Action: Sept. 15, 2014

TMA Action Sept. 15, 2014   News and Insights from Texas Medical Association


Guidance on Prescribing Schedule II Hydrocodone Products
New Option for Providing LARCs to Medicaid, TWHP Patients
CMS Sets ICD-10 Testing Dates
DSHS Provides Interim Guidance on Enterovirus D68
PQRS: Take Immediate Action by Sept. 30
TDI FAQs Address 90-Day Grace Period, Prompt Pay
TMA Comments on TDI Draft Rules for Independent Review Organizations
New CMS Rule Slightly Modifies EHR Program
2014-15 RSV Season Begins Oct. 1
Massive HIPAA Breach Affects 4.5 Million Patients
Take TMA's Texas Physician Survey
Last Call for Helmet Giveaways in October
Fight the Flu With Tools From TMA
TMA Practice Consulting Helps You Maintain a Healthy Practice
This Month in Texas Medicine

Guidance on Prescribing Schedule II Hydrocodone Products

Over TMA's objections, the Drug Enforcement Administration (DEA) published a final rule in the Federal Register reclassifying drugs that contain hydrocodone combinations from Schedule III to Schedule II. The change will take effect Oct. 6.

[Read TMA's Q&A for Physicians on the Hydrocodone Reclassification.]

The move is designed to help curb the abuse of hydrocodone-containing medications. It would:  

  • Prohibit physicians from delegating advanced practice nurses and physician assistants authority to prescribe these drugs outside of a hospital or hospice setting;
  • Prevent physicians from calling in prescriptions for these medications to pharmacies; and
  • Prohibit refills of prescriptions for these drugs without a patient visit or consultation. 

Additionally, moving hydrocodone combination products from Schedule III to Schedule II will have an impact on Texas physicians' prescribing practices. According to the Federal Register, after Oct. 6, drugs such as Vicodin will only be prescribed for a 90-day period. The current federal rule allows patients to receive a 180-day supply of this Schedule III drug.

Please note the rule change affects only hydrocodone combination products. Pure hydrocodone already is classified as a Schedule II drug.

The Texas Department of Public Safety (DPS) website has additional information about hydrocodone. DPS also provides an order form for physicians and an order form for nonphysician practitioners

The American Medical Association released a bulletin regarding the reclassification. 

At TexMed 2014 in May, physicians voiced their opposition to the reclassification in testimony before the Reference Committee on Science and Public Health. In its review of TMA's current policy on hydrocodone, the Council on Science and Public Health also noted the complexity of the issue, agreeing on the need to study it further to develop a TMA position. In the end, TMA's House of Delegates reaffirmed TMA's policy, which states the association "supports the classification of hydrocodone as a Schedule III, not a Schedule II, drug." 

The Council on Science and Public Health's review of the policy regarding hydrocodone classification and management noted that while recognizing the public health problems caused by the misuse, abuse, and diversion of prescription narcotics that result in death and addiction, hydrocodone is associated with more drug abuse and diversion than any other licit or illicit opioid. TMA's opposition to reclassifying the drug hinges, in part, on members' perception that this would place unnecessary requirements on physicians and additional burdens on patients.

The council agrees that addressing the public health problems of misuse, abuse, and diversion of hydrocodone requires comprehensive and integrated strategies in education, monitoring, and enforcement.

TMA continues to express opposition to the change in classification and to support a focus on physician education. Find more information, or access a free course on how to achieve safe use of opioids.

For information on prescribing Schedule II drugs, see the Texas Medical Board's online FAQs.

New Option for Providing LARCs to Medicaid, TWHP Patients

Physicians now have a new option for providing select long-acting reversible contraceptives (LARCs) to their Medicaid or Texas Women's Health Program (TWHP) patients. 

Effective Aug. 1, the Texas Health and Human Services Commission (HHSC) added Mirena and Skyla to the Medicaid drug and device formulary, allowing physicians the option of writing a prescription for the devices instead of buying and billing, as they had to do before the change.

To provide the device using the patient's pharmacy benefit, a physician will send a prescription to one of two specialty pharmacies contracted with HHSC to provide LARCs: CVS CarePlus Specialty Pharmacy or Walgreens Specialty Pharmacy. HHSC says physicians who have patients in managed care should "work with the patient's managed care organization (MCO) to determine which pharmacy should receive the prescription form. The MCO may be contracted with a single specialty pharmacy." The pharmacy will ship the device to the practice. Physicians will then bill the patient's Medicaid HMO, traditional Medicaid, or TWHP for device insertion only.

For the participating specialty pharmacies' contact information, visit the Texas Medicaid Vendor Drug Program website

Only Mirena and Skyla are available under the new option, though HHSC continues to negotiate with other LARC manufacturers to provide their products via the pharmacy benefit. 

A LARC obtained through the pharmacy benefit must be used only by the patient to whom the physician prescribed it. However, physicians will be able to return unused and unopened LARC products to the manufacturer's third-party processor. 

The new option will make it financially viable for many practices to provide LARCs to their Medicaid and TWHP patients. Currently, the buy-and-bill process means the practice is financially on the hook if the device's acquisition cost exceeds Medicaid payment. Practices may, however, continue to obtain Mirena and Skyla through the existing process.

The Texas Medical Association, along with the Texas Association of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists, Texas chapter, encouraged HHSC to make the change to increase LARC use. 

According to an HHSC analysis provided to TMA, Texas lags the nation in use of LARCs. Yet numerous studies show increased use of long-acting contraception, such as implants or intrauterine devices, substantially reduces rates of unintended pregnancies and helps women better plan and space their pregnancies. HHSC also is researching a TMA-backed initiative to pay for immediate postpartum insertion of LARCs. Increasing LARC use among Medicaid and TWHP enrollees has the potential to improve birth outcomes while reducing Medicaid costs.

CMS Sets ICD-10 Testing Dates

The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare administrative contractors (MACs) to promote three specific testing weeks with health professionals and to provide data and statistics to CMS that demonstrate readiness for the ICD-10 transition. CMS scheduled the following testing weeks: 

  • Nov. 17-21, 2014;
  • March 2-6, 2015; and
  • June 1-5, 2015. 

The mandatory switch to ICD-10 is set for Oct. 1, 2015.

While submitters may test ICD-10 claims at any time through implementation, "the ICD-10 testing weeks have been created to generate awareness and interest, and to instill confidence in the provider community that CMS and the MACs are ready and prepared for the ICD-10 implementation," CMS says.

In addition, CMS highlights the following key points of the testing process: 

  • Test claims with ICD-10 codes must be submitted with current dates of service, as testing does not support future dates of service.
  • Claims will be subject to existing National Provider Identifier (NPI) validation edits.
  • Test claims will receive the 277CA or 999 acknowledgment as appropriate to confirm Medicare accepted or rejected the claim.
  • Test claims will be subject to all existing electronic data interchange (EDI) front-end edits, including submitter authentication and NPI validation.
  • Testing will not confirm claim payment or produce a remittance advice. 
  • MACs and Common Electronic Data Interchange will be appropriately staffed to handle increased call volume on their EDI help desk numbers, especially during the hours of 9 am to 4 pm, local MAC time, during the testing weeks.  

DSHS Provides Interim Guidance on Enterovirus D68

A recent outbreak of enterovirus D68 (EV-D68) is affecting children in six states throughout the Midwest. The Centers for Disease Control and Prevention (CDC) reports that as of Sept. 10, 84 people had been confirmed to have respiratory illness caused by EV-D68. 

According to CDC, EV-D68 can cause mild to severe respiratory illness. Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches. Severe symptoms may include difficulty breathing and wheezing. People with asthma may have a higher risk for severe respiratory illness.

Many hospitals and doctors' offices can test for enteroviruses, but CDC says most can't do testing to determine the specific type of enterovirus, like EV-D68. State health departments and CDC conduct this testing.

The Texas Department of State Health Services (DSHS) says it will conduct testing of specimens submitted for pediatric patients younger than 18 years who are in an intensive care unit with severe respiratory illness and symptom onset no earlier than Aug. 1, and who have tested positive for an enterovirus or enterovirus/rhinovirus. Physicians can contact their local health department to find out if it is able to do virus typing.  

DSHS provides interim guidance on EV-D68 specimen collection and submission, as well as a patient under investigation form local health departments can submit to regional health departments. Regional health departments can fax the report to (512) 776-7616. 

 TMAIT Action Ad Sept 14 

PQRS: Take Immediate Action by Sept. 30

Group practices that plan on participating in the 2014 Physician Quality Reporting System (PQRS) program year through the group practice reporting option (GPRO) must register by Sept. 30, 2014. This deadline does not apply to physicians who will participate in the 2014 PQRS program year as individual eligible professionals (EPs) or to physicians in a group practice who will participate in the 2014 PQRS program year as individual EPs. 

Groups with 10 or more EPs need to take immediate action to avoid the automatic calendar year 2016 value-based payment modifier downward payment adjustment. Read the Centers for Medicare & Medicaid (CMS) notice for more information and a list of options.

Group Practice
According to the Centers for Medicare & Medicaid Services (CMS), a group practice under the 2014 PQRS program year is defined by a single tax identification number (TIN), with two or more individual EPs, as identified by an individual national provider identifier, who have reassigned billing rights to the TIN. Group practices will be categorized by group size: two to 24 EPs, 25 to 99 EPs, and 100 or more EPs. Keep in mind GPRO reporting requirements and reporting method options vary based on the size of a group practice. 

2014 PQRS Reporting Options (All cover the period from Jan. 1 through Dec. 31, 2014):

Aug 15 14 Action PQRS Reporting Table

GPRO Benefits 
There are benefits to participating as a group practice under GPRO, including: 
  • Group practices may report one set of quality measures data on behalf of all EPs in the group (rather than having each EP report data individually), and 
  • Group practices may receive a larger incentive at the TIN level, which is 0.5 percent of all Medicare Part B Physician Fee Schedule claims for covered professional services furnished during 2014. 

Where and How to Register
Group practices may register through the online PV-PQRS Registration System now through Sept. 30, 2014. Group practices that previously reported under GPRO and plan on reporting PQRS data again via GPRO must register every year. 

To register for the 2014 PQRS GPRO: 

  1. Go to On the right side, select Login to CMS Secure Portal.
  2. After accepting the terms and conditions, enter your Individuals Authorized Access to CMS Computer Services (IACS) user ID and password in the Welcome to CMS Enterprise Portal screen. Select Log In to continue.
  3. Select the PV-PQRS tab at the top of the screen, and select Registration from the drop-down menu.
  4. You will see a screen where the group practice(s) and EP(s) (if applicable) associated with your IACS account are listed. To register a group practice for the first time, select the Register link to the right of the group practice you want to register. 

If reporting via a qualified registry, consider one of TMA's endorsed, qualified registries. PQRSwizard, and Covisint PQRS provide simple and cost-effective ways for EPs to collect and report quality measures data for the 2014 PQRS program year. Visit the TMA website to learn more.

PQRS CME Webinar
Don't know where to start with PQRS? TMA offers continuing medical education on the 2014 PQRS program year.

PQRS GPRO Resources
For additional PQRS GPRO information, visit:  

For answers to PQRS questions, contact the CMS QualityNet Help Desk, Monday through Friday, 7 am to 7 pm (CT), by phone, (866) 288-8912, or email. You can also contact the TMA Knowledge Center by phone, (800) 880-7955, or email.

TDI FAQs Address 90-Day Grace Period, Prompt Pay

The Texas Department of Insurance (TDI) has updated its FAQs for Health Carriers to include information about the federal 90-day grace period granted to patients with subsidized Affordable Care Act health insurance marketplace coverage and about prompt payment of claims.

ACA marketplace regulations give patients with subsidized health insurance coverage three months to pay their premiums. They also allow health plans to deny or later recoup payments from doctors for services provided to patients who are 31 to 90 days delinquent. The patients must at least have paid their first month's premium to be eligible for that 90-day grace period.

A marketplace patient's failure to make a premium payment triggers the so-called "90-day grace period." Health plans must give the patient 90 days to catch up. Insurers must pay physicians for services provided in the first 30 days of the grace period.

Federal rules, however, allow health plans to pay, hold, deny, or later recoup claims payments for services incurred in the second or third month of that window if patients remain delinquent on premium payments. TMA officials say health plans must comply with Texas' prompt pay law for claims submitted at any point in the grace period. 

TDI's FAQs on prompt payment state that "Texas’ requirements (TIC Chapter 1301, Subchapter C) related to the prompt payment of claims do not allow issuers to 'pend' claims as suggested under federal rules. Thus, issuers will generally be expected to pay claims received during months 2 and 3 of the grace period in a timely manner."

TDI goes on to explain that "if the grace period expires, an issuer may recoup claims paid during months 2 and 3 as an overpayment under §1301.132 of the Insurance Code. Issuers may also pay claims during months 2 and 3 subject to audit, consistent with §1301.105 of the Code, which requires the issuer to clearly note that the claim is being paid subject to audit."

Federal regulations require exchange plans to notify affected physicians "as soon as is practicable when an enrollee enters the grace period, since the risk and burden are greatest on the provider." Notification includes where the enrollee is in the grace period and the names of everyone covered by the policy. The notice must tell doctors the health plan may ultimately deny payment. 

In TDI's FAQs, the department clarifies that while "Texas law does not reference the federal grace period, … TDI anticipates that, if an issuer receives an eligibility inquiry during months 2 and 3 of the grace period, the issuer will provide the federally required notice to the requesting provider as part of its eligibility response."

The Centers for Medicare & Medicaid Services says federal rules don't specify when or how insurers have to send the notification. TMA officials caution that health plans' practices will vary.

For more on the ACA health insurance marketplace and the 90-day grace period, read “The ACA Marketplace” in the April 2014 issue of Texas Medicine. Also, check out TMA's ACA Exchange Plans Questions and Answers for Texas Physicians (for TMA members only)

TMA Comments on TDI Draft Rules for Independent Review Organizations

TMA told the Texas Department of Insurance (TDI) in a letter that the association will oppose any potential fee increases affecting physicians involved in a review of an independent review organization (IRO). TMA provided comments Aug. 15 on TDI's informal draft rules for IROs. 

"TMA is particularly concerned about how potential fee increases might adversely impact access to care for injured workers, in those situations involving retrospective reviews for non-network services," the letter states, adding that "fee increases would compound the administrative burden on non-network physicians who provide, in good faith, services they believe are medically necessary and in the best interests of the patient."

In the letter, TMA also commented on TDI's proposed requirements for the submittal of an application to be certified as an IRO and on licensure qualifications for personnel conducting independent reviews for an IRO. 

"The draft rules would require the IRO to be 'under the direction of a medical director who is a physician currently licensed and in good standing to practice medicine by a state licensing agency in the United States,'" the letter states. "TMA would prefer that the rules require the IRO to be under the direction of a medical director who is a physician licensed in this state; however, TMA acknowledges the existence of current state law that provides for utilization review to be under the direction of a physician licensed to practice medicine by a state licensing agency in the United States."

New CMS Rule Slightly Modifies EHR Program

The Centers for Medicare and Medicaid Services (CMS) recently published a final rule designed to give physicians more flexibility with the floundering electronic health record (EHR) incentive program. While TMA appreciates that CMS recognized the need for modification, the association says CMS did not go far enough and did not heed most of TMA's suggested comments

The flexibility allows physicians to report Stage 1 or Stage 2 using a 2011 or 2014 certified EHR to meet meaningful use in 2014, but only if the 2014 edition of the certified EHR is not available. TMA is concerned that CMS, in trying to add flexibility, has now added another layer of complexity to the program. 

Physicians need to proceed carefully and should refer to the chart below, also included in the CMS press release regarding program flexibility.

 Sept 14 15 Action EHR meaningful use chart

Physicians with questions about the federal EHR program can still receive assistance from one of the four regional extension centers (RECs) in Texas, established specifically to assist physicians with the program. 

Physicians who have questions related to the EHR meaningful use program may email TMA's Health Information Technology Department or call (800) 880-5720. Refer to TMA's education page for EHR continuing medical education opportunities on the meaningful use program. 

TMLT Action Ad 4.13  

2014-15 RSV Season Begins Oct. 1

The 2014-15 respiratory syncytial virus (RSV) season begins Oct. 1 for a majority of the state and Nov. 1 for counties in the western part of the state. Health professionals participating in Medicaid must obtain Synagis (palivizumab), a prescription medication used to help prevent RSV in infants and children at high risk, through the Texas Medicaid/Children's Health Insurance Program (CHIP) Vendor Drug Program (VDP) for all eligible traditional Medicaid and Children With Special Health Care Needs clients.

Health professionals can now use the prior authorization request form, with approvals through VDP, beginning Sept. 23. The prior authorization request form and county schedule are available online.

The Texas Health & Human Services Commission says Medicaid health plans will adapt the same criteria used by VDP. 

Massive HIPAA Breach Affects 4.5 Million Patients

In just the past month, 18 Texas medical centers were part of a massive nationwide HIPAA breach that included the data of 4.5 million patients. The penalties, lawsuits, and negative publicity to follow are sure to take a staggering financial toll. Texas physicians should take proactive steps to implement processes that secure patient data and mitigate risk.

Many breaches can be avoided easily through regular risk analyses and up-to-date company policies. Under the new HIPAA Final Omnibus Rule, covered entities and business associates responsible for violating HIPAA Privacy and Security rules by failing to safeguard patient protected health information could face up to $1.5 million in annual fines.

HIPAA Security: The Keys to Compliance is a new TMA seminar that will give you an overview of the HIPAA Security Rule and then explore techniques you can use to identify and address any HIPAA deficiencies in your practice. This is a perfect opportunity for you and your staff to jump ahead of the curve on HIPAA security readiness.

Seminar dates began in Houston on Sept. 9 and continue throughout the month in cities across the state. Can't attend in person? Register for the live webcast, and participate via the Internet on Sept. 25 from your home or office.

Those who attend this live program will receive a coupon code for $10 off the electronic version of TMA's new publication, HIPAA Security: Compliance and Case Studies.

Take TMA's Texas Physician Survey

TMA's 2014 Texas Physician Survey is under way. Complete the survey, and provide TMA with your opinion on and experience related to health care issues. Your feedback helps support the association's policy development and political focus. 

Since 1990, TMA has conducted a biennial survey of Texas physicians that focuses primarily on health care practice and economic and legislative issues. Each month, TMA emails a section of the survey to all Texas physicians with email addresses in the association's directory.

If you have not received an email, contact Jessica Davis, TMA health care research and data analyst. Texas physicians who answer all of the surveys in 2014 are eligible to win one of five Apple iPads. 

Last Call for Helmet Giveaways in October

It’s a celebration you won't want to miss: TMA's Hard Hats for Little Heads 20th birthday blitz in October. You still have time to plan a helmet giveaway to help Hard Hats celebrate 20 years of keeping kids safe. TMA wants to have 50 bike helmet giveaways across the state; at press time, we were about halfway there. Host an event in your community to help us reach the goal. 

TMA will send a media advisory announcing all events during the month. To have your event included, let TMA know by Monday, Sept. 22. We need the name of your event, date, time, location and address, and cell phone number for the person in charge on the day of your event. 

TMA provides everything you need for a successful event: free helmets, banners, event signage, promotional flyers, educational handouts, and media relations support. When you buy helmets, TMA will match your purchase with more free helmets. Helmets are $7.35 each, including shipping. 

Email Tammy Wishard, TMA's outreach coordinator, or call (800) 880-1300, ext. 1470, or (512) 370-1470, to RSVP about your event or to request an order 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. 

PC Action Ad Sept 13

Fight the Flu With Tools From TMA

Flu season is just around the corner, and TMA's Be Wise — ImmunizeSM program has tools you can use to protect yourself, your staff, and your patients:  

  • Remind your employees about the importance of getting their flu vaccination with this poster to hang in your break rooms or other areas where your staff gathers. 
  • Educate your patients about the importance of an annual flu vaccination with TMA's flu fact sheet.
  • Plan a flu shot clinic for your community with the help of a local impact grant from Be Wise — Immunize. Grants of up to $2,000 are available to county medical societies, TMA Alliance chapters, medical student chapters, and TMA member-physician practices/clinics. Applications are due Oct. 1.  

To order flu education materials or for help planning your flu vaccination event, email Tammy Wishard, TMA's outreach coordinator, or call (800) 880-1300, ext. 1470, or (512) 370-1470.

TMA launched Be Wise — Immunize in 2004 to increase Texas' immunization rates. Since then, the program has provided more than 275,000 shots to Texas children, adolescents, and adults. 

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance. Funding for Be Wise —Immunize is provided by the TMA Foundation thanks to generous support from H-E-B, TMF Health Quality Institute, and gifts from physicians and their families. 

Be Wise — Immunize is a service mark of the Texas Medical Association.

TMA Practice Consulting Helps You Maintain a Healthy Practice

Getting paid for your services accurately and on time is the key to preserving the viability of your practice. By maintaining efficient processes and carefully monitoring each step in the revenue cycle, you can minimize future problems, ensure sufficient cash flow, improve collection rates, and increase staff productivity. 

Why choose TMA Practice Consulting? Effective revenue cycle management begins with a smart approach to appointment scheduling and ends with collecting prompt and proper payments for billed charges. TMA Practice Consulting is a trusted and proven resource for help with these and other business aspects of your medical practice.

A qualified professional from the TMA Practice Consulting team will assess your practice's billing and collections procedures, evaluate your business office operations and staff competencies, and review office workflow.

All data collected are then analyzed and presented in a customized report with written recommendations for improvement within 30 days of the on-site assessment, giving you the opportunity to earn up to 20 AMA PRA Category 1 Credits™ (per physician), while improving the health of your practice.

Let TMA Practice Consulting take care of your practice while you take care of your patients. Contact a TMA consultant today to schedule a revenue cycle assessment by calling (800) 523-8776 or emailing TMA Practice Consulting.

This Month in Texas Medicine

The September issue of Texas Medicine features a cover story on the growing need for physician involvement in the TMA Political Action Committee (TEXPAC) and the group's mission to ensure medicine's voice rings in the Texas Legislature and good health policy prevails. It also highlights TMA's latest scope-of-practice battles, the association's role in recruiting physicians to care for veterans, tropical disease emerging in Texas, and Texas medical schools' efforts to help students match to a residency program.

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.


PQRS: Deadline to Register to Participate in GPRO for 2014   


HIT: First-Year Participants: Deadline to Attest to Meaningful Use for the 2014 Medicare EHR Incentive Program  

HIT: Upgrade EHR for Meaningful Use Stage 2


Reclassification of Hydrocodone Combination Products  

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.  

HIPAA Security: The Keys to Compliance
9/25 Live Webcast: Register 

On-Demand Webinars

Dealing with Difficult Patients 
Making Discussions About Death and Dying Easier 
Meaningful Use: Information Technology Bundle   

Physician Health and Wellness, ext. 1342

 Physician Well-Being for Life  
10/24-25 Dallas                  

Healthy Physicians: Healthy Patients 
9/27    El Paso  
10/4    Tyler  

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

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Last Updated On

November 09, 2017