Action: Nov. 2, 2012

TMA Action Nov. 2, 2012  
News and Insights from Texas Medical Association


INSIDE: Novitas to Take Over Medicare Claims  

Novitas to Process Medicare Claims
TMA Membership Exceeds 46,000!
E-Rx Hardship Deadline Extended
HIT Webinar on Nov. 5
EHR Surveys Available to All Physicians
Women's Health Program Gag Rule Defeated
Organized Medicine Seeks Medicare Reform

Patients Like Their Doctors
TEXPAC Works for Medicine's Candidates
Ranking Letters Coming From United
CME the Easy Way
Tell Us Your Problems
This Month in Texas Medicine

Novitas to Process Medicare Claims

Novitas Solutions takes over administration of physicians' Medicare claims in Texas and several surrounding states from TrailBlazer Health Enterprises on Nov. 19. It began handling Medicare claims for hospitals and skilled nursing facilities on Oct. 29.  

TMA established the Novitas Resource Center on the TMA website. It tells you what you need to do right now, provides a link to the Novitas transition website, and lists the toll-free telephone number Novitas has set up to answer your questions. The number is (855) 252-8782.   


Many physicians across the state are uncertain about Medicare, its future requirements, maintaining compliance and profitability, and the claim administrator transition to Novitas. It's not too late to get informed and prepare your practice for what lies ahead.  

TMA's Medicare 2013 seminar offers the best opportunity for physicians to get in-depth and specific details on all things Medicare, including the Novitas transition, "incident to" billing, recovery audits, fraud and abuse, and other key topics. Beyond covering Medicare's upcoming core issues, the seminar also plans a virtual walkthrough of Novitas' website and processes to show exactly where to find local coverage determination policies, contact information, payment practices, and anything else physicians may need to reference.

To reserve a spot for yourself or a staff member, visit the TMA Education Center.

TMA Membership Exceeds 46,000!

Thank you so much! TMA membership recently passed the milestone of 46,000, and the year isn't over yet. We are projecting ending 2012 with about 46,500 members – on our way to 50,000, the goal of TMA President Michael E. Speer, MD. That means TMA remains the largest (and the best) state medical association in the country. The more members we represent, the stronger our collective voice, and the more we can accomplish for every Texas physician and the patients you serve.

The next legislative session is right around the corner. 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.

Renew your membership today or recruit a new member.

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


E-Rx Hardship Deadline Extended

If you missed the opportunity earlier this year to claim an e-prescribing exemption to prevent a 1.5-percent penalty in 2013 on all Medicare allowable charges, you now have a second chance. The Centers for Medicare & Medicaid Services (CMS) announced it would accept new hardship exemption requests for three months so you can claim one of the four hardship exemptions.

Those exemptions are: 

  1. You cannot electronically prescribe due to local, state, or federal law or regulation (e.g., you prescribe controlled substances).
  2. You infrequently prescribe (e.g., fewer than 100 prescriptions between Jan. 1 and June 30).
  3. Your practice is in a rural area without high-speed Internet access.
  4. Your practice is in an area without sufficient available pharmacies for electronic prescribing.  

To claim the exemption, log on to Medicare's Quality Reporting Communication Support webpage to access the exemption form between Nov. 1 and Jan. 31, 2013.

There are two more proposed exemptions currently awaiting final rule in the 2013 Medicare Physician Fee Schedule:

  • Physicians who achieved meaningful use during certain e-prescribing adjustment reporting periods; and  
  • Physicians who demonstrate intent to participate in the Electronic Health Record (EHR) Incentive Program and adoption of certified EHR technology.

TMA will announce if these additional exemptions are available when the information becomes available.  

Remember, you are automatically excluded from the 2013 penalty if:

  • You submitted at least 25 e-prescriptions in 2011 and reported such with G-code G8553.
  • You submitted fewer than 100 denominator-eligible claims to Medicare in 2012; or
  • Less than 10 percent of your allowed charges between Jan. 1, 2012, and June 30, 2012, consist of denominator eligible codes.

There is still time to earn a 1-percent bonus on 2012 Medicare allowable charges by e-prescribing 25 times and reporting G-code G8554 on encounters taking place by Dec. 31, 2012. (See TMA's 2012 e-prescribing informational paper.)  

If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and much more. Visit TMA’s Texas REC Resource Center for more information.

Questions regarding the e-prescribing program may be directed to TMA's Health Information Technology Department by calling (800) 880-5720 or emailing HIT.  

HIT Webinar on Nov. 5

You can participate in a free webinar, Demystifying Meaningful Use: Impact on Health Information Technology and Improving Practice Outcomes, on Nov. 5. Joseph Schneider, MD, chair of TMA's Ad Hoc Committee on Health Information Technology, is one of the presenters.

You will learn about: 

  • How is meaningful use intended to improve patient outcomes?
  • Is it related to evidence-based practice?
  • What are the implications of the new Stage 2 electronic health records (EHRs) incentive programs?
  • What are unintended consequences of EHRs?
  • How can EHRs be optimized to help improve patient safety and quality?
  • How does health care information technology support the emerging role of the accountable care organization?   

Get details, registration, and CME information here.  



EHR Surveys Available to All Physicians

The American Medical Association and AmericanEHR Partners are teaming up to survey physicians using or planning to use an electronic health record (EHR). The survey results will help populate a growing database of EHR system rankings. In addition, the Louisiana State Medical Society (LSMS) is surveying physicians' use of EHRs. 

The feedback from the AMA/AmericanEHR Partners 150-question survey will help all physicians with future EHR purchases as well as help improve the EHR industry overall. The questions use a five-level rating system that looks at various aspects of EHRs. The results are collated to assign a collective rating for each category.  

The site has top 10 lists of various products based on the ratings. Only those systems that have at least 10 survey evaluations are given a collective rating score and are used in the rankings. The database is free and can be queried according to practice size. The survey should take approximately 5 minutes for non-EHR users and 20 minutes for EHR users. The TMA Ad Hoc Committee on Health Information Technology frequently discusses how physicians can benefit from EHR vendor rankings, which only improve with feedback by users. Although the survey home page says it is for AMA members, the AMA says any physician – AMA member or not – can complete it.   


Surveys completed before Nov. 8 will be entered into a drawing for the latest tablet computer or one of five $100 Visa gift cards. However, members may take the survey after that date. Physicians must create an account to participate in the survey, and their professional status will be verified using the AMA's Physician Verification Service.

The new LSMS survey expands on a statewide study the medical society conducted last year. Almost 600 Louisiana physicians responded. LSMS received a Physicians Foundation grant to study EHR nonadoption among physicians nationwide. The report on the national survey will address:  

  • Factors that discriminate between nonadopters and adopters;
  • The presence of specific regional drivers (or inhibitors) of EHR adoption; and
  • The patterns of adopters that lead to meaningful use.

Physicians who take the survey are eligible to win an e-reader.  

Women's Health Program Gag Rule Defeated

TMA Victory Icon

Responding to strong opposition from TMA and state specialty societies, Health and Human Services Commissioner Kyle Janek, MD, pulled the gag clause from rules governing the state's redesigned Women's Health Program.

As proposed by Commissioner Janek's predecessor, the rule would have prohibited a participating physician from discussing abortion with a patient. The new rule still prohibits Women's Health Program funds from going to a physician or provider who promotes or performs abortion, but the definition of "promote" was revised to exclude "neutral, factual information and nondirective counseling."

TMA President Michael Speer, MD, praised the change. "It is very important that patients are able to trust that their doctor is giving the best medical advice for them – based on their medical needs and nothing else," he said.

TMA remains concerned for the program's long-term viability – and for the women it serves – as the state next month tries to run the program on its own without $35 million a year in federal funding.

On Oct. 31, the Texas Tribune reported that the revised Women's Health Program would not launch on Nov. 1, as the state had planned, until the legal battle over including Planned Parenthood in the program is resolved. But the Austin American-Statesman said Gov. Rick Perry announced the state is ready to begin the program without Planned Parenthood when the federal government stops funding for the contraceptive and preventive care program for low-income women.  

After Texas legislators excluded Planned Parenthood and other "abortion affiliates" from participating as providers in the program, the federal government withdrew funding. Planned Parenthood sued the Texas Health and Human Services Commission to remain in the program. The new rules governing the redesigned program include a "poison pill" provision, which would eliminate the program entirely if Planned Parenthood prevails in the lawsuit.  

Organized Medicine Seeks Medicare Reform

TMA joined the American Medical Association and 108 other state and specialty medical societies in urging Congress to not just repeal the flawed Medicare payment formula, but to replace it with a system grounded in a set of core principles essential to creating a "high-performing" Medicare program.

Although it wants the Sustainable Growth Rate (SGR) formula eliminated, "the physician community recognizes that this is only one-half of the equation," the groups say in an Oct. 15 letter to the chairs and ranking members of the Senate Finance and House Ways and Means and Energy and Commerce committees. Successful delivery reform that provides patient choice also is a must, along with new payment models that reflect the expense of providing services, as well as efforts to improve quality and manage costs, they add.

The letter warns that the SGR is an "enormous impediment" to reform efforts such as patient-centered medical homes, accountable care organizations, and shared savings programs The formula does not keep up with the cost of care, and the constant threat of steep cuts and last-minute congressional action creates an environment of uncertainty for physicians, their senior patients, and access to care.

Medicare payments to physicians will be cut 27 percent on Jan. 1 unless Congress intervenes as it has for the last decade to stop SGR-mandated fee reductions.

The letter says physicians want to ensure a "robust transition period that can fill the gap" between eliminating the SGR and implementing a new, nationwide system. That transition plan should include elements that reflect the diversity of physician practices and give physicians the freedom to choose a model that works for their practices and patients, and encourage incremental changes with positive rewards, instead of using penalties to order abrupt changes in care delivery.

Any new system should allow physicians to take a leading role in health care delivery, while offering a way for them to measure, demonstrate, and achieve rewards for progress on quality and costs, the letter said. Among other criteria, physicians also want to see that new federal policy promotes structures that:

  • Reward physicians for reducing costs;
  • Tie incentives to physicians' own actions, not the actions of others or factors beyond their influence;
  • Encourage systems of care, regional collaborative efforts, and primary care and specialist cooperation while preserving patient choice;
  • Allow specialty and state society initiatives to be credited as delivery improvements and recognize the central role of the profession in determining and measuring quality; and
  • Provide exemptions and alternatives for physician practices for which the investments necessary to reform care delivery would constitute a hardship.  

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Patients Like Their Doctors

Americans are very happy with their primary care physicians, according to a new national survey conducted by The Physicians Foundation.

Among those who had visited a family physician or primary care doctor (at least once) in the past year, 79 percent said they were very satisfied” or “extremely satisfied” with the visit(s). When asked why, one typical respondent said, “Because he is an excellent doctor. He knows me and understands my medical needs.” Americans point away from physicians when asked who is to blame for the rising cost of health care.  

Three-quarters said insurance companies and pharmaceutical manufacturers were “very” or “completely responsible,” 62 percent cited the cost of liability insurance, and 59 percent laid the blame on the government.

When asked about the Patient Protection and Affordable Care Act, 39 percent believe it will have a negative impact on health care, 26 percent feel the impact will be positive, and 35 percent express no opinion.

Harris Interactive conducted the survey of 2,236 adults for The Physicians Foundation in late July.  

TEXPAC Works for Medicine's Candidates

Early voting for the Nov. 6 general election ends Nov. 2.

The Texas Medical Association Political Action Committee (TEXPAC), TMA's political arm, 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 is in the November issue of Texas Medicine.  

Ranking Letters Coming From United

In late October, UnitedHealthcare began sending letters to physicians in its network outlining their rankings in the insurer's Premium Designation program for 2013. The specialties involved in the program range from family practice to rheumatology.

Nov. 26 is the deadline to appeal your ranking before United posts it on its website.  

You can find information on physician rankings on the Physician Ranking page of the TMA website. The page includes Basic Steps for Reviewing and Disputing Physician Rankings & Tierings, a two-page guide on how to appeal your ranking.  

United says its physician-ranking program "supports practice improvement and provides physicians with access to information on how their clinical practice compares with national and specialty-specific measures for quality, and with local cost-efficiency benchmarks in the same geography."  

In the 2009 session of the Texas Legislature, TMA won passage of legislation giving physicians the right to dispute their ranking or classification before an insurance company publishes it. In addition, the law says physicians currently in clinical practice must be actively involved in developing standards used in the health benefit plan's comparison program, whose measures and methodology must be transparent and valid.

TMA remains opposed to any institution or company publicly profiling and penalizing individual physicians based on faulty methodology. That's why TMA made sure the 2009 law requires health plans to base individual physician rankings only on bona fide, nationally recognized guidelines.

If you have questions or need help, 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

CME the Easy Way

TMA has taken physician continuing medical education (CME) to the next level through the TMA Education Center. You may now access and complete CME and have your earned credits applied to your transcript instantly, thanks in part to TMA's collaboration with technology partner InReach.  

This state-of-the-art technological framework, combined with an extensive distribution platform, means TMA can offer its vast quantity of high-quality CME programs and materials directly to you on your terms and in your time – no matter where you are.  

The education center currently has more than 50 courses (many offering ethics credits) covering a vast array of topics, from tobacco counseling to practice management and physician leadership to Medicare compliance. You can take advantage of CME presented on-demand via webinars, podcasts, and print course downloads, or choose to order a hard-copy publication or attend a live seminar.   


The TMA Education Center offers convenient, one-stop access to the CME you need. Log in using your TMA website username and password to automatically receive member pricing.  

Tell Us Your Problems

TMA is collaborating with the American Medical Association and several other state and specialty medical societies to address problems physician practices may have with benefit and disease management companies. We need your input to help with our advocacy efforts.

Among the problems with benefit or disease management companies that practices report are trouble contacting them, burdensome preauthorization requirements, and frequent denials.

Please take a few minutes to complete this short survey so we can better advocate on your behalf.

This Month in Texas Medicine

The November issue of Texas Medicine tells you about the impressive list of physicians and TMA Alliance members running for office in the Nov. 6 general election. You'll also learn how proposed changes in the state employee health plan could affect you, how physicians responded to the West Nile virus outbreak, and why the state wants specific information on causes of death. You’ll also learn how the DocbookMD app can enhance the care you give your patients.  

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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