Action: April 1, 2013

TMA Action April 1, 2013  
 News and Insights from Texas Medical Association 

INSIDE: TMA Explains Today's Medicare Fee Cut

TMA Calculates Impact of Medicare Fee Cut
Perry Draws Line on Medicaid Expansion
IRS Owes Some of You Money
CMS Call to Cover ICD-10 Transition
Meaningful Use Audits Start
Experience TEDMED 2013 Free – Courtesy of TMA 

Written Compliance Plan Is a Must
Doom No More
Did You Know…? Benefits of Your TMA Membership
April 8 Deadline for Gold Academic Award
This Month in Texas Medicine

TMA Calculates Impact of Medicare Fee Cut

Medicare payments to physicians will drop 2 percent on April 1 because of the federal budget sequester. TMA's Payment Advocacy Department analyzed the impact of the fee reduction and compiled a list of answers to questions you may have.

Here is an example of how the fee cut would affect payment for a service with a Medicare fee schedule amount of $100:


Payment Arrangement       Par Physician       Non-Par/Assigned       Non-Par/Unassigned
Total Payment Rate       100% = $100     95% = $95       115% of $95 = $109.25
Amount From Medicare Before April 1     80% of $100 = $80     80% of $95 = $76


Payment From Patient Before April 1       20% of $100 = $20     20% of $95 = $19

80% of $95 ($76) paid by Medicare to patient + 20% of $95 ($19) paid by patient + $14.25 balance bill paid by patient

Amount From Medicare After April 1       80% of $100 - 2% cut = $78.40       80% of $95 - 2% cut = $74.48       $0
Payment From Patient After April 1       20% of $100 = $20
    20% of $95 = $19

80% of $95 - 2% cut ($74.48) paid by Medicare to patient + 20% of $95 ($19) + $15.77 balance bill paid by patient


Total Payment After
April 1  

    $98.40     $93.48


Frequently Asked Questions  

Q: Can I pass on the 2-percent cut to my patients and collect it from them?
A: No.

Q: When will the Centers for Medicare & Medicaid Services (CMS) post an updated 2013 fee schedule based on the 2-percent cut?
A: CMS will not post an updated 2013 fee schedule. The fee schedule you use for 2013 will remain the same.

Q: Will CMS apply the fee reduction to claims processed starting April 1? What if I have a claim from March that hasn't been paid yet?
A: CMS will apply the cut to claims with a date of service of April 1or later. CMS will pay claims from January through March at the posted fee schedule amount without a 2-percent reduction.

Q: Will this cut also impact my payment from Medicare Advantage plans?
A: Possibly. It depends on your contract. If you are out of network with a plan and it pays claims based on the 2013 Medicare Fee Schedule, you will see the 2-percent cut reflected in your payment.

Q: If I'm a Medicare-enrolled physician who is non-par and doesn't accept assignment, do I need to calculate the 2-percent cut off what I collect from the patient?
A: No. You will continue collecting the same amount as you did before. Your patients will see the cut taken on the amount Medicare reimburses them, thus you may receive questions from them.

Q: Will CMS hold claims like it does when the fee schedule undergoes changes?
A: No.

Q:  How is the 2-percent reduction identified on the electronic remittance advice (ERA) and the standard paper remittance (SPR)? 
A:  The Claim Adjustment Reason Code (CARC) 223 is used to report the sequestration reduction on the ERA and SPR.

Q: What is the verbiage for CARC 223? 
A: "Adjustment code for mandated federal, state, or local law/regulation that is not already covered by another code and is mandated before a new code can be created."

Perry Draws Line on Medicaid Expansion

In a March letter to the Texas congressional delegation, Gov. Rick Perry set strict parameters for any possible expansion of the Texas Medicaid program using billions of dollars available under the federal health reform law, saying he would support a plan that includes "increased flexibility" for Texas to develop a state-specific plan.  

But the governor was careful to reiterate his stance against a full expansion of the current program as prescribed by the Patient Protection and Affordable Care Act (PPACA), as Medicaid continues to consume "a ballooning portion of state budgets – already a quarter of our budget in Texas."

The reforms Governor Perry says he would like to implement include promoting the use of:

  • Cost sharing to establish copays, deductibles, and premiums payments on a sliding scale;
  • Asset testing to ensure care is there for those who need it most;
  • Health savings accounts to improve patients' control over heath care spending; and
  • Existing private coverage and employer-sponsored coverage.  

"States have innovative ideas for providing accessible and affordable health care for those in need, but lack the flexibility to implement any meaningful reforms," Governor Perry wrote.

The Senate Finance Committee attached a rider to its version of the 2014-15 budget that seeks to test the waters of a Medicaid expansion but first requires the Texas Health and Human Services Commission to seek legislative approval. The rider specifically says that "no amount may be expended to modify Medicaid eligibility unless the commission develops a plan to create more efficient health care coverage options for all existing and newly eligible populations."

That plan also must pass certain muster and meet several principles spelled out in the rider that include those outlined by the governor, as well as:

  • Reduced uncompensated care costs and nonemergency visits to emergency departments;
  • Customized benefit plans for a defined Medicaid population;
  • Pay-for-performance initiatives;
  • Efficiency controls, including cost-containment and improved care coordination; and
  • Elimination of the need to gain federal approval for minor program changes.

The proposals echo those made by TMA to first fix the current broken Medicaid system by increasing physician payments and reducing hassles, and then use expansion money in a way that makes care available to more Texas patients.

The April issue of Texas Medicine has more information on TMA's plan to fix the state's Medicaid system.  

IRS Owes Some of You Money

TMA has learned that if you were in residency or fellowship training between Jan. 1, 1995, and March 31, 2005, you may qualify for a refund of Federal Insurance Contributions Act (FICA) taxes collected on your stipend during that time. 

In March 2010, the Internal Revenue Service (IRS) determined that residents were exempt from FICA taxes, based on the student exception, for that 10-year period. But the exemption ended when new IRS regulations took effect April 1, 2005. IRS now disqualifies residents and fellows from continued exemption from the FICA tax because they work at least 40 hours per week. FICA taxes consist of Social Security and Medicare taxes.

If a training institution filed a refund claim on your behalf, with your consent, contact the graduate medical education office there to determine if you are due a refund. Many have received refunds already, so this could definitely be worth your while. 

For more information, call IRS at (800) 919-1703, or review the Questions and Answers posted on the IRS website.


TMLT Nest Egg Ad

CMS Call to Cover ICD-10 Transition

Centers for Medicare & Medicaid Services (CMS) officials will give you information on preparing for the Oct. 1, 2014, switch to the ICD-10 coding system in a nationwide conference call for physicians and staff on Thursday, April 18. The 90-minute call begins at 12:30 pm CDT. 

The agenda includes:

  • Planning for transition to ICD-10,
  • Claims processing,
  • National implementation issues,
  • National coverage decisions, and
  • Outreach.  

Click on the link above for more information and to register.

You must begin preparing for ICD-10 now if you haven't already. TMA has a variety of ways to help you prepare. They include:

  • ICD-10 Now! – a three-hour seminar series in 18 cities in May and June and in September and October across Texas that will offer a detailed look at everything you need to know and do to prepare for ICD-10. The presentation begins with an overview of ICD-10, then delves into real-world explanations of how to assess your practice's readiness and to plan and implement a successful transition. The workshops cover policies, procedures, processes, relationships with other organizations, and information systems and technology. Attendees will receive forms and questionnaires to help create an ICD-10 transition plan.  
  • Simple Solutions ICD-10 Transition Software to assist practices with the transition to ICD-10. This tool, available as a download or web-based, will help you quickly and easily identify which ICD-10 codes replace the ICD-9-CM codes your practice uses now.
  • An on-demand webinar, ICD-10 Starts With Physicians: A Primer for Beginning the Process.
  • On-site ICD-10 training. The one-hour and half-day programs are customized to your needs.

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.

For the latest information, visit the ICD-10 page on the TMA website and the CMS ICD-10 website

TMA Practice Consulting also 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.

Meaningful Use Audits Start

Meaningful use audits are under way in Texas, and TMA is receiving calls from members seeking assistance. Figliozzi and Company is the designated contractor performing the audits on behalf of the Centers for Medicare & Medicaid Services (CMS).

The company offers some guidance for audited practices. 

Be sure to answer all questions to the best of your ability. One of the documentation requirements is an audit trail from the electronic health record (EHR) software demonstrating that drug formulary or drug allergy checks were enabled for the entire reporting period. Not all EHR vendors have this capability. If that is the case, you can make a statement attesting that your drug formulary checks were enabled for the entire reporting period and that your EHR vendor does not have functionality to provide proof. 

The deadline for the initial request of documentation is two weeks. If the auditors consider your answers deficient, they will make a second request with a one-week deadline. Figliozzi will extend the deadline upon request, but your second-year payment may be delayed until the audit is finalized. Once the audit ends, you will receive an audit determination letter from Figliozzi. If the auditors find you ineligible for the incentive payment, you can appeal.

Be sure to maintain, for at least six years, documentation supporting the meaningful use measures, calculations, and data submitted during attestation. CMS prepared EHR Incentive Programs Supporting Documentation for Audits to help practices better understand the documentation needed in an audit. 

To help physicians with the EHR incentive program complexities, 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 more information 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.  

Experience TEDMED 2013 Free – Courtesy of TMA

TMA has been accepted as a simulcast site for TEDMED 2013, and we invite members to join us at the TMA building in Austin on Wednesday, April 17, from 1:30 to 6:30 pm, for the exhilarating speakers and invigorating discussion.

TEDMED is where the world's most creative minds meet health care's most innovative science. Speakers include global leaders from science, research, technology, academia, business, government, and the arts. Join us in what many have called a "life-changing experience."

If you can't make it to Austin, your TMA membership entitles you to watch any or all of the four-day conference – it runs from the evening of April 16 through noon on April 19 – from your desktop computer or mobile device. Take a look at the agenda, and plan some time for you, your colleagues, and your staff to think about the future of health care.

Maybe you want to watch National Institutes of Health Director Francis S. Collins on Wednesday? Or Institute of Medicine President Harvey Weinberg on Tuesday? Or 18-year-old venture capitalist Laura Deming on Friday? Or all three? Or more? You can.

To watch the program, go to and then "Click Here To Start." In the drop-down box, select "Texas Medical Association" from the list of organizations and enter L82830 as your affiliate ID.

Download the TEDMED app for iPhone, iPad, and Android. TEDMED Connect contains all the key information about TEDMED session schedules and speakers' bios, as well as a "What's On Now" button that allows real-time check-in on conference talks.

For more information on the April 17 simulcast at the TMA building, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email


 TMAIT Action Ad 4.13


Written Compliance Plan Is a Must

Physicians must have a plan to comply with regulations for federal health programs, including Medicare and Medicaid. It's no longer acceptable to only have a compliance strategy; each practice must have a written plan that addresses key compliance issues such as proper coding, medical necessity, and appropriate documentation.

An effective compliance plan can reduce the number of innocent mistakes and will go a long way toward audit avoidance. And, if your practice ends up as the target of allegations, having an effective compliance plan can help your outcome tremendously.

TMA offers a one-day seminar, Commit to Compliance: Build an Effective Compliance Plan, on May 3 at the TMA building in Austin. It will show you how to develop and implement a compliance plan that includes all of the necessary components. The seminar will cover:

  • Coding: documentation guidelines and what triggers an audit;
  • Billing: internal controls and embezzlement protection and billing disclosure requirements;
  • Human resources: federal labor laws for multiple size offices;
  • HIPAA privacy: handling of medical records, myths about HIPAA, and Texas privacy laws; and
  • HIPAA security: rules and safeguards and what's different in Texas.  

As a seminar attendee, you will receive TMA's new guide, Build Your Compliance Plan, by Amanda B. Hill, JD, which you can easily customize for any size practice.

The May issue of Texas Medicine will have more on this issue.

Doom No More

TMA's "Calendar of Doom" is now "Deadlines for Doctors: Do This Now."  

It is still loaded with the key dates you need to know to stay abreast of all the upcoming state and federal regulations and key health policy issues that impact you and your practice. It is still filled with the outstanding TMA information resources, tools, and educational programs you need stay in compliance. It is still a great way for you to plan ahead for those insurance company demands and health information technology carrots and sticks.

But your TMA Council on Practice Management Services wanted to give the calendar a new name, one that wasn't so negative and ominous. Council member Susan Blue, MD, of Fort Worth, came up with "Deadlines for Doctors."

Bookmark and visit regularly, or subscribe to the RSS feed.

Never be surprised by another deadline. Always know what you need to do now. All thanks to TMA.

Did You Know…? Benefits of Your TMA Membership

One of your TMA member benefits is access to exclusive discounts on a variety of products and services.

TMA Endorsed Vendors offer practice management solutions that can help you succeed in the ever-changing medical environment. And we've done the legwork to ensure their integrity and value. When contacting an endorsed company, be sure to identify yourself as a TMA physician member to receive exclusive savings and great customer service.  

TMA's Group Discount Programs allow you to leverage your membership in the largest state medical association in the country in order to receive great deals. Available to TMA members and their families and friends, these programs save you money on products and services you use every day, whether in your practice or in your home. Save on computers, magazine subscriptions, hotel stays, and more. Visit the TMA website to find discount codes, and start saving today.

Click here to explore all of your TMA member benefits and services! 


Practice Consuling Ad Action 4.13

April 8 Deadline for Gold Academic Award

Academic physicians have until 5 pm CDT on April 8 to apply for Gold Level recognition in the TMA Award for Excellence in Academic Medicine program. The program recognizes academic physicians as teachers, role models, and medical professionals.

To be eligible, you must have at least 10 years of service in an academic faculty position and must have held leadership positions within organized medicine.

If you have questions, email Jennifer McHaney or call her at (800) 880-1300, ext. 1451, or (512) 370-1451.

This Month in Texas Medicine

The April issue of Texas Medicine explains why state and federal authorities are cracking down on pain management clinics and gives you information you need before buying, serving as medical director of, or joining any medical practice. It also outlines TMA's recommendations for improving Medicaid, tells you why TMA backs bills against distracted driving, details why it's necessary to plan for what happens to your practice and your patients if you die unexpectedly, and provides insight on how quality measures are developed. 

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

 About Action   


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Last Updated On

January 26, 2016