| TMA Action July
|| News and Insights from Texas Medical
INSIDE: CMS Opts Not to Delay Medical Staff
CMS Opts Not to
Delay Medical Staff Regs
HHSC Releases Marketing Guidelines
HHSC Transitioning to New
Medicaid Claims Administrator
Live TMA Webinars Cover Revenue Cycle, Claims
Things You Must Know Before Signing an Employment Contract
Management Help From TMA
Grant Deadline Approaching
Join TMA's Huge Statewide Helmet
and Save DocbookMD Messages
HCMS Alliance Provides Scholarships to Med
Register for the Focus on the Female Patient
Attend the Patient-Centered Medical Home Learning
This Month in Texas Medicine
CMS Opts Not to Delay Medical Staff Regs
In a formal comment letter to the Centers for Medicare & Medicaid Services
(CMS), the Texas Medical Association, the American Medical Association, and more
than 80 other medical societies urged the agency to give hospital medical staffs
more time to study and prepare to implement a new rule that makes "unprecedented
changes to the Medicare hospital Conditions of Participation (CoPs) that will
dramatically alter the make-up and efficacy of hospital medical staffs
The letter addressed a provision of the final rule, published May 12, that
allows multihospital systems to elect a single integrated medical staff
structure and provides that individual hospital medical staffs may opt in or opt
out of this structure. Nevertheless, these regulations took effect July 11. TMA,
AMA, and the other organizations asked CMS to delay the effective date of the
provision until May 12, 2015, one year after the final rule's publication.
"Most medical staffs are unaware of or unprepared for the impending decision
to either integrate into a single model or opt-out, and will undoubtedly be ill
served by the expediency of these requests. CMS should give medical staffs both
clarifying guidance as well as more time to understand and explore these
issues," the letter to CMS Administrator Marilyn Tavenner states.
The signatories said medical staffs needed more time to understand the CoPs
changes and a number of implementation issues not addressed in the rule.
Among the issues warranting further examination was licensure. The letter
poses the following question: "In large, multi-state hospitals, will physicians
who become a part of a single integrated medical staff be required to be
licensed in each state in which the hospital provides services?" The letter
elaborates, saying such a requirement "could create significant logistical
issues and add to physicians’ administrative burden and is an issue that
HHSC Releases Marketing Guidelines
Senate Bill 8, which passed during the 2013 legislative
session, prohibits certain marketing activities under Medicaid fee-for-service,
Medicaid managed care, and the Children's Health Insurance Program. The Texas
Health and Human Services Commission (HHSC) released "Texas Provider Marketing Guidelines" to help physicians and
other health professionals assess their compliance with the rules, which took
effect July 6.
The guidelines include a self-review checklist and examples of permissible
and prohibited marketing activities under the new law.
The guidelines also feature a form health professionals can use to ask HHSC
to review and approve proposed marketing materials. The review process allows
for submission of draft materials to HHSC via email.
Generally, HHSC has 30 days to approve or deny a submission, unless the agency
needs additional time or information to complete the review. In the event of
denial, the agency should include an explanation, and the physician may revise
and resubmit proposed materials for review.
For more information, visit the Texas Medicaid & Healthcare Partnership
HHSC Transitioning to New Medicaid Claims Administrator
The Texas Health and Human Services Commission (HHSC) is working to move the
Medicaid claims administration contract from Xerox to Accenture. HHSC is
reviewing Accenture's readiness to take over the contract, which also includes
processing claims for the Children with Special Health Care Needs Services
Program and vendor drug services.
On May 9, the Texas Attorney General's Office sued Xerox Corporation and its wholly owned subsidiary, ACS
Healthcare LLC in state court. The state's legal action seeks to recover
fraudulent Medicaid payments for orthodontic and dental services improperly
approved by Xerox.
HHSC notified Xerox the state would terminate the company's Medicaid claims
administration contract after Xerox staff approved thousands of requests for
braces that weren't medically necessary.
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. Accenture will take over the work performed by
Xerox on Aug. 1.
HHSC says staff members will continue to work with Accenture and Xerox to
identify and resolve issues or risks before Accenture assumes full
responsibility for the contract. That work includes reviewing and improving the
prior authorization process. Most other functions will transfer "as is" to
Accenture, meaning the current policies and procedures will largely remain the
same, according to HHSC.
Live TMA Webinars Cover Revenue Cycle, Claims Submission
The Texas Prompt Pay Act requires HMOs and insured PPOs to pay clean claims
within a set timeframe. Texas law provides for payment no later than 45 days
after the date a health plan receives a nonelectronic clean claim and no later
than 30 days after receipt of an electronic clean claim.
But prompt pay laws are all about the details. Many claims may be paid
outside the 30-day window for legitimate reasons. How effectively prompt pay
laws work for you depends on your claim submission process.
On July 23, during the noon-1 pm CT lunch hour, a new live TMA webinar will address prompt pay as it relates
to your revenue cycle and claim submission process. Prompt Pay and the Revenue Cycle — Part II: Clean Claims
discusses the following concepts:
- The impact of patient responsibility on prompt pay,
- Submitting clean claims,
- Accounting for accuracy and timeliness of receipts, and
- Appeal and reconsideration requirements prior to prompt pay action.
The final webinar of this financial series, Effective Collections Techniques, will be broadcast live July
30, also during the noon-1 pm CT lunch hour. This webinar will address the
discomfort many feel about asking patients for money and will outline how to
reduce lost revenue, how to create a collection policy for your practice, how to
implement effective and tactful collection strategies, and how to talk to
patients from whom you need to collect payment.
TMA plans to release all three webinars on demand in the coming months. Stay
tuned for details.
7 Things You Must Know Before Signing an Employment Contract
A good contract by definition is one that is fair and reasonable and is a
win-win situation for everyone involved. But how do physicians ensure they are
getting a good contract before agreeing to work for a hospital or group
Health care attorney Norman Jeddeloh shared seven essential pointers at the
American Medical Association Annual Meeting:
- A solid contract is essential for physician employment
relationships. Talking about all the negatives and "what-ifs" at the
beginning of a new relationship may seem counter-productive, Mr. Jeddeloh said,
but "there are a lot of very good reasons for the parties to sit down and force
themselves to do a contract. It memorializes agreements. That's very important
because everybody's memory fades."
- Contract language must be clear and unambiguous. "I can't
tell you how many contracts I see that are impossible to understand," Mr.
Jeddeloh said. "It leads to disputes. One of the most important things that a
contract does is it serves as a reference point between the parties in the event
of disputes." The standard rule of thumb is that a college sophomore should be
able to read and understand the contract.
- All key issues need to be covered. "The contract needs to
be detailed but not too detailed," Mr. Jeddeloh said. Contracts that are overly
detailed "can impose a feeling of inflexibility in the relationship going
forward. It's important to think about the really crucial issues and include
those in the contract."
- Understand your compensation model. Some contracts offer
fixed compensation, in which the physician receives a set salary regardless of
performance. This model is more typical for new physicians, while more
experienced physicians can expect some version of variable compensation, in
which payment is determined based on the physician's performance. Every variable
compensation model "takes into account the 'bucket of money' theory," Mr.
Jeddeloh said. "It's really about how the bucket is split: the revenue,
expenses, and built-in profit for the organization."
- Know the numbers of your compensation. "Every contract will
have a formula for variable compensation, and formulas can get quite
complicated," Mr. Jeddeloh said. "In addition to hiring a lawyer, you also ought
to have an accountant look at it and run some numbers. It's good to attach a pro
forma to the contract." Having an example with actual numbers can help you
better understand what your compensation might be and will make it easier for a
judge to understand what could be a very complex formula, in the event of a
- Make sure liability insurance is included. "Liability
insurance is crucial," Mr. Jeddeloh said. Some things that will need to be
addressed include whether the insurance is adequate and whether the hospital or
group offers tail coverage when the physician leaves.
- Understand what will happen upon termination of the relationship.
"People clearly don't want to talk about this at the beginning, but
it's a very necessary provision of every contract," Mr. Jeddeloh said. Some
things to look for include whether physicians will have a way to refute charges
against them if their employer tries to terminate the relationship, whether a
noncompete provision is included, and whether a restrictive covenant would keep
the physician from practicing nearby once the relationship ends.
For additional insight into employment contracting, AMA offers two annotated
model employment agreements: one for contracting with a
hospital and one for contracting with a group practice.
Reprinted from AMA Wire with permission of the American Medical
STAR+PLUS Expansion News
People with intellectual and developmental disabilities covered by Medicaid
will need to choose a STAR+PLUS health plan this summer for their doctor,
hospital visits, and medications. Starting Sept. 1, these people will get their
basic medical services through STAR+PLUS.
The change applies to people who live in a community-based intermediate care
facility for individuals with intellectual disabilities or related conditions
(ICF-IID) or receive services through one of the following ICF-IID waiver
- Home and Community-based Services (HCS),
- Community Living Assistance and Support Services (CLASS),
- Texas Home Living (TxHmL), or
- Deaf Blind with Multiple Disabilities (DBMD).
Visit the STAR+PLUS Expansion webpage and watch a video to learn
Business Management Help From TMA
The TMA Financial Trend
Tracker is a free online tool to help association members and their staff
track monthly and yearly net collection ratios, accounts receivable percentages,
and new and established patient visits. The tool presents a practice's key
performance indicators via easy-to-read graphs and charts.
The Financial Trend Tracker allows users to:
- Identify potential problems,
- Use the information to make decisions that benefit the practice, and
- Set goals.
Before logging on to the Financial Trend
Tracker, gather your month-end practice management reports. Visit the site,
and enter the data requested into the My Practice Data entry form. The program
will generate information on accounts receivable, collection ratios, and
productivity, allowing you to monitor your data monthly and to make annual
comparisons. Users can only view data associated with their
Looking for more on medical practice financial management?
TMA's latest publication also focuses on the business side of medicine.
Business Basics for Physicians guides physicians in setting the vision, direction, and
policies that help ensure practice viability and helps them gain a basic
understanding of financial management and other business topics.
To purchase the book, visit the TMA website.
TMAF Grant Deadline Approaching
The TMA Foundation (TMAF) is accepting applications for its 2014-15 Medical
Community Grants and Medical Student Leadership Grants programs. Deadlines are
July 31 for TMA county medical societies and alliance chapters and Aug. 29 for
medical student chapters.
Programs should address TMA priorities such as obesity, tobacco,
immunizations, health disparities, unplanned pregnancy, mental health,
environmental health, violence, and disaster preparedness and response.
Society and alliance chapters may apply for up to $7,500, and medical student
chapters may apply for up to $3,000. Learn more, and download the applications
on the TMAF
Join TMA's Huge Statewide Helmet Giveaway
Mark your calendar for October — TMA's Hard Hats
for Little Heads big giveaway month to celebrate the program's 20th
birthday. TMA wants to give 5,000 Texas children a free helmet in October, and
we need your help.
Hosting a Hard Hats event is easy and rewarding. TMA provides everything you
need: free helmets, banners, event signage, promotional flyers, educational
handouts, and media relations support. We’ll even give you up to five free
anniversary T-shirts for your volunteers.
Sign up today to host an event. You can plan a stand-alone event or pair it
with an existing one, such as a:
- Fall festival,
- Health fair,
- National Night-Out activity, or
- TMA Be Wise — ImmunizeSM flu shot clinic (combine
two of TMA's outreach programs and give flu shots and helmets).
Check out other ideas for
events, and start planning your event now. Contact Tammy Wishard, TMA’s outreach
coordinator, or call (512) 370-1470 today to request your event packet.
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.
Be Wise — Immunize is a service mark of the Texas Medical
Print and Save DocbookMD Messages
Do you want to get important patient information from DocbookMD into that
patient's medical record? It's now easier than ever with the new Print and Save
functions from DocbookMD.
You and your CareTeam members can now print a DocbookMD message or image or
save it as a PDF directly from the web version of the app, using your existing
computer and printer. Regardless of your existing health information technology,
messages can become a part of your electronic or paper records. This added layer
of convenience is a welcome addition to the growing list of features and
functionality DocbookMD brings to all TMA members and builds upon the
HIPAA-secure communication platform that more than 8,000 Texas physicians use
To use the web version of DocbookMD, visit docbookmd.com and click the
red "Login" button at the top right corner of the page. Simply enter your
DocbookMD login email and password, and start securely communicating instantly.
You must first register for DocbookMD on a mobile device to have web access (you
can't yet register on the web), but registration is fast and free for TMA
DocbookMD is available to all TMA members as a free member
benefit. Across the country, more than 25,000 physicians in 41 states use
DocbookMD, further connecting the community of medicine. DocbookMD is available
for iPhone, iPad, and Android devices, as well as PC and Mac. The app can be
downloaded using the Apple App
Store or Google Play.
Docbook Enterprise offers a scalable and secure way for
groups, hospitals, and accountable care organizations 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 by email or phone, (512) 383-5822.
HCMS Alliance Provides Scholarships to Med Students
By the end of 2014, the Harris County Medical Society (HCMS) Alliance will
have awarded more than $275,000 in scholarships to about 240 medical students
attending The University of Texas Medical School at Houston and Baylor College
of Medicine. The medical student scholarship program is one of the most
important philanthropic activities the HCMS Alliance supports each year.
HCMS Alliance's philanthropic activities and endowment provide annual funding
for the scholarship program. Scholarship funds are equally divided between the
two medical schools in Harris County. The recipients must be third- or
fourth-year medical students in good standing with their respective medical
"In 2013, we were honored to have HCMS Past President Carlos Hamilton, MD,
and TMA Alliance Past President Linda Atkins participate in our awards
presentations. They were joined by several local physicians as well as local
alliance members,” said Carmen Zartorski, HCMS Alliance president.
The HCMS Alliance scholarship program is part of the TMA Special Funds Foundation, which supports loan and
scholarship programs throughout Texas.
For information about the HCMS Alliance, click here.
Register for the Focus on the Female Patient Conference
Women's health continues to evolve, and many new and updated practice
guidelines have recently been released related to the care and treatment of
female patients. Physicians need to stay up to date on the broad array of
changes taking place in women's health.
Several upcoming live webcasts on women's health are available through the
TMA Education Center. The courses detail evidence related to diagnosis,
management guidelines, prevention strategies, and new, as well as controversial,
therapies of common diseases relevant to women's health — across the lifespan —
with an emphasis on practical clinical knowledge.
The presentations will broadcast live from Southern Medical Association's
25th Annual Focus on the Female Patient Conference. Visit the TMA Education Center for more information or to register for a
July 28, 2014: Osteoporosis, Women and Heart Disease, and Risk
5 AMA PRA Category 1 Credits™ (live
The first segment of this five-and-a-half hour webcast will focus on
osteoporosis, including controversies in screening, calcium and vitamin D
therapy, when to use and when to stop using bisphosphonates to prevent
fractures, and alternatives to bisphosphonates, concluding with cases.
The second segment will focus on women and heart disease, and the final
presentation will discuss risk management/liability issues related to
technology, including e-communications and electronic health records, and
concluding with cases related to technologic liability and frequently asked
questions. Register today.
July 29, 2014: Office Gynecology and Update in Obstetrics
5 AMA PRA
Category 1 Credits™ (live activity)
The first segment of this five-hour webcast will provide an update in
obstetrics, including advanced maternal age, update on infections in pregnancy,
and noninvasive prenatal testing, followed by case presentations. The second
segment will feature identifying placental abnormalities. The final segment,
office gynecology, will cover new options in the treatment of vulvovaginal
atrophy, menopause and the microbiome, and vulvodynia and vulvar pain syndromes.
July 30, 2014: Gynecology and Gynecologic Surgery
5 AMA PRA Category 1
Credits™ (live activity)
The first segment of this five-hour webcast will focus on gynecologic
surgery, including identification and management of surgical injuries, an update
on urethral slings, and new treatments of uterine fibroids, concluding with
cases in gynecologic surgery. The second segment will address sexuality issues
in menopause, and the final segment will focus on premenopausal uterine bleeding
— ruling out cancer and cesarean hysterectomy, tips and techniques, and
screening for vaginal, vulvar, and anal cancers. Register today.
July 31, 2014: Health Care and Business and Psychiatry
5 AMA PRA
Category 1 Credits™ (live activity)
The first segment of this five-hour webcast will focus on psychiatric topics,
including bullying and suicides in adolescent psychiatry, depression in
pregnancy, and diagnosing and treating anxiety disorders in women. The second
segment of this webcast will focus on health care and business, including the
prevention of medical errors and an update on health care reform, accountable
care organizations, and tort reform. Register today.
Attend the Patient-Centered Medical Home Learning Collaborative
Register today for the Patient-Centered Medical Home Learning Collaborative,
held in Austin July 31. The Texas Medicaid Wellness Program, in partnership with TransforMED, will host the event.
You can register to attend the conference in person or virtually.
The conference is ideal for physicians, practice managers, clinical lead
nurses, and nonclinical staff.
At the end of this session, you will:
- Understand the value of the patient-centered medical home to the practice
- Understand the value of teamwork, leadership, and communication;
- Define roles and responsibilities; and
- Identify structured processes that encourage collaboration, coordination,
This Month in Texas Medicine
The July issue of Texas Medicine examines the evolution of telemedicine and
addresses a new Federation of State Medical Boards model policy aiming to create
a roadmap for the safe, appropriate practice of telemedicine. It also informs
physicians about cyber liability insurance, policymakers' price transparency
efforts, an initiative to improve health literacy in the state, and the status
of e-prescribing controlled substances.
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.
First-Year Participants: Deadline to Attest to Meaningful Use for the 2014
Medicare EHR Incentive Program
HIT: Upgrade EHR for Meaningful Use Stage
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.
Dealing with Difficult Patients
Making Discussions About Death and Dying Easier
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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