Tell Congress to Kill the SGR Zombie
We need your help to convince Congress to stop the "zombie Medicare financing" it uses to pay physicians. Every year for the past 12, cuts driven by the defective Sustainable Growth Rate (SGR) formula have come back from the dead … but in even worse shape. The SGR crisis is not dead nor does it lie dormant. It's very much alive.
Year after year of payment uncertainty is forcing doctors out of Medicare, making it more difficult for seniors, Texans with disabilities, and military families to get the care they need. In fact, the number of Texas physicians accepting all new Medicare patients dropped from 78 percent in 2000 to only 58 percent in 2012. This statistic is frightening. The crisis can only get worse as millions of baby boomers become of Medicare age.
Please call Washington today (Tuesday, Dec. 4) at 7 am and every Tuesday thereafter until Congress stops the payment cut and agrees to fix the defective SGR. Join your colleagues to convince Congress to stop this year's 27.5-percent cut. Get commitments from Sens. John Cornyn and Kay Bailey Hutchison and your representative to fix the 12-year-old problem.
For talking points and congressional phone numbers, go to the Medicare Meltdown Action Center.
Update Your Staff's HIPAA Training
A new state law that took effect in September has more stringent regulations for protected health information (PHI) than its federal counterparts, the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. Among other things, it has new requirements for notices to patients regarding electronic disclosure of PHI. And practices that wrongfully disclose a patient's PHI face increased civil penalties.
The law (House Bill 300) also requires employee training on state and federal laws regarding PHI. TMA will soon launch a new webinar series that satisfies these training requirements. Held at noon CST, these programs offer training tailored to each employee's scope of employment (as required by HB 300).The webinar dates and subjects are:
- Dec. 11: Complying With HIPAA & Texas Privacy Laws – a must for compliance officers and a good overview for the entire staff;
- Dec. 12: HIPAA for Non-Clinical Staff – tailored for reception and medical records personnel; and
- Dec. 15: HIPAA for Clinical Staff – focuses on physicians, nurses, billing and coding staff, and others involved in clinical care.
Registration for each webinar is $59, or you may purchase all three as a bundle for $129. For this low fee, practices can train everyone on the staff.
HB 300 Action Plan
- Update your policies and procedures to incorporate changes resulting from HB 300. This includes providing the newly required notice to an individual for whom your practice creates or receives PHI.
- Develop and implement an employee training plan. New employees must receive training on state and federal laws concerning PHI for privacy/security compliance within 60 days of hire. Existing employees must complete PHI training at least once every two years. Training must relate to your practice and the employee's duties. In other words, one size does not fit all.
- Document, document, document! To meet the training requirement, employees are required to sign, electronically or in writing, a statement verifying attendance at the training program. Your practice is required to keep the signed statement on file.
Visit TMA's HIPAA Resource Center for more information and resources on HB 300, including downloadable forms needed for compliance.
Blues Ranking Letters on the Way
Beginning mid-February, physicians may begin checking their mailboxes for letters from Blue Cross and Blue Shield of Texas (BCBSTX) containing doctors' latest ratings in the plan's BlueCompare quality and cost-efficiency assessment program. BCBSTX says it will publish those ratings, displayed as ribbons, in its web-based "Provider Finder" tool as of June 1.
The plan also will send information outlining a new "Physician Quality Measurement" (PQM) online ranking program set to launch some time later in 2013.The PQM initiative is part of a national effort by the Blue Cross and Blue Shield Association (BCBSA) to improve transparency for consumers when they shop for a doctor.
Under the new program, each state's plan will rate physicians based on its choice among a pool of 20 set quality measures that BCBSA indicates will come from nationally endorsed quality measures of common conditions like asthma, back pain, diabetes, depression, and heart disease. BCBSTX says it will use the same measures for the new PQM as those used for BlueCompare, and the new program is meant to "enhance" the BlueCompare ratings by displaying the details of a doctor's measurement results for each quality metric.
Patients searching online for a physician will see a physician's performance rating for each quality measure displayed as a star next to his or her name, in addition to a score comparing the doctor with local peer groups. Patients also can view an online description of the quality measures used to rate a physician.
"Today's consumers are always looking for more information about physicians and quality health care," said Allan J. Chernov, MD, BCBSTX medical director for health care quality and policy. The PQM program supports patients' "healthcare decision-making, and promotes the collaboration of physicians, patients, health plans and employers in continuously improving the quality of care."
TMA Director of Payment Advocacy Genevieve Davis said the association is working with BCBSTX to make sure the plan's program complies with a 2009 state law governing physician ranking and tiering programs. TMA won legislation that gives physicians the right to appeal their ranking or classification before a health insurance company publishes it or to opt out of a program completely. Plans also must involve actively practicing physicians in developing quality standards used.
For physicians who choose to participate in a rating program, TMA wants to make sure they can truly review their quality data before Blue Cross posts it for all to see. On the other hand, messages indicating to patients that a physician has opted out should not be disparaging, Ms. Davis says.
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.
2013 Medicare Enrollment Ends Dec. 31
Physicians have until Dec. 31 to enroll in the Medicare program for 2013.
You have three options:
- Sign a participation (PAR) agreement and accept Medicare's allowed charges as payment in full for all Medicare covered services for your Medicare patients.
- Elect nonparticipation (non-PAR), which allows you to make assignment decisions on a case-by-case basis and to bill patients up to the Medicare limiting charge for unassigned claims.
- Opt out and become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to your patients or yourself. To become a private contractor, PAR physicians must give 30 days' notice before the first day of the quarter the contract takes effect. For non-PAR physicians, the opt-out effective date is the date the affidavit is signed, provided it is filed within 10 days after the physician signs his or her first private contract with a Medicare beneficiary.
Novitas Solutions, which replaced TrailBlazer Health Enterprises as the Medicare contractor for Texas on Nov. 19, has several resources on its website. They include an overview of Medicare assignment, participation, and the opt-out process. A separate page on the Novitas website offers more detailed information on the opt-out process. The page also includes a sample affidavit a physician must file if he or she decides to opt out.