Action: Aug. 16, 2013

TMA Action Aug. 16, 2013      News and Insights from Texas Medical Association            

INSIDE: AMA Analyzes Medicare Physician Fee Rule


AMA Analyzes Medicare Physician Fee Rule
Incarcerated Patient Demand Letter — New Instructions
It's Time to Start ICD-10 Implementation
HIPAA Security Requires Practice Risk Analysis
Texas Company Recalls Sterile Use Products
Conference Probes Payment/Delivery Reform
Vaccinations Available at Fall Conference
Throw a Vaccination Party on Influenza Awareness Day
Preparing for EHR Divorce
Save an Extra 17 Percent on Dell Products
Nominate a Journalist for Health Reporting
This Month in Texas Medicine

AMA Analyzes Medicare Physician Fee Rule

The American Medical Association has prepared an eight-page analysis of the government's proposed 2014 Medicare Physician Fee Schedule.

The Centers for Medicare & Medicaid Services (CMS) proposal does not address the overall impact of the Sustainable Growth Rate (SGR) formula on physician fees. CMS will release that information in November. Previously, CMS estimated the SGR will reduce payments to physicians by 24.4 percent effective Jan. 1 if Congress takes no action before then.

The AMA analysis covers the 605-page rule's provisions on relative value units, payments for care coordination, the Medicare Economic Index, geographic practice cost indexes, Physician Compare, the Physician Quality Reporting System, electronic health record incentives, value-based payment modifiers, physician feedback reports, telehealth services, billing by chiropractors, colorectal cancer screening, clinical laboratory fees, and liability for overpayments. It also breaks down total allowable charges by specialties.

Efforts in Congress to repeal the SGR continue. In July, the House Energy and Commerce Committee passed and sent to the full House of Representatives HR 2810, the Medicare Patient Access and Quality Improvement Act of 2013. It has received bipartisan support. Instead of just delaying the inevitable annual pay cut, as Congress has done for more than a decade, the bill creates a two-phase plan to eliminate the SGR and provide five years of stable fee updates. It then transitions to a new quality reporting system that links physician pay to a set of physician-endorsed quality measures, while allowing doctors to opt into alternative payment models.

Neither AMA nor the Texas Medical Association fully endorsed the legislation, but leaders of both organizations say they are pleased to see a constructive SGR replacement bill actually gaining some traction in Congress.

The September issue of Texas Medicine will have more information on the bill. 

Incarcerated Patient Demand Letter — New Instructions

Are you confused about how to respond if the Centers for Medicare & Medicaid Services (CMS) attempts to recoup your payments for treating an incarcerated patient?

You probably are, as CMS last month changed its mind on what you're supposed to do after learning it had received incomplete information from the Social Security Administration. Contrary to what it previously said, CMS now advises you not to ask your patient to contact the local Social Security office to have his or her records updated and not to fax information to the CMS regional office in Dallas.

So what are you supposed to do if CMS demands its money back? The agency says this list of Frequently Asked Questions will tell you. CMS is reviewing its data to determine if inappropriate recoupments occurred.

And, keep an eye on the CMS All-Fee-For-Service Providers page for updates.

TMA's Payment Advocacy Department staff is working with the American Medical Association and CMS staff in Baltimore to resolve the issue but in the meantime encourages you to appeal a recoupment demand.

TMA, AMA, and other medical organizations told CMS its recovery efforts are "significantly flawed." In a letter to CMS, they urged the agency to stop the recover and "improve the process used to identify periods of incarceration and clarify denial forms and notices so that providers are aware of the explicit reason justifying a recoupment."

The letter said the groups "oppose the burdensome requirement placed on physicians to confirm the incarceration status of patients. While under certain circumstances providers may be aware that a patient is incarcerated, in other instances providers may have no indication of a patient's status, especially if the patient is residing in a halfway house, living under home detention, on parole, or unconscious and unable to convey that he or she is in custody. To confirm a patient's status, CMS recommends that providers call their Medicare Administrative Contractor (MAC) to inquire whether a patient is incarcerated. This additional administrative duty, however, interferes with the physician's focus on patient care and is overly burdensome given that these inquiries may only affect a small portion of patients. CMS should therefore consider these challenges and find an alternate, more appropriate way to determine whether a patient is in custody.

"Based on reports from physicians and other stakeholders, we believe that providers had little or no knowledge of this payment prohibition or the broad definition of 'incarcerated.' This term applies even when an individual is on parole, on a supervised release, on medical furlough, residing in a mental institution, or other similar situation. Without this clarity, we believe CMS should not unjustly punish physicians and retroactively seek overpayments. Rather, CMS should finalize clear, bright-line guidance to educate providers going forward regarding these types of claims."

CMS began trying to recover improper payments for treating incarcerated patients after the U.S. Department of Health and Human Services Office of Inspector General reported that Medicare erroneously paid $33.6 million for incarcerated patients between 2009 and 2011. Prisons, not CMS, pay for health care of incarcerated people who are otherwise eligible for Medicare. However, a person can be incarcerated without being in jail. A patient who is on parole, supervised release, or medical furlough or who lives in a halfway house or in another similar situation may be in the custody of authorities under a penal statute. In such cases, Medicare payment may be barred.

If you need additional information, email TMA Reimbursement Specialist Liz Jero or call her at (800) 880-1300, ext. 1389, or (512) 370-1389.    


It's Time to Start ICD-10 Implementation

You and your practice staff have hopefully taken the necessary planning and preparation steps to get your ICD-10 transition off to the right start. But the period for planning is quickly coming to an end, and now it's time to get serious about a practical and efficient ICD-10 implementation.


Now that you know the time to get started is now and you have an overview of how it's going to affect your practice and why it's happening, it's time to start piecing the ICD-10 puzzle together and take the first three steps. TMA's seminar ICD-10 Now! How and Why presented earlier this year is now available as an on-demand webinar. You do not want to miss this webinar. It will help you with the next most important phase – implementation.

The time for ICD-10 action is here, and TMA's next seminar, Achieving ICD-10 Implementation Success, will help your practice put all the pieces in place. This seminar details exactly what you need to do in all areas of your practice, highlighting all the basic elements – from initial organizational setup through post-ICD-10 implementation assessment.


TMAIT Action Ad 4.13     

HIPAA Security Requires Practice Risk Analysis

The HIPAA Security rule addresses administrative, physical, and technical safeguards to ensure confidentiality, integrity, and availability of electronic protected health information (e-PHI). It also requires that every practice perform a risk analysis to look for potential risks and vulnerabilities to the confidentiality, availability, and integrity of all e-PHI that an organization creates, receives, maintains, or transmits.


This includes e-PHI in all forms of electronic media, both standard and removable. Computer hard drives and servers, CDs, DVDs, SD cards, external hard discs, smartphones, and tablets are all included. No practice is too small when it comes to compliance, as everything from a single workstation office to a complex network connected among multiple locations fall under the security regulations.

TMA offers two important webinars covering HIPAA Security and the various training updates to the Texas privacy law. With these two TMA HIPAA webinars, you can get the latest security and training requirement updates:

Complying With HIPAA Security 
Aug. 20, noon-1 pm

HIPAA Training for Medical Office Staff
Aug. 27, noon-1 pm 



Texas Company Recalls Sterile Use Products

Sterile Compounding of Cedar Park has voluntarily recalled all products it produced and distributed for sterile use because of reports of bacterial bloodstream infections possibly related to the company's calcium gluconate infusions.


The U.S. Food and Drug Administration (FDA) said in a news release that it "has received reports of 15 patients from two Texas hospitals who received an infusion of calcium gluconate 2 grams in Sodium Chloride 0.9 percent for Injection, supplied by Specialty Compounding. Then the patients developed bacterial bloodstream infections caused by Rhodococcus equi. These infections are thought to be related to the infusions. Cultures from an intact sample of calcium gluconate compounded by Specialty Compounding show growth of bacteria that are consistent with Rhodococcus species."

The FDA said sterile use products produced and distributed by Specialty Compounding are being recalled, "and none of these products should be used by patients or administered to patients. Facilities, health care providers, and patients who have received the products should immediately discontinue use, quarantine the products, and return the products to Specialty Compounding."

The FDA said the firm told it the recalled products "were distributed directly to patients nationwide, with the exception of North Carolina. Recalled products were also distributed directly to hospitals and physicians' offices in Texas."



Conference Probes Payment/Delivery Reform

Potential models the state should consider for reforming health care payment and delivery models will be examined at the Texas State Innovation Models Initiative Conference hosted by the Texas Health and Human Services Commission Aug. 20-21 in Austin.


The Centers for Medicare & Medicaid Services (CMS) granted Texas funding to research and design multipayer payment and delivery system models to help improve health care quality while lowering costs. Potential models include:

  • Accountable care organizations or shared savings arrangements,
  • Bundled or episodic payments,
  • Medical or health homes, and
  • A combination of models.

Texas will submit a report on potential options to CMS by the end of September. In 2014, CMS may award Texas additional funding to help underwrite implementation of the proposed models.

Registration is free on a first-come, first-served basis.


TMLT Action Ad 4.13


Vaccinations Available at Fall Conference

Do you need a flu or Tdap (tetanus, diphtheria, and pertussis) vaccination? If so, you can get one or both at TMA’s Fall Conference.


Physicians and their families, medical students, and office staff can get a vaccination from 7:30 to 8:30 am on Saturday, Oct. 19. The event is sponsored by TMA's Committee on Infectious Diseases and TMA's Be Wise — ImmunizeSM program. 

The cost for the flu shorts will be $27; for FluMist, $40; and for Tdap shots, $80. Be sure to reserve your vaccination when you register for TMA's Fall Conference.

TMA physician leaders and staff are putting together the agenda for the conference. It tentatively calls for updates on what's happening on important health care-related issues in Congress, a review of TMA's success in the 2013 session of the legislature, and a session on TMA's new Physician Services Organization for Patient Care

TMA councils, boards, committees, and sections will meet during the conference.

Book your hotel reservation online by Sept. 26 to receive a discounted room rate.

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance, funded by the TMA Foundation through generous grants from H-E-B and TMF Health Quality Institute. Since the program began in 2004, more than 235,000 vaccinations have been given to Texas children, adolescents, and adults.

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



Throw a Vaccination Party on Influenza Awareness Day

Influenza Awareness Day on Oct. 1 is a perfect time to protect your patients, your staff, and yourself from the flu with a vaccination.


TMA's Be Wise — ImmunizeSM program invites you to sponsor a flu clinic and/or an educational event for your patients. Our poster and flu fact sheet – great for your break rooms or other areas where your staff gathers – help educate your employees about the importance of vaccinations.

To order flu education materials, email Tammy Wishard, TMA's outreach coordinator, or call her at (800) 880-1300, ext. 1470, or (512) 370-1470.

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance, funded by the TMA Foundation through generous grants from H-E-B and the TMF Health Quality Institute.

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



Preparing for EHR Divorce

It's said that choosing an electronic health record (EHR) system is like choosing a spouse. While the majority of EHR unions seem destined for happily ever after, that is not the case with all. Physicians should have an exit strategy as they enter the EHR vendor relationship. The best way to do this is to seek mutually agreeable contract terms. 


TMA recognized the need for this and developed EHR Buyer Beware:  Issues to Consider When Contracting with EHR Vendors. This 8-page document encompasses eight must haves for physicians, including the transferability of patient data. The Office of the National Coordinator (ONC) for Health Information Technology recently released EHR Contracts:  Key Contract Terms for Users to Understand. The 25-page document is more inclusive and covers key information such as details about a "meaningful use" warranty.  

A number of EHR vendors recently banded together to create an EHR Developer Code of Conduct. Ask your EHR vendor if it is part of the code of conduct. If not, it should be. TMA will add that criteria to the current list of questions for the EHR Comparison Tool

If you need assistance with EHR selection, implementation, or meaningful use, the federally established regional extension centers (RECs) can help. For more information, visit the Texas Regional Extension Center Resource Center on the TMA website.  

You can direct questions related to EHRs and other office technologies to TMA's Health Information Technology Department by calling (800) 880-5720 or by email.  


PC Action Ad Aug 13

Save an Extra 17 Percent on Dell Products

From Aug. 17 to Aug. 23, Dell will offer TMA members an additional 17 percent off of all purchases.


To take advantage of this special offer, email Dell and reference Texas Medical Association and your discount ID: HS57183230. Dell will send you a coupon code. Please allow up to 24 business hours to receive a response.

Then, shop online and enter the coupon code at checkout to receive an additional 17 percent off the already discounted pricing! 

And don't forget: Your TMA membership gives you access to all of TMA's Group Discount Programs, including year-round deals on a variety of Dell products.

The offer cannot be used with the student discount.



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.



This Month in Texas Medicine

The August issue of Texas Medicine details TMA's numerous accomplishments in the 2013 Texas Legislature, from regulating "silent PPOs," to reducing red tape in your practices, to adding due process to state Medicaid fraud protections, to preserving tort reform. You can also read about federal preparations for health insurance exchanges and how auditors can make sure insurers are paying you properly.

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. 

Live Webinars  

Complying With HIPAA Security

HIPAA Training for Medical Office Staff

Live Seminars

Achieving ICD-10 Implementation Success

Physician Health and Wellness, Ext. 1342  

Getting Older: Beats the Alternative!
9/20-21 Montgomery

Healthy Physicians: Healthy Patients
9/7 Houston
10/26 San Antonio



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Last Updated On

January 26, 2016