Action: Oct. 15, 2012

TMA Action

Oct. 15, 2012         

HHSC Adopts Disputed Medicaid Fraud Rules
Hello, Novitas? Is That You?
TEXPAC Works for Medicine's Candidates
PPACA Tops Fall Conference Agenda
2013 TMA Dues Statements Coming
Meaningful Use HIPAA Security Analysis
TMA's Physician Surveys
This Month in Texas Medicine

HHSC Adopts Disputed Medicaid Fraud Rules

Despite the Texas Medical Association's objections, the Texas Health and Human Services Commission (HHSC) adopted new "program integrity rules" that TMA believes give the agency's Office of Inspector General (OIG) too much power and presume that physicians are crooks. The rules took effect Oct. 14.

In September, TMA sent HHSC officials a 35-page letter opposing the rules, which make every Medicaid billing error a possible target for fraud-and-abuse prosecution.

"TMA strongly opposes the proposed rules because they expand OIG's authority, minimize the rights of physicians and other providers, and have a tenor that implies a presumption of wrongdoing," John Holcomb, MD, chair of TMA's Select Committee on Medicaid, CHIP and the Uninsured, wrote. Without due process protections and other important changes in the rules as proposed, he wrote, "the pervasive fear among physicians that they will be incorrectly accused of fraud, waste, or abuse, or denied meaningful recourse in a fraud investigation will continue to contribute to the decline in physician participation in Medicaid."  

Dr. Holcomb objected to the proposed rules repealing current language that not all actions resulting in overpayment to a provider are necessarily fraudulent. He asked HHSC to retain that language and reiterate in the new rules that some overpayments are the result of mistakes, not fraud. HHSC responded that the "definitions provided in these rules clearly define the types of violations that may occur, and the rules outline the violations that may or may not include fraud. OIG is aware that various factors can contribute to overpayments and that it may or may not constitute fraud, and does not feel reiteration is necessary."  

TMA opposes health care fraud and supports fair processes designed to prevent and detect actual fraud, said Darren Whitehurst, TMA's vice president of advocacy. He said TMA will evaluate its options for asking the legislature to make sure the state conducts fair fraud and abuse investigations and gives appropriate due process protections to physicians and other health care professionals accused of fraud, waste, or abuse. Additionally, TMA will convene a Physicians Medicaid Congress at its fall conference in Austin to discuss ways to attract more physicians to participate in the program and to alleviate physicians' fears of the OIG.  

The December issue of Texas Medicine will have more information on the rules and how they impact physicians' practices and how TMA can help physicians avoid problems with state and federal OIGs.

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.

TMLT Nest Egg Ad  


TEXPAC Works for Medicine's Candidates

Early voting for the Nov. 6 general election begins Oct. 22 and continues through Nov. 2. Oct. 30 is the last day to apply for a ballot by mail.

The Texas Medical Association Political Action Committee (TEXPAC), TMA's political arm, has endorsed an impressive list of candidates in both parties running for state and federal office. TEXPAC is positioned to help elect an unprecedented eight TMA and TMA Alliance members to the Texas Legislature and U.S. Congress. 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.

Each election cycle, TEXPAC and the medical community distributes up to a million slate cards to help educate voters on the best judicial candidates. Endorsements are based on local physician recommendations, the candidates' judicial philosophy, and their ability to win. We encourage you to order and distribute these slate cards as widely as possible between now and Nov. 6.

More information on medicine's candidates and the efforts to elect them by TEXPAC and the alliance will be published in the November issue of Texas Medicine.  


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 began 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.  

Meaningful Use HIPAA Security Analysis

Physicians participating in the federal electronic health record (EHR) incentive program must comply with meaningful use measures. One of the measures requires physicians to "protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities."

The rule requires physicians to "conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process."  

The Office of the National Coordinator (ONC) oversees compliance with the meaningful use incentive program and offers a tool to help practices comply with the security risk analysis. The tool is an Excel spreadsheet that gives instructions as well as forms that can be filled in by the physician or designated HIPAA officer.

The purpose of a risk assessment is to identify conditions where electronic protected health information (EPHI) could be disclosed without proper authorization, improperly modified, or made unavailable when needed. This information is used to make risk management decisions on the reasonable and appropriate safeguards needed to reduce risk to an acceptable level. This tool provides helpful information, but does not guarantee HIPAA or meaningful use compliance. The practice must ensure that appropriate policies and procedures are always followed and that the requirements of the specific rules are satisfied.

TMA recognizes the complexities of compliance with the federal EHR incentive program and encourages physicians to contact their local regional extension center (REC), which the ONC established to help with program compliance. The RECs can help all physicians, but they may be able to discount services for primary care physicians. Details about the REC program are available on TMA's Regional Extension Center Resource Center.

For more information, call the TMA Health Information Technology Department at (800) 880-5720 or 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 


TMA's Physician Surveys

In July, physicians responding to a TMA survey agreed that "we need a system for providing health care to low-income Texans with realistic payment, less stifling state bureaucracy, and no fraud-and-abuse witch hunts." That's just an example of the responses TMA is receiving in its 2012 survey series.

Physicians who answer each monthly survey are eligible for a drawing for one of five $50 continuing medical education gift certificates.

TMA will email the next survey on Oct. 17. Check your email inbox for a survey invitation. Physicians who wish to respond but have not received an invitation should contact Jessica Davis.


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.  

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