Action: May 16, 2014

TMA Action May 16, 2014   News and Insights from Texas Medical Association

INSIDE: Tax Refund Fraud Scheme Affects Texas Physicians  

Tax Refund Fraud Scheme Affects Texas Physicians
Eligible Primary Care Physicians Get Medicaid Pay Increase
A Handful of Candidates Need Your Votes
United's New Reports Target Physician Outliers
AG Sues Xerox; HHSC Cancels Xerox Medicaid Contract
Keep Records When Attesting to Meaningful Use
Contact Congress on High-Risk Lung Cancer Screens
CDC Releases MERS-CoV Advisory Following First U.S. Case

Consider Chikungunya in Patients Who Have Traveled Internationally
Hard Hats for Little Heads Marks 20 Years
TMA Offers Comprehensive Guide for Physician Employment
TMA Training Helps Docs Who Treat Commercial Drivers
TMA Seminar Outlines New NPP Supervision Regs
Apply Now 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 IRS letter. 

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

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 issue.  

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) 908-4490. 

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 fraudulently: 

  • 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 additional information.

Also, the FBI has tips to help you protect your personal identity from thieves. 

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 quarterly payments. 

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 payment. 
  • 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) 925-9126. 

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 tide.

"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 well. 

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.

     TMAIT Action Ad 4.13   

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 services.

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 area. 

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 tomography (LDCT).

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 radiography."

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 (512) 776-6338. 

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 laboratory: 

  • Nasopharyngeal swab;
  • Oropharyngeal swab (can be placed in the same tube of viral transport medium); and
  • Sputum, serum, and stool/rectal swab.

For consultation or to report possible cases, contact the CDC Emergency Operations Center at (770) 488-7100.

TMLT Action Ad 4.13   

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 disease.

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 disease.

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 Medicine

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, including shipping.

Email TMA's 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 available.

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 must: 

  • 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 Doctors webpage.

   PC Action Ad Oct 13  

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 Award

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 deadline.

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:   

  1. Go to the event page at the time of the meeting by clicking on the link above. Note: No registration is required. 
  2. The call-in information will be displayed when you log in. 
  3. If requested, enter your name and email address. 
  4. This meeting does not require a password. 
  5. Click "Join." 
  6. 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 decade.

Register today. 

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.

Click 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 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.   

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.  


New Requirement for Performing Medical Exams on Commercial Vehicle Drivers


HIT: Last Day For First-Year Participants to Begin the 90-day Reporting Period for the 2014 Medicare EHR Incentive Program

 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. 


New NPP Regulations: Rules You Need to Know
5/20     McAllen
5/21     Corpus Christi
6/4       El Paso
6/10     Wichita Falls
6/11     Lubbock
6/17     Fort Worth
6/18     Dallas
6/19     Tyler

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