Action: July 15, 2013

TMA Action July 15, 2013       News and Insights from Texas Medical Association  

  INSIDE: Loan Repayment Applications Due Aug. 31 


Loan Repayment Applications Due Aug. 31
TMA's PSO Hires Consultant, Seeks Vendors
PPACA Employer Mandate Delayed
ICD-10: 442 Days and Counting
Do EHR Mandates Exist?
Website Helps You Save Babies
Nominate a Journalist for Health Reporting
TMA Member Benefit: Special Offer
Act Now to Get Medicaid Fee Increase
This Month in Texas Medicine

Loan Repayment Applications Due Aug. 31

Aug. 31 is the deadline to apply for the state Physician Education Loan Repayment Program (PELRP). Physicians who agree to practice for four years in primary-care health professional shortage areas (HPSAs) can receive up to $160,000 to repay medical school loans.

The 2013 session of the legislature appropriated $33.8 million for 2014-15, an increase of more than 500 percent above the $5.7 million in the 2012-13 budget. The funds were so low for the current biennium that the Texas Higher Education Coordinating Board had been unable to accept new applications since 2011.

The PELRP webpage features a fact sheet and application for enrollment. It also has the ranking criteria used to determine which applicants will be accepted into the program.

In addition, a U.S. Department of Health and Human Services website includes a search function that allows you to find out if your practice is in a designated HPSA by entering your street address. 

Officials hope to sign 100 physicians for loan repayment by Aug. 31. 

The state will expand PELRP even further in fiscal year 2014 to allow physicians who treat relatively high levels of Medicaid patients to qualify for loan repayment, even if they practice in areas not designated as HPSAs. This expansion is similar to the previous Frew loan repayment program. The implementation delay for this aspect of the program is due to the need for the board to adopt new program rules and enter into a memorandum of understanding with the Texas Health and Human Services Commission. Applications from physicians practicing in HPSAs will receive priority over Medicaid, non-HPSA applications.

TMA's PSO Hires Consultant, Seeks Vendors

A formal search for vendors, the inauguration of the physician-led steering committee, and the hiring of an experienced project consultant are signs of strong life in TMA's new organization to give you the survival tools you need to compete in today's health care marketplace, says Louis J. Goodman, PhD, executive vice president and chief executive officer.

Dr. Goodman announced the selection of Three-Sixty Advisory Group of Pasadena, Calif., as a consultant to manage the launching of the TMA Physician Services Organization for Patient Care. The organization is physician-led and will offer services to bolster your clinical and financial autonomy. In addition to TMA, the Dallas County Medical Society and the Harris County Medical Society are key members. The center will bring in new and existing physician groups, health plans, and technology vendors as needed to test and develop effective new care models. 

"The Three-Sixty principals have significant experience in accountable care organizations development, collaborative care models, and building infrastructure to support physician practice management needs," Dr. Goodman said.

The Physician Services Organization for Patient Care also issued a request for information (RFI) for service and software vendors to help it carry out its mission.

"We are looking for the very best vendors, the ones who can help us build the services organization Texas physicians need," said TMA President Stephen L. Brotherton, MD. "We are looking for firms whose skills and expertise can complement TMA's outstanding organization, brand image, and credibility among Texas doctors."

Specifically, TMA seeks firms whose products and services: 

  • Drive improved outcomes in patient health and satisfaction;
  • Support decreased cost of care and ensure operational efficiencies, compliance, and revenue integrity at the physician point of care; and
  • Encompass local market strategy through accountable care organization formation, collaborative care initiatives, and innovative new delivery and payment models.

 July 19 is the deadline to submit a notice of intent to participate. Visit the TMA website to download a copy of the RFI and instructions for completion.

Dr. Goodman praised Three-Sixty's TMA team, including CEO John Nackel, PhD, and client service executive Aimee Sziklai. "John Nackel is a well-known and influential authority in the health care industry, and Aimee Sziklai brings significant experience in building infrastructure for payers and clinical information technology," Dr. Goodman said.

Dr. Nackel said he is excited about the opportunity to work with TMA's Physician Services Organization for Patient Care. "It's transformational," he said. "It's going to provide a more balanced view of the health care industry from the physician perspective, which has traditionally been undervalued within the payer-hospital-physician delivery system.

"Going forward, success in the industry is going to depend on reinforcing the patient-physician relationship and helping physicians spend less time on administrative and other nonpatient-related functions. If we get the patient-physician relationship right, then there will be significant opportunities to improve quality and patient satisfaction, and lower health care cost."

TMA also seeks strategic investment partners. 

TMLT Action Ad 4.13 


PPACA Employer Mandate Delayed

Physicians who have 50 or more employees have another year to comply with the "employer mandate" of the Patient Protection and Affordable Care Act (PPACA). The law requires employers with 50 or more employees to offer health insurance coverage or pay a penalty.

The Obama administration announced in a U.S. Treasury Department blog on July 2 that it is delaying enforcement of the mandate until Jan. 1, 2015. It was scheduled to take effect Jan. 1, 2014.

"We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively," Mark J. Mazur, assistant secretary for tax policy, wrote in the blog. "We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so."

The delay does not affect other PPACA provisions, the Internal Revenue Service (IRS) said in a July 8 notice. "This transition relief will provide additional time for input from employers and other reporting entities in an effort to simplify information reporting consistent with effective implementation of the law," the IRS said, adding it "also is intended to provide employers, insurers, and other providers of minimum essential coverage time to adapt their health coverage and reporting systems."

ICD-10: 442 Days and Counting

The remaining time before the ICD-10 transition date is short, especially given the amount of preparation that must be completed. This transition to a new coding system is primed to be the most challenging initiative since the inception of medical coding.

The comprehensive preparation is much more than learning a new code set and upgrading office technology. TMA offers a variety of training opportunities, including live seminars, hands-on workshops, live and on-demand webinars, software, and even a prepackaged ICD-10 implementation solution.

The Complete ICD-10 Implementation Solution walks your practice through every aspect of preparation including policies, procedures, processes, relationships with other organizations, and even information technology. Your transition plan is laid out on an easy-to-follow timeline that allows you to assign specific tasks to staff members and quickly track your practice's progress. Even after the ICD-10 transition date has passed, the toolkit remains invaluable. You will get payer-by-payer analytics that make it easy to compare post-transition revenue with previous years, spot trouble areas, and address payer issues.

Turn to TMA for all of your ICD-10 questions and needs. Visit the online ICD-10 Resource Center for news, tools, videos, and information; contact TMA's Payment Advocacy Billing and Coding Hotline at (800) 880-1300, ext. 1414; or email TMA Payment Advocacy for ICD-10 answers.

Do EHR Mandates Exist?

It depends. What is your definition of a mandate? You do not have to use an electronic health record (EHR) in your practice, but if you don't, Medicare penalties will be incurred beginning in 2015. 

Currently, Medicare is the only payer planning to penalize physicians who are not "meaningfully using" their EHR system. That's right, meaningful use is required to prevent the penalty. The penalties begin at 1 percent in 2015 and will cap at 3 percent in 2017. If at least 75 percent of office-based physicians are not meaningfully using an EHR by 2017, the U.S. Department of Health and Human Services secretary has the authority to ratchet the penalty by two more percentage points, capping the penalty at 5 percent in 2019. TMA created a one-page explanation that charts the penalties for both scenarios and provides information on penalty exemptions.

To prevent the penalty, you must start your meaningful use reporting period by July 1, 2014. The federally established regional extension centers (RECs) are ready to help you with EHR selection, adoption, and meaningful use. For more information, visit the Texas Regional Extension Center Resource Center on the TMA website.  

Questions related to EHRs and other office technologies may be directed to TMA's Health Information Technology Department by calling (800) 880-5720 or by email.  

 TMAIT Action Ad 4.13   

Website Helps You Save Babies

A free Texas-based website will help physicians and hospitals comply with a new state law requiring all newborn babies to be screened for critical congenital heart disease (CCHD).

The University of Texas Health Science Center at San Antonio and the Texas Pediatric Society also plan to have this information on their websites in the future.

The site is part of the Texas Pulse Oximetry Project (TxPOP) that Baylor College of Medicine, Texas Children's Hospital, UT-San Antonio, and 12 other birthing facilities in South Texas and the Houston area established in 2012 in anticipation of the legislation. TxPOP trains nurses, physicians, and other health care professionals at delivering hospitals in Texas on CCHD newborn screening using pulse oximetry. Alice Gong, MD, at UT-San Antonio School of Medicine, and Charleta Guillory, MD, at Baylor, members of the TxPOP Project, developed the materials.

TMA Immediate Past President Michael E. Speer, MD, medical director of the Neonatal Nurse Practitioner Program at Texas Children's Hospital and professor of pediatrics and ethics at Baylor, says similar sites in other states "charge a significant amount of money to provide the same information."

Nominate a Journalist for Health Reporting

Have you read, heard, or seen a great health news story this year? If so, take a moment now to nominate it for a TMA Anson Jones, MD, Award.

This is the first time members of the TMA family can nominate journalists for the Anson Jones awards, which recognize excellence in health journalism in Texas. Nominating one or two of your local journalists is a great way to enhance your relationship with the media and encourage continued health news coverage.

The Anson Jones competition recognizes print, broadcast (television and radio), and online media, plus a Texas Health Journalist of the Year Award. Physician-reporters also are recognized with the Physician Excellence in Reporting category. So nominate your colleagues' outstanding journalism, too.

It's easy to nominate your local journalist.   

The official entry deadline is Jan. 15, 2014.

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

TMA Member Benefit: Special Offer

For a limited time, TransFirst®, a TMA-endorsed vendor for payment processing, is offering a special savings bundle with Transaction Express®, its proprietary, web-based payment management system and gateway. 

The offer ends Aug. 15. 

 PC Action Ad July 13 

Act Now to Get Medicaid Fee Increase

Later this year, Texas will increase Medicaid payments to Medicare parity for two years – retroactive to Jan. 1, 2013 – for select primary care services provided by primary care physicians (PCPs) and related subspecialists.

However, to benefit from the fee increase, you must submit a signed self-attestation form to the state's Medicaid claims payer, the Texas Medicaid and Healthcare Partnership (TMHP). The state has not set a deadline for returning attestation forms but will do so in the coming months. (Physicians who return the attestation form after the deadline will not be eligible for increases retroactive to Jan. 1, 2013, though they will be eligible for higher payments through the end of 2014.) If you are eligible, attest early to ensure the state receives your paperwork.

 Who is eligible for the higher payments?
Pediatricians, family physicians, and general internists are eligible for the higher payments as are these subspecialists.

To qualify, you must be practicing in an eligible specialty and either board certified or attest that 60 percent of your Medicaid billings are eligible for evaluation and management (E&M) or vaccine administration CPT codes. 

Texas Medicaid will conduct a random, statistically valid audit of PCPs receiving the higher payments to ensure they are qualified.

Are advanced practice nurses and physician assistants eligible for higher payments? 
Yes. The rate increase will apply to services provided by advanced practice nurses (APNs) or physician assistants (PAs) under physician supervision. APNs or PAs who bill under their own Medicaid Texas provider identification (TPI) number will be paid at 92 percent of the Medicaid payment rate as per current Medicaid payment rules.

What CPT codes are eligible for the higher payments?
Evaluation and management codes 99201 to 99499, including new and established patient preventive care codes and behavioral health counseling codes not covered by Medicare, are eligible. So are vaccine administration codes 90460, 90461, 90471, 90473, and 90474.  The higher payments will apply to eligible services provided from Jan. 1, 2013, through Dec. 31, 2014.

How do I attest that I am eligible for the higher payments?
Complete and sign the self-attestation form.  

You must complete an attestation form for each individual physician Medicaid TPI number, such as those for Texas Health Steps or multiple practice locations. A group practice may submit attestation forms on behalf of each physician within the practice but cannot attest as a group.

When will higher payments begin, and how will they be made?
Texas anticipates beginning the higher payments in early fall. Eligible claims submitted before the start date will automatically be adjusted retroactively to Jan. 1, 2013, and paid in a lump sum. Thereafter, physicians will receive quarterly payments through the end of the two years.

Once payments begin, HMOs will disburse payments to network physicians for eligible services provided to their enrollees. TMHP will issue payments for services provided to fee-for-service enrollees.

Is the PCP payment increase linked to the state's decision to forego Medicaid expansion to low-income adults as authorized by the Patient Protection and Affordable Care Act? 
No. Eligible physicians will be paid the higher fees regardless of whether Texas eventually expands Medicaid.

What is the difference in Medicaid versus Medicare payments?
See this chart showing how the new payments for select CPT codes compare with current payments for Medicaid adult and child services.  

The Texas Medical Association will send you updates on the fee increase in Action and post them on the TMA website. For additional help, call the TMA Knowledge Center at (800) 880-7955 or the TMHP Contact Center at (800) 925-9126.

This Month in Texas Medicine

The July issue of Texas Medicine explains accountable care organizations and what they mean to you, tells you why electronic health records can be a hassle but worth the trouble, and details the benefits of TMA's new medication reconciliation tool. It also describes how physician and emergency medical personnel responded to April's deadly explosion in West and reports on what happened at TexMed 2013 in San Antonio in May.

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 Wellness, Ext. 1342    

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Healthy Physicians: Healthy Patients 
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10/26   San Antonio  

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