing care for newly insured and aging boomers.  
  • Hospital-physician relationship and how it has changed.
  • Performance-based payment models and new Centers for Medicare & Medicaid Services incentives.
  • Can the small practice survive? What role can TMA/organized medicine play?   

While at TexMed 2011, you also can:

  • Spend some quality time with colleagues and friends at the Networking Luncheon in the Expo Hall. After lunch, stroll through the Expo Hall and preview the latest technology, products, and services for your practice. Boxed lunch tickets are $15. Sponsored by Blue Cross and Blue Shield of Texas.  
  • Check out the breakout session on accountable care organizations; the Public Health CME track on new incentives and tools that allow physicians to track and benchmark preventive services; and the Quality track, which will help physicians meet the demands of public and private payers as they push forward value-based purchasing programs that offer rewards for efficiency and quality outcomes.  
  • Join us at a new event – a reception honoring 2011-12 TMA President C. Bruce Malone, MD, Austin, and TMAA President Bridget McKeever, Corpus Christi. Sponsored by the Texas Medical Association Insurance Trust.  
  • Portrait Studio: Smile for the Camera! Visit booth #431 at the Expo Hall during TexMed 2011 to have your professional portrait taken by RCL Portrait Design. These photos will be used for the TMA online directory, the new TMA Mobile App, and public relations. View your proofs on the spot through an instant video system, and choose your favorite photo to have in your TMA file. Additional photos are available for purchase, but there is no pressure to buy. This is a free service. Call (800) 951-8712 for an appointment before you arrive at TexMed.   
  • Enjoy fine wine at the Texas Oenological Society annual wine dinner at 7 pm, Thursday, May 12, at Charivari Specialty Restaurant, 2521 Bagby. Tickets are $125. You may register online on the TexMed website.  
  • Eat, drink, and be merry at the TMA Foundation's 18th annual gala, Picture of Good Health. This annual fundraiser is a chance to have fun with friends while supporting TMA's health improvement programs.  

Register for the conference and make your housing reservations online, or contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail.  

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.

A practice management tip from
TMA Practice Consulting


TMF Seeks Diabetes Program Partners

You can help improve the health outcomes of Hispanics and Native Americans with diabetes by participating in a new TMF Health Quality Institute project. The Salud por Vida/Health for Life initiative seeks physicians to eliminate health disparities and increase opportunities for diabetes self-management education for these patients.

Among the resources you will receive for free by participating in the program are:

  • Educational materials and program resources;  
  • Training in diabetes curriculum;  
  • Medicare billing and reimbursement training;  
  • Help with data collection and analysis;  
  • Workflow evaluation and recommendations;  
  • Quality improvement consultation;  
  • Enhanced care management with evidence-based guidelines; and  
  • Continuing medical education.  
 E-mail or call (800) 725-2663 for more information.   


This Month in Texas Medicine

The April issue of Texas Medicine details TMA's efforts to protect patients by keeping chiropractors from performing procedures they're not adequately trained to do and reports on other health professionals' attempts to practice medicine without a license, explains why TMA backs public health legislation that would save lives and save money, and reports on how physicians can use quality as a revenue stream. You'll also learn about attempts to create a statewide health insurance exchange.


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.


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

Billing and Compliance
4/12     San Antonio
4/14     Austin
4/26     Houston
4/28     McAllen
5/4       Dallas
5/5       Fort Worth

Recorded Web Seminars

Avoiding RAC Audits
Communication Skills: Why Bother?
Evaluating Your Medicare Options
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
4/2       Tyler
4/16      Galveston
9/10      Amarillo
10/20    El Paso

About Action

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