|TMA Action May 16,
|| News and Insights from Texas Medical
INSIDE: Tax Refund Fraud Scheme Affects Texas
Tax Refund Fraud
Scheme Affects Texas Physicians
Eligible Primary Care Physicians Get Medicaid Pay
Handful of Candidates Need Your Votes
United's New Reports Target Physician
Sues Xerox; HHSC Cancels Xerox Medicaid Contract
Keep Records When
Attesting to Meaningful Use
Contact Congress on High-Risk Lung Cancer
Releases MERS-CoV Advisory Following First U.S. Case
|Consider Chikungunya in Patients Who Have
Hard Hats for Little Heads Marks 20
Offers Comprehensive Guide for Physician Employment
TMA Training Helps Docs
Who Treat Commercial Drivers
TMA Seminar Outlines New NPP Supervision
for the 2013-14 Texas Physician Practice Quality Improvement Award
Register for the Texas
Healthcare and Bioscience Summit
This Month in Texas Medicine
Tax Refund Fraud Scheme Affects Texas Physicians
Physicians are the latest victims in a tax refund fraud scheme making waves
across the nation. The American Medical Association reports it's working with
federal officials in the investigation, headed by the Internal Revenue Service
(IRS) and the Secret Service. While the exact source of the identity theft
hasn't been detected, several theories exist.
Most physicians who are victims of this scam first learn of it when they
receive an IRS 5071C letter advising them of possible fraud. Others receive a
rejection notification when attempting to file their tax return electronically.
It indicates it cannot be submitted because a return has already been filed
under the physician's Social Security number.
The 5071C letter from the IRS has instructions for providing information via
the IRS identity theft website. Affected physicians can call the IRS at (800)
830-5084 to let the agency know they did not file the return referred to in the
So far, the Texas Medical Association has learned four Lubbock physicians
have fallen prey to this scam. They discovered the theft when they attempted to
file their tax returns.
Please notify TMA if you have been victimized by this scheme. The association
can then convey the scope of the situation to the proper authorities. Contact
the TMA Knowledge Center at (800) 880-7955, or email email@example.com.
In February, the IRS issued a report titled "Dirty Dozen" Tax Scams for 2014 on identity theft
affecting tax payers.
AMA has the following guidance for fraud victims:
- File a paper return, and attach a Form 14039 Identity Theft
Affidavit to explain what happened.
- Attach copies of the 5071C letter and any other notices from the IRS on this
Physicians who did not receive a 5071C letter or already have received
confirmation of legitimate tax return acceptance most likely are not victims of
this year's scam.
If you have not received notice from the IRS but believe your personal
information may have been used fraudulently or worry you may have been
victimized, call the IRS Identity Protection Specialized Unit at (800)
The North Carolina Medical Society (NCMS) has heard from dozens of physicians
in the state who are victims of this scheme. NCMS suggests contacting the
following agencies if you learn your Social Security number has been used
- File a complaint with the Federal Trade Commission (FTC), which
recommends other immediate steps and provides helpful information on its website.
- Consider filing a police report locally. Bring all documentation available,
including any state and federal complaints you filed. This likely will be
necessary if financial account fraud occurred as a result of the identity theft.
If the only fraud is tax-related, however, the police report will be necessary
only if the IRS requests it.
- Call the Social Security Administration's fraud hotline at (800) 269-0271 to
report fraudulent use of your Social Security number. In case your number is
being used for fraudulent employment, you also can request your Personal Earnings and
Benefit Estimate Statement or call (800) 772-1213. Check it for accuracy.
- Consult the U.S. Department of Justice website for
Also, the FBI has tips to help you protect your personal identity from
Eligible Primary Care Physicians Get Medicaid Pay Increase
On May 7, the Texas Medicaid and Healthcare Partnership (TMHP) began issuing
retroactive supplemental Medicaid payments for fee-for-service claims submitted
by primary care physicians who qualify for the payment increase as authorized by
the Affordable Care Act. Supplemental payments will be made weekly until TMHP
has paid all retroactive eligible claims. Once caught up, TMHP will then make
ACA increased Medicaid payments to Medicare parity for evaluation and
management and vaccine administration services provided by pediatricians, family
physicians, and general internists, as well as each of their respective
subspecialists. The higher payments, paid for entirely with federal funds, apply
to claims submitted between Jan. 1, 2013, and Dec. 31, 2014. To receive the
higher payments, physicians must attest to their eligibility.
Physicians who attested before April 1, 2014, are eligible for payments
retroactive to Jan. 1, 2013. Those who attest after the deadline will receive
supplemental payments only for claims submitted after April 1.
Rates were increased to the state fiscal years 2013 and 2014 adjusted Medicare rate for eligible services. Physicians will
be paid the difference between the paid Medicaid amount and the minimum payment
required under federal law. Federal regulations require Medicare and Medicaid to
pay the "lesser of" physicians' billed charges or the allowable amount. The same
regulation applies to the Medicaid primary care physician rate increase.
- If the physician's billed charges on the original claim are greater than or
equal to the state adjusted Medicare rate, he or she may receive a supplemental
- If the health professional's billed charges on the original claim are less
than the state adjusted Medicare rate, no supplemental payment will be made.
Earlier this year, Medicaid HMOs began issuing retroactive supplemental
payments to eligible primary care physicians within their networks. Those
initial payments excluded vaccine administration codes, as well as Texas Health
Steps services provided in group practices.
Beginning in late May or early June, HMOs also will issue retroactive
payments for these services. At the same time, the HMOs will reconcile payments
to physicians who received retroactive payments for the second quarter of 2013
but not the first quarter because of the timing of their attestation. The
reconciliation process also is expected to resolve missing payments for
erroneously excluded physicians or services.
Direct any questions regarding supplemental payments for either HMO or
fee-for-service claims to TMHP, the Texas Medicaid administrator, at (800)
The state calculates the amount of supplemental payments owed to each
physician based on HMO encounter data. The state sends the monies to the HMOs,
which act as agents of the state and pass the monies along. HMOs are not
involved in determining how much each physician should be paid.
Federal regulations prohibit both TMHP and the HMOs from charging an
administrative fee to distribute the funds due to physicians.
A Handful of Candidates Need Your Votes
TEXPAC Chair Jerry Hunsaker, MD, asks an interesting question: "When is a
handful really a whole lot?"
The answer: "When that handful is the 12 outstanding candidates TEXPAC has endorsed in the May 27
primary election runoffs. Electing these 12 men and women to office will make a
whole lot of difference to our profession and our patients."
Early voting for the runoffs is 7 am-7 pm, Monday, May 19, through Friday,
May 23. If you are registered to vote, you may vote in either party's runoff
unless you voted in the March 7 primary. Then you must stay with that party. It
is not necessary to have voted in the primary to vote in the runoff.
Helping State Sen. Robert Deuell, MD (R-Greenville), win his party's
nomination for reelection is TEXPAC's No. 1 goal for the runoffs. The PAC is
heavily involved in nine other legislative runoffs — Democratic and Republican,
House and Senate. In statewide Republican races, TEXPAC endorsed:
- Lt. Gov. David Dewhurst for renomination, and
- Dan Branch for attorney general.
Each of these candidates has earned TEXPAC's endorsement based on their
records in office and/or interviews with local physicians.
"It's critical that we help all 12 secure their nominations," Dr. Hunsaker
said. "It's almost gotten to the point where intra-party fights are trumping
partisan differences in Austin. Since turnout is notoriously low in runoffs,
your vote and your friends,' family members,' and neighbors' votes can turn the
"Vote early, but not often."
Paid for by Texas Medical Association Political Action Committee, 401 W.
15th St., Austin, TX 78701
United's New Reports Target Physician Outliers
If UnitedHealthcare (UHC) identifies you as an outlier among its physicians,
you may receive a new type of report from UHC that details tests, procedures,
referrals, and/or billing patterns in your practice that may be inconsistent
with certain evidence-based medicine criteria. Initially, UHC is looking at
primary care physicians (internal medicine, family practice, and pediatrics),
cardiologists, and endocrinologists. It will add other specialists later.
UHC began sending letters with reports in April to Houston-area physicians.
Identified outliers in the rest of Texas will receive letters eight to 10 weeks
later. These physicians can expect to receive one or two follow-up reports, as
UHC says the project goal is "not to penalize physicians but drive
improvement in behavior and practice patterns." However, failure to improve
practice patterns could affect a physician's future participation in UHC
programs and products.
AG Sues Xerox; HHSC Cancels Xerox Medicaid Contract
The Texas Attorney General's (AG's) Office filed a civil lawsuit in state
district court this week against Xerox Corporation and its wholly owned
subsidiary, ACS Healthcare LLC. The state's legal action seeks to recover
fraudulent Medicaid payments for orthodontic and dental services improperly
approved by Xerox.
Since 2003, Xerox has been responsible for reviewing dental and orthodontic
claims submitted to the Medicaid program. Under state law, orthodontic services
are not generally eligible for Medicaid coverage. Only the most acute cases in
which orthodontic disfigurement poses a health risk to a patient are eligible
for Medicaid coverage; Medicaid does not cover cosmetic orthodontics.
The state's lawsuit seeks to recover the fraudulent Medicaid payments. The
state is seeking injunctive relief, civil penalties, and restitution of Medicaid
overpayments as a result of Xerox's unlawful conduct.
Additionally, the Texas Health and Human Services Commission (HHSC) notified
Xerox the state is terminating the company's Medicaid claims administration
contract after Xerox staff approved thousands of requests for braces that
weren't medically necessary.
"Xerox failed to perform the medical reviews that our contract required and
taxpayers deserved," said HHSC Executive Commissioner Kyle Janek, MD.
"We are committed to recovering the money from these fraudulent claims from
all parties involved. Dentists were putting braces on children who clearly
didn't meet the Medicaid standard for that care, and Xerox didn't have the
processes in place to review those cases before paying them."
HHSC is finalizing an agreement with Accenture, the largest subcontractor
under Xerox, to take over as the lead vendor until the state can competitively
rebid the work. Accenture has been operating the Medicaid claims payment system
under the contract since 2004.
Xerox employees handle business operations under the contract, including
processing requests for services that require prior authorization or advance
approval before Medicaid will pay for the treatment.
Accenture will take over the work performed by Xerox on Aug. 1.
During the rebid, HHSC will break the large contract into as many as five
contracts to make it easier to take action against a vendor without disrupting
medical care for people with Medicaid. In addition to processing Medicaid claims
and requests for prior authorization of services, the current contract covers
several other tasks, including maintaining data on Medicaid managed care
transactions, collecting drug manufacturer rebates, and staffing call centers
for Medicaid providers. In 2013, HHSC paid $168 million to Xerox for those
Keep Records When Attesting to Meaningful Use
TMA has learned of yet another snag in the Medicare and Medicaid electronic
health record (EHR) incentive programs. A successful attestation submission may
be voided if the submitter logs back in to the Centers for Medicare &
Medicaid Services (CMS) attestation portal postsubmission. Any edits made
postsubmission — even something as small as hitting the space bar — could void
the original submission.
After successfully completing attestation, take a screenshot for your
records. Be sure to save any confirmation emails or other information you
receive from CMS indicating a successful attestation. You should save all
attestation documentation in the event of an audit.
If your submission has been voided, submit an appeal to CMS with appropriate
documentation of your original acceptance. To start the appeal process, call CMS
at (888) 734-6433, option 1.
Physicians who need assistance with the EHR incentive programs may receive
consulting help from one of four Texas regional extension centers (RECs). The
RECs can help physicians navigate the complexities of the programs. Check out TMA's REC Resource Center to find out which REC serves your
For more information about EHRs or other health information technology
issues, email TMA's HIT Department or
call (800) 880-5720.
Contact Congress on High-Risk Lung Cancer Screens
The TMA House of Delegates on May 3 adopted the latest U.S. Preventive
Services Task Force (USPSTF) recommendations regarding the annual screening of
appropriately selected high-risk patients for lung cancer with low-dose computed
Now, America's radiologists are asking Texas physicians to urge Congress to
push the U.S. Department of Health and Human Services (HHS) to adopt the scans
for high-risk Medicare patients. The deadline is May 30.
"A randomized control trial of more than 53,000 high-risk patients between
the ages of 55 and 74, provide[d] indisputable empirical evidence of the
benefits of screening patients with this advanced imaging modality," the American College of Radiology said in a statement. The "data
found that patients receiving annual CT screens had a 20-percent lower lung
cancer mortality rate in comparison to individuals screened using standard
In December 2013, the USPSTF assigned a grade of "B" to annual LDCT scans for
patients aged 55 to 80 years who are current smokers with at least 30 pack years
of smoking history or former smokers who quit within the past 15 years. The
Affordable Care Act requires private insurance companies participating in the
health insurance exchanges to provide all preventive services with a USPSTF
grade of "B" or higher to patients without cost sharing. A different law gave
Medicare the power, but not the requirement, to add new preventive services if
the USPSTF assigns them a grade of "B" or higher.
HHS has begun a national coverage determination (NCD) process to assess
whether Medicare will fully cover this screening exam. In early May, the
Medicare Evidence Development & Coverage Advisory Committee voted against
offering LDCT in Medicare.
The College of Radiology, the Society of Thoracic Surgeons, and the Lung
Cancer Alliance have asked physicians to ask their members of the U.S. House of
Representatives to sign a letter to the secretary of HHS "urging expeditious
completion" of the NCD. Contact information to share with your House member is
in this "Dear Colleague" letter.
CDC Releases MERS-CoV Advisory Following First U.S. Case
The Centers for Disease Control and Prevention (CDC) issued an official health advisory May 3 on the identification of the first case
of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the
United States. On May 1, the Indiana State Department of Health reported the
suspected case to CDC, which confirmed the infection in a traveler who had
visited Saudi Arabia.
CDC, in conjunction with the Florida Department of Health, confirmed the
second U.S. case of the virus May 12. The infected patient is a health care
professional who lives and works in Saudi Arabia.
The advisory features a summary of the first case in the United States;
background information on MERS-CoV; recommendations for health professionals;
and guidance on infection control, specimen collection, and submission.
For more information, Texas physicians may email Michael P. Fischer, MD,
an expert on coronavirus infections who works in the Texas Department of State
Health Services Emerging and Acute Infectious Disease Branch, or call him at
CDC alert asks clinicians, health officials, and others to consider MERS-CoV
infection in travelers from the Arabian Peninsula and neighboring countries.
MERS-CoV reports have involved respiratory illness and high death rates, as well
as mild and asymptomatic infections.
CDC says health care professionals should be alert for and evaluate patients
for MERS-CoV infection who:
- Develop severe acute lower respiratory illness within 14 days after
traveling from countries in or near the Arabian Peninsula, excluding those who
only went through airports in the region;
- Are close contacts of a symptomatic recent traveler from this area who has
fever and acute respiratory illness; or
- Are close contacts of a confirmed case.
CDC has additional guidance on its website.
For suspected MERS-CoV cases, health professionals should collect the
following specimens for submission to CDC or the appropriate state public health
- Nasopharyngeal swab;
- Oropharyngeal swab (can be placed in the same tube of viral transport
- Sputum, serum, and stool/rectal swab.
For consultation or to report possible cases, contact the CDC Emergency
Operations Center at (770) 488-7100.
Consider Chikungunya in Patients Who Have Traveled Internationally
The TMA Committee on Infectious Diseases encourages you to consider
chikungunya virus infection for patients who have traveled to areas with known
outbreaks and who present with illness consistent with this mosquito-borne
Patients with this infection most commonly present with acute fever and
severe joint pain, which is often bilateral and can be debilitating. Petechial
rash can occur. The incubation period is typically three to seven days. There is
no specific treatment or vaccine. Those at higher risk for more severe disease
include neonates exposed intrapartum, older adults, and those with underlying
medical conditions, including hypertension, diabetes, and cardiovascular
You are encouraged to report suspected cases to the Texas
Department of State Health Services (DSHS). For more information, contact
Nicole Evert in the DSHS Zoonosis Control Branch at (512) 776-2890. Diagnostic testing is available.
Chikungunya has shown rapid global spread in the past decade, causing
outbreaks in the Indian Ocean region, India, Southeast Asia, and Europe. In
December 2013, local transmission of chikungunya was reported for the first time
in the Americas — in the Caribbean. Over the past five months, more than 24,000
cases have been reported in this ongoing outbreak in the Caribbean islands.
Although chikungunya is not currently found in the United States, the Centers
for Disease Control and Prevention (CDC) warns the virus may continue to spread
to new areas in the Americas; the mosquitoes that transmit the virus are found
in parts of the United States, including Texas.
The CDC website has more information on the virus.
Hard Hats for Little Heads Marks 20 Years
TMA's Hard Hats
for Little Heads bike helmet giveaway program turns 20 years old this month.
In celebration of this milestone, TMA recognized program founder Larry C.
Driver, MD, of Houston, at TexMed 2014 in Fort Worth. Read about Dr. Driver's
brainchild in the December 2011 issue of Texas
During the TMA House of Delegates meeting, TMA "passed the helmet" and raised
nearly $6,500 for the Hard Hats program. The donations will provide
1,600 Texas children with a helmet..
Dr. Driver's resolution to the house in 1994 initiated the program. It
encouraged physicians to take an active role in protecting the health of young
Texans by providing bike helmets and by educating them about how to wear them
properly. Since 1993, TMA physicians, TMA Alliance members, and medical students
have hosted thousands of helmet giveaway events and given more than 175,000
children a new helmet.
This year, Hard Hats for Little Heads is trying to give away 34,000 helmets,
an all-time annual record. We are nearly one-third of the way there but need to
give away 23,000 more. We need your help to achieve that goal.
Sponsoring a giveaway is easy. TMA provides helmets, fact sheets, publicity,
merchandise, event material, and more. And for the first 50 helmets you
purchase, TMA gives you another 50 helmets free. Helmets are $7.35 each,
outreach coordinator, or call (800) 880-1300, ext. 1470, or (512) 370-1470
to learn more about hosting an event.
Hard Hats for Little Heads is made possible through a grant from the TMA
Foundation thanks to top donors — Blue Cross and Blue Shield of Texas,
Prudential, and two anonymous foundations — and generous gifts from physicians
and their families, and friends of medicine.
TMA Offers Comprehensive Guide for Physician Employment
Are you a physician thinking about accepting an employment relationship?
Whether you are just starting your practice or making a career-changing move,
discover in detail how to evaluate contractual arrangements so you can protect
your best interest.
TMA's Comprehensive Guide for Physician Employment analyzes the
risks, benefits, and other considerations of an employment decision. It broadly
encompasses traditional employment relationships and newly invented
relationships with institutional employers. Special TMA-member pricing is
Part I discusses all aspects of a physician's contractual employment. In
particular, it scrutinizes the risks and benefits of employment by
hospital-sponsored entities including compensation models, restrictive
covenants, handling of medical records, and health and liability insurance.
Part II discusses the sale of a medical practice to an institutional
employer, including such aspects as valuation, deliverables, and liability.
Before you sign an employment agreement, be sure to read this
information-packed guide written by a seasoned attorney.
Plus, you can earn continuing medical education credit for reading this
publication. TMA designates this enduring activity for a maximum of 9 AMA
PRA Category 1 Credits™. Physicians should claim only the credit
commensurate with the extent of their participation in the activity. The
activity has been designated for 9 credit(s) of education in medical ethics
and/or professional responsibility.
TMA Training Helps Docs Who Treat Commercial Drivers
Effective May 21, physicians must complete accredited certification training
and pass an examination before they perform examinations and issue new medical
certificates to interstate commercial motor vehicle drivers.
This new requirement from the Federal Motor Carrier Safety Administration (FMCSA) states all
medical certificates issued to interstate truck and bus drivers must come from
medical examiners listed on the National Registry of Certified Medical Examiners.
To be listed on the registry, physicians and other health care professionals
- Maintain a valid state license to conduct medical examinations,
- Complete required training on FMCSA's physical qualification standards,
- Pass the FMCSA Medical Examiner Certification Test to demonstrate knowledge
of FMCSA's physical qualification standards, and
- Complete refresher training every five years and recertification testing
every 10 years.
The TMA Education Center offers a course titled Medical
Certification of Commercial Drivers that fulfills the training requirement for this rule. After
completing the course, find a testing center near you on the National Registry of Certified Medical Examiners' website, and
schedule your certification test.
Keep up with this and other new regulations on TMA's Deadlines for
TMA Seminar Outlines New NPP Supervision Regs
Due in large part to TMA's efforts to streamline the rules, the 2013 Texas
Legislature simplified the process by which physicians supervise and delegate to
nonphysician practitioners (NPPs).
The new law replaces the old site-based regulatory structure with a more
collaborative model based on periodic quality assurance reviews and a new
prescriptive authority agreement. The parties to the prescriptive authority
agreement — the supervising physician and an advanced practice registered nurse
(APRN) or physician assistant (PA) — determine the number of charts the
physician will review. These changes will enable physicians to lead PAs and
APRNs more effectively in collaborative practice.
TMA's new evening seminar, New NPP Regulations: Rules
You Need to Know, will teach you and your staff about the new required
prescriptive authority agreements and quality assurance plans and more.
Physicians, NPPs, and office managers should all attend to learn their altered
responsibilities under the new supervision framework and how to avoid legal
pitfalls. Hors d'oeuvres will be served during check-in, and all attendees will
receive a sample prescriptive authority agreement.
Visit the TMA Education Center,
and register to attend a live seminar in your area.
Apply Now for the 2013-14 Texas Physician Practice Quality Improvement
Texas physician practices providing reliable preventive services via health
information technology and effective care management methods deserve to be
recognized for your hard work. Download the application checklist for the 2013-14 Texas Physician Practice Quality Improvement Award and submit your online application before the June 13
TMF Health Quality Institute, TMA, and the Texas Osteopathic Medical
Association have partnered again to sponsor the award program.
If you have questions about the award or application process, plan to attend
an informal question-and-answer session May 20, 2014, from 12:30 to 1:30 pm CT.
On the day of the session:
- Go to the event page at the time of the meeting by clicking on the link
above. Note: No registration is required.
- The call-in information will be displayed when you log in.
- If requested, enter your name and email address.
- This meeting does not require a password.
- Click "Join."
- All lines will be open, so you will be asked to mute your phones.
Register for the Texas Healthcare and Bioscience Summit
The First Annual Texas Healthcare and Bioscience Summit will take place at the Renaissance Hotel in Austin June
4-5. The summit will feature discussion by biotech and health care industry
leaders on critical issues affecting the industries' growth.
Chaired by Texas Health and Human Services Executive Commissioner Kyle Janek,
MD, the summit will outline how Texas can become a leading region over the next
This Month in Texas Medicine
The May issue of Texas Medicine encourages physicians and their staff
to continue preparing for ICD-10, despite the one-year implementation delay;
highlights a state pilot project aimed at streamlining care for dual-eligible
patients; introduces Texas' new medical school deans; tells the story of a
hospital and physicians who reached an agreement in a dispute over obstetric
privileges; and features the 2013 TMA Annual Report.
to launch the digital edition in a new window.
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.
Requirement for Performing Medical Exams on Commercial Vehicle
Last Day For First-Year Participants to Begin the 90-day Reporting Period for
the 2014 Medicare EHR Incentive Program
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
NPP Regulations: Rules You Need to Know
5/21 Corpus Christi
6/4 El Paso
6/17 Fort Worth
Dealing with Difficult
Making Discussions About Death and Dying
Meaningful Use: Information Technology
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