|TMA Action June 16,
|| News and Insights from Texas Medical
INSIDE: Secret Service to Make Arrests in Tax
Refund Fraud Case
Enlist Now to Serve
Secret Service Expects to Make Arrests in Tax
Refund Fraud Case
Free TMA Publication: Business Basics
Apply for the TMA
Leadership College by July 2
Sunshine Act Physician Registration Process Has
Physicians Receive ACA Grace Period Notice
Meaningful Use Exemption Deadline Approaches
|Patients Continue to Ask Doctors for Unnecessary
Tests, Study Finds
CMS Proposes Flexibility for Meaningful Use
AccessMedicine Replaces MD Consult in TMA
Independent Contractor or Employed
Bike Helmets for Pediatricians, Family Physicians
Custom Ringtones Added to
Month in Texas Medicine
Enlist Now to Serve Our Veterans
Here's your opportunity to join with physicians across the state and provide
medical care to veterans caught in a scandal-plagued and overloaded system. Enlist today.
Texas Medical Association has joined with the American Medical Association
and medical societies around the country to help bring a temporary resolution to
the crisis in access to health care for our nation's veterans. At the urging of
Texas physicians, the AMA House of Delegates voted overwhelmingly to ask President
Obama to provide timely access to entitled care for eligible veterans using the
health care sector outside of the U.S. Department of Veterans Affairs (VA)
health care system until the VA can provide health care in a timely fashion.
Further, AMA will also urge Congress to rapidly enact long-term solutions so
eligible veterans can always have timely access to entitled care.
"Our veterans have stepped up and served our country, so physicians want to
be able to step in and serve them," said Austin
I. King, MD, TMA's president. "It is tragic that our veterans have been
forced to wait for the health care they need and deserve, so Texas physicians
and our colleagues across the nation want to help care for them until the VA can
right the ship."
As part of this plan, TMA is creating a registry of private physicians across
the state who would be willing to see veterans in their offices. (We don't know
payment specifics yet. However, when physicians currently agree to treat
veterans, those payments are typically made according to the Medicare fee
schedule.) TMA will share the registry (name, specialty, office address, and
phone number) with community groups that work with Texas veterans and with the
medical directors of VA facilities in Texas.
Sign up today for the registry. Check
the "I am willing to serve veterans" box and click "SAVE." Or call the TMA
Knowledge Center at (800) 880-7955. TMA will pull the additional information
from our membership database.
Secret Service Expects to Make Arrests in Tax Refund Fraud Case
Last month, the Texas Medical Association first reported Texas physicians
are victims of a tax refund/identity theft fraud scheme making waves across the
nation. The association has since learned the crime's victims also include
physician assistants, advanced practice registered nurses, dentists,
podiatrists, and pharmacists. Texas is one of 49 states and the District of
Columbia affected by this con.
New Hampshire Medical Society Executive Vice President Scott Colby shared
with TMA the following update from the U.S. Secret Service:
- The agency is developing leads nationally and internationally.
- In addition to the Secret Service, federal agencies involved in the
investigation include the U.S. Department of Health and Human Services, the
Social Security Administration, and the Internal Revenue Service.
- The Secret Service has identified several suspects and expects to begin
- The Secret Service said finding those committing the fraud is critical in
determining the ultimate source of the suspected data breach.
- At this time, there is no solid evidence pointing to the source of the
The Secret Service recommends all physicians visit www.experian.com/fraud and place themselves on a 90-day credit
fraud alert. This could potentially slow or halt further attempted identity
theft activities. While not every physician is at risk of identity theft, this
is a suggested precautionary measure.
So far, TMA has learned more than 60 Texas physicians have fallen prey to
this scam. 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. Email the TMA Knowledge
Center or call (800) 880-7955.
The majority of 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, indicating the tax return 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
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
In February, the IRS issued a report titled "Dirty Dozen" Tax Scams for 2014 on identity theft affecting
The American Medical Association has the following guidance for fraud
- 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)
If you learn your Social Security number has been used fraudulently, contact
the following agencies:
- 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. Provide 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
Free TMA Publication: Business Basics
Thanks to a generous grant from The Physicians Foundation, you can download
Business Basics for Physicians, TMA's newest publication, free.
Business Basics for Physicians guides you through essential business
skills like hiring and managing staff, developing a budget, crafting
administrative policies and procedures, and promoting the practice. Learn more
on the TMA website.
Apply for the TMA Leadership College by July 2
TMA is now accepting applications for the TMA Leadership College Class of
2015. The deadline to apply is July 2.
The TMA Leadership College, established in 2010 as part of TMA's effort to
ensure strong and sustainable physician leadership within organized medicine, is
geared toward active TMA members younger than 40 or who are in the first eight
years of practice.
TMA Leadership College graduates serve as thought leaders who can close the
divide among clinicians and health care policymakers, and as trusted leaders
within their local communities. Many also receive priority consideration for
appointment to TMA councils and committees.
Visit the TMA Leadership College webpage for full
program details, a class schedule, and application.
For more information, contact Christina Shepherd in the TMA Membership
Development Department by email or by calling (800)
880-1300, ext. 1443, or (512) 370-1443.
Sunshine Act Physician Registration Process Has Begun
Later this year under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services
(CMS) will make public physician payments reported by manufacturers of drugs,
medical devices, and biologicals that participate in federal health care
Most of the information contained in the reports will be available on a
public, searchable website.
The law, which took effect Aug. 1, 2013, is part of the Affordable Care Act
and requires manufacturers and group purchasing organizations to report
ownership interests held by physicians and their immediate family members.
Earlier this year, CMS opened payments registration and data submission for
applicable manufacturers and group purchasing organizations for the 2013
Beginning June 1, physicians could register in the CMS Enterprise Portal, which allows physicians to sign up for
notification when their financial disclosures are available for review and
dispute. CMS says it will provide physicians access to their consolidated
financial disclosures for the prior calendar year.
Phase two of the access process — registration in the CMS Open Payments system — is set to begin in early July.
According to the American Medical Association, CMS will release most of the data
on a public website by September.
The Open Payments Mobile for Physicians app allows you to capture and
confidentially collect information on reportable transfers between you and
industry representatives. This information comes in handy should you need to
challenge any inaccurate information reported to the government. Download the
app on your Apple or Android device.
According to CMS, you will not be able to access the Open Payments system
before phase two begins in July. The agency says physicians who attempt to
access Open Payments through the Enterprise Portal will discover the functions
on the "Welcome to Open Payments" main screen will not be operational until the
system opens for phase two.
AMA's online toolkit features a webinar on preparing for the Sunshine Act,
an overview of the financial interactions and ownership interests that will be
reported, an explanation of the excluded financial interactions, answers to
frequently asked questions, and a summary of the act's key provisions.
AMA advises physicians to:
- Ensure all financial and conflict-of-interest disclosures required by
employers and other entities that provide funding are current and updated
- Update professional information and ensure the correct specialty
- Learn what financial transfers and ownership interests must be reported by
drug and device manufacturers and group purchasing organizations; and
- Ask industry contacts to provide transfer information in advance for an
opportunity to correct the information before it's transmitted to the
Note: The Sunshine Act stipulates payments or other transfers of value
provided as compensation for speaking at a continuing medical education (CME)
program are not required to be reported if the following conditions are met:
- The activity meets the requirements of the continuing education accrediting
agency, e.g., the Accreditation Council for Continuing Medical Education;
- The pharmaceutical or device company does not pay the speaker directly; and
- The pharmaceutical or device company does not choose the speaker or give the
CME provider a group of speakers to consider for the activity.
Physicians Receive ACA Grace Period Notice Letters
Some Texas physicians have notified TMA they have received letters from Blue
Cross and Blue Shield of Texas (BCBSTX) notifying them that a patient is in the
second or third month of the Affordable Care Act (ACA) 90-day grace period. The
grace period is triggered once a patient with subsidized marketplace coverage
misses a premium payment. Instead of immediately terminating the policy, health
plans must give the patient 90 days to catch up.
Federal rules allow health plans to pay, hold, deny, or later recoup payment
of claims for services incurred in the second or third month of that window if
patients are delinquent on their premium payments. However, insurers must pay
physicians for services provided to a patient in the first 30 days of the grace
period, and insurers still must comply with Texas law requiring prompt payment
of claims submitted at any point in the grace period.
Federal regulations require exchange plans to notify affected physicians "as
soon as is practicable when an enrollee enters the grace period." This includes
whether the enrollee is in the second or third month of the grace period and the
names of all individuals covered by the policy. The notice also must tell
doctors the health plan may ultimately deny payment.
Grace period notification is also available when verifying patient benefits,
both online and over the phone.
Physicians who have signed a BCBSTX contract have agreed to limit the reasons
for which they may terminate the patient-physician relationship. The payer's
February 2014 Blue Review newsletter includes a provision that states:
"Your agreement with BCBSTX requires the provision of services to members and
prohibits advance payment for such covered services except for member’s required
cost sharing, if any. You may notify your patients that they will be responsible
for payment for the full cost of provided services, up to billed charges, if
their health care coverage terminates at the end of the grace period. You can
encourage your patients to make their premium payments to avoid termination of
their health insurance policies. In addition, the terms of your BCBSTX agreement
prevent you from refusing to provide services to a BCBSTX member, irrespective
of where they purchased their coverage."
TMA President Austin King, MD, iterates physicians' ethical responsibilities
to the patient despite payment problems.
"Unlike insurance companies, we can't ethically tell patients that suddenly
we cannot care for them since they did not pay their premium. In fact, if the
patient has a complex condition such as cancer, heart problems, or many other
serious conditions then we may have to care for that patient for many months
until their condition stabilizes and only then can we think about discontinuing
care," Dr. King said.
TMA encourages physicians to educate themselves about the ACA exchange plans.
TMA has the following helpful resources on its website:
TMA, AMA, and more than 80 state medical societies and specialty
organizations have asked the Centers for Medicare & Medicaid Services (CMS)
to revisit its policy that allows plans to pend and deny claims for months two
and three of the 90-day grace period. The groups say insurers who offer health plans on the ACA
exchanges should provide immediate notice when patients enter the first month of
the 90-day grace period.
In addition, the Texas Delegation to the American Medical Association took a
resolution to the AMA House of Delegates, which convened in
Chicago this month, asking the AMA to work to prevent recoupment if an ACA
marketplace insurer has not notified the physician a patient is in the last 60
days of the grace period for not paying his or her premiums.
July 1 Meaningful Use Exemption Deadline Approaches
Physicians who are not participating in the Medicare electronic
health record (EHR) incentive program, also known as meaningful use, will be
penalized by Medicare beginning Jan. 1, 2015. To prevent the penalty, physicians
must either attest to meaningful use by Oct. 1, 2014, or apply for a hardship
exemption by July 1, 2014.
Physicians who meet the following criteria are automatically exempt from the
program and do not need to file an exemption application:
Specialties: If you're classified in the Medicare Provider
Enrollment, Chain and Ownership System (PECOS) as one of these five specialties,
you don't need to file an exemption and will be exempt for payment year 2015:
- Diagnostic radiology,
- Nuclear medicine,
- Interventional radiology,
- Anesthesiology, and
New to practice: If you are in your first year of practice,
you do not need to claim an exemption. Based on Medicare data in PECOS, the
Centers for Medicare & Medicaid Services (CMS) says it will know you are new
to practice and will automatically exempt you.
Hospital-based: If you perform more than 90 percent of
services using place of service codes 21 or 23 (hospital), then you will
automatically be exempt from the Medicare penalty.
Other exemptions are available, but you must take the time to fill out the 14-page application and submit it to CMS by July 1, 2014. If
multiple physicians at one practice are applying, be sure to include the multiple NPI addendum.
You can apply for a hardship exemption if your circumstances fall under one
of the following categories:
- Infrastructure: You must demonstrate that your practice is
in an area without sufficient Internet access to comply with meaningful use and
that you face insurmountable barriers to obtain such connectivity.
- Unforeseen circumstances: This exemption can be claimed in
the case of a natural disaster, closing of a practice, bankruptcy, or if the EHR
vendor goes out of business.
- Lack of face-to-face patient interactions: If your
specialty isn't listed above as exempt and you lack face-to-face interactions
with your patients, you can claim an exemption.
- 2014 EHR vendor issues: If your EHR vendor was unable to
obtain a 2014 certification by July 1, 2014, you should file an application for
Exemptions must be renewed annually, and you may not claim an exemption for
more than five years.
For more information on penalties and exemptions, please refer to TMA's one-pager. Contact TMA's Health Information Technology
Department with questions by email or by
calling (800) 880-5370.
Patients Continue to Ask Doctors for Unnecessary Tests, Study Finds
Two-thirds of physicians say they have a great responsibility in making sure
their patients do not receive unnecessary tests and procedures, yet even more
say American physicians today are ordering these exams every week, a new survey finds.
Conducted for the ABIM Foundation, the study has helped gauge physicians'
attitudes about the issue of inappropriate medical tests and procedures in the
U.S. health care system.
The Choosing Wisely®
campaign promotes healthy dialogue between physicians and their patients.
Commencing in 2012, this physician-led movement attempts to eliminate
unnecessary tests and procedures for patients based on evidence-based
recommendations. These recommendations come from leading medical specialty
societies that have identified the most salient issues patients should discuss
with their physicians.
TMA is working with
the ABIM Foundation to make physicians and the public more aware of the
lists and to encourage their use.
This study reveals physician opinions on unnecessary tests and procedures.
Physicians are trying to steer their patients in the right direction, yet only
27 percent of physicians say patients listen to their advice half of the time.
On the other hand, more than 1 in 3 physicians (36 percent) say they order
unnecessary tests and procedures for patients "just to be safe." With rising
health care costs and patients continuing to ask for unnecessary medical tests
and procedures, communication between patients and physicians is more important
On the positive side, the survey found physicians are beginning to speak more
to prevent their patients from undergoing unnecessary tests and procedures. The
research found physicians who have seen Choosing Wisely material are
more likely to refuse to order patient testing (44 percent) than those who have
no knowledge of the movement (37 percent). "Physicians with exposure to the
Choosing Wisely campaign are 17 points more likely to have reduced the
number of tests or procedures they have done in the last 12 months," the study
Through the help of the ABIM Foundation and the Robert Wood Johnson
Foundation (RWJF), more Texas physicians are continuing to use Choosing
Wisely to guide patients in their decisionmaking on tests and procedures.
Along with TMA, the ABIM Foundation has awarded 20 other state medical
societies, specialty societies, and several regional health institutions to help
promote positive conversations between physicians and patients on the overuse of
medical tests and procedures. More Texas physicians continue to learn ways to
decrease health care costs as well as effective ways to speak with patients
about the medical care they need.
The survey was administered via phone interview with 600 practicing
physicians nationwide, including Texas physicians. RWJF, a supporter of the
Choosing Wisely campaign, funded this analysis.
CMS Proposes Flexibility for Meaningful Use Program
The Centers for Medicare & Medicaid Services (CMS) released proposed rules that allow flexibility for electronic health
record (EHR) certification and extend Stage 2 meaningful use. TMA will carefully
review the proposal and submit comments by July 21, the end of the comment
TMA views this as a positive step as many EHR vendors have not yet achieved
their 2014 certification, required for meaningful use attestation in 2014,
regardless of stage. The timing of the proposed rules is less than ideal as many
physicians need to take action by July 1, 2014, to prevent an EHR penalty in
2015. As with many regulations, the devil is in the details.
Stay tuned for more information and guidance on how physicians should proceed
with these newly announced proposed rules.
AccessMedicine Replaces MD Consult in TMA Databases
As of June 30, MD Consult will no longer be offered by Elsevier. The TMA
Knowledge Center is now offering AccessMedicine from McGraw Hill. AccessMedicine
is an innovative online resource that provides TMA members more than 75 medical
titles from the best minds in medicine, updated content, thousands of images and
illustrations, interactive self-assessment, case files, time-saving diagnostic
and point-of-care tools, a comprehensive search platform, and the ability to
view from and download content to a mobile device.
Updated frequently and expanded continuously by world-renowned physicians,
AccessMedicine provides fast, direct access to the information necessary for
completing evaluations, diagnoses, and case management decisions, as well as for
pursuing research, medical education, or self-assessment and board review.
AccessMedicine, as well as other TMA database offerings, can be found on the
TMA Databases page. These are free to TMA members as a benefit
of membership. For more information, email
the TMA Knowledge Center or telephone (800) 880-7955.
Independent Contractor or Employed Physician?
Disputes over independent contractor status can be tricky, says Regina
Williams, a board-certified human resources lawyer in Austin.
"There have been cases in which a physician goes to work for a medical group
as an independent contractor and then claims he or she was actually a full-time
employee entitled to certain health insurance and financial benefits," she
Having a contract with independent contractors is helpful but not enough to
defend a potential lawsuit, according to Ms. Williams.
Under the law, an individual could be considered an employee if he or she
doesn't work for any other entities and conforms to the same rules and standards
as all other employees.
Determining independent contractor status involves a test, Ms. Williams
The Internal Revenue Service (IRS) consolidated its "Twenty Factor" test for
determining independent contractor status into 11 main tests. The IRS organized
them into three groups: behavioral control, financial control, and the type of
relationship of the parties. (See the IRS' "Employer's
Supplemental Tax Guide.")
For more information about the tests, visit the Texas Workforce Commission website, which defines each type of
- Behavioral control covers instructions the business gives the worker about
when, where, and how to work, as well as training the business gives the worker;
- Financial control covers the extent to which the worker has unreimbursed
business expenses, the extent of the worker's investment, the extent to which
the worker makes services available to the relevant market, how the business
pays the worker, and the extent to which the worker can realize a profit or
- Type of relationship delves into written contracts, the provision of
"employee-type benefits," the permanency of the relationship, and "the extent to
which services performed by the worker are a key aspect of the regular business
of the company."
Free Bike Helmets for Pediatricians, Family Physicians
The Texas Pediatric Society (TPS) and the Texas Academy of Family Physicians (TAFP) support TMA's
Hard Hats for Little Heads program by purchasing up to 50 helmets for their
members to host helmet giveaway events. TMA matches the purchase, so TAFP and
TPS members receive up to 100 helmets at no cost for their giveaways.
Hard Hats for Little Heads is celebrating 20 years of keeping kids safe. In
celebration of that milestone, the program wants to set a new record of giving
away 34,000 helmets. Help with meeting the goal by signing up for a Hard Hats
Hosting a Hard Hats for Little Heads event is easy and rewarding. TMA
provides everything you need: free helmets, banners, event signage, promotional
flyers, educational handouts, and media relations support. The program will
provide up to five free anniversary t-shirts for volunteers.
Here are some great opportunities for hosting a helmet giveaway:
- Back-to-school events or giveaways in connection with your local school.
- Summer and fall health fairs.
- October, during TMA's statewide Hard Hats giveaway. We need more than 50
events lined up to meet our 5,000 helmet giveaway goal during that month.
- During the December holidays in conjunction with local bike giveaways.
outreach coordinator or call (800) 880-1300, ext. 1470, or (512) 370-1470 to
learn more about hosting an event. Be sure to mention if you're a TAFP or TPS
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.
Custom Ringtones Added to DocbookMD
Physicians can now customize their iOS ringtones to differentiate new DocbookMD messages from other messages they receive. The new
feature resides in the Settings menu within the app. Choose from 40 different
sound notification options, and assign a different tone to each of the three
message priority times. From an iPhone or iPad, tap on Settings from the main
menu, and decide which ringtone you want for messages sent with the following
priorities: 5 minutes, 30 minutes, or none.
Beyond the new ringtone customization feature, the settings section of DocbookMD has additional tools, including:
- Enable messaging: Turn DocbookMD messages receipt on and off.
- Enhanced notifications: Enter an email address and/or phone number to be
notified of an unread DocbookMD message waiting for your attention. No protected
health information is sent via email or standard text, simply a notification
that you have a pending DocbookMD message.
- Lock app with PIN: An additional level of HIPAA security allows you to
create and use a PIN to gain access to the DocbookMD app. It's a quick way to
further protect yourself and your patients.
- Refresh data: Tap to ensure the most up-to-date TMA directory is at your
DocbookMD is available to all TMA members as a free member
benefit. Across the country, more than 25,000 physicians in 40 states use
DocbookMD, further connecting the community of medicine.
DocbookMD is available for iPhone, iPad, and Android devices as well as PC
and Mac via the new web version. The app can be downloaded using the Apple App Store or Google Play.
Docbook Enterprise offers a secure way for groups and
hospitals to meet a wide variety of workflow needs and enhance existing
technology systems. To bring the Enterprise version of DocbookMD to your
hospital or large group, contact DocbookMD Director of Partnerships Chad Shepler
or phone at (512) 383-5822.
This Month in Texas Medicine
The June issue of Texas Medicine delves
into Congress' decision to patch the flawed Medicare Sustainable Growth Rate
payment formula for the 17th time and highlights the publication of physician
quality data, resources to reduce electronic health record errors,
recommendations aimed at reducing cesarean sections, the release of Medicare
physician payment data, and evidence-based decisionmaking tools physicians can
share with patients.
to launch the full 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.
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
New NPP Regulations: Rules You Need to
6/17 Fort Worth
Dealing with Difficult
Making Discussions About Death and Dying
Meaningful Use: Information Technology
Physician Health and Wellness, ext. 1342
Physician Well-Being for
Healthy Physicians: Healthy
9/27 El Paso
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