Action: Aug. 15, 2012

TMA Action Aug. 15, 2012                                 News and Insights from Texas Medical Association          

INSIDE: CMS Audits Meaningful Use

DPS Tracks Drug Shoppers
TMA Helps You Avoid Fraud
Attention ZIP Code 78648
Get Ready for Novitas
Goal: 50,000 Members!
Medicaid OIG Seeks Medical Director
Concussion Education Resources
TMLT Lowers Rates Again 
CPRIT Showcases Cancer News
CMS Audits Meaningful Use
Fall Conference Fights the Flu
MD Consult Educates Patients
New Member Discounts Available
Tell Us About Medicaid HMOs
This Month in Texas Medicine               

DPS Tracks Drug Shoppers

Physicians can check patients' controlled substance prescription history through the Texas Department of Public Safety's (DPS') new secure online Prescription Access in Texas (PAT) database. The program – designed to reduce patients' prescription drug abuse – allows physicians and police to go online to see what controlled substances a patient has been prescribed in the past year.

DPS began testing PAT last August and, after pronouncing it successful, has made it available to physicians, law enforcement, midlevel practitioners, and medical board and nursing board investigators. The database includes Schedule II-Schedule V drugs for the last 12 months only. Pharmacists must report prescription data within seven days of filling a prescription.  

"It is essential that doctors and pharmacists have quick access to the information they need to identify potential prescription drug abusers and traffickers before they fraudulently receive the drugs," said DPS Director Steven McCraw. "Law enforcement access to this information is also crucial to investigating those individuals or organizations engaged in the trafficking of prescription drugs. This new tool will allow a proactive approach to prevention, assist with criminal investigations, provide historical reporting, and identify trends."

The legislature created the original prescription drug monitoring program, now called the Texas Prescription Program, in 1982. Since then, authorized users have had to access this information through a paper process.

Texas law restricts access to prescription data to physicians, dentists, veterinarians, podiatrists, advanced practice nurses or physician assistants, and pharmacists inquiring about their patients and to various regulatory and law enforcement personnel conducting investigations.


TMA Helps You Avoid Fraud

Fraud and abuse convictions – even allegations – can drastically affect your bottom line and jeopardize your practice. TMA's new two-hour evening seminar, "What Every Physician Needs to Know About Fraud & Abuse," will help you understand what constitutes fraud and abuse and how you can avoid such claims in your practice.

You’ll learn: 

  • The laws, penalties, and ethical issues associated with health care fraud and abuse;
  • Steps your practice can take to avoid fraud and abuse claims;
  • How to avoid an audit and how to prepare in case it happens; and
  • How to develop a solid compliance plan.

Led by respected attorney Donna Clark, the seminar will help make sure your practice isn't the next statistic in the government's crackdown on health care fraud and abuse.

The seminar schedule is: 

9/5     San Antonio
9/6     Austin
9/12     Houston
9/13     Fort Worth
9/19     Sugar Land
9/20     Dallas
9/27     Houston
10/4     McAllen

For more information, visit the TMA website or call (800) 880-7955. 


Attention ZIP Code 78648

TrailBlazer Health Enterprises may be asking you to repay a health professional shortage area (HPSA) bonus you received this year.

That's because the Centers for Medicare & Medicaid Services found an error in its HPSA 2012 files  that affects ZIP code 78648 (Luling and surrounding areas in Caldwell County). Medicare no long considers ZIP code 78648 a primary care HPSA for dates of service on or after Jan. 1, 2012, but it remains a mental health HPSA.   

Physicians who treat Medicare patients in ZIP code 78648 may have received a HPSA bonus in error. TrailBlazer will contact physicians about recoupment of any incorrectly paid HPSA bonuses, via the Part B overpayment demand letter process.

The HPSA is based on the ZIP code where the services are provided, not where the patient lives.



Get Ready for Novitas

TMA is helping you prepare for the transition from TrailBlazer Health Enterprises to Novitas Solutions for handling Medicare claims this fall. 

The association has established the Novitas Resource Center on the TMA website. The resource center tells you three things you need to do now, provides a link to the Novitas transition website, gives you a heads-up on training events such as a tele-town hall meeting set for Oct. 25 and an upcoming webinar in mid-October, and lists the toll-free telephone number Novitas set up to answer your questions. That number is (855) 252-8782.

Texas physicians will switch to Novitas Nov. 19. Hospitals and skilled nursing facilities will switch Oct. 29. Novitas will also handle Medicare claims in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, and Oklahoma.      


TMLT Nest Egg Ad


Goal: 50,000 Members!

TMA President Michael E. Speer, MD, has set a goal of increasing TMA membership to 50,000 in the coming year. And he is pounding the pavement to meet it.

Dr. Speer is prepared to go anywhere in the state and speak to any Texas physician group, no matter how large or small, about the incredible value of TMA membership.

He asks of all nonmember physicians: Join TMA to represent your patients. Join us to present a unified voice in Austin and Washington, D.C. Help make sure physicians remain the trusted leaders of the health care team. 

But Texas is a big state, and he needs your help to reach all Texas physicians. So Dr. Speer is asking of you, each TMA member physician: Please get at least one physician colleague to join TMA.

Won't you join Dr. Speer in this effort? For help in recruiting a member, visit the TMA website for membership benefits and FAQs, the online application, and more.


Medicaid OIG Seeks Medical Director

The Texas Health and Human Services Commission's Office of Inspector General (OIG) is accepting applications for the position of medical director.

The job description says the medical director will perform "highly advanced consultative physician work. Duties include: conducts medical records review to determine medical necessity, correct billing and coding, and compliance with Texas Medicaid policy; provides expert testimony at hearings as needed…"

Applicants must be licensed in Texas, board-certified in family medicine or pediatrics, and have practiced for at least 10 years.  


Concussion Education Resources

As young athletes prepare for the start of the fall sports season, Texas physicians also can prepare by learning about continuing medical education programs available on concussions among student athletes.

Physicians play a critical role in diagnosing and treating concussions, the brain injuries that are attracting increasing attention from the sports, media, and research communities. Physicians also are playing a more prominent role in their local school districts and communities when it comes to managing concussions. House Bill 2038, passed during the 2011 legislative session, requires school districts to establish concussion management teams that include a physician.

TMA members wishing to learn more about concussions, including diagnosis and treatment, may consider the following resources aimed at physicians:

  • The Texas Orthopaedic Association (TOA) has a 2.5-hour webinar, "Sports Related Concussion & Mild TBI: Developments in Treatment & Management." The online course includes information on identifying suspected concussions, pre- and post-injury assessments, and managing concussions. Participants can earn 2.5 AMA PRA Category 1 CreditsTM. TMA members can register at the Orthopaedic CME Online site and receive a discounted one-year subscription to the TOA's online CME course catalog.
  • The Texas Pediatric Society 2012 Annual Meeting will feature a 1-hour course, "HB 2038 — Concussions and the Impact of the New Texas Law on Pediatricians," Sept. 15, at 10 am, in Plano. Shane Miller, MD, will describe the signs and symptoms of a concussion, discuss initial evaluation and management of sports-related concussion, and explain the new legislation and its impact on Texas pediatricians. Participants can earn 1 AMA PRA Category 1 Credit.TM 
  • The Centers for Disease Control and Prevention provides various resources, including a Heads Up: Brain Injury in Your Practice toolkit with clinical information and an online course, "Heads Up To Clinicians, Addressing Concussion in Sports Among Kids and Teens." 


TMLT Lowers Rates Again

The Texas Medical Liability Trust (TMLT) is reducing liability premiums an average of 4 percent for policyholders who renew in 2013. It is TMLT's 10th rate cut since 2004, following passage of the liability reforms TMA pushed through the legislature in 2003.

This comes off the July 20th announcement of a 15-percent policyholder dividend. The dividend and rate reduction will result in out-of-pocket savings of more than $25 million for TMLT physicians in 2013, TMLT said. The combined effect of rate cuts and dividends will result in an approximate 52-percent decrease from 2003 rates. TMLT says this is unprecedented in the history of TMLT and the Texas liability insurance marketplace.

"The rate cut and dividend will save our policyholders more than $25 million in 2013, which greatly exceeds anything done by our competitors in Texas. A number of carriers have entered the state in recent years, but only TMLT is 100 percent dedicated to the Texas marketplace," said TMLT President and Chief Executive Officer Charles R. Ott Jr.

Texas physicians interested in applying for TMLT coverage can email or call the sales department at (800) 580-8658, ext. 8603. Current policyholders will receive detailed information about their rates before their policy renews.

TMLT is the largest medical liability insurance provider in Texas. It serves more than 15,500 TMA members. TMA created and endorses TMLT. 




CPRIT Showcases Cancer News

The Cancer Prevention and Research Institute of Texas (CPRIT) will showcase many of its achievements, as well as provide insights into the latest initiatives and interventions in the fight against cancer, at its Innovations in Cancer Prevention and Research Conference, Oct. 24-26 in Austin.

CPRIT has awarded more than $650 million in grants for cancer prevention, research, and commercialization to institutions, companies, and community organizations across the state since Texas voters passed a constitutional amendment creating the institute in 2007.


CMS Audits Meaningful Use

The Centers for Medicare & Medicaid Services (CMS) is auditing physicians and other health care professionals who receive meaningful use incentive payments. CMS is required to audit those attesting to meaningful use, but until this point, the agency has only posted general information  about the audits.

CMS says anyone who receives the incentives could be audited and that recipients should retain all supporting documentation, whether it is paper or electronic, for six years.   

The Garden City, N.Y., accounting firm Figliozzi & Co. is conducting the audits for CMS. The firm is sending letters asking for documentation supporting the meaningful use attestation.

Figiliozzi seeks four types of data:

  • Documentation from the Office of the National Coordinator for Health IT showing use of a certified electronic health record (EHR) system for meaningful use attestation;
  • Information about the method used to report emergency department admissions (for hospitals);
  • Documentation that the attestation for the core set of meaningful use criteria was completed; and
  • Documentation that the required number of menu set meaningful use objectives was completed.

Physicians and others selected for the audits have two weeks to submit their documentation. The audits are not expected to involve site visits, CMS says. 

The Texas regional extension centers (RECs) were established with federal grants to help physicians with EHR adoption and the meaningful use incentive program. The grants provide subsidies to primary care physicians. Specialists are also eligible for REC services, but the services are not subsidized.  

For questions about the incentive program and other health information technology needs, contact TMA's Department of Health Information Technology at (800) 880-5720 or by email.


Fall Conference Fights the Flu

TMA's 2012 Fall Conference, Oct. 19-20, will give you the latest information on issues that affect your practice and will help you, your family, and staff avoid the flu this year.

The conference will feature a flu shot clinic in the Grand Ballroom Foyer of the AT&T Center from 7:30 to 8:45 am on Oct. 20. The shots are $25. The nasal-spray vaccine is $40. Register for the conference and a flu vaccine though the TMA registration page.   

Registration opens Aug. 10. Book your hotel room through the conference website by Sept. 27 to get the special TMA room rate.


MD Consult Educates Patients

MD Consult can make patient education easy! In addition to clinical textbooks and journals, MD Consult has more than 15,000 patient education handouts that you can print and distribute to your patients. Most are written at a grade 6-8 reading level, and Spanish versions are available for 75 percent of the topics. These handouts are easily customizable, allowing you to include care instructions and contact information.

MD Consult, a free benefit of TMA membership, can be accessed on the TMA website. For more information, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email.




What Can Practice Production Numbers Tell You?

 Consider these factors if your production isn't consistent.

 A practice management tip from
 TMA Practice Consulting 





New Member Discounts Available

Your membership in TMA earns you discounts on many products and services.

InGauge Healthcare Solutions offers health care-related publications and software products for your medical practice and medical education needs. Visit and use key code TMA136 in the shopping cart to receive your TMA-member group discount, or find more information on the program on the InGauge website.  

TMA members are also eligible to receive 15 percent off tamper-resistant prescription pads and forms from Rx Security. You can use the pads for Schedule III, IV, and V controlled substances as well as noncontrolled substances. Special pricing is available for high-volume purchasers. Order online or call (800) 667-9723.  

Visit TMA's Group Discount Programs page on the TMA website for more great deals.    


Tell Us About Medicaid HMOs

This month, TMA wants to know more about your experience with Medicaid HMOs. Do you treat Medicaid HMO patients? If so, look for a new survey in your email on Friday, Aug. 17.

Each month, a TMA staff member randomly draws the names of five physicians who responded to the survey to receive $50 continuing medical education gift certificates. Physicians who respond to every survey this year will have a chance at one of five Apple iPads. 

If you have not received a survey, please check your junk mail and add to your address book. If you need a survey, contact Jessica Davis. Surveys will be open until the end of the year. Preliminary results are available on the TMA website at TMA Survey Results.


This Month in Texas Medicine

The August issue of Texas Medicine tells you why physicians and many state licensing boards are worried about the Federal Trade Commission's decision to involve itself in scope-of-practice issues, explains the new state law requiring health care workers to be vaccinated, and gives you valuable practice management advice on how to avoid legal trouble in human resources issues. You'll also learn why TMA backs hospitals in their claims against Aetna and find out about new residency accreditation standards. The issue also contains the second chapter of Healthy Vision 2020, TMA's prescription for a healthy Texas.

Check out our digital edition.

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.

This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to  Blogged Arteries.  

 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. The seminars listed below are among the CME opportunities found in the TMA Education Center.

Practice Management, Ext. 1421

Recorded Web Seminars  

Avoiding RAC Audits 
Avoiding the Courthouse: 10 Practice Pitfalls 
10 Ways to Turn Satisfied Patients Into Loyal Patients 
Write, Click, or Paste ... The Changing World of Documentation      

Physician Health and Rehabilitation, Ext. 1342

Healing the Healer 
9/14-15 Fort Worth   

Healthy Physicians: Healthy Patients 
9/8    Austin 
9/29  Dallas  

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