Action: Jan. 4, 2013

TMA Action Jan. 4, 2013  
News and Insights from Texas Medical Association


INSIDE: More Time for Medicare Participation Decision  

2013 Medicare Participation Deadline Extended
ICD-10 Prep May Take Longer Than You Think
Medicaid, Demographics at Winter Conference
Get Grants for Vaccine Events
Meaningful Use and Clinical Summaries

TexMed 2013: Remember the Patient
Need a New White Coat?
Awards Honor Physician-Journalists
This Month in Texas Medicine

2013 Medicare Participation Deadline Extended

Physicians now have until Feb. 15 to decide whether to participate in the Medicare program this year, the Centers for Medicare & Medicaid Services (CMS) announced Jan. 3. The announcement follows Congress' New Year's Day decision to freeze Medicare payments to physicians through Dec. 31 as part of the legislation to avoid the so-called "fiscal cliff." Physician payments were scheduled to plummet almost 30 percent.

Physicians have three options in deciding whether to participate in 2013:

  1. Sign a participation (PAR) agreement and accept Medicare's allowed charge as payment in full for all Medicare covered services for their Medicare patients.
  2. Elect nonparticipation (non-PAR), which permits physicians to make assignment decisions on a case-by-case basis and to bill patients up to the Medicare limiting charge for unassigned claims.
  3. Opt out and become a private contracting physician, agreeing to bill patients directly and to forego any payments from Medicare to their patients or themselves. 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 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.

Participating physicians should file claims using their standard charge. That will allow Novitas to pay you correctly, as soon as CMS calculates the new fee schedule.

TMA is preparing a new webinar discussing the details of the three Medicare options. A link to the webinar will be posted in the TMA Education Center. More information will be available in future issues of Action.

The fiscal cliff agreement – which President Obama signed Jan. 2 – replaces the 26.5-percent Medicare physician payment cut with a "zero-percent update" to the Medicare physician fee schedule conversion factor for 2013. This does not mean that fees are the same as last year because conversion factor adjustments and relative value unit (RVU) changes contained in the final fee schedule rule for 2013 may result in payment rate changes. The deal also postpones for two months the additional 2-percent Medicare cut that was part of automatic, across-the-board cuts in federal spending.

In addition, Congress preserved the higher Medicaid payments for primary care services, as requested by the Texas Medical Association and other state and national medical societies. The geographic work adjustment (1.0 floor) was extended through Dec. 31, 2013. However, the Medicare Part B equipment utilization assumption for advanced imaging services was raised to 90 percent, effective for fee schedules established for 2014 and subsequent years, thus reducing future payment.

The $25 billion cost of the freeze is paid for by cuts in Medicare payments to hospitals, pharmacies, and end-stage renal disease treatment.

Congress did not address organized medicine's top priority: repeal of the Sustainable Growth Rate formula that forces the annual crisis in payments for Texas physicians who care for 2.8 million Medicare patients and more than 870,000 military families who receive coverage through TRICARE.

ICD-10 Prep May Take Longer Than You Think

The official deadline for ICD-10 implementation is Oct. 1, 2014. While this may seem like a distant date now, executing a seamless transition plan will take deliberate planning and strategizing on your part.

Although the deadline is two years away, you can follow these steps now to help minimize your stress level in the months leading up to implementation:

  • Identify who will assume overall responsibility for managing the transition. This can be one staff member or a collaborative group, depending on the size of your practice.
  • Contact your vendors, colleagues, affiliated practices, clearinghouses, and any other involved parties to determine their plans for ICD-10 and your specific next steps.
  • Start thinking now about a realistic budget. This should include costs such as software and hardware upgrades, staff training, and vendor transition fees.  

TMA's new webinar, ICD-10 Starts with Physicians: A Primer for Beginning the Process, reviews the new coding standard, explains the differences from ICD-9, and offers directions for the first steps you should take. This continuing medical education program will give you a head start into the planning process and includes an interactive Q&A session with Denny Flint, president of Complete Practice Resources.

Starting preparations now, delegating responsibilities, and developing a month-by-month plan will help ensure that your practice is not overwhelmed when the implementation date finally arrives.

The January issue of Texas Medicine has more information on what you need to do to prepare for ICD-10.

For additional questions or services, contact TMA's certified coders by email or at (800) 880-1300, ext. 1414, or (512) 370-1414.

Medicaid, Demographics at Winter Conference

Medicaid's future and the changing face of Texas highlight the agenda for the 2013 TMA Winter Conference, Feb. 1-2, at the AT&T Conference Center in Austin.

Health and Human Services Commissioner Kyle Janek, MD, and a panel of physicians and legislators will discuss the Medicaid program in Texas and the progress TMA's Physicians Medicaid Congress is making in suggesting ways to improve the program. Former state demographer Steve Murdock, PhD, will make a presentation on changes in the state's demographics and what it means for medicine.

Book your hotel reservation by Jan. 11 to get the discounted rate.

Watch your email and the Winter Conference webpage for more information.


Get Grants for Vaccine Events

You can receive up to $2,000 to support local vaccination events in 2013. TMA's Be Wise — ImmunizeSM will offer local impact grants for events that target children, adolescents, or adults. Eligible applicants are physicians, medical students, TMA Alliance chapters, and county medical societies.

Funds can be used for a new shot clinic or an expanded event. Grant applications are due March 1, 2013, for the spring grant cycle and Oct. 1, 2013, for the fall grant cycle. Awardees have up to 12 months to use the funds.

To help plan your free or low-cost vaccination event, check out the Be Wise — Immunize Quick Start Manual: A Step-by-Step Vaccination Outreach Guide and Be Wise Event Ideas. Contact Tammy Wishard, TMA;s outreach coordinator, at (512) 370-1470, to find out how the grants program can benefit your community.

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance. Funding for Be Wise — Immunize is provided by the TMA Foundation thanks to generous support from H-E-B and gifts from physicians and their families.

Be Wise — Immunize is a service mark of the Texas Medical Association.  

Meaningful Use and Clinical Summaries

One of the most difficult meaningful use measures that practices must meet is the one requiring them to give patients a clinical summary for each office visit more than 50 percent of the time.

TMA frequently gets questions regarding this measure, such as: 

  • What if my patients don't want it?
  • Is this only for patients that request it?
  • What should be included in the summary?  

You must offer a summary to more than 50 percent of the patients, not just those who request one. You don't have to give summaries to patients who don't request them, although you may be surprised that many will appreciate having the information. You may give patients a summary in many ways. It can be printed, uploaded to a patient's electronic personal health record (PHR), or uploaded to a patient portal. Be sure the patient has signed up for the portal for this to count. You may also give it to the patient on a portal device such as a USB drive.

If the patient refuses a summary, be sure to document that you made the offer and the patient refused so that you can count that office visit in your numerator towards the 50-percent requirement. Some electronic health record (EHR) vendors track this by asking physicians to "print to file" so it is documented.

Take a moment to review what data elements are pulled into the clinical summary. They are listed under Definition of Terms on the clinical summary link in the first paragraph. Some physicians may make notations not intended for patient viewing, and it is vital that you understand exactly what is extracted into the summary. For example, one clinical summary indicated the patient was an alcoholic because the calibration within the EHR based that information on the number of drinks per week.

To help physicians, the Office of the National Coordinator for Health Information Technology established regional extension centers (RECs) to provide onsite health information technology (HIT) consulting in physician practices. For questions about eligibility and REC services, visit the REC Resource Center on the TMA website.

For questions about meaningful use or other HIT issues, contact TMA's HIT Department by telephone at (800) 880-5720 or by email, or visit the TMA EHR Incentive Program Resource Center

TMLT Nest Egg Ad


TexMed 2013: Remember the Patient

With the increasing complexities of modern technology, coupled with the spiraling labyrinth of rules and regulations, physicians can find themselves scattered to the edge of distraction. TMA is working to help physicians remain focused on the mission of medicine – the patient.

Join us for TexMed 2013 at the Grand Hyatt San Antonio and the Henry B. Gonzalez Convention Center on May 17-18 as we remember the patient.

Highlights of TexMed 2013 include:

Friday, May 17  

7:30 am-3 pm
CME Tracks
Allergy, Anesthesiology, Cancer, Colon Rectal Surgery, Diabetes/Endocrinology, Emergency Medicine, General Session, Geriatrics, Occupational Medicine, Ophthalmology, Otolaryngology, Pain Medicine, Physical Medicine & Rehab, Physician Health, Practice Management, Psychiatry, Quality

8-9:30 am
House of Delegates Opening Session

9:30 am-noon
House of Delegates Reference Committees

11:30 am-1:30 pm
Networking Lunch in Expo Hall, sponsored by Blue Cross and Blue Shield of Texas

2:30-3:30 pm
Candidate Forum

3:30-5 pm
General Session with Abraham Verghese, MD: A Doctor's Touch, sponsored by the Texas Medical Liability Trust

5-6 pm
Welcome Reception, sponsored by the Texas Medical Liability Trust
Welcome Reception and Book-signing, Cutting for Stone, with Dr. Verghese

6-7 pm
TMA/TMAA 2013-14 Presidents' Reception, sponsored by the Texas Medical Association Insurance Trust
TMA President Stephen Brotherton, MD, Fort Worth, and TMAA President Cheryl Jones, Temple

7-11 pm
TMA Foundation's Roaring Twentieth Gala

9 pm-2 am
Student, Resident, and Young Physician Mixer

Saturday, May 18  

6-8 am
County Medical Society Caucus Meetings

8:30 am-noon
House of Delegates

8 am-5 pm
CME Tracks

Register online. April 23 is the deadline to make a hotel reservation and pay the special rate of $199 single/double.

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

Need a New White Coat?

TMA has partnered with SmartScrubs to offer TMA members a custom website uniform store and exclusive offers on S.C.R.U.B.S. brand apparel.

Order your white coat online and get free TMA logo embroidery through March 1. To get started, simply visit Once inside the uniform store, navigate the links to choose your coats, tops, pants, and hats. 

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.  

A practice management tip from
TMA Practice Consulting

Awards Honor Physician-Journalists

Jan. 15 is the last day for you to submit entries in the 2013 TMA Anson Jones, MD, Awards program. Send your best work to

For more than 50 years, TMA has honored award-winning Texas journalists with the Anson Jones, MD, Awards for excellent medical news reporting. TMA opened the competition to physician-reporters in 2007 with the Physician Excellence in Reporting category.

Visit the Anson Jones webpage for contest rules and an entry form. If you have questions, email or call TMA Outreach Coordinator Tammy Wishard at (800) 880-1300, ext. 1470, or (512) 370-1470. 

This Month in Texas Medicine

The January issue of Texas Medicine explains TMA's ambitious agenda in the 2012 legislative session, talks to new Health and Human Services boss Kyle Janek, MD, and tells you what you need to do to get ready for ICD-10 in 2014. It also reports on the planned merger of allopathic and osteopathic accreditation and AMA's new principles for physician employment.

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.

Physician Health and Rehabilitation, Ext. 1342

Interventions for Health: PHR Training Session and 20th Annual Retreat
2-22/23 Horseshoe Bay  

Healthy Physicians: Healthy Patients
4/6 Lubbock
4/27 Fort Worth


About Action   


Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice.

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at

If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Larry BeSaw, Action editor.