Action: June 1, 2011

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

INSIDE: Remember Eight, at Eight, on the Eighth

Remember Eight, at Eight, on the Eighth
TMA for Medicare Private Contracting Bill
TMA Explains Medicare/Medicaid Coding
TMB to Resume Death Registration Fines
CMS Proposes New E-Prescribing Exemptions
You've Got a Friend in Payment Advocacy
You Can Lead the House of Medicine  

TMA Seminars Explain ACOs
Reward An Obesity Fighter
Charles Ott New TMLT Chief
TMA Wins Platinum
This Month in Texas Medicine
Do You Twitter? Follow TMA

Remember Eight, at Eight, on the Eighth

Want to learn how the 2011 legislative session affects you and your patients? Then remember these three numbers: 8, 8, and 8. On June 8 at 8 pm, you can learn what actions legislators took on medicine's top eight issues.

TMA President C. Bruce Malone, MD, will call you at your home telephone number and invite you to stay on the line for TMA's Tele-2011 Legislative Victory Update. For the next 45 minutes, Dr. Malone and TMA's lobby team will discuss these eight issues:  

  1. 2012-13 state budget;
  2. Employment protections;
  3. Texas Medical Board reform;
  4. Scope of practice expansions;
  5. Health system reform;
  6. Workforce;
  7. Public health; and
  8. Health insurance reform. 

You may ask questions after each topic and use your phone to participate in a survey. And, the best part, you will earn 1 AMA PRA Category 1 Credit™ for your time (providing you stay on the line for the entire program).

If you prefer that we call you on your cell or office telephone, please contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail  by Friday, June 3, and let us know. We hope to talk to you on June 8.

You also can learn more about the 2011 legislative session on TMA's website.

 TMA for Medicare Private Contracting Bill

TMA joined the American Medical Association, 42 state medical associations, and 33 national specialty societies in asking House Speaker John Boehner to support and cosponsor the "Medicare Patient Empowerment Act" [PDF] (HR 1700) by U.S. Rep. Tom Price, MD (R-Ga.).

Texas Reps. Michael Burgess, MD, Pete Sessions, and Sam Johnson are cosponsors. Sen. Lisa Murkowski (R-Ark.) introduced a similar bill (S 1042) in the Senate.

"This legislation will help to preserve the patient-physician relationship by allowing seniors to continue to use their Medicare benefit, even with physicians who do not accept Medicare patients," the groups said in a letter to the speaker.

The letter says poor reimbursement and growing administrative burdens are forcing many physicians to leave the Medicare program or limit the number of patients they see.

"Unfortunately, for most Medicare beneficiaries, this also means the end of a relationship with a physician whom they have come to trust," the physicians wrote Speaker Boehner. "Currently, seniors who wish to see a doctor who does not accept Medicare must pay for all services by that physician out of their own pocket. The physician may not seek reimbursement from Medicare for the care provided, nor will Medicare reimburse the beneficiary. This despite the fact that seniors have paid into the program in the form of payroll taxes throughout their working lives.”

Passage of the Medicare Patient Empowerment Act, they wrote, "means Medicare would continue to pay the amount it typically covers today, with the patient paying the doctor directly for the difference between what Medicare pays and what the doctor charges. It would also enable physicians to help patients in financial need by permitting them to charge a lower amount than Medicare currently allows, something they are legally forbidden from doing today."

Allowing patients and physicians to independently and voluntarily contract for care "puts control back into their hands and preserves the relationship with their physician," they concluded.

The AMA will host a webinar explaining the details of the bill at 6 pm June 8. Hosted by AMA President Cecil B. Wilson, MD, the webinar will outline the major provisions of the bill, review the history of federal and state policy on Medicare fee limits, and discuss steps that physicians can take to build support for the bill. It is free for AMA members and $39 for nonmembers.


TMA Explains Medicare/Medicaid Coding

TMA's Payment Advocacy staff have prepared a free presentation to refresh physicians' understanding of how the Medicare National Correct Coding Edits (NCCI) process works. It explains the importance of billing according to the NCCI edits, includes tips for ensuring that your practice stays current with NCCI changes, outlines the differences among the Medicare, Medicaid, and commercial edits, and provides other helpful billing tips.

The Centers for Medicare & Medicaid Services requires all Medicare claims to be processed against the NCCI to promote accurate coding. The health system reform law required Medicaid to implement the NCCI edits, as well. Texas Medicaid did so last fall. All Medicaid claims submitted on or after Oct. 1, 2010, are subject to NCCI edits.

The edits tell you when two procedures can be reported together and when they cannot. For example, cutting through lesions during surgery is part of the surgery and not a separate payable service.  


TMB to Resume Death Registration Fines

On June 1, the Texas Medical Board (TMB) will resume disciplining physicians who do not use the Texas Electronic Registrar (TER) Death Registration system to register patient deaths, TMB Executive Director Mari Robinson, JD, told the TMA Patient-Physician Advocacy Committee at TexMed 2011. The fine is $500.

Last November, TMB refunded money to more than 100 physicians who had already been fined and suspended pending cases because of physicians' complaints about the registration system. TMB said the delay in disciplining physicians would last until the 2011 session of the Texas Legislature ends this month.

If you haven't registered and aren't using the system, now is a good time to do so. Here's what TMB said in the January TMB Bulletin: "It's important to note that electronic death certification is here to stay. The health department adopted this system because it is faster for all parties involved, and it's less susceptible to fraud than paper."  





CMS Proposes New E-Prescribing Exemptions

The Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the 2011 e-prescribing program [PDF] by adding exemptions for the 2012 penalty. Texas physicians still have until June 30 to e-prescribe to avoid penalties in 2012 (1 percent of Medicare Part B claims). If you have not started, you should.

Physicians must report e-prescribing via claims using G-code G8553 on at least 10 unique Medicare encounters by June 30 to prevent the penalty. Report at least 25 times by Dec. 31 to qualify for a 1-percent bonus of Medicare Part B claims and prevent the penalty in 2013. Follow the instructions in TMA's 2011 E-Prescribing informational paper [PDF], or email or call the TMA HIT helpline for more information at (800) 880-5720.

Physicians will have an opportunity to attest through an online web portal (CMS has not yet created the URL) by Oct. 1 that they should be eligible for one of the following exemptions to avoid the 2012 e-prescribing penalty:    

  • Physician is registered to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program and has adopted certified EHR technology.   
  • Physician is unable to electronically prescribe due to local, state, or federal law or regulation (e.g., he or she prescribes controlled substances).   
  • Physician infrequently prescribes (e.g., he or she prescribes fewer than 10 prescriptions between Jan. 1, 2011, and June 30, 2011).   
  •  There are insufficient opportunities to report the e-prescribing measure due to program limitations.    

Existing program exemptions can be reported now using a G-code on Medicare claims, including:

  • G8642: Physician's practice is in a rural area without high-speed Iinternet access; and  
  • G8643: Physician's practice is in an area without sufficient available pharmacies for electronic prescribing.  

These changes are largely a result of the concerns expressed by physicians across the country. TMA urged CMS to revise the current e-prescribing penalties. TMA will comment on the proposed rule urging CMS to adopt the additional exemptions.  

Looking for on-site help with e-prescribing? If you are a primary care physician, you may qualify for assistance through a federal grant for technical consulting services for only $300. Specialists interested in receiving services should contact their regional extension center (REC) for pricing information. The Texas RECs provide consulting help with programs like e-prescribing, selecting and implementing EHRs, and reaching meaningful use to earn federal EHR incentives up to $44,000-$63,750 under Medicare and Medicaid. Visit the TMA REC Resource Center for more information.

You've Got a Friend in Payment Advocacy

The TMA Payment Advocacy Department now has a direct link on Facebook.

The experts in Payment Advocacy can help you make sure insurance carriers pay you what you are owed.

You Can Lead the House of Medicine

Who will lead medicine into the future? Will it be you?

If you are 40 or younger or in the first eight years of practice, the Texas Medical Association Leadership College (TMALC) can put you on the path to becoming a leader in TMA and organized medicine. The leadership college now is accepting applications for the TMALC Class of 2012. There is no tuition. This is a free TMA member benefit. June 15 is the deadline to apply.

Now more than ever, TMA needs young new leaders to continue our vision to "Improve the Health of All Texans." Now in its second year, TMALC is an intensive leadership program designed to identify, orient, and train young TMA members for future leadership positions at the county and state levels. Its mission is to ensure strong and sustainable leadership and to promote the role of physicians as trusted leaders in their local communities.

The 2012 class will be limited to 20 to 30 physicians. The program combines the elements of organizational education, skills training, mentoring, and guided experiences that cover the three "Ps" of leadership: philosophy, principles, and practice. 

Class of 2010-11 scholars already are putting their training to work. The majority of class members have been placed in TMA leadership positions, and all have been placed in positions with their county society and/or Texas specialty society.

To learn more about TMALC and the application process for 2011-12, visit the TMA website  or request an emailed application by contacting the TMA Knowledge Center by telephone at (800) 880-7955 or (512) 370-1550 or by e-mail.  The new class starts in Austin, Oct. 20-23, and concludes at TexMed in Dallas, May 18-19, 2012.  




TMA Seminars Explain ACOs

If you are thinking about joining an accountable care organization (ACO) or if you don't know what an ACO is, TMA has the answers you need in a series of seminars across Texas this summer. The series, What Health Reform & "Accountable" Care Mean to Physicians, will address whether ACOs are an opportunity or challenge, understanding and negotiating employment contracts, new payment models, and health information technology.

Loosely defined, an ACO is a collaboration of health care providers who accept responsibility for the costs, quality, and effectiveness of care delivered to a defined patient population. The Centers for Medicare & Medicaid Services will launch the ACO model as a voluntary program no later than January 2012. And although ACO regulations have not been finalized, many hospitals and physicians are rushing to form collaborations – worried they'll be locked out of the market as ACOs expand beyond Medicare. TMA will conduct a free webinar update when the rules are finalized.

You may earn 3 hours of continuing medical education credit by attending one of the seminars. Physicians who are insured with the Texas Medical Liability Trust and complete this course will earn a 3-percent discount (not to exceed $1,000), which will be applied to their next eligible policy period.  

TMA does not endorse participation in an ACO or any other postreform program. Physicians are encouraged to be wary, to be informed, and to take the time to learn about these systems, understand their differences, and what they can mean to their practice and their patients.


Reward An Obesity Fighter

Do you know of a colleague or group in your community that is making a difference in reducing obesity? If so, nominate that person or group for the 2011 Texas Health Champion Award. The award honors an individual or organization demonstrating an innovative approach to raising awareness about obesity.

Nomination forms, along with more information about the award, are available online. Nominations are due July 1.

The Texas Health Champion Award Ceremony will be part of the Texas Obesity Awareness Week Lecture in Austin on Sept. 13. It is hosted, in part, by TMA.

For more information, email Emily Babcock at TMA.


Charles Ott New TMLT Chief

The Texas Medical Liability Trust (TMLT) named Charles R. (Chip) Ott, Jr., as president and chief executive officer (CEO), replacing Bob Fields, who is retiring in July after 25 years with TMLT.  

TMLT Chair Robert I. Parks, Jr., MD, said the trust "is very fortunate to have secured Mr. Chip Ott for its next CEO. Mr. Ott's knowledge of the medmal industry and reputation should serve our company well. We are extremely happy to welcome him into our family."

Most recently, Mr. Ott was executive vice president at the Minneapolis, Minn., office of Guy Carpenter and Company, LLC, a global reinsurance broker. His responsibilities included developing and executing strategic plans for high-profile clients and prospects, as well as both retention and new business generation.

TMLT is a physician-owned health care liability claim trust offering medical professional liability insurance products and risk management education services to Texas physicians. Created in 1979 by TMA, TMLT currently protects more than 15,000 physicians in all specialties practicing in all areas of Texas.  

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.

A practice management tip from
TMA Practice Consulting


TMA Wins Platinum

TMA's Communications Division received three Hermes Creative Awards from the Association of Marketing and Communication Professionals. The Hermes Creative Awards program is an international competition for creative professionals involved in the concept, writing, and design of traditional and emerging media. 

In the Community Relations category, our Stop the Medicare Meltdown campaign received a Platinum award, cited as "among the most outstanding entries in this competition."

TMA's Health Reform School received a Gold award, and  received an Honorable Mention certificate in the website overall category.


This Month in Texas Medicine

The June issue of Texas Medicine helps young physicians choose between their own practice and working for someone else. It also details efforts in Congress to pass Texas-style tort reform, reports on a TMA program that helps physicians get paid, and explains how hiring a billing company can improve collections. You'll also learn about a new way of teaching at The University of Texas Medical Branch and read about how to talk to teenagers about sensitive subjects.  


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

Medical Records & Documentation in a Post-Reform World
6/16      Austin
6/23      Fort Worth 
7/19      McAllen
7/20      Houston
8/3        San Antonio  

Special Group and Hospital Programs
7/12      McKinney
7/13      Abilene
7/27        Lufkin
8/4       Amarillo   

What Health Reform & "Accountable" Care Mean to Physicians
6/7      Austin
6/8      Lubbock
6/21    Abilene
6/22    Amarillo
6/28    Fort Worth
6/29    Dallas
6/30    Houston
7/12    San Antonio
7/13    McAllen

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

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