Action: Oct. 1, 2012

TMA Action Oct. 1, 2012  
News and Insights from Texas Medical Association


INSIDE: The Medicare Phone Call You Can't Miss

Hello, Novitas? Is That You?
Novitas Posts E&M Score Sheets
Survey Gauges Physician Dissatisfaction
Make a Difference on Nov. 6
AMA: Stop Medicare RAC Audits
PPACA Tops Fall Conference Agenda
2013 TMA Dues Statements Coming

Benefits of Your TMA Membership
Meaningful Use by Oct. 3 or Lose Money
How to Be on the Feds’ Flu Finder
TMA Honors Science Teachers
Win $5,000 for Your Champion of Health!
Tell Us Your Status
This Month in Texas Medicine


Hello, Novitas? Is That You?

TMA will hold a tele-town hall meeting at 8 pm CDT on Oct. 25 as part of its ongoing efforts to help physicians prepare for the Nov. 19 switch from TrailBlazer Health Enterprises to Novitas Solutions for processing Medicare claims. Novitas representatives will join TMA physician and staff experts to give you a quick overview of what the transition means to you and to field your questions.

TMA will call you at your home phone number. If you would prefer TMA to call you at another number or if you would like to include your office administrator or another staff member, contact the TMA Knowledge Center by phone at (800) 880-7955 or by email.

TMA's Novitas Resource Center tells you what you need to do right now, provides links to the Novitas transition website, gives you a heads-up on training events such as the upcoming webinar in mid-October, and lists the Novitas toll-free phone number established to answer your questions. That number is (855) 252-8782.

While Texas physicians switch to Novitas on 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.

Novitas Posts E&M Score Sheets

Evaluation and management (E&M) procedures for Medicare exams can be quite confusing. But the Nov. 19 administrator transition from TrailBlazer Health Enterprises to Novitas Solutions is an opportunity to hit the ground running with new tools from your new Medicare administrative contractor – provided you familiarize yourself with them beforehand.  

Novitas Solutions made its Evaluation and Management Exam Score Sheets available on their website in several formats to make the switch as simple as possible. Novitas sorted the score sheets by specialty; they are an easy reference for the level of care given and a way to ensure that you've accounted for every service rendered. Remember the old adage "If it isn't documented, it hasn't been done."    


TMA's Medicare 2013 seminar series will cover E&M documentation and billing, as well as many other trends and changes coming to Medicare over the next year.  

Survey Gauges Physician Dissatisfaction

Physicians are working fewer hours, seeing fewer patients, and limiting access to their practices in light of significant changes to the medical practice environment, according to a comprehensive new survey of practicing physicians by The Physicians Foundation.

Among the key findings of one of the largest physician surveys ever undertaken in the United States are:

  • More than 60 percent of physicians would retire today if they had the means.
  • Physicians see 16.6 percent fewer patients per day than they did in 2008, a decline that could lead to millions of fewer patients seen per year.  
  • More than 52 percent limit Medicare patients' access to their practices or plan to do so.  
  • More than 26 percent have closed their practices to Medicaid patients.  
  • Physicians spend more than 22 percent of their time on nonclinical paperwork, resulting in a loss of some 165,000 full-time equivalent (FTE) physicians.   

The survey also found that over the next one to three years, more than 50 percent of physicians will cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access.

Texas physicians' responses to some of the key Physicians Foundation survey questions were generally along the same lines as their colleagues across the country.

Forty-five percent of Texas doctors described their feelings about the current state of the medical profession as somewhat negative, compared with 44.8 percent of physicians nationally. Sixty-seven percent of Texans said they would retire if they could, compared with 61 percent nationally. Thirty percent of Texas physicians plan to place new or additional limits on accepting Medicaid patients, compared with 22.2 percent nationally. The numbers for limiting acceptance of new Medicare patients were similar.

"It is clear that the introduction of nearly 30 million new patients into the U.S. health care system through health care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care," said Walker Ray, MD, vice president of the foundation and chair of its Research Committee. "The rate of private practice physicians leaving the medical field, as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients, is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face."  

The Physicians Foundation Board of Directors will share the survey results with political leaders, policymakers, and the news media nationwide.  

The survey, fielded online from late March to early June 2012 by Irving-based Merritt Hawkins for The Physicians Foundation, is based on responses from 13,575 physicians across the country.

Created by settlement of organized medicine's landmark antiracketeering lawsuit against America's largest for-profit HMOs, The Physicians Foundation is a nonprofit 501(c)(3) organization that seeks to advance the work of practicing physicians and help facilitate health care delivery to patients. The foundation's activities include grantmaking, research, and policy studies. The foundation provides grants to nonprofit organizations, universities, hospital systems, and medical society foundations that support its mission and, since 2005, has awarded numerous multiyear grants totaling more than $28 million.

Louis J. Goodman, PhD, TMA's executive vice president and chief executive officer, is the president of the foundation.  

Make a Difference on Nov. 6

Tuesday, Oct. 9, is the last day to register to vote in the Nov. 6 general election. Make sure you are registered to vote in this important election.

The Texas Medical Association Political Action Committee (TEXPAC), TMA's political arm, is positioned to help elect an unprecedented eight TMA and TMA Alliance members. This would give TMA more elected members than any other state in the country – a true testament to our organization and the public's trust in our message. (More information on medicine's candidates and the efforts by TEXPAC and the alliance will be published in the November issue of Texas Medicine.)   


 In addition to physician and alliance members, TEXPAC played a major role in defeating several anti-medicine incumbents and helping some new candidates win open seat elections.

These important dates lead up to Election Day:  

First day of early voting – Oct. 22
Last day to apply for ballot by mailOct. 30
Last day of early voting – Nov. 2  

TMLT Nest Egg Ad


AMA: Stop Medicare RAC Audits

Government audits of physicians' Medicare evaluation and management (E&M) coding "will undoubtedly lead to erroneous recoupments and lengthy, expensive appeals" for both doctors and the government, the American Medical Association contends in a letter to Centers for Medicare & Medicaid Services (CMS) Acting Administrator Marilyn Tavenner.

The letter urges CMS to rescind its authorization for Recovery Auditor Contractor (RAC) Connolly, Inc. to begin auditing Medicare coding for CPT 99215 – evaluation and management of an established patient – in physician offices in Texas and several other states.   


The AMA letter says "physician choices regarding appropriate code designation can be a subjective matter based on the complexity of the patient visit. Physicians who provide E&M care apply complex decision-making based on myriad clinical approaches, including research and review of patient medical history, analyses regarding appropriate medication, discussion of home situation and prescription distribution plan, preventive care planning, and many other variables.  

"Based on our historical experience with the RACs, and in light of the fact that the RACs are not required to have same-specialty physicians review RAC determinations, we have no confidence that the RACs will be up to the task of understanding these variables or their clinical relevance."  

TMA Payment Advocacy Director Genevieve Davis says TMA is concerned that Connolly will extrapolate its findings based on a statistical sample of claims, which is not always an accurate assessment of a physician's coding and documentation. She says TMA has expressed that and other concerns about the impending audits to both Connolly and the regional CMS staff but neither has responded.  

The AMA letter says allowing Connolly to extrapolate its findings "based on a sample of CPT code 99215 claims is misguided and should be rescinded. Each E&M visit is different based on the unique needs of the patient."  

TMA Payment Advocacy says you have options if Connolly selects you for an audit.

TMA Ready to Help
TMA offers several online courses and publications to help you avoid trouble. They also offer continuing medical education (CME) credit. They include:  


For a complete list of offerings, go to the TMA Education Center. It's a convenient, one-stop access to CME when you need it.

TMA's Coding Hotline can answer your questions. Call (800) 880-1300, ext. 1414.  

TMA Practice Consulting advises you against waiting for a formal third-party or RAC audit. Be proactive. Find out if you or your practice is at risk for an audit. TMA Practice Consulting has certified professional medical auditors and coders on staff to review physicians' documentation to determine if you are following documentation guidelines, correctly coding levels of service, and establishing medical necessity. It also offers these services to help make sure you code correctly and document what you've done:

  • Coding and documentation audits, comprehensive reviews of medical record documentation to identity opportunities for improvement, helping reduce liability and risk of third-party audits;  
  • Coding and documentation training, in-depth instruction on the coding and documentation guidelines and criteria for appropriate charge capture; and  
  • Coding and documentation check-ups, abbreviated reviews of claims coding and medical record documentation to provide a glimpse into a physician's coding techniques.

Call TMA Practice Consulting at (800) 523-8776 for a proposal, or email

CMS also has resources for physicians. They include the Evaluation and Management Services Guide and Documentation Guidelines for Evaluation and Management Services. Physicians should follow these guidelines; auditors use them when reviewing medical records. They're also the guidelines that electronic health record vendors should use when setting up physician templates. Physicians should make sure their vendor does this.  

PPACA Tops Fall Conference Agenda

Health care economist Thomas Miller will discuss the impact of the Supreme Court's ruling on the Patient Protection and Affordable Care Act (PPACA) on physicians and patients at TMA's 2012 Fall Conference, Oct. 19-20, at the AT&T Conference Center in Austin.

Mr. Miller is a former senior health economist for the Joint Economic Committee of Congress and has been at the forefront of health care policy on the national level.  

Also on tap is a panel discussion featuring legislators and candidates for election in November. Invited to participate are:

  • Greg Bonnen, MD, Republican nominee, Texas House District 24;  
  • Rep. Michael Burgess, MD, U.S. House District 26;  
  • Donna Campbell, MD, Republican nominee, Texas Senate District 25;  
  • Sen. Bob Deuell, MD, Texas Senate District 2;  
  • Rep. Susan King, Texas House District 71;  
  • Rep. Charles Schwertner, MD, Republican nominee, Texas Senate District 5;  
  • J.D. Sheffield, DO, Republican nominee, Texas House District 59;  
  • Rep. Mark Shelton, MD, Republican nominee, Texas Senate District 10; and
  • Rep. John Zerwas, MD, Texas House District 28.    

And, the conference's Legislative Training Session can teach you how to be a persuasive and effective communicator in the debate over new state and federal laws that affect you and your patients. Two training sessions will be conducted on Friday: 1:30-3 pm and 3-4:30 pm. Space is limited, so register today.

Finally, 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.

For more information, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email.  

2013 TMA Dues Statements Coming

TMA begins mailing 2013 membership renewal statements on Oct. 1.

We value your membership and participation, and urge you to renew today. The 2013 Texas Legislature is just around the corner. If the last session was any indication, it will be 140 very difficult days for medicine. But don't worry. TMA is hard at work, laying the groundwork for medicine's priorities at the Capitol.  

We heard your concerns – the ones about reduced payments, growing overhead, and the future of your practice. You told us about burdensome regulations, endless paperwork, and the cost of compliance. And most of all, you told us about protecting your clinical autonomy and about your commitment to caring for your patients in spite of the changes and challenges.  

We hear you, and we are committed to finding the solutions. Rest assured, no one will fight harder to restore a sense of control, stop the tide of decisions made by others, make sure you are paid what you're worth, and allow you more time for patient care.

Only with grassroots support … only with your support … can we kill or amend the bad bills and pass the ones that are good for medicine and patients. Renew online today! The TMA Knowledge Center can answer your renewal questions by telephone at (800) 880-7955 or by email.   




Benefits of Your TMA Membership

Your membership in TMA provides you access to great products, services, and discounts. 

TMA endorsed vendors offer convenience, dependability, and savings on practice management products and services that can help you succeed in the ever-changing medical practice environment. And we've done the legwork to ensure their integrity and value. When contacting an endorsed company, be sure to identify yourself as a TMA physician-member to receive exclusive savings and great customer service. Visit the TMA website to learn more.     


TMA's group discount programs allow you to leverage your membership in the largest state medical association in the country in order to receive great deals. Available to TMA members, family, and friends, these programs save you money on products and services you use every day, whether in your practice or in your home. Save on computers, magazine subscriptions, hotel stays, and more. Visit the TMA website to find discount codes and start saving today!  

Meaningful Use by Oct. 3 or Lose Money

Physicians participating in the Medicare Electronic Health Record (EHR) Incentive Program must start their 90 days of meaningful use by Oct. 3 for 2012 participation. Waiting to begin the program in 2013 means $5,000 less because the maximum amount available drops from $44,000 to $39,000.

Avoid delays and problems by registering now for the EHR incentive program, and then attest once you have completed 90 days of meaningful use. Registration and attestation are two separate actions. Some practices that waited until the last minute reported problems with the registration process last year as the system became overloaded. While physicians have until Feb. 28, 2013, to complete the attestation, TMA recommends you complete the attestation as soon as you can once you have completed the 90-day process. This will ensure everything is completed on time and will speed up your payment. Physicians who began the EHR incentive program in 2011 will report on a full calendar year of meaningful use and should also complete the attestation process early in January to prevent problems and delays.

The Texas regional extension centers (RECs) stand ready to help physicians with any aspect of the EHR incentive program – workflow changes, EHR implementation, registration, or attestation. A federal subsidy has significantly reduced the cost of consulting for primary care physicians. Visit TMA's REC Resource Center. For answers to questions about the EHR incentive program, RECs, and other office technologies, call TMA's HIT Helpline at (800) 880-5720 or email

How to Be on the Feds’ Flu Finder

The U.S. Department of Health and Human Services (HHS) created an online tool, the Flu Vaccine Finder, to help patients find where to get a flu shot.  

Earlier this month, TMA and the Texas Pediatric Society, the Texas Academy of Family Physicians, and the American College of Physicians, Texas Chapter, wrote HHS to complain about an obvious problem with the tool. The web app did not acknowledge the medical home as the first place to seek flu shots and appeared to be populated primarily with freestanding and grocery-store pharmacies that provide the influenza vaccine.      


"Your point is well taken, and we are already exploring options to resolve the oversight," an HHS official answered two days later. "The finder will become even more important later this year or early in 2013 when the finder will be expanded beyond flu vaccine(s) to provide information about the availability of nearly a dozen adult vaccines."  

The official also shared with TMA the basic instructions for making sure your practice shows up on the flu finder application:  

  • To upload your office's information, you'll first need to create an account at  
  • You will receive a password via email once your account has been approved, usually within 24 hours.  
  • You can then log in at  
  • Once you're logged in, click on the "Add Provider" tab. If you are adding one or a few locations, scroll down to the Individual Provider Entry Form and fill out the relevant fields. Be sure to press "Submit" at the bottom of the page.  
  • If you need to add multiple locations, use the "Upload a Spreadsheet" tool at the top of the Add Provider tab. Download the spreadsheet template,, fill in the relevant fields, and upload as a .csv file. See the formatting tips on the "Help" tab to ensure you format your spreadsheet correctly.  
 More help can be found under the "Help" tab or by emailing  

TMA Honors Science Teachers

TMA will honor deserving Texas educators again in 2013 with the Ernest and Sarah Butler Awards for Excellence in Science Teaching.

Three Texas science teachers will receive $5,000 each and an expense-paid trip to TexMed 2013 in San Antonio in May. Their schools will receive a $2,000 award to use toward the science curriculum. In addition, second-place winners receive $500 for their schools.  

The annual awards recognize and reward elementary, middle, and high school teachers who share their energy and enthusiasm for science with their students because innovative teaching supports the basic premise of medicine – that health care has a scientific foundation.  

Who's eligible? All Texas state-certified, full-time public and private school science teachers with a minimum of two years' classroom experience who will return to teach during the 2013-14 school year. All areas of science are welcome.  

To nominate science teachers or to apply, visit the TMA website, where you will find more information and the appropriate forms. The deadlines are Oct. 20 for nominations and Dec. 29 for applications. TMA will ask all nominees to complete an application packet.

Questions? Email Gail Schatte at TMA, or call her at (800) 880-1300, ext. 1600, or (512) 370-1600.   

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.  

A practice management tip from
TMA Practice Consulting


Win $5,000 for Your Champion of Health!

Nominate a community outreach program in your neighborhood that promotes healthy lives and healthy communities.  

The 2013 Texas Medical Association Foundation John P. McGovern Champion of Health Award focuses on exceptional projects that address urgent threats to the public's health and those projects that further the foundation's mission: "To help physicians create a healthier future for all Texans."   


Established in 1995, the award recognizes local and statewide programs for their innovative and effective ways of reaching Texans.

Nov. 16 is the entry deadline. Winners will be notified in December and be honored at the TMA Winter Conference Feb. 2 in Austin.  

For more information on this and all of the foundation's activities, click here or call (800) 880-1300, ext. 1664, or (512) 370-1664.  

Tell Us Your Status

We keep hearing that physicians are leaving practice ownership roles for employed positions. However, our March survey shows 44 percent of Texas physicians are in solo practice and an additional 29 percent are group practice owners or partners.  

Are you a group practice owner? Are you employed? Please answer our latest survey so we can learn more about your experience in these types of practice settings.  

Every Texas physician who answers the survey by Nov. 1 will be entered into a drawing for one of five $50 continuing medical education gift certificates. We've awarded 25 certificates to date.   



Check your email inbox for a survey invitation. Physicians who wish to respond but have not received an invitation should contact TMA to be sure we have your email address.  

This Month in Texas Medicine

The October issue of Texas Medicine outlines TMA's efforts to protect patients by stopping nonphysicians' attempts to practice medicine without going to medical school. It also tells you about the impending switch from TrailBlazer to Novitas as the Medicare claims administrator for Texas, what Texas physicians are doing to prevent childhood injuries, and how health information exchanges help improve care.  

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.  

About Action  

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