Action: Jan. 5, 2015

TMA Action Jan. 5, 2014   News and Insights from Texas Medical Association

INSIDE:  Save 20 Percent on All CME

This Month Only: Save 20 Percent on All CME
GME Expansion a Top Priority for Texas Specialty Societies
Medicare 2015 Fee Schedules Delayed
Are You Receiving a PQRS Penalty in 2015?
Quality and Cost Reports Are Here
Half of Eligible Professionals Will Face Meaningful Use Penalty in 2015
Save the Date(s) for First Tuesdays 

New Comp Fee Guideline Conversion Factors Available
Workers' Comp Has New Training Resources for Treating Doctors
2015 TMA Winter Conference: Leading the Way Through Crisis and Change
Sign Up Now for TMA Legislative News Hotline
TexMed 2015 Registration Is Now Open. It’s Free!
Vaccination Event Funding Available From TMA
This Month in Texas Medicine  

This Month Only: Save 20 Percent on All CME

You already receive exclusive member pricing on all TMA continuing medical education (CME) courses as a benefit of your membership, but for the entire month of January the discounts available in the TMA Education Center have gotten even bigger — 20 percent bigger. 

With more than 80 CME courses covering a wide variety of topics, including 50 offering ethics credit, you won't have a problem finding education that can benefit you and your practice.

Visit the TMA Education Center now and use coupon code NEWYEAR20 to receive an additional 20 percent off your entire TMA Education Center purchase. This exciting offer applies only to current TMA members and their staff and excludes live programs. 

Contact the TMA Knowledge Center with questions or for assistance by email or phone, (800) 880-7955. 

GME Expansion a Top Priority for Texas Specialty Societies

Winning greater investment in graduate medical education (GME) programs is a 2015 legislative priority for most of the Texas Family of Medicine.

Standing up before their peers at the 2015 TMA Advocacy Retreat, seven state specialty societies joined TMA and the Texas Osteopathic Medical Association in calling on state lawmakers to expand the number of residency slots Texas training institutions can support. They spoke not only of the need to grow Texas' physician workforce but also of Texas' inability to further train the growing number of graduates from the state's medical schools.

Most organizations at the retreat endorsed greater GME funding; those with specific suggestions included:

  • Texas Academy of Family Physicians,
  • Texas Chapter of the American College of Physicians,
  • Texas Ophthalmological Association,
  • Texas Pediatric Society,
  • Texas Society of Anesthesiologists, 
  • Texas Society for Gastroenterology and Endoscopy, and 
  • Texas Society of Psychiatric Physicians. 

GME expansion is a key component of TMA's Healthy Vision 2020, Second Edition, the association's advocacy plan for the remainder of the decade: "To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. We must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm physicians who complete medical school and residency training in the state are three times more likely to practice here." Read all of Healthy Vision online.

Speaking at the advocacy retreat's closing luncheon, State Rep. John Zerwas, MD (R-Simonton), who has been a key figure in drafting the past several state budgets, said physicians could realistically expect lawmakers to continue the GME expansion trend they began in the 2013 legislative session. They will find more money for GME, Representative Zerwas said, if physicians speak out about it loudly enough.

Twitter conversations during the advocacy retreat verified his prediction, as lawmakers from both sides of the political spectrum weighed in for more GME spending. State Rep. Donna Howard (D-Austin) called it "a priority for many of us in the Texas Legislature." That brought an "Agree!" tweet from State Rep. Jeff Leach (R-Plano), who then added, "It's a problem that so many Texas-educated docs are doing residencies and practicing medicine outside of Texas. Let's fix it."

Among other legislative priorities were: 

  • Stopping inappropriate expansion of the scope of practice of nonphysician practitioners;
  • Increasing state Medicaid payments and extending Medicare parity for Medicaid payments for primary care services;
  • Stopping the spread of health insurance narrow networks and protecting out-of-network physicians;
  • Regaining state funding support for several primary care preceptorship programs for medical students; and
  • Protecting Texas' 2003 medical liability reforms. 

Several other specialty societies expressed their frustration with new federal regulations reclassifying drugs that contain hydrocodone combinations from Schedule III to Schedule II. They asked Texas lawmakers to investigate what steps the state can take to ease the paperwork requirements associated with the reclassification.

As in every legislative session, Texas physicians, residents, medical students, and TMA Alliance members have four unique opportunities this year to affect medicine's legislative agenda. The "White Coat Invasion" has been the key to physicians' successes in the Texas Legislature since the inception of First Tuesdays at the Capitol in 2003. The 2015 First Tuesdays at the Capitol are set for Feb. 3, March 3, April 7, and May 5. Register online.

Medicare 2015 Fee Schedules Delayed

The American Medical Association reports that Medicare claims-processing contractors removed the 2015 physician fee schedules from their websites in late December. A notice on the sites indicated that technical corrections are being made to the payment rates and that they will be posted no later than Jan. 20, 2015. On Dec. 29, the Centers for Medicare & Medicaid Services issued a related announcement regarding Medicare claims for 2015 dates of service being held for the first two weeks of the year. 

Following is the full text of the CMS announcement:

Holding of 2015 Date-of-Service Claims for Services Paid Under the 2015 Medicare Physician Fee Schedule

On Nov. 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday, Jan. 1, through Wednesday, Jan. 14). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

MPFS claims for services rendered on or before Wednesday, Dec. 31, 2014, are unaffected by the 2015 claims hold and will be processed and paid under normal procedures and time frames.  

TMA and AMA will continue to monitor the situation and provide updates if necessary.

Are You Receiving a PQRS Penalty in 2015?

Payment adjustments under the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) have begun. CMS is cutting payments by 1.5 percent  under the Medicare Physician Fee Schedule for eligible professionals (EPs) who did not report or satisfactorily participate in the 2013 PQRS program year. Physicians receiving a PQRS payment adjustment who believe the penalty is being applied in error can appeal the determination and request an informal review from CMS now through Feb. 28. 

Informal Review

An informal review is the process in which CMS will investigate whether an EP met the criteria for satisfactorily reporting under PQRS. After submitting a request for an informal review, CMS will review incentive eligibility or payment adjustment determination and notify physicians with a final decision via email within 90 days of the original request. If the payment cut is in error, CMS will reprocess claims for all charges with dates of service in 2015 and return the payments.

Are You Subject to a PQRS Penalty?

Check your mail. Over the past few months, CMS has sent letters to inform physicians of the 2015 PQRS payment adjustment. If you reported PQRS data in 2013 as an individual EP, refer to the final determination in your 2015 PQRS Payment Adjustment Feedback Report.

If you reported PQRS data in 2013 under the Group Practice Reporting Option (GPRO), refer to the final determination in your CMS Physician Feedback Program Quality and Resource Use Report (QRUR). 

Physicians receiving a PQRS payment adjustment will see the indicator "LE" on their remittance advice for all Medicare Part B services rendered in 2015. Look for a claim adjustment reason code (CARC) and the remittance advice remark codes (RARCs): 

  • CARC 237: Legislated/regulatory penalty, to designate when a negative or downward payment adjustment will be applied.
  • RARC N699: Payment adjusted based on the PQRS Incentive Program. 
  • RARC N701: Payment adjusted based on the value-based payment modifier. 

If you are subject to a PQRS penalty, check with your medical liability insurer to determine whether your policy provides any type of coverage to appeal the assessment of the PQRS penalty.

How to Request an Informal Review  

  1. Identify who will submit the request. Individual physicians, support staff, group practice contacts, electronic health record (EHR) vendors, and registry representatives can all request an informal review. If an EHR vendor or registry representative submits the request on behalf of a client, CMS will send only the final decision to the applicable physician. Requests must be submitted for each tax identification number a national provider identifier is questioning.
  2. To submit a request for an informal review, go to the Quality Reporting Communication Support Page. This page is available from Jan. 1 to Feb. 28.
  3. Ensure all fields in the online form are complete. CMS will not fulfill a request for an informal review unless all mandatory sections are answered. Once a request has been submitted, CMS should send a confirmation email. If an email is not received, contact the CMS QualityNet Help Desk.
  4. For additional details and step-by-step guidance on how to request an informal review, refer to this CMS guide

How to Avoid Future Penalties

Physicians can avoid future payment adjustments in 2016 by reporting data on quality measures under the 2014 PQRS program year. Although the 2014 calendar year has ended, physicians still have time to comply. Depending on the reporting method used, submission deadlines vary from February through March 2015. Read more on how to avoid future penalties in the Dec. 15 issue of Action

Submission Deadlines for the 2014 PQRS Program Year  

More Information

For questions about submitting an informal review request, 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. For complete details, visit the CMS website

  TMAIT Action Ad Sept 14    

Quality and Cost Reports Are Here

This past fall, the Centers for Medicare & Medicaid Services (CMS) made quality and cost reports available to physicians and group practices nationwide for the first time. The Quality and Resource Use Reports (QRURs) provide comparative information about the quality and cost of the care you delivered to your Medicare fee-for-service patients during 2013.

The reports use quality measures from the Physician Quality Reporting System (PQRS) as well as the information you report through PQRS. Your QRUR supplies data for the Medicare patients you "directed" (likely those for whom you were the primary care physician), "influenced" (likely those you treated as a specialist), and/or "contributed to" (all others).

The 2013 QRURs include data assessing a physician's or group's performance on cost measures, information about the services and procedures contributing most to patients' costs, and performance on quality measures including performance on three outcome measures.

CMS intends the QRURs to provide clinically meaningful information you can use to improve quality and efficiency as you care for your Medicare patients. And the QRURs preview the performance scores CMS will use to calculate your value-based payment modifier under a new payment system, set to take effect in 2015 for larger practices and by 2017 for all physicians. The value-based payment system moves toward physician payment that rewards value rather than volume. 

Physicians have reported the QRURs are difficult to interpret. For help, you can turn to the TMF Quality Innovation Network Quality Improvement Organization, an offshoot of TMF Health Quality Institute (See “Partner in Quality” in the October 2014 issue of Texas Medicine.). 

Under a contract with Medicare, TMF has created several quality networks you can join to get help and consulting at no cost. To get started with PQRS, QRUR, and value-based payment help, join the Value-Based Improvement and Outcomes Network. (And while you're at it, check out the Meaningful Use Network.)

Or, contact these TMF Quality Innovation Network representatives for information:

Christine Allen
Program Manager
(866) 439-8863

Tracy Swoboda
Project Resource Consultant
(361) 258-1053

To find out more about the QRUR, visit the 2013 QRUR and the How to Obtain the 2013 QRUR webpages on the CMS website.

It's not too late to report to PQRS for the 2014 program year via registry (last day for reporting via PQRSwizard and Covisint PQRS is Feb. 26, 2015) or electronic health records (last day for reporting is Feb. 28, 2015). It's too late to start reporting via claims for 2014 because physicians most likely will not meet all of the reporting requirements. 

For an overview of the 2014 PQRS reporting requirements, visit the TMA website or check out TMA's on-demand webinar. 

Half of Eligible Professionals Will Face Meaningful Use Penalty in 2015

Recent news from the Centers for Medicare & Medicaid Services (CMS) that more than 50 percent of eligible professionals will face penalties under the meaningful use program in 2015 sent shock waves through the medical community. 

American Medical Association President Elect Steven J. Stack, MD, said in a statement the program "was intended to increase physician use of technology to help improve care and efficiency. Unfortunately, the strict set of one-size-fits-all requirements is failing physicians and their patients. They are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden."

Still, physicians participating in the federal electronic health record (EHR) meaningful use program must report a full calendar year in 2015. Many stakeholders recommended CMS require only a 90-day reporting period for 2015, but CMS did not listen. Regardless of Stage 1 or Stage 2 participation, physicians must use 2014 certified EHR technology (CEHRT) and report on patient encounters taking place from Jan. 1, 2015, through Dec. 31, 2015. The only exception to full-year reporting is if it is a physician's first year to participate. Those doctors have a 90-day reporting period.

Physicians not participating, and who did not apply for an exemption, will begin to see a 1-percent reduction in Medicare allowable charges for claims processed on 2015 patient encounters. Details about the program are available on the TMA website in the EHR Incentive Resource Center

If you have questions about the timelines and the EHR incentive program, contact TMA's Health Information Technology Department by calling (800) 880-5720 or by email

Save the Date(s) for First Tuesdays

First Tuesdays at the Capitol returns next month, and the Family of Medicine needs you to be there.

The "White Coat Invasion" has been the key to physicians' successes in the Texas Legislature since the inception of First Tuesdays at the Capitol in 2003. Our senators and representatives listen when their hometown doctors appear in their offices. Our influence is so much greater when physicians and alliance members arrive en masse in the House and Senate galleries. It's time again to bring out Texas medicine's strongest weapon.

Mark your calendar for the 2015 First Tuesdays at the Capitol, and register today:

  • Feb. 3,
  • March 3,
  • April 7, and
  • May 5.

Although the Texas Legislature is becoming more hyper-partisan and hyper-political, TMA will continue to work for what's best for patients and their physicians. Medicine's 2015 legislative agenda, based on TMA's Healthy Vision 2020, Second Edition, will focus on:

  • Increasing funding for graduate medical education.
  • Improving physicians' Medicaid and CHIP payments to more appropriately reflect the services they provide to patients.
  • Holding health insurance companies accountable for creating and promoting adequate physician networks.
  • Devising and enacting a system for providing health care to low-income Texans that improves efficiencies by reducing bureaucracy and paperwork.
  • Stopping any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners' education, training, and skills.
  • Promoting government efficiency and accountability by reducing Medicaid red tape.
  • Protecting physicians' ability to charge for their services.
  • Improving the state's public health defense to better respond in a crisis.
  • Preserving Texas' landmark medical liability reforms.
  • Protecting the patient-physician relationship from corporate intrusions.

 TMLT Action Ad 4.13  

New Comp Fee Guideline Conversion Factors Available

The Texas Department of Insurance (TDI) has posted the annual change to the Medical Fee Guideline conversion factors. The most current reimbursement methodologies, models, and values or weights used by the Centers for Medicare & Medicaid Services are the basis of the fee guidelines adopted by the Texas Division of Workers' Compensation (DWC) for non-network services and approved out-of-network services.

DWC established a conversion factor and an annual update to provide predictability and reflect changes in medical service delivery costs to system participants. The annual update is based on the Medicare Economic Index (MEI), which for 2015 reflects an increase of 0.8 percent. MEI is a weighted average of price changes for goods and services used to deliver physician services.

For services provided in calendar year 2015, the new Medical Fee Guideline conversion factors are: 

  • $56.20 for service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery performed in an office setting; and
  • $70.54 for surgery performed in a facility setting. 

If you have questions or would like more information, call the toll-free Comp Connection for Health Care Providers at (800) 372-7713.

Workers' Comp Has New Training Resources for Treating Doctors

The Texas Division of Workers' Compensation (DWC) has created new training materials to help treating doctors understand the role of a causation analysis in resolving a dispute and to educate them on what information is most helpful in these analyses. 

The new materials for treating doctors include:

  • A seven-minute educational video, 
  • A sample treating doctor report, 
  • A summary of best practices for preparing analyses, and 
  • Other resources for treating doctors.  

Injured employees may need injury causation analyses from their treating doctors when there is a dispute. A treating doctor may be asked to provide a report that explains how and why the claimed accident or injury was a substantial factor in causing the work-related injury or illness within a reasonable degree of medical probability. 

For additional information, call (512) 804-4040.

2015 TMA Winter Conference: Leading the Way Through Crisis and Change

The 2015 TMA Winter Conference takes place Jan. 30-31 at the Hyatt Regency in downtown Austin. Physicians and medical students will have the opportunity to conduct TMA business, obtain continuing medical education credit, and network with peers. 

Join your colleagues and participate in discussions on crisis management, the current legislative session, and changes in the health care landscape. 

Register and make your hotel reservations on the TMA website.

Sign Up Now for TMA Legislative News Hotline

Want to stay fully informed of the latest happenings of the 2015 Texas Legislature? Subscribe today to TMA Legislative News Hotline.

The hotline is a daily electronic newsletter only for TMA members that reports the legislature's latest news and actions affecting organized medicine. Subscribers receive the newsletter each day the legislature is in session, beginning Jan. 5. A weekly recap, which TMA delivers each Sunday, is also available. You can subscribe for the daily or weekly TMA Legislative News Hotline online (members only).

 PC Action Ad July 13   

TexMed 2015 Registration Is Now Open. It’s Free!

Register today for TMA's free annual conference, and join thousands of fellow Texas physicians as TexMed 2015 descends on Austin May 1-2 for a weekend of advocacy, education, and collaboration. TexMed is TMA's largest event of the year, offering more than 80 hours of available continuing medical education (CME), an extensive gathering of exhibitors to help with every aspect of your practice, and, because it's in Austin, a special Thursday event at the Capitol.

Thursday, April 30

2-4 pm 
Arrive early on Thursday, April 30, and bring your white coat with you for TexMed at the Capitol. Head to the statehouse and visit with legislators and key staff. You will have the opportunity to meet with elected officials face-to-face to voice the priorities for medicine this legislative session. Join other physicians and alliance members to make a big impression. Please note: TMA will provide a shuttle from the Hilton to the Capitol for your convenience.

Friday, May 1

3:30-5 pm 
During TexMed's Opening General Session, Ira Byock, MD, will address the issue of palliative care and dying in America. Dr. Byock, author and one of the foremost palliative care physicians in the country, argues that to ensure the best end-of-life care possible we must not only remake our health care system but also move past our cultural aversion to talking about dying. 

Saturday, May 2 

1:30-2:30 pm 
Patricia A. Shands, MD, will share her unique journey through health care during TexMed's Closing General Session. An orthopedic surgeon, Dr. Shands lives and works in Anchorage, Alaska, and for the Alaska Native Tribal Health Consortium. She'll share her motivational recount of her work with native/Inuit tribes. She provides an extraordinary look at the path medicine has taken her. 

For a full schedule of events, CME, exhibitors, lodging information, and fun things to do in and around Austin, visit the TexMed 2015 webpage, and be sure to register today to reserve your spot so you can enjoy this free benefit of your TMA membership.

Vaccination Event Funding Available From TMA

TMA can help you fund a local shot clinic. TMA's Be Wise — ImmunizeSM program offers grants of up to $2,500 to fund free or low-cost events for children, adolescents, or adults. 

In 2015, TMA will offer three opportunities for physicians, medical students, TMA Alliance chapters, and county medical societies to apply for a Be Wise local impact grant. The first opportunity to apply is March 1. TMA will accept applications again on July 1 and Nov. 1. 

Need help planning your event? Attend the Be Wise — Immunize Outreach Meeting Jan. 30 at 2:30 pm during TMA's Winter Conference in Austin. Or check out the Be Wise — Immunize Quick Start Manual: A Step-by-Step Vaccination Outreach Guide and Be Wise Event Ideas. 

Contact Tammy Wishard, TMA's outreach coordinator, at (512) 370-1470 or (800) 880-1300, ext. 1470, to find out more about how to bring a vaccination event to your community.

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 Permian Basin Youth Chavarim, along with gifts from physicians and their families. 

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

This Month in Texas Medicine

The cover story in the January issue of Texas Medicine provides a 2015 legislative preview outlining TMA's ambitious agenda to ensure the patient-physician relationship is a priority and that legislators consider it as bills work through the session. The latest issue also examines TMA's support of improving the Office of Inspector General's investigations of physicians accused of Medicaid fraud, waste, and abuse; Texas' coverage gap that leaves more than 1 million uninsured; efforts among physicians to educate their patients about Ebola; what medical practices are doing to prepare for the newly insured in round two of the Affordable Care Act marketplace; and the transition of hydrocodone combination products to Schedule II.

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.      

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.  


Medicare 2015: Feb. 3-25
Hope in a Changing World: Feb. 27-28
ICD-10: Will You Just Survive, or Will You Thrive? March 3-26
Commit to Compliance: Meeting the Challenge: May 8

On-Demand Webinars

Prompt Pay and the Revenue Cycle
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Conferences and Events

2015 Winter Conference
1/30-31    Austin     

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Last Updated On

December 20, 2016