Action: May 1, 2013

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


INSIDE: TMA Urges Bold Medicaid Fee Hike


TMA Urges Bold Medicaid Fee Hike
CMS Delays Plan to Deny Non-Enrollees' Medicare Claims
Senators Want HITECH Act Reviewed
TMA Offers EHR Interoperability Tips
Medicaid Fee Hike Requires Eligibility Confirmation
TexMed 2013: Remember the Patient
Docbook Offers Free Telemedicine Conference Admission
Fiery Water Skis? There's an ICD-10 Code for That!
This Month in Texas Medicine

TMA Urges Bold Medicaid Fee Hike

Legislators should take "bold action to fix a major problem" in the Medicaid program and "increase Medicaid payments to Medicare parity for all physicians and services," Texas Medical Association President Michael E. Speer, MD, urged in a letter to House and Senate members writing the 2014-15 state budget.

"We know our request entails significant new costs," Dr. Speer wrote. "But fixing a Medicaid system widely acknowledged to be in need of significant repair will require bold action by Texas leaders. Regardless of whether Texas expands Medicaid or achieves any other reforms through a Medicaid waiver, millions of poor patients – your constituents – will continue to rely on Medicaid for their medical care. To be sure, other Medicaid reforms are needed, too, including improving patient outcomes and increasing use of preventive care, promoting greater patient accountability through use of copayments, and implementing payment reforms to promote better quality."

His letter included a chart comparing Medicaid, commercial, and Medicare payments for various physician services. It showed Medicaid payments range from 48 percent to 94 percent of Medicare and 42 percent to 75 percent of commercial insurance. "These rates are hardly enticing to physicians who may want to sign up for Medicaid, particularly when they can barely keep up with demand for their services from better-paying privately insured patients."

Dr. Speer pointed out a TMA 2012 survey showing that only 31 percent of physicians accept all new Medicaid patients, down 36 percentage points since 2000. Another 26 percent report accepting Medicaid with limits, he added, but that is troubling because more low-income Texans rely on Medicaid. And, state officials estimate 4.2 million Texans will be on Medicaid even if Texas does not expand coverage as authorized by federal law. "As you well know, a Medicaid card without a physician to provide care is no real access at all."

He also said TMA Physicians Medicaid Congress – appointed last summer to find ways to keep physicians in the system – concluded that "grossly inadequate payment was the single overriding reason physicians cited for why they or their colleagues limit or no longer participate in Medicaid." He said many physicians support Medicaid and want to participate, but "as owners of small businesses, facing ever more costly and demanding federal and state regulatory burdens, many just cannot afford to stay in a program that pays less than half their costs."

Dr. Speer concluded, "Like a rundown house in need of repair, you've got to pick up a hammer and start somewhere. Increasing Medicaid payment rates to Medicare parity is the nail that needs to be hit first."

CMS Delays Plan to Deny Non-Enrollees' Medicare Claims

Technical issues have delayed plans by the Centers for Medicare & Medicaid Services (CMS) to begin denying claims for services ordered or referred by a physician who is not enrolled in Medicare. The denials were scheduled for May 1. CMS did not elaborate on the technical issues or set a new deadline.

Physicians should monitor the Ordering & Referring Information page on the CMS website for updates.

Once CMS solves its technical issues, physicians who receive claim denials will need to contact the ordering or referring physician to verify that he or she has enrolled in Medicare to prevent future denials. You can use TMA's free tool to check your Medicare ordering and referring status.

CMS still urges physicians who order such services and are not enrolled to do so immediately, or the applications may not be processed before May 1.

Physicians who have opted out of Medicare can order items or services for Medicare beneficiaries by submitting an opt-out affidavit to Novitas Solutions, the Texas Medicare claims administrator. The opt-out information must be current: An affidavit must be completed every two years, and the physician's National Provider Identifier (NPI) is required on the affidavit.

The American Medical Association and the Medical Group Management Association developed a list of frequently asked questions and answers about the change.

If you are reconsidering your Medicare participation status, TMA offers a webinar on physicians' Medicare participation options.

Senators Want HITECH Act Reviewed

Six Republican senators voiced "significant concerns" with the government's implementation of the HITECH Act and meaningful use program in a letter to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius. The letter says their concerns include "the lack of data to support the Administration's assertions that this taxpayer investment is being appropriately spent and actually achieving the goal of interoperable health IT."


They also asked for a list of every contract or task order awarded under the HITECH Act.

A 28-page white paper, "REBOOT:  Re-examining the Strategies Needed to Successfully Adopt Health IT," accompanied the letter. It lists list five implementation deficiencies:

  1. Lack of clear path towards interoperability,
  2. Increased costs,
  3. Lack of oversight;
  4. Patient privacy at risk, and
  5. Program sustainability. 

The senators asked Secretary Sebelius to respond by June 16.

TMA has shared some of the same concerns in various comment letters to HHS and the Office of the National Coordinator for Health Information Technology. To review TMA's comments, log on to the EHR Incentive Program Resource Center on the TMA website and scroll down to Advocacy.

For more information about the electronic health record incentive program or other health information technology issues, contact TMA's HIT Department at (800) 880-5720 or by email.     


TMLT Action Ad 4.13

TMA Offers EHR Interoperability Tips


When federal officials asked for comments on how to make electronic health records (EHRs) work together, TMA offered some suggestions.

In a letter from Joseph H. Schneider, MD, chair of TMA's Ad Hoc Committee on Health Information Technology, TMA told the U.S. Department of Health and Human Services and the Office of the National Coordinator (ONC) for Health Information Technology that:


  • ONC needs to focus on comprehensive connectivity tests that certified EHR vendors must pass;.
  • Physicians should be able to electronically share any piece of a patient's health data;
  • EHR vendors should be required to tag all data elements with standardized XML; and
  • ONC should promote a common data standard format for the transfer of health information.  


 TMA recognizes that the value of EHRs increases significantly when physicians and other providers can seamlessly exchange data with each other and with patients. Health information exchanges (HIEs) are being developed in Texas, but most are not yet fully operational. Details about HIEs in Texas are available online. TMA has a webpage dedicated to information about HIEs, including questions physicians should ask before joining one. 

For more information about HIEs or other HIT issues, contact TMA's HIT Department at (800) 880-5720 or by email.

Medicaid Fee Hike Requires Eligibility Confirmation

Primary care physicians who treat Medicaid patients will receive fee increases for 2013 and 2014 under the Patient Protection and Affordable Care Act, but only if they sign an attestation form confirming they're eligible for the raise, state officials say.

Although the state received the final federal rules too late to begin the higher payments on Jan. 1, the Texas Medicaid & Healthcare Partnership (TMHP) will make retroactive payments to that date. The state anticipates beginning payments in midsummer.

Under federal rules, physicians will qualify for the rate increase if:


  • They practice family medicine, general internal medicine, pediatrics, or a subspecialty within those designations recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties, and
  • They are board certified in an eligible specialty or subspecialty designation and practice in primary care, or more than 60 percent of the services they provide are primary care services eligible for the rate increase. Specifically, the increase will apply to evaluation & management codes 99201 through 99499 and vaccine administration codes 90460, 90461, 90471, 90472, 90473, and 90474. Preventive care codes for new and established patients also will be included in the increase even though Medicare does not cover them.  


New physicians with no history of Medicaid billings can attest that 60 percent of their Medicaid billing will be for primary care services, the Texas Health and Human Services Commission (HHSC) said.

HHSC has not yet set a deadline for filing the attestation form but says it will continue to keep physicians informed of the timeline. However, TMA encourages physicians to complete and return the form as soon as possible.

The higher payments will benefit physicians who participate in both Medicaid fee-for-service and Medicaid HMO plans, says Helen Kent Davis, director of government affairs for TMA. Further, the rate increase will significantly help those physicians hurt by the cut in payment for the Medicare Part B coinsurance enacted in 2012. Currently, for those patients, Texas will not pay the 20-percent coinsurance if what Medicare pays is more than the Medicaid allowable for the same services. However, once the rate increase takes effect, eligible physicians will be paid the full coinsurance because the Medicare and Medicaid allowable for the service will be the same.

Payments for eligible services provided by physician assistants or advanced practice nurses also will increase if patients receive the service under physician supervision. If midlevel providers bill under their own Medicaid numbers, they will be paid 92 percent of the higher rate, the same discount that applies to their services today.

For more information, call the TMHP Contact Center at (800) 925-9126.

TMAIT Action Ad 4.13

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, MDA 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

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

Docbook Offers Free Telemedicine Conference Admission

TMA's mobile communication solution, DocbookMD, in partnership with Medweb, offers TMA members free admission to the exhibit hall at the American Telemedicine Association (ATA) Conference in Austin, May 5-7. It's a savings of $50.


This will be the ATA's largest meeting. The exhibit hall hosts nearly 300 leading vendors with groundbreaking remote health care technologies and services. And, with more than 6,000 expected to attend, there's no better place to meet and network with your peers and thought leaders in telemedicine and mHealth.

Print this coupon to gain free entry, and stop by Booth #826 to learn more about DocbookMD and to demo their innovative telemedicine, radiology information system, and picture archiving and communication system.

Be sure to check out DocbookMD and all of your TMA Member Services at TexMed 2013 in San Antonio, May 17-18, as well. TexMed admission is free as a benefit of your TMA membership.


 PC Action Ad May 13 

Fiery Water Skis? There's an ICD-10 Code for That!

Over the course of your career, you've undoubtedly treated countless patients suffering from burns caused by their water skis catching fire. In the past, these all-too-frequent tragedies were complicated even more by the shortcomings of an outdated and ambiguous coding standard. No longer! You'll be happy to know the new ICD-10 coding system scheduled to take effect Oct. 1, 2014, will have an ICD-10 code for that.

In fact, it has three:

ICD-10 code set V91.07: Burn due to water-skis on fire:
V91.07xA…… Initial encounter
V91.07xD…… Subsequent encounter
V91.07xS……. Sequela

ICD-10 adds more 70,000 new codes to the mix, down to the most detailed specifics of circumstance and diagnosis, and payers are going to look for the most descriptive code available.

There is a chance ICD-10 will never happen. TMA is supporting legislation by U.S. Rep. Ted Poe (R-Houston) that would prevent the government from starting ICD-10. Representative Poe filed HR 1701, the "Cutting Costly Codes Act," on April 24. It also requires the Government Accountability Office to study ways to reduce the disruption switching from ICD-9 to ICD-10 would cause.

ICD-10 truly does start with physicians. It begins by familiarizing yourself with these new, much more specific codes, and documenting every patient interaction in a way that will allow your coding staff to easily and properly file. If the ICD-10 transition occurs, "burn to the left leg" will no longer cut it if the patient's water skis were aflame, and it may end up costing your practice a great deal in revenue.

TMA has developed many key ICD-10 resources to help you get started in your transition preparations:  


  • ICD-10 Now! How and Why 
    This three-hour seminar offers a detailed look at everything you and your staff need to know and do to prepare for ICD-10, and why it is absolutely imperative to begin the transition process now.
  • ICD-10 Transition Software
    This will help you quickly and easily identify which ICD-10 codes replace the ICD-9 codes your practice uses now. Watch a demo of the software in action.
  • ICD-10 Resource Center
    Stay up-to-date with the latest news, information, tools, videos, and resources. All things ICD-10 are in one place. Check back often for new content and information.
  • TMA ICD-10 Video Vault
    Video Q&As covering the ICD-10 transition, direct from industry experts.
  • ICD-10 Starts With Physicians
    An on-demand webinar that highlights the five phases of the ICD-10 transition, looks at the ICD-10 code structure, and addresses how ICD-10 will impact your practice. It's a great, quick way to get started.


This Month in Texas Medicine

The May issue of Texas Medicine outlines the landmark agreement TMA reached with allied health professionals to improve patients' access to care through an improved delegated model for team-based health care, tells you why charging extra fees may cause problems, and explains the federal government’s demands that practices have formal antifraud compliance plans. You’ll also learn why documenting personnel information makes sense and how Medicare bonuses can turn to penalties. Finally, the 2012 Annual Report tells you what TMA did for you and your patients last year.   

Check out our digital edition.

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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Last Updated On

January 27, 2016