Action: Jan. 3, 2014

TMA Action Jan. 3, 2014   News and Insights from Texas Medical Association 

INSIDE: 20 Percent Off: Exceptional CME at an Exceptional Value

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 Texas Physicians

TMA Discovery at Winter Conference
Is Your Practice Compliant With HIPAA Privacy Laws?
New Claim Form Adopted for Workers' Compensation
Cultural Competence Focus of Physician Health and Wellness Conference
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) 880-7955.

Didn't Report PQRS Data in 2013? You Still Have Time to Avoid the Penalty 

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.

Individual EPs

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 

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 EHR.

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.

More Information  


TMA to Feds: Don't Finance Inaccurate Plan Directories on Physicians' Backs

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 directory." 

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 wrote.

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:   

  1. 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.
  2. 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 misrepresentations." 


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 eligibility. 

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 said.

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 County.   


 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 tool;
  • 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 Implementation Solution.  

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 regulations.

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 deadlines.

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.   


   PC Action Ad June 13

Cultural Competence Focus of Physician Health and Wellness Conference

"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 differences;
  • Assess the ethics of balancing nondiscrimination and respect for specific cultural values;
  • 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.

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. 


OSHA Annual Training Webinar

Hard Knocks: An Update on Concussion and Texas Law  


TMA Winter Conference
1/31-2/1    Austin

5/2-3    Fort Worth  

Physician Health & Wellness, ext. 1342

Cultural Competence: Putting Patients First  
2/14-15 Fredericksburg 

Healthy Physicians: Healthy Patients 
3/29      Galveston 
4/5        Amarillo 

About Action       

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Last Updated On

August 23, 2016