Action: March 1, 2013


TMA Action

March 1, 2013      

INSIDE: Sequestration Means Lower Medicare Fees April 1    

Sequester Cuts Medicare Fees Starting April 1
Congress Takes Up Medicine's Plea on SGR, IPAB
Novitas Mails Medicare Revalidation Letters
Feds Reject Request to Delay ICD-10
EHR Stage 2 Webinar on March 20
Watch for E-Prescribing Overpayments
 TMA, AMA Promote Healthier Life
Nominate Local Stories for Anson Jones Award
DSHS Revises Umbilical Cord Blood Brochure
Legislative News Delivered to Your Inbox
This Month in Texas Medicine

Sequester Cuts Medicare Fees Starting April 1

Medicare payments to physicians will drop 2 percent because Congress and President Obama failed to avoid the sequestration budget cuts. Although the sequestration takes effect March 1, an American Medical Association advisory says the Medicare fee reductions will not begin until April 1.

AMA said some details of the Medicare sequester still have not been made public. "For example, we do not know if the 2-percent payment cut will be applied to allowed charges under the Medicare physician fee schedule (and so affect beneficiary copayments), or if it will be applied only to the physician's Medicare claims payment. It also is not clear whether the cuts will be applied to claims with a date of service on or after April 1, or to all claims payments made on or after April 1," the advisory said.

Still hanging over physicians' heads is an almost 27-percent cut in Medicare payments fueled by the Sustainable Growth Rate (SGR) formula. That cut was supposed to take effect Jan. 1, but Congress and the president delayed it for a year when they reached a deal Dec. 31 to avoid the so-called "fiscal cliff."

The Texas Medical Association, AMA, and more than 100 other state medical associations and specialty societies said in letter to Congress last fall that sequestration and SGR cuts "would not only impede improvements to our health care system, it could lead to serious access-to-care issues for Medicare patients as well as employment reductions in medical practices."

Citing preliminary Office of Management and Budget estimates, the Medicare Newsgroup website said sequestration will cost Medicare providers nationwide $11 billion in reduced payments in 2013. "In Texas, the jobs of 258,529 employees of medical practices, as well as access to care for 3,187,332 Medicare patients and 869,573 TRICARE patients are at risk due to these cuts," says an AMA state-by-state analysis of the impact of sequestration and SGR cuts.

Congress Takes Up Medicine's Plea on SGR, IPAB

TMA officials are optimistic about proposals to reform Medicare's physician payment system this year, a top goal for the association's federal legislative agenda.

TMA physicians met with congressional leaders as part of the American Medical Association's National Advocacy Conference in February to advocate for an alternative to Medicare's Sustainable Growth Rate (SGR) formula, which doctors say does not keep up with the cost of care and deters them from caring for senior patients.

Republican leadership of the House Ways and Means Committee and the Energy and Commerce Committee jointly unveiled plans for a three-phase bill that would eliminate the SGR and move toward a system that pays doctors based on physician-endorsed quality measures, and later on efficiency.

Also in February, Rep. Allyson Schwartz (D-Pa.) and Rep. Joe Heck, DO (R-Nev.), reintroduced the Medicare Physician Payment Innovation Act (HR 574) to repeal the SGR formula and test new payment models that promote quality and reduce costs.

Both plans reflect core principles that medicine, including TMA, advocated to Congress for transitioning from the SGR to a new, high-performing Medicare system.

House Energy and Commerce Committee Chair Rep. Fred Upton (R-Mich.) said he hopes to have a bill on the floor this summer. His committee held its first hearing on the SGR in February, which TMA officials say is a good sign of long-overdue progress on the issue.

The plan also has support from a key lawmaker in Texas, U.S. Rep. Kevin Brady (R-The Woodlands), Health Subcommittee chair of the House Ways and Means Committee.

The SGR proposals came not long after the Congressional Budget Office (CBO) revised its estimate for the 10-year cost to repeal the SGR formula down from $243 billion in 2012 to $138 billion in 2013. Representative Upton suggested the lower cost could make it easier to pass legislation on the issue this year.

Texas physicians also pressed lawmakers for repeal of the Independent Payment Advisory Board (IPAB) set up under the Patient Protection and Affordable Care Act (PPACA), another key goal on TMA's agenda.

Doctors say the board's ability to arbitrarily cut Medicare costs – which, because of restrictions on limiting benefits, are likely to hit physician payments – could be a double blow to access to care for Medicare patients on top of existing payment cuts. Physicians also worry the 15-member panel of health care experts takes decisions out of the hands of doctors and patients.

Medicine supports legislation introduced in the Senate and House to repeal the IPAB: S 351 by Sen. John Cornyn (R-Texas) and HR 351 by Rep. Phil Roe (R-Tenn.).

"The PPACA prohibits the [IPAB] from recommending changes to Medicare eligibility or coverage, or other factors that drive utilization of health care services. This means the board will have only one option – cut payments," TMA President Michael E. Speer, MD, said in a letter thanking Senator Cornyn for introducing the legislation. "And through 2019, hospitals, Medicare Advantage plans, Medicare prescription drug plans, and health care professionals other than physicians are exempt. That leaves the board only one option – cut Medicare payments to physicians. Cuts the board recommends will take effect automatically unless Congress acts to suspend them.”

Similar measures passed the House in 2012, but did not get through the Senate.

Novitas Mails Medicare Revalidation Letters

On March 1, Novitas, the Texas Medicare claims processor, began sending physicians in the Medicare program letters asking them to revalidate their enrollment information. Physicians not on the March 1 mailing list will receive their letters either March 15 or March 29.


Here is a sample of the letters Novitas is sending. They include information needed to send the requested information.

On the Centers for Medicare & Medicaid Services website is a list of physicians who have received a revalidation letter.

Contact the Novitas Provider Enrollment Center for additional information.



Feds Reject Request to Delay ICD-10

Centers for Medicare & Medicaid Services (CMS) officials rejected organized medicine's request to delay implementation of the ICD-10 coding system. That means the new coding system will take effect Oct. 1, 2014.

CMS Acting Administrator Marilyn Tavenner said in a letter to American Medical Association President Jeremy Lazarus, MD, that a previously granted one-year extension gave physicians "adequate time to train their coders, complete system changeovers, and conduct testing." She said further delay "would fundamentally alter a policy the health care industry has been working since 2009 to implement. ICD-10 is not only the foundation for health care reform, but is a cornerstone of several integrated programs that build toward a modernized health care system and work in concert to achieve better care, better health, and lower costs."

In December, TMA joined AMA and other state medical societies to ask CMS to stop the switch from ICD-9 to ICD-10 and work with all interested parties to find a better replacement for ICD-9. They said ICD-10 "will create significant burdens on the practice of medicine with no direct benefit to individual patient care and will compete with other costly transitions associated with quality and health IT reporting programs." They added that switching to ICD-10 will cost a medical practice anywhere from $83,290 to $2.7 million, depending on the size of the practice, and will disrupt physicians' efforts to implement health information technology and participate in new delivery and payment reform models.

Because of the CMS decision, you must begin preparing for ICD-10 now if you haven't already. TMA has a variety of ways to help physicians prepare. They include:



You can start by watching the short TMA video, "Doctor, What's Your Role in Transitioning to ICD-10?"

Coming soon is an ICD-10 Transition Toolkit that will guide you through learning, planning, organizing, implementing, and analyzing the ICD-10 transition. It will include the tools – budgets, organization surveys, and impact assessments – you need for a successful transition. TMA also will offer three live seminars that provide an overview of ICD-10 and code structure, discuss the five phases of ICD-10 transition, and examine the impact on physician practices. Attendees will learn the important aspects of ICD-10 documentation and coding, how to engage physicians in the transition process, and how to get started preparing for and executing your transition plan. Future issues of Action will have more information.

In addition, TMA Practice Consulting offers a variety of services to help ensure your reimbursement doesn't suffer during the ICD-9 to ICD-10 transition. Contact TMA Practice Consulting by telephone at (800) 523-8776 or by email.

Physicians should also check the CMS ICD-10 website for the latest information.

EHR Stage 2 Webinar on March 20

The Centers for Medicare & Medicaid Services (CMS) will present a webinar on the Stage 2 Electronic Health Record (EHR) Incentive Payment Program at 12:30 pm CDT on Wednesday, March 20. Stage 2 EHR incentive requirements take effect next year.

Click on the link above to get more information and to register. You will receive an appointment for the webinar, which will include information on how to connect to the webinar on March 20.

If possible, before March 20, visit the CMS EHR Incentive Payment Program website to view these earlier presentations that will not be covered during the March 20 webinar:



Make a list of your questions to ask during the Q&A session of the webinar. If you prefer, you may submit questions in advance to Adra Mayberry at CMS by March 18. Please use "Mar 20 EHR Webinar" in the subject line of your email.

The March 20 session will accommodate 300 webinar and teleconference participants on a first-come, first-served basis. If several people are calling from one location, please use one line if possible. When calling in for the teleconference, provide your name, your organization's name, the state from which you are calling, and the number of people listening from your location.

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

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

Watch for E-Prescribing Overpayments

Texas Medicare contractor Novitas Solutions has identified a problem with files the Centers for Medicare & Medicaid Services (CMS) provides that are supposed to show physicians who did not meet CMS requirements for e-prescribing. The files are not showing this information, and physicians are not being penalized 1 percent as required by the e-prescribing rules. Thus, they are being overpaid, and CMS will want the money back.


Novitas is working with CMS to resolve this problem. Watch the Novitas System Alerts for an update.

Who is subject to 1-percent penalty? If you did not e-prescribe and report the G-code G8553 at least 10 times by June 30, 2011, or claim a valid exemption by Nov. 7, 2011, you were penalized 1 percent of your 2012 Medicare Part B claims. Some of your claims for 2012 will include the overpayment.

2013 e-prescribing reminder: You have until June 30 to avoid a 2-percent penalty on all 2014 Medicare Part B claims. If you do not already e-prescribe in your office, now is the time to begin. If you do not already use an electronic health record (EHR) system with e-prescribing capabilities, you can install a stand-alone e-prescribing system and still meet the approaching deadline. You must report e-prescribing via claims using G-code G8553 on at least 10 unique Medicare encounters by June 30 to prevent the penalty. Three prescriptions for one patient encounter will count as only one e-prescribing incident.

Find out more on the TMA 2013 E-Rx Penalty and Incentive Guidelines page. If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support 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.

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  

TMA, AMA Promote Healthier Life

Are you routinely counseling your patients about how their lifestyles impact their health? Are you encouraging your patients to exercise, quit smoking, eat healthier, and reduce risky alcohol use? If so, check out the American Medical Association (AMA) Healthier Life Steps® program.

The program, offered by TMA, provides practical resources and tools for establishing and supporting healthy lifestyle goals:


  • Patient lifestyle questionnaires;
  • Action plans;
  • Progress-tracking calendars, and
  • Continuing medical education opportunities.


You'll even find a roadmap to help you put the program into action in your practice. The webpage also includes other resources to assist you in coding for these preventive services.

AMA Healthier Life Steps program materials are free for physicians and patients, courtesy of TMA and AMA. Physicians can download the materials for use in their practice.

For more information, email TMA's outreach coordinator or call (800) 888-1300, ext. 1470, or (512) 370-1470.

Nominate Local Stories for Anson Jones Award

For the first time, members of the TMA family can nominate local journalists for the TMA Anson Jones, MD, Awards, which recognize excellence in health journalism in Texas. So if you see or hear an outstanding health-related TV or radio news story, or read a top-notch news article or blog, let TMA know.

For more than 50 years, TMA has honored award-winning Texas journalists with the Anson Jones, MD, Awards. Until this year, only journalists could submit their work for the awards. Now, TMA physician members, medical students, county medical societies, and TMA Alliance members can nominate them.

The competition features 11 award categories for reporting in print, broadcast (television and radio), and online media, plus a Texas Health Journalist of the Year award. TMA also recognizes physician-reporters with the Physician Excellence in Reporting category. So nominate your colleagues' outstanding journalism, too.

Submit nominations all year to ansonjones[at]texmed[dot]org. Be sure to provide the reporter's name, date of broadcast/publication, and media outlet. TMA will alert the reporter to your nomination and urge him or her to complete an award application.

If you have questions, call Tammy Wishard, TMA's outreach coordinator, at (800) 880-1300 ext. 1470, or (512) 370-1470.

DSHS Revises Umbilical Cord Blood Brochure

The Texas Department of State Health Services (DSHS) has issued a new version of the umbilical cord blood brochure that physicians must give prenatal patients. TMA's Maternal and Perinatal Health and Blood and Tissue Usage committees worked extensively with DSHS on edits to the brochure to make the information more relevant and easier for patients to understand.


State law (HB 709) requires physicians or any other person permitted by law to attend a pregnant woman during gestation or at delivery to give the woman the brochure before the third trimester of her pregnancy, or as soon as reasonably feasible.

For questions or comments about the brochure, email Aisling Mcguckin at DSHS, or call her (512) 776-2746.

You may order the brochure through the DSHS Literature and Inquiry and Order Entry site or by calling the DSHS Warehouse at (512) 458-7761 for assistance. The stock numbers are:

  • #6-73 – English, and
  • #6-73A – Spanish.

You can get this brochure in PDF format by downloading the English or Spanish version.



What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.  

A practice management tip from
TMA Practice Consulting



Legislative News Delivered to Your Inbox

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The electronic newsletter reports the legislature's latest actions on bills affecting you, your practice, and your patients. It's delivered daily before noon. A weekly recap, delivered each Friday, also is available.  

This year, the hotline also brings you weekly video updates from TMA lobbyists, health care experts, and even state legislators. Don't miss out. Subscribe today.  

This Month in Texas Medicine

The March issue of Texas Medicine explains the flaws in the Medicaid 1115 waiver program, explores the concept of publishing physician fees, and tells you why Aetna is forking over some cash. It also explains how the Texas Department of Insurance is trashing network adequacy rules and how EHR meaningful use can help patients stop smoking.  

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

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



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Last Updated On

January 27, 2016