|TMA Action Jan. 3,
|| News and Insights from Texas Medical
INSIDE: 20 Percent Off: Exceptional CME at an
20 Percent Off:
Exceptional CME at an Exceptional Value
Didn't Report PQRS Data in 2013? You Still Have
Time to Avoid the Penalty
TMA to Feds: Don't Finance Inaccurate Plan
Directories on Physicians' Backs
Two Meaningful Use Deadlines Coming Up
Texas Health Department
Issues Influenza Warning
ACA Exchange Plans: Questions and Answers for
Discovery at Winter Conference
Is Your Practice Compliant With HIPAA Privacy
Form Adopted for Workers' Compensation
Cultural Competence Focus of Physician Health and
This Month in Texas Medicine
20 Percent Off: Exceptional CME at an Exceptional Value
Save money through Jan. 31 by taking 20 percent off your already low member
price for Texas Medical Association's continuing medical education (CME) courses
in the TMA Education Center.
Visit the TMA Education
Center to stockpile the CME courses you’ll need for the year. Any on-demand
courses and publications you buy in January will be available for viewing later
as your schedule allows time for completion.
A discount on all TMA CME courses is already a great benefit of your TMA
membership, but for the entire month of January, this substantial member
discount has gotten even bigger. Now through Jan. 31, get everything you need to
satisfy your CME credit requirements and receive an additional 20 percent off
your entire TMA Education Center purchase.
Whether or not you've ever taken advantage of your TMA member discount on
CME, now is the perfect time to see what's available in the TMA Education Center. With more than 80 TMA-quality CME
courses, including some 50 that offer ethics credit, you won't have a problem
finding something that can benefit you and your practice.
This exciting offer applies only to current TMA members and their staff and
is available only through the end of January. It excludes live seminars,
software tools, and the Texas Medical Jurisprudence Manual and Study
Guide. Contact the TMA Knowledge Center with questions or for assistance by
email or by phone at (800)
Didn't Report PQRS Data in 2013? You Still Have Time to Avoid the
Eligible physicians (EPs) not participating in the Physician
Quality Reporting System (PQRS) for the 2013 reporting year will pay a
1.5-percent penalty on their Medicare claims in 2015. However, individual
physicians and group practices that have not yet reported PQRS data, did not
elect the administrative claims-based reporting option in October, and do not
plan on meeting the full requirements to earn the 0.5 percent bonus still can
avoid the penalty.
According to the Centers for Medicare & Medicaid Services (CMS), the
following options are available.
EPs can avoid the penalty if they report at least:
- One valid individual measure via claims, participating registry, or
qualified electronic health record (EHR); or
- One valid measure in a measures group via claims or participating registry.
Group practices participating in the group practice reporting option,
referred to as GPRO, can avoid the penalty if they report at least:
Note: You will not earn the 2013 PQRS 0.5-percent bonus payment
simply by reporting one valid measure or one measures group. You will only avoid
the future 1.5-percent penalty in 2015. Physicians and group practices can still
participate fully in PQRS for 2013 — thus earning the bonus and avoiding the
penalty — by reporting the required measures via claims, registry, or qualified
PQRS Reporting Methods and Deadlines
Claims-Based Reporting: All claims adjustments, re-openings,
or appeals processed by Novitas Solutions must reach the national Medicare
claims system data warehouse by Feb. 28, 2014, to be included in the 2013 PQRS
analysis. To view a claims example, see CMS-1500 Claim PQRS Example.
Participating Registry: TMA endorses two registries for PQRS:
PQRSwizard and Covisint PQRS.
The submission deadline for the PQRSwizard registry is March 13, 2014. For
Covisint PQRS, the submission deadline is March 1, 2014. Learn about TMA's discounted rates for these registries.
Electronic Health Record (EHR): You have until Feb. 28, 2014,
to submit data via a qualified EHR. Find out from your EHR vendor if this
capability is incorporated into your EHR or is an add-on service.
TMA to Feds: Don't Finance Inaccurate Plan Directories on Physicians'
Calling it either "an enormously unfortunate oversight" or "a government
grab at discount health care services," TMA is vehemently opposing a new federal
policy regarding physician participation in the Affordable Care Act exchange
marketplace health plans. The policy is one of the "smooth transition" policies
the U.S. Department of Health and Human Services (HHS) recommended in an interim
final rule published Dec. 17, 2013.
At issue are the notoriously inaccurate provider directories that health
plans publish. In the interim final rule, HHS acknowledged that patients
choosing a marketplace plan very well could be misled if they rely on the
often-outdated directories the plans publish. Nonetheless, that interim final
rule "strongly encourages" health plans to treat any out-of-network physician as
in-network if the plan incorrectly lists that physician in its directory.
"In other words," TMA wrote in a strongly worded letter to HHS officials, "a physician's
out-of-network status may change, without the physician's knowledge or consent,
based solely on a [plan's] failure to maintain an accurate provider
Effectively, the policy would require physicians to abide by terms of a
contract they have not agreed to and actually may have rejected or terminated.
"This suggests that the traditional contractual relationship between a health
plan and an in-network physician be trumped by a rule of convenience," TMA
To emphasize the importance of its concern, TMA shared the results of its 2012 Survey of Physicians, which found that 62 percent of
physicians had detected cases in which they were listed as participating in
networks when in fact they were not. Medical and surgical specialists reported
the bad listings most frequently.
To protect both patients who rely on the inaccurate directories and the
physicians who are erroneously listed, TMA suggested several additions to the
interim final rule:
- Health plans "shall fully pay" the incorrectly listed physician and
calculate the patient's financial responsibility for services provided to
patients who buy a marketplace exchange plan based on the out-of-network
physician's billed charge.
- For patients in "special circumstances," in which the physician believes
discontinuing care could cause harm, the physician may ask that he or she
continue to provide care to the patient. In those cases, the plan will "fully
pay" the physician based on the out-of-network physician's billed charge. The
patient would be responsible for no more than he or she would have paid if the
physician actually was in-network.
"TMA strongly opposes the financing of [marketplace] coverage on the backs of
physicians," the association wrote. "Only [the marketplace plans] have the
access, ability, and obligation to ensure that provider directories are accurate
and up-to-date, and [they] must be held accountable for such
Two Meaningful Use Deadlines Coming Up
Physicians participating in the Medicare electronic health record (EHR)
meaningful use program have until Feb. 28, 2014 (precisely at 10:59 pm CT) to
complete their attestations. Physicians participating in the Medicaid meaningful
use program have until March 16.
TMA recommends that you DO NOT WAIT until the last minute to complete the
attestation. Any glitch that prevents you from attesting by the deadline could
compromise your 2013 payment.
The Centers for Medicare & Medicaid Services has created a new interactive tool that helps physicians determine their
eligibility to participate in various eHealth programs such as:
- EHR incentive program,
- Value-based payment modifier program,
- Physician Quality Reporting System (PQRS), and
- Maintenance of Certification Program Incentive.
The tool prompts you to answer a few basic questions to help you determine
For more information about EHRs or other health information technology
issues, contact TMA's Health Information Technology Department by telephone at
(800) 880-5720 or by email.
Texas Health Department Issues Influenza Warning
With influenza "now widespread" across Texas, the Department of State Health
Services (DSHS) has issued flu testing and treatment guidance for Texas physicians. More
than 80 percent of the confirmed cases have been of the H1N1 subtype.
DSHS Commissioner David Lakey, MD, also reminded Texans that it's not too
late to get a flu shot. "Flu can be deadly," Dr. Lakey said. "People who have
not been vaccinated should do so now. It's the best defense we have."
He added that protection from the 2009 pandemic H1N1 subtype is included in
this year's influenza vaccine.
Dr. Lakey advised physicians to consider antiviral treatment even for
patients whose initial rapid-flu test is negative. "When there is clinical
suspicion of influenza and antiviral treatment is indicated, antiviral treatment
should be started as soon as possible, even if the result of the RIDT is
negative, without waiting for results of additional influenza testing," he
The commissioner added that neither novel influenza cases nor antiviral
resistant influenza strains have been reported in Texas.
"All Texas regions have reported laboratory-confirmed influenza," Dr. Lakey
said. "Over 90 percent of positive influenza tests reported from Texas
laboratories have been typed as influenza A. Of those influenza A viruses that
have been subtyped, 90 percent have been the 2009 pandemic H1N1 subtype."
According to media reports in mid-December, public health officials in the
Houston area had confirmed that six people had died from H1N1 in the region.
That includes four deaths at Conroe Regional Medical Center in Montgomery
County. An additional death from H1N1 was reported in Travis
TMA Discovery at Winter Conference
Want to learn more about the many great benefits your TMA membership brings?
Have a question or want hands-on training on how to use a member service? Stop
by the TMA Discovery Zone at the 2014 TMA Winter
Conference, where you can explore some fantastic things your TMA is doing to
support physicians across Texas.
Visit the TMA Discovery Zone to:
- Peruse the current CME catalog in the TMA Education Center;
- Learn how TMA's expert consultants can assist your practice;
- Get hands-on training for DocbookMD — a HIPAA-secure mobile communication
- Get answers from TMA Knowledge Center staff;
- Find technology and quality resources for meaningful use, the Physician
Quality Reporting System, and more; and
- Ease your transition to ICD-10 with an introduction to TMA's Complete ICD-10
TMA Winter Conference will be at the Hyatt Regency in Austin Jan. 31-Feb. 1,
and registration is open. Make your hotel reservations by Jan. 9
to receive the special TMA rate of $189. Book online or by calling (888) 421-1442. Texas Health and Human
Services Executive Commissioner Kyle Janek, MD, along with a panel of physician
leaders and legislators, will discuss this new health care transformation during
the General Session on Saturday, Feb. 1, from 8:30 to 11:45 am.
Is Your Practice Compliant With HIPAA Privacy Laws?
Covered entities that have signed new business associate agreements since
Jan. 25, 2013, (when the HIPAA Omnibus Final Rule was published) had until Sept.
23, 2013, to amend those agreements so they comply with the new
The final rule broadens the definition of a business associate to include all
entities that routinely require access to protected health information (PHI). It
also dictates that any entity that contracts with one of your business
associates and regularly deals with PHI on their behalf also will be regulated
as a business associate.
Do any of your vendors come under the expanded definition of business
associate? Is your notice of privacy practices up to date? TMA is offering a
replay of the webinar Complying With HIPAA and Texas Privacy Laws from noon to 1 pm
CT on Jan. 15 to ensure you can answer these questions. Register now to learn about the latest HIPAA updates and
Need to know more? Visit TMA's HIPAA Resource Center, and
don't miss these upcoming HIPAA security and training requirement updates:
New Claim Form Adopted for Workers' Compensation
Texas Commissioner of Workers' Compensation Rod Bordelon adopted rules requiring the use of the newly updated 1500 Health
Insurance Claim Form Version 02/12 (CMS-1500).
The rules, adopted Dec. 16, 2013, mandate that physicians and other health
care professionals use the new CMS-1500 form for bills submitted for workers'
compensation medical services on or after April 1, 2014.
TMA has been informed that the Texas Department of Insurance-Division of
Workers' Compensation will announce some training sessions for the new rules to
take place in February. Stay tuned to Action and the workers'
compensation advocacy section of the TMA website for updates.
Cultural Competence Focus of Physician Health and Wellness
"Cultural Competence: Putting Patients First" will be the theme of the
Physician Health and Wellness (PHW) Training Session and 21st Annual Retreat
held Feb. 14-15 at the Inn on Barons Creek in Fredericksburg. Presented by the
TMA Committee on PHW, the conference has been accredited for a maximum of 10.25
AMA PRA Category 1 Credits™, 7.5 of which are designated as ethics
and/or professional responsibility education.
Those who will benefit from the seminar are physicians of all specialties;
members and potential new members on the regional education teams of the PHW
Committee; members and consultants of state and county medical society PHW
committees; district coordinators; hospital chiefs of staff, medical staff
coordinators, and members of hospital-based peer assistance committees; and
others interested in learning more about the issues.
Presentations during the conference will include Prescription Access in
Texas; Cultural Competence; How to Engage Your Audience in an Effective
Presentation; Beyond PowerPoint: Other Technologies on the Horizon; Copyright
Laws: What Physicians Need to Know; Ethics of Cultural Conflicts in Medicine;
Folk Medicine; Complementary and Alternative Medicines; How to Improve
Communication Skills in Cross-Cultural Populations; and Sexuality, Gender
Variance, and Cultural Competence.
Upon completion of this activity, participants should be able to:
- Evaluate how using the Prescription Access in Texas program improves patient
health and well-being and helps avoid discipline by the Texas Medical Board for
prescribing controlled substances to patients with substance abuse issues;
- Define cultural competence in patient-centered care;
- Distinguish the broad view of cultural competence from a focus on individual
- Assess the ethics of balancing nondiscrimination and respect for specific
- Analyze cross-cultural similarities;
- Recognize the ethical dilemmas associated with cultural competence;
- Use tools presented to improve patient outcomes through cultural competence;
- Practice skills that will engage an audience in an effective presentation;
- Compare the technologies that may be used, an addition to PowerPoint;
- Summarize copyright laws that pertain to physicians who serve on TMA boards,
councils, and committees;
- Determine the ethical implications of cultural conflicts in medicine;
- Assess the role and ethics of folk medicine in patient care;
- Examine complementary and alternative medicines that patients may request;
- Translate skills learned to improve communication skills with diverse
patient populations; and
- Determine the implications of patients' sex and culture in clinical practice
and how they affect patient outcomes.
Review the conference brochure and register online. To request a brochure or
for additional information, contact Linda Kuhn by telephone at (800) 880-1300,
ext. 1342, or (512) 370-1342, or by email.
This Month in Texas Medicine
The January issue of Texas Medicine
reports the results of a RAND survey about what makes physicians
happy and what makes them feel dissatisfied with practicing medicine. It
also tells you how TMA's Physician Services Organization will equip
physicians for the crucial role they will play in new health care models;
explains the key role physicians play in educating patients about vaccines;
discusses how an improved Medicaid provider portal has the potential to improve
care, if done right; examines the impact of AMA's declaration that obesity is a
disease; and explains how TMA is helping physicians incorporate the "Choosing
Wisely" program into their daily practice.
out our digital edition.
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OSHA Annual Training Webinar
Hard Knocks: An Update on Concussion and Texas
Physician Health & Wellness, ext. 1342
Cultural Competence: Putting Patients First
Healthy Physicians: Healthy Patients
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