Action: Oct. 31, 2014

TMA Action Oct. 31, 2014   News and Insights from Texas Medical Association

INSIDE: Ebola Treatment, Containment Facilities on Tap

Ebola Treatment, Containment Facilities on Tap
Time’s Running Out to Vote
TMA Backs Plan to Revamp Medicaid Fraud Cops
New Deadline to Apply for Meaningful Use Hardship Exception
Doctors Worried About Nonphysician Entities Providing Medicare Wellness Visits
Judge Sides With Aetna Against Texas Clinics
FDA Warns Against Using NuVision Pharmacy Sterile Products

FDA Allows Normal Saline Importation to Alleviate Shortage
Guard Your Practice Against Employee Theft
New Webinars Offer Guidance on Accurate, Timely Payments
TMA Is Searching for the Top Health News of 2014
Don’t Let Your Membership Lapse. Renew Today!
This Month in Texas Medicine  


Ebola Treatment, Containment Facilities on Tap

In the wake of last week's announcement that a New York doctor who returned from Guinea tested positive for Ebola, public health professionals and hospitals have remained vigilant in preparing to respond to potential future cases of the disease.

Gov. Rick Perry took a step to beef up Texas' preparedness level and announced the creation of a state-of-the-art Ebola treatment and infectious disease biocontainment facility in North Texas, as recommended by the Texas Task Force on Infectious Disease Preparedness and Response. 

In addition to the North Texas facility, The University of Texas Medical Branch (UTMB) at Galveston has also been designated an Ebola treatment and infectious disease biocontainment facility.

"In the event of another diagnosis, this facility will allow us to act quickly to limit the virus' reach and give patients the care they need in an environment where health care workers are specially trained and equipped to deal with the unique requirements of this disease," Governor Perry said. "We are fortunate to have such talented and dedicated leaders here in North Texas and at UTMB Galveston who are willing to step forward during a time of need."

UT Southwestern Medical Center, Methodist Hospital System, and Parkland Hospital System will partner to set up and operate the North Texas facility. Partner hospitals plan to provide the facility and equipment, and staffing will be moved to the facility on an as-needed basis upon activating the unit.

The Texas Medical Association has been busy providing Ebola virus information and resources to Texas physicians.

The TMA Committee on Infectious Diseases urges physicians to study the Centers for Disease Control and Prevention's recommendations for personal protective equipment and environmental infection control measures in ambulatory settings. Physicians can also contact their local health department or regional health office and the DSHS infectious disease unit at (800) 252-8239 for further instructions. 

TMA also has developed patient handouts — in English and in Spanish — and released a video, Why You're Not At All Very Likely to “Catch” Ebola, featuring Robert Haley, MD, director of the Division of Epidemiology in the Internal Medicine Department at UT Southwestern Medical Center in Dallas.

For additional guidance on the virus, visit the TMA Ebola Virus Resource Center.

Time's Running Out to Vote

Today (Oct. 31) is the final day of early voting for the Nov. 4 elections. During early voting, which ends at 7 pm, you may cast a ballot at any election site in your county. On Election Day, you must vote in your home precinct (7 am-7 pm).

Here's a few reasons for you to head to the polls in this nonpresidential election year:

  • One candidate for the Texas Senate says physicians want to "administer life-ending procedures" to their patients! Really.
  • Other, more medicine-friendly, candidates have pledged to help TMA cut government regulations on physicians’ practices, boost public health, increase funding for graduate medical education, and protect Texas’ 2003 medical liability reforms.

TEXPAC recommends these outstanding candidates on your ballot.

One way to remember to vote is to envision now a detailed plan of exactly where and when you will go to the ballot box. Make sure that plan includes encouraging your family, friends, staff, and patients to vote as well.

TMA Backs Plan to Revamp Medicaid Fraud Cops

The state's use of freezing payments to physicians suspected of possible Medicaid fraud "has gone beyond the law's intent," according to a 225-page report on the Texas Health and Human Services Commission (HHSC) by the Texas Sunset Advisory Commission. The report describes the HHSC Office of Inspector General (OIG) as an agency with poorly trained staff and little accountability or transparency. 

TMA has long championed improvements in the Medicaid system and in OIG's investigations of physicians accused of fraud, waste, and abuse. In comments submitted to the commission, John Holcomb, MD, chair of the TMA Select Committee on Medicaid, CHIP, and the Uninsured, iterated TMA's support for the commission's recommendations "to improve the efficiency and effectiveness of OIG's administrative and investigative processes" and to "clarify OIG's payment hold authority and streamline the CAF [credible allegation of fraud] hold hearing process."

In the comments, TMA outlines its support for the report's recommendations to: 

  • Have a fair administrative process designed to define, detect, and prevent fraudulent and abusive conduct that wastes taxpayer funds;
  • Improve the efficiency of the investigation process, reserve CAF holds for serious situations to mitigate ongoing financial risk to the state, and streamline the administrative appeal hearing process;
  • Include the expertise of medical practitioners with appropriate training and experience in investigations concerning the practice of medicine;
  • Implement quality assurance reviews and consistency in investigations;
  • Clarify organizational oversight and accountability in an effort to ensure OIG is efficiently and effectively accomplishing its mission to combat fraud, waste, and abuse;
  • Better clarify the roles and responsibilities among and between OIG, managed care organizations, and special investigative units; and
  • Require OIG to pay the full hearing costs for CAF hold appeals at the State Office of Administrative Hearings (SOAH). 

TMA encourages the commission to align the overpayment and appeal hearings process with requiring the agency to pay for SOAH hearings.

The letter stresses TMA's desire for clear Medicaid rules and regulations that would allow physicians who care for this patient population to "dedicate their time, talent, and staff resources to patient care, as opposed to administrative hassles, burdensome audits, and fear of fraud and abuse accusations."

TMA also advocates education and outreach to prevent administrative errors and improper payments. The commission's report discusses the need to "promote compliance and help prevent fraud, waste, abuse, and certainly errors, by educating providers on Medicaid policies and procedures." 

TMA worked with lawmakers in 2013 to craft legislation that improves due process when a physician faces Medicaid fraud or overpayment accusations. The hard work paid off in the passage of Senate Bill 1803, which clarifies the definition of "credible allegation of fraud" and establishes timelines for when OIG must notify doctors of an investigation or can withhold payments in the process. 

Sunset Commission recommendations serve as a starting point for deliberations by the 2015 legislature.

As reported in a previous issue of Action, TMA is also pushing the legislature to "take bold action" to increase "utterly inadequate physician payment rates" in Texas Medicaid and the Children's Health Insurance Program.

New Deadline to Apply for Meaningful Use Hardship Exception

The Centers for Medicare & Medicaid Services (CMS) will reopen its meaningful use hardship exception application for physicians and hospitals to avoid the 2015 penalty. Following advocacy efforts by the American Medical Association, the new deadline is Nov. 30. The hardship exception application deadline had been April 1 for hospitals and July 1 for physicians.

For more information and a link to the hardship exception application, visit the CMS website.

While all Medicare physicians have until Feb. 28, 2015, to attest to any 90-day reporting period in 2014 to obtain a meaningful use incentive, Medicare physicians who started the program this year had to attest by Oct. 1 to avoid a penalty of up to 2 percent in 2015. Those new to the meaningful use program who missed the Oct. 1 deadline can now apply for a hardship exception to avoid this penalty. 

In addition, those physicians planning to attest by Feb. 28, 2015, can still apply for a hardship exception as a fallback precaution to avoid the penalty. 

The hardship exception, however, only provides relief from the meaningful use penalty. It will not earn physicians an incentive. Meaningful use incentives are still available for those who are able to meet and attest to the Stage 1 or Stage 2 measures by the February deadline. 

This reopened hardship exception period is for Medicare physicians and hospitals that: 

  • Have been unable to fully implement 2014 Edition certified electronic health record technology (CEHRT) due to delays in 2014 Edition CEHRT availability; and
  • Physicians who were unable to attest by Oct. 1 and hospitals that were unable to attest by July 1 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

The CMS 2014 CEHRT Flexibility Rule allows physicians to use older certified EHR technology (version 2011), a combination of old and new technology (versions 2011 and 2014), or just new technology (version 2014) to attest for their 2014 reporting period. Visit the TMA website for a more in-depth review of the rule.

The CMS system was not ready to accept attestations by Oct. 1, the last date Medicare physicians new to meaningful use could attest to avoid a penalty. AMA says this is part of the reason CMS reopened the hardship filing period, ensuring more doctors avoid a 2015 penalty.

CMS is offering a new webinar on Nov. 19 at noon CT on the 2014 CEHRT Flexibility Rule. 

TMA recently reported that CMS modified the meaningful use reporting requirements for 2014 if the EHR vendor did not successfully update and certify its system to allow for timely reporting. This webinar provides instructions on how physicians can use the CEHRT Flexibility Rule to report for 2014.

The webinar will kick off with an overview of CEHRT by David Nilasena, MD, CMS chief medical officer for Region VI, which includes Texas, New Mexico, Oklahoma, Arkansas, and Louisiana. 

Once you register, you'll receive an appointment notice that includes information on how to connect to the webinar. 

If you have questions, email Ceceilia Robl. Include "November CEHRT webinar" in the subject line of your email.  

  TMAIT Action Ad Sept 14 

Doctors Worried About Nonphysician Entities Providing Medicare Wellness Visits

TMA officials remind physicians they can provide Medicare annual and first-time "Welcome to Medicare" wellness visits to their patients and warn that nonphysician health care entities may be beating doctors to the punch, albeit legally. "Welcome to Medicare" visits occur within a patient's first 12 months of having Medicare Part B coverage.        

Medicare rules do not require primary care physicians to provide the service but allow a range of health professionals to give the exam, including physicians; qualified nonphysician or licensed practitioners, such as physician assistants, nurse practitioners, clinical nurse specialists, and registered dietitians; or a team of such medical professionals working under the direct supervision of a physician.

TMA has received complaints that newer companies focusing on long-term and preventive care are offering the Medicare wellness checkups, sometimes unknown to the patient's doctor. After the fact, physicians may receive a notice from the company stating it already provided the service, for example, by a certified nurse practitioner.

Physicians worry the nonphysician entities are contributing to patient confusion and fragmented care because patients may receive generic or incomplete medical guidance from someone unfamiliar with the patient's history. Nor can physicians claim Medicare payment for the wellness visit once another company performs the same service, due to frequency limits.   

TMA's Payment Advocacy Department staff strongly encourages physicians to verify Medicare patients' eligibility for preventive services through Novitas, the state Medicare contractor. Either by phone or through Novitas' online portal, physicians can check the date of patients' last annual wellness visit. They should also consider sending out reminders to patients before their annual wellness visits are due, prompting them to contact their doctors directly for an appointment.

For more information, download a free Medicare quick-reference guide on annual wellness visits.

Physicians may also issue an advance beneficiary notice (ABN) if they believe the wellness service may exceed the frequency limitation. The ABN alerts patients they may be financially liable if Medicare denies the claim. Physicians can only collect from the patient when Medicare denies the service if they issue a valid ABN. Read the rules in this guide from the Centers for Medicare & Medicaid Services. 

Judge Sides With Aetna Against Texas Clinics

Aetna is collecting $8.4 million from a small hospital and three clinics after a Texas judge ruled the facilities overbilled the insurer for two years. 

According to, a federal judge in Texas sided with Aetna in August, saying three freestanding emergency clinics north of Houston — Trinity Healthcare Network, ER DOC 24/7, and Premier Emergency Room and Imaging (which has since closed) — lied about being affiliated with Cleveland Imaging and Surgical Hospital, a nearby four-bed hospital, to charge higher fees. As a result, the clinics overbilled Aetna by $9.3 million over the course of two years, the judge says. reports Cleveland Imaging and Surgical Hospital let the clinics use its provider number in exchange for about 15 percent of the payments from Aetna.

"Using the hospital's number made it look like the clinics' treatment happened at a full-service hospital, rather than an unlicensed clinic," wrote U.S. District Judge Lynn Hughes. "If these clinics want to charge higher fees, they need to become a licensed hospital, not craft devious, inauthentic billing contracts to make it appear as though they have become part of the hospital."

The ruling did not address Aetna's accusations of fraud, negligent misrepresentation, and civil conspiracy on the part of the clinics. The owners of the clinics argued in court their billing was legal based on the arrangement with the licensed hospital. 

Trinity said in a statement to the Fort Worth Star-Telegram, "Aetna has decided to increase their profits on the backs of low-cost community facilities like Trinity Healthcare that is designed to decrease cost to their patients. Trinity Healthcare will be appealing this decision without hesitation." 

FDA Warns Against Using NuVision Pharmacy Sterile Products

The U.S. Food and Drug Administration (FDA) has safety concerns about sterile-use drug products made and distributed by Downing Labs LLC, doing business as NuVision Pharmacy, in Dallas. 

An FDA press release states, "Health care professionals should not use any NuVision/Downing Labs sterile products for their patients because the firm cannot ensure the safety or quality of these products." 

FDA says it is not aware of recent reports of illness associated with the use of these products and asks health care professionals to report adverse reactions or quality problems with any products made at the Downing Labs facility to the FDA's MedWatch Adverse Event Reporting program.

The agency issued a formal request to Downing Labs in September for the immediate recall of all of its purportedly sterile products currently on the market. In the letter, FDA outlined poor conditions and practices identified by FDA investigators during a July 2014 inspection of Downing Labs' Dallas facility. The inspection revealed sterility failures in 19 lots of drug products intended to be sterile, endotoxin failures in three lots of drug products, and inadequate or no investigation of these failures. 

"Patient safety is our top priority. We recommend health care professionals stop prescribing sterile drugs from Downing Labs because they pose serious potential risks to patients," said Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research. "Patients deserve medications that are safe, effective, and of high quality no matter who makes them, and the FDA will continue to take action to protect patients."

 TMLT Action Ad 4.13  

FDA Allows Normal Saline Importation to Alleviate Shortage

A critical shortage of 0.9-percent sodium chloride injection (normal saline) that threatens patients' safety prompted the U.S. Food and Drug Administration (FDA) to allow B. Braun Medical Inc., of Bethlehem, Pa., to temporarily distribute the drug in the United States from its manufacturing facility in Germany. 

FDA will also allow importation of saline products from Baxter Healthcare Corporation's plant in Spain and Fresenius Kabi USA's plant in Norway to help fill the demand for the drug in the wake of the shortage. 

FDA reports it inspected all three manufacturers' facilities abroad to ensure they currently meet FDA standards. FDA asks health care professionals to contact the manufacturers directly to obtain their products. 

Visit FDA's drug shortage webpage for updates.

Guard Your Practice Against Employee Theft

Medical practices are especially vulnerable to embezzlement, in part, because they are typically cash businesses. According to a 2009 Medical Group Management Association study, 83 percent of the medical practices polled had been the victim of employee theft or embezzlement. But because medical offices are run by a close-knit staff, it can be hard for a physician to imagine any employees stealing from the practice. 

You can best protect your practice by establishing a formalized system of controls for monitoring money. If you need help on where to start, a TMA consultant can review your current internal control procedures, identify potential weaknesses, and make specific recommendations for safeguards, processes, and duty assignments your practice needs to shield you against embezzlement. Read more about preventing embezzlement in the November issue of Texas Medicine

An embezzlement risk review from TMA Practice Consulting includes a review of cash handling and inventory control procedures and a comparison of profit and loss statements to benchmark data. TMA provides a written report with recommendations for improvement to the practice within 30 days of the on-site assessment. Submit an online request for proposal for your practice today.

Questions? Contact TMA Practice Consulting at (800) 523-8776 or e-mail TMA Practice Consulting.

Find more on fraud and embezzlement prevention from TMA: 

 PC Action Ad Nov 13

New Webinars Offer Guidance on Accurate, Timely Payments

Late payments? Missed revenue? The efficiency of your billing can make or break your practice. By using accurate billing techniques and effective collection strategies you can keep your practice revenue flowing.

These new on-demand webinars from TMA can help you learn how to manage your revenue cycle:

Effective Collections Techniques 
1 AMA PRA Category 1 Credit™ (enduring)

Prompt Pay and the Revenue Cycle 
1 AMA PRA Category 1 Credit™ (enduring)

Prompt Pay and the Revenue Cycle: Clean Claims 
1 AMA PRA Category 1 Credit™ (enduring)

Browse the TMA Education Center for more quality CME on a wide range of topics. Be sure to login to receive your TMA member discount.

More from TMA on ensuring accurate and timely payments: 


TMA Is Searching for the Top Health News of 2014

The TMA Anson Jones, MD, Awards honor outstanding health journalism, and we need your help to find the best stories of 2014. If you've seen, heard, or read an article that caught your attention, nominate it for an award.

TMA family members (physicians, medical students, TMA Alliance members, and county medical societies) can nominate journalists for the Anson Jones awards. Categories cover print, broadcast (television and radio), and online media. Any story from 2014 is eligible.

To nominate a journalist, simply email your nomination; include the reporter's name, name of article (if available), date of broadcast/publication, and the media outlet. Please try to include a URL.

TMA will send the reporter a postcard with a handwritten note. We'll let the reporter know you nominated him or her and for which story or broadcast. 

Visit the Anson Jones webpage for complete nomination details, contest rules, and categories. If you have questions, call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470, or email her. 

Don't Let Your Membership Lapse. Renew Today!  


Intrusion after intrusion is threatening your practice and the care of your patients as you know it. Fortunately, you can trust TMA and your county medical society to stand by you to address them. 

Your association advocates relentlessly in Washington and Austin to eliminate red tape and bureaucracy. But even as we work to deliver these legislative fixes, TMA provides first-class solutions to your practice headaches.

The 2015 congressional and state legislative sessions are right around the corner. Renew today

The TMA Knowledge Center can answer your renewal questions at (800) 880-7955 or by email.

This Month in Texas Medicine

The November issue of Texas Medicine features a cover story on the patient-centered medical home. It examines investments being made in the model by policymakers, payers, and physician practices. In the latest issue, you'll also find tips to prevent employee theft in your practice, details about a virtual kidnapping scheme targeting Texas physicians, efforts by allergists in the state to allow EpiPens on school campuses, and ways that using registries can help take the sting out of quality reporting.

Click 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 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.  

Extension to 2016 for Grandfathered Small Group Insurance Plans

CMS Medicare Beneficiary Open Enrollment Ends

 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.  


Business Boot Camp: Take Charge of Your Finances 
11/3    San Antonio
11/4    Austin
11/5    Beaumont
11/11  Abilene
11/12  Wichita Falls

On-Demand Webinars

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

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Last Updated On

November 09, 2017