|TMA Action March 3,
|| News and Insights from Texas Medical
INSIDE: Doctors' Orders: Vote
Tell Congress March 5 to Repeal SGR
DPS Announces Interim CSR
CMS Puts Recovery Audit Program on
Meaningful Use Attestation Extended to March 31
Are You Ready for
Stage 2 Meaningful Use Tool
Penalty, Submit PQRS Data by March Deadlines
Nominate a Psychiatrist for DSHS Advisory
How Valuable Your TMA Membership Is
Recognize a Local Journalist’s Health
Exhibit Focuses on Forensics
This Month in Texas Medicine
Doctors' Orders: Vote Tuesday
TEXPAC Board of Directors Chair Jerry Hunsaker, MD, would like you to take a
moment and think about where and when you will vote on Tuesday.
- Which party primary?
- Where is your precinct voting place?
- Will you vote on the way to the office? After hospital rounds? Before you
head home for a fun evening of paperwork?
"Research shows that when people visualize themselves at the polls, in very
concrete ways, they are more likely to actually vote," Dr. Hunsaker, a Corpus
Christi ophthalmologist, said. "I hope this little visualization trick works on
you because we need every physician, alliance member, and medical student in
Texas to turn out and vote for the Party of Medicine."
Texas Medical Association's political action committee, has endorsed a slate of candidates who have strong physician support, who
understand medicine's issues, and who have a good chance of winning. "By helping
to elect these candidates, you're helping TEXPAC protect your patients and your
profession from the intruders who want to tell you how to practice medicine,"
Dr. Hunsaker said.
TEXPAC-endorsed candidates at the top of the ballot include:
- For U.S. senator: John Cornyn (R)
- For governor: Greg Abbott (R) (open seat)
- For lieutenant governor: David Dewhurst (R)
- For attorney general: Dan Branch (R) (open seat)
- For comptroller of public accounts: Harvey Hilderbran (R) (open seat)
For Supreme Court of Texas:
- Place 1: Nathan Hecht (R)
- Place 6: Jeff Brown (R)
- Place 7: Jeffrey Boyd (R)
- Place 8: Phil Johnson (R)
"Also," Dr. Hunsaker noted, "the trial lawyers have infiltrated the
Republican primary for seats on the Texas Supreme Court. Read this analysis from Austin lawyer Mike Hull before you
The full slate also includes Democrats and Republicans endorsed in
races for the Texas Senate and House of Representatives.
"Whether you've already voted or you're headed to the polls on Tuesday, share
the experience," Dr. Hunsaker urged. "Remind your spouse and your colleagues and
your staff and your patients and your friends and your family to vote, too. The
Party of Medicine needs your support."
Tell Congress March 5 to Repeal SGR
You can send a strong message to Congress to eliminate the Medicare
Sustainable Growth Rate (SGR) formula and establish new payment systems that
support high-quality patient care by participating in a national call-in
organized by the American Medical Association on March 5.
Call AMA's toll-free hotline, (800) 833-6354, March 5 to tell Sens. John
Cornyn and Ted Cruz and your House member that you want SGR repeal, not another
short-term payment patch for the 17th time.
Physicians and patients are closer than ever to reaching their long-sought
goal. HR 4015, by Rep. Mike Burgess, MD (R-Texas), and S 2000, by Sens. Max
Baucus (D-MT) and Orrin Hatch (R-UT), represent the first bipartisan, bicameral
legislation to replace the flawed Medicare physician payment update formula.
But Congress has very few days to establish a pathway and enact this
legislation before the scheduled 2014 Medicare physician payment cut of 24
percent takes effect April 1.
AMA developed the following message points you can use when speaking to
- The SGR is widely acknowledged to be a policy failure. Congress has been
forced to intervene 16 times since 2003 to prevent steep payment cuts and
preserve seniors' access to care.
- Now, a bipartisan, bicameral process involving three congressional
committees has produced agreement on a new policy framework that repeals the SGR
and creates a pathway to a higher-performing Medicare program.
- Repealing the SGR is the fiscally responsible choice. Congress has spent
more taxpayer money on short-term payment patches that continue supporting this
failed policy than it would cost to pass the legislation pending today.
- It's time to establish new payment methods that will support the health care
delivery systems that Medicare patients and American taxpayers deserve.
- Congress must seize this opportunity and act before March 31, when the SGR
calls for a 24-percent across-the-board cut in Medicare physician payments.
- Tell Congress it's time to pass HR 4015 and S 2000.
Additional supporting material can be found on the AMA's dedicated website
DPS Announces Interim CSR Renewal Solution
On Jan. 1, renewal of controlled substances registration (CSR) permits
issued by the Texas Department of Public Safety (DPS) should have become part of
physicians' biennial online medical license renewal with the Texas Medical Board
(TMB). TMA advocated passage of House Bill 1803 by Rep. Bill Callegari (R-Katy)
and Sen. Joan Huffman (R-Houston) to ease the administrative hassle and red tape
on physicians when they renew their CSR permits, and to avoid interruptions in
patient care and in physicians' practices due to inadvertent expirations.
Under the law, permits valid on Jan. 1 would automatically extend to the date
of the physician's next state medical license renewal. At that time, the CSR
permit would be valid for two years for a $50 fee.
TMB reports that it had completed the work necessary to implement HB 1803 by
Jan. 1, including developing data-sharing capabilities that allow information to
flow electronically to DPS for processing. DPS wasn't prepared, however, by Jan.
1 to allow for the two-year permit and to synchronize the expiration of the
permit with the physician's license renewal date.
In the past, physicians have had problems when DPS didn't process renewals in
a timely manner, before the CSR permit's expiration. When physicians are unable
to renew their CSR permits, they can't prescribe medications. A physician's
ability to prescribe medications hinges on possession of a valid CSR, which is
necessary to obtain a permit from the Drug Enforcement Administration.
Just as critical, a physician whose CSR permit lapses faces (at least)
temporary suspension of hospital privileges, as maintaining current
certifications is a requirement to retain medical staff privileges in Texas.
To address concerns among physicians and to ensure DPS is ready to begin
processing CSR renewals, TMA has been meeting with department officials and TMB
representatives. DPS told TMA in February that it will take at least six weeks
to implement necessary changes to its processing system and to verify test
As an interim solution, DPS officials say they'll begin synchronizing the CSR
expiration date with the TMB expiration date "in the near future." To ensure
physicians don't experience any disruption in their controlled substances
prescribing authority or place medical staff privileges at risk, DPS has posted
the following information on its Controlled Substances Search and Verification
- CSRs that currently expire in February 2014 or March 2014 will automatically
be renewed by DPS with a temporary one-year expiration date. The renewal will be
completed before expiration without the renewal application and associated fee.
No action is required by the physician. The information on the Controlled
Substances Search and Verification System will be updated.
- Programming changes are under way at DPS to implement the statutory
requirement to synchronize the CSR expiration date with the TMB expiration date.
- Upon completion of the synchronization, the information on the Controlled
Substances Search and Verification System will be updated, and new CSR
certificates will be mailed to each affected practitioner.
Visit the DPS Regulatory
Services webpage for updates and additional information as it becomes
CMS Puts Recovery Audit Program on Pause
The Centers for Medicare & Medicaid Services announced in late February
that it will pause additional documentation requests by Recovery Audit
Contractors (RAC) until new RAC contracts are finalized. The pause in requests
began Febr. 21, the last day a recovery auditor could send postpayment
additional documentation requests (ADRs).
Take note of the following important dates:
- Feb. 28 was the last day a Medicare administrative contractor (MAC) could
send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration.
- June 1 is the last day a recovery auditor may send improper payment files to
the MACs for adjustment.
"It is important that CMS transition down the current contracts so that the
recovery auditors can complete all outstanding claim reviews and other processes
by the end date of the current contracts. In addition, a pause in operations
will allow CMS to continue to refine and improve the Medicare Recovery Audit
Program," CMS said in an online notice. "CMS has proven it is committed to constantly
improving the program and listening to feedback from providers and other
CMS says it will "continue to review and refine the [Medicare Recovery Audit
Program] process as necessary."
The agency will continue to update its Recovery Audit Program website with more information on the procurement and awards as
information is available. Providers should email RAC[at]cms[dot]hhs[dot]gov for additional
Medicare Meaningful Use Attestation Extended to March 31
March 31 is the new deadline for physicians to attest to meeting the
Medicare electronic health record (EHR) meaningful use criteria for the 2013
program year, the Centers for Medicare & Medicaid Services (CMS) announced.
The previous deadline was Feb. 28.
Physicians participating in the Medicaid EHR incentive program have until
March 16 to attest.
TMA recommends that physicians not wait until the last minute to attest, as
CMS could experience system overload that may impact your ability to attest on
TMA has developed these step-by-step instructions to help guide physicians
through the process:
CMS has provided these tips on attesting:
- Ensure that your payment assignment and other relevant information is up to
date in the Medicare payment system PECOS.
- Make sure to include a valid email address in your EHR program registration.
- Consider logging on to use the attestation system during nonpeak hours such
as evenings and weekends.
- Log on to the registration and attestation system now; ensure that your
information is up to date and begin entering your 2013 data.
- If you experience attestation problems, report the problem to the EHR
Incentive Program Help Desk at (888) 734-6433.
Direct your questions about the program to TMA's Health Information
Technology Department by calling (800) 880-5720 or by email.
Physicians needing onsite assistance with the EHR meaningful use program may
consider contacting one of the four Texas regional extension centers (RECs).
Visit TMA's REC Resource Center for information about the RECs and
the services they provide.
Are You Ready for ICD-10?
The Oct. 1 compliance date to transition to ICD-10 will be here before you
know it. A January report from the Medical Group Management Association (MGMA)
suggests physicians, payers, and electronic health record (EHR) vendors are all
well behind the curve in preparing for implementation.
The report shows fewer than 10 percent of responding practices had made
significant progress when rating their overall readiness for ICD-10
implementation. Only 8.2 percent had begun or completed testing with their EHR
vendor, and nearly 60 percent of respondents stated they hadn't heard from their
major health plans as of December regarding when ICD-10 testing would
On top of that, a new AMA-commissioned cost study
says the costs for physician practices to implement the
federally mandated transition to the ICD-10 code set are three times earlier
Using the new report as ammunition, AMA "strongly urged" U.S. Health and
Human Services Secretary Kathleen Sebelius to "reconsider the mandate."
The study, conducted by Nachimson Advisors, compared current estimates of
ICD-10 conversion with Nachimson's 2008 report. For a typical small practice,
the costs increased from $83,290 in 2008 to a range of $56,639 to $226,105 in
2014. Costs for a typical large practice jumped from $2.7 million in 2008 to a
range of $2 million to $8 million this year.
The Centers for Medicare & Medicaid Services (CMS) mandated the ICD-10
diagnosis code set for use by physician practices, other practitioners,
clearinghouses, and health plans. With ICD-10 containing more than five times
the number of codes as ICD-9 and incorporating a completely different structure,
the new code set will require extensive changes for medical groups.
On Feb. 19, the federal government agreed to conduct limited end-to-end
testing on ICD-10 for a small sample group of health professionals selected to
represent "a broad cross-section of provider types, claims types, and submitter
"End-to-end testing includes the submission of test claims to [the Centers
for Medicare & Medicaid Services] with ICD-10 codes and the provider's
receipt of a Remittance Advice (RA) that explains the adjudication of the
claims," CMS said in a memo to health professionals.
American Medical Association President Ardis Dee Hoven, MD, says that while
the decision to conduct end-to-end testing pleases AMA, the association
"continues to urge CMS to reconsider the ICD-10 mandate during a time when
physicians are struggling to keep up with many other costly, federal
At the AMA House of Delegates meeting in June, TMA delegates directed
AMA to support federal legislation to "stop the implementation of ICD-10 and
remain with ICD-9 until ICD-11 can be properly evaluated." Although TMA opposes
the transition to ICD-10, the association has many tools and resources to help
you get ready for the new coding system, should CMS persist in its current
- TMA's newest statewide seminar series, ICD-10 Documentation and Auditing: Success Is
in the Details, delves into how to use the new ICD-10-CM code book and its
guidelines and how to audit physician documentation in day-to-day practice.
- ICD-10 Now! How and Why, an on-demand webinar from TMA, offers a detailed
look at everything you need to know and do to prepare for ICD-10. TMA's
on-demand webinar ICD-10 Starts With Physicians targets physicians, office
managers, and coders. It highlights the ICD-10 transition process, code
structure, and the impact of ICD-10 on a practice. Register for the webinars online.
- Be sure to bookmark TMA's ICD-10 resource page for news,
tools, education, updates, and the ICD-10 Readiness Questionnaire for Vendors
from the American Health Information Management Association.
- The TMA Knowledge Center
alert service will also keep practices up to date with the newest articles and
latest developments on ICD-10 and other health care topics. TMA Knowledge Center
staff have created custom searches on ICD-10 and many other topics set to run
weekly. The search can be emailed directly to you or accessed via RSS feed. TMA
Knowledge Center alerts provide citations and abstracts along with some
full-text access. Fill out the online form to sign up.
New Stage 2 Meaningful Use Tool
The Centers for Medicare & Medicaid Services (CMS) and the Office of the
National Coordinator for Health Information Technology (ONC) have a new tool to
help you meet the meaningful use Stage 2 transitions of care measure. The EHR Randomizer allows physicians to exchange data with a
designated test electronic health record (EHR) system to meet part of the
The transitions of care requirement includes three measures. The EHR Randomizer
assists in meeting the third measure, which requires you to:
- Conduct at least one successful electronic exchange of a summary-of-care
document with a recipient who has EHR technology developed by a different
- Conduct at least one successful test with the CMS designated test EHR during
the EHR reporting period.
CMS and ONC have chosen McKesson and Meditech as test EHRs. The agencies have
asked other EHR technology developers to participate in the test program.
Follow these steps to use the EHR Randomizer:
- Register online with EHR Randomizer. Your EHR technology will
pair automatically with a different test EHR from a list of authorized systems.
- Send a Consolidated Clinical Document Architecture (CCDA)
summary-of-care record to the test EHR. Make sure the test CCDA document you
submit doesn't contain actual patient data.
Within one day of the test transmission, the test EHR will email you a
notification of success or failure. Keep the notification as proof of meeting
the transitions of care measure.
For more detailed information, view the EHR Randomizer Test Instructions.
For more information about the EHR Medicare and Medicaid meaningful use
incentive programs, see the TMA website or contact
TMA's Health Information Technology Department by telephone, (800) 880-5720, or
Avoid Penalty, Submit PQRS Data by March Deadlines
Act now to avoid the Physician Quality Reporting System (PQRS) penalty,
which in 2015 will be based on the 2013 PQRS reporting year.
Deadlines for reporting through the TMA-endorsed online registries are
approaching. To avoid the penalty, you have until March 13 at 4 pm CT to submit
PQRS data for the 2013 PQRS reporting year via the PQRSwizard. Click here to see a 10-minute tutorial on how to report PQRS data in
four easy steps or visit PQRSwizard to get started.
For the Covisint PQRS
registry, the submission deadline has been extended to March 8. Find more information here on how to report data using Covisint PQRS, or register for PQRS reporting today.
Remember, participation in the electronic health record (EHR) meaningful use
program does not mean automatic PQRS participation. Check with your EHR vendor
now. If PQRS data were not submitted, your last option to report PRQS data for
the 2013 reporting year is through the online registries.
Nominate a Psychiatrist for DSHS Advisory Board
The Texas Department of State Health Services (DSHS) is seeking physician
nominees certified in psychiatry to serve on the department's Medical Advisory
Board (MAB). Physicians appointed to the MAB work with DSHS and the Department
of Public Safety on determining whether driver's license applicants or current
license holders are medically capable of safely operating a motor vehicle.
Physician members also review concealed handgun license applications.
MAB meetings occur twice a month in Austin. DSHS requires members to attend
approximately six meetings a year, and the department provides $100
reimbursement to board members per meeting attended.
If you'd like to nominate a psychiatrist to serve on the MAB, email the
potential nominee's contact information to TMA's Director of Public Health Margaret Mendez by April 18.
For more information on the MAB, visit the DSHS website.
Find Out How Valuable Your TMA Membership Is
Do you ever wonder how hard your membership dues dollars are working for
you? By delivering a wealth of benefits and services,
your TMA and county medical society membership offers a great return on
Whether you're looking for help with compliance issues, running into payment
problems, or just searching for some quality continuing medical education, make
the most of your membership by taking advantage of the resources available from
TMA and your local county medical society.
Take a look at what your peers are getting out of their membership:
See for yourself just how valuable your investment is by trying out TMA's ROI
Your TMA membership also provides you access to exclusive discounts on
products and services from reputable vendors. TMA Endorsed
Services and TMA's Group Discount
Programs allow you to leverage your membership in the largest state medical
association in the country. Be sure to mention your TMA membership to receive
great deals on items you use every day.
to calculate your ROI. Visit the TMA website to explore
all of your member benefits, and renew today.
Recognize a Local Journalist’s Health Reporting
Flu. Health disparities. Obesity. Concussions. These are just a few topics
already making headlines in 2014. If you read or hear a great health news story,
nominate it for the TMA Anson Jones, MD,
Awards, which recognize excellence in health journalism in Texas. TMA has
honored award-winning Texas journalists for more than 50 years.
Physicians, medical students, TMA Alliance chapters, and county medical
societies now can nominate local print or broadcast journalists for an
Send your nominations to ansonjones[at]texmed[dot]org. Include the
reporter's name, date of broadcast/publication, and the media outlet. TMA will
send a postcard to the reporter with a handwritten note alerting him
or her of your nomination.
TMA Exhibit Focuses on Forensics
Forensics experts peer into microscopes to solve crimes almost nightly on
television. How did forensic medicine, which has revolutionized investigations,
begin? Find out with a visit to TMA's newest History of
Medicine exhibit, "Bugs, Bones, and Blood," which examines forensic medicine
— the search for truth when someone dies suddenly or mysteriously.
Who knew that the first forensic report determining someone's cause of death
was about Julius Caesar 2,500 years ago? (The reporting physician identified a
stab wound in Caesar's chest — one of 23 wounds he suffered — that killed him.)
And few realize that Paul Revere was the first to use teeth to identify a
deceased person — after the Battle of Bunker Hill of the American
and Blood" chronicles the evolution of forensic medicine from 5,000 years
ago to present day. The exhibit includes two monumental events in Texas history:
the Texas City Disaster of 1947 — the worst industrial accident in American
history — and President John F. Kennedy's assassination.
The exhibit, located in the History of Medicine Gallery on the first floor of
the TMA building, is open from 9 am to 5 pm Monday through Friday.
This Month in Texas Medicine
The March issue of Texas
Medicine examines how Texas practices are coping with challenges brought
about by the Affordable Care Act, new rules that overhaul residency training
accreditation, the impact of patient noncompliance on quality outcomes and
physician ratings, the challenges physicians face in giving the HPV vaccine, new
DocbookMD features, and a profile of the TexMed 2014 General Session speaker,
Zubin Damania, MD.
out our digital
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
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
This Just In ...
Want the latest and hottest news from TMA in a hurry? Then log on to Blogged
Deadlines for Doctors
TMA's Deadlines for Doctors alerts you and your staff to upcoming
state and federal compliance timelines and offers information on key health
policy issues that impact your practice.
Submission Deadline for 2013 PQRS Reporting Via
Medicaid: EHR Incentive Program Attestation Deadline
for 2013 Participation
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
ICD-10 Documentation and
4/3 Wichita Falls
Dealing with Difficult
Making Discussions About Death and Dying
Meaningful Use: Information Technology
Physician Health & Wellness, ext. 1342
Healthy Physicians: Healthy Patients
Action, the TMA newsletter, is emailed twice a month to bring you
timely news and information that affects your practice.
To change the email address where you receive Action, go to Member
Log-In on the TMA website, then click on "Update Your TMA Demographic
Information (including newsletter subscriptions and preferences)."
To unsubscribe from Action, email TMA's Communication Division at tmainfo[at]texmed[dot]org.
If you have any technical difficulties in reading or receiving this message,
please notify our managing editor, Shari
Henson. Please send any other comments or suggestions you may have about the
newsletter to Crystal Zuzek,