Action: Jan. 15, 2015

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

INSIDE:  Medicare Meaningful Use Attestation Deadline Looms

Medicare Meaningful Use Attestation Deadline Looms
Performance Scores Added to Physician Compare Website
Feds Say They Cut Burden of RAC Audits
TMLT Adds $15 Million to Trust Rewards Program
Save the Date(s) for First Tuesdays
Dual Demonstration Training Opens This Month

Get Tweeting! Hashtag #TMASMA
Save 20 Percent on All Online CME This Month Only
TMA Calls for Tougher HMO Network Adequacy Rules
Bone Up on New Medicare Mandates at TMA's Annual Medicare Seminar
Register Today for TexMed 2015, TMA's Premier Annual Event
This Month in Texas Medicine  

Medicare Meaningful Use Attestation Deadline Looms

Don't miss out on your Medicare electronic health record (EHR) incentive payment for 2014. The deadline is Feb. 28 at 10:59 pm CT to attest that you met the Medicare EHR meaningful use criteria for 2014. You also must meet this deadline to avoid the 3-percent penalty on Medicare charges in 2017.

The Centers for Medicare & Medicaid Services (CMS) may have high traffic on its attestation website as Feb. 28 nears. TMA recommends not waiting to the last minute and attesting during off-peak hours to avoid delays.

TMA has developed step-by-step instructions to help guide physicians through the meaningful use process. Scroll down to Step 6 for attestation help and a link to the CMS attestation website.

If you have questions about the program, contact TMA's Health Information Technology Hotline at (800) 880-5720 or by email

Performance Scores Added to Physician Compare Website

Patients can now look online to see how some physician practices performed on certain Medicare rankings.

The Centers for Medicare & Medicaid Services (CMS) this December posted new performance scores to its Physician Compare website on four quality measures from the 2013 Physician Quality Reporting System (PQRS) program reporting year.

Performance scores were added for: 

  • Controlling blood sugar levels in patients with diabetes,
  • Controlling blood pressure in patients with diabetes,
  • Prescribing aspirin to patients with diabetes and heart disease, and
  • Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions. 

The newly posted performance scores came from 139 group practices with 25 or more eligible professionals, 214 Shared Savings Program accountable care organizations (ACOs), and 23 Pioneer ACOs that reported through the Group Practice Reporting Option (GPRO) as part of the 2013 Physician Quality Reporting System (PQRS) program reporting year. 

Mandated by the 2010 Affordable Care Act, CMS launched the Physician Compare website in 2010 to help patients make informed decisions and to create incentives for physicians to maximize performance. 

Physician Compare first contained mainly demographic information about participating Medicare physicians and other health care organizations and professionals. CMS now collects quality-of-care performance scores through a variety of programs and reporting systems, which include: 

CMS plans this year to increase the number of quality measures the public can see on Physician Compare and will post performance scores for groups of all sizes and all individual physicians who see Medicare patients. Read more about Physician Compare in the June 2014 issue of Texas Medicine

CMS also posted information this December on four patient experience of care measures for ACOs obtained from Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) surveys. Data include:  

  1. Getting Timely Care, Appointments, and Information;
  2. How Well Your Doctors Communicate;
  3. Health Promotion and Education; and
  4. Patients' Rating of Doctor. 

How to Access Your Profile and View Your Performance Scores

Physician Compare displays scores for how well a group performed on each measure as a percentage, with a corresponding five-star scale. Here's how to access your profile and view your performance scores on the Physician Compare website: 

  1. Enter your location, last name, and click the search button.
  2. Expand the list of names by clicking on "Healthcare Professional Names with …"
  3. Click on your full name to view your profile.
  4. Click on the name of your group affiliation to view your list of quality programs.
  5. Above the list of quality programs, click on the tab that states "Clinical Quality of Care." If there is no tab, either you did not satisfactorily participate in PQRS, or CMS has not yet posted your data,
  6. View your performance scores.  

For performance scores on ACOs, visit the ACO Quality Reporting page. 

Physician Compare Resources

More Information

For questions about your profile or publicly reported data, contact Physician Compare by email. For questions about PQRS, contact the CMS QualityNet help desk, Monday through Friday, 7 am to 7 pm CT, by calling (866) 288-8912, or by email. You can also contact the TMA Knowledge Center by phone, (800) 880-7955, or by email. For complete details, visit the CMS website

Feds Say They Cut Burden of RAC Audits

In response to industry feedback, the Centers for Medicare & Medicaid Services (CMS) last month released 20 improvements to its Recovery Audit Contractors (RAC) program to reduce its burden on physicians, enhance oversight, and increase transparency. The changes take effect when the next recovery auditor contracts are awarded and are listed on the CMS website.

Addressing one of physicians' chief complaints, CMS will shorten the look-back period for patient status reviews from three years to six months from the date of service, as long as the hospital submits its claim within three months of that date. Another change will adjust the number of case reviews – which CMS calls additional document requests (ADRs) – physicians undergo, and base them on physicians' compliance with Medicare rules. Where before there was no differentiation, now, physicians with low claims denial rates will have fewer ADRs. 

Instead of physicians having to wait 60 days for a determination in a complex review, RAC auditors must now complete them and notify providers about their findings in 30 days. Additionally, CMS increased the post-determination discussion period. RAC auditors must now wait 30 days after their determination before sending claims to Medicare administrative contractors for adjustment. This gives physicians time to submit a discussion request without forcing them to choose between initiating a discussion and submitting an appeal. The extra time also allows for modifications to improper payment determinations before submitting the claim for adjustment. 

To increase system accountability, CMS now requires RAC auditors to maintain an overturn rate of less than 10 percent at the first level of appeal and an accuracy rate of 95 percent on automated reviews; otherwise, they face a corrective action plan that could include lower ADR limits. RAC auditors will not receive a contingency fee until after the second level of appeal is exhausted. Previously, they were paid immediately upon denial and recoupment of the claim. 

CMS also will increase public reporting on data such as appeals, quality assurance activities, and timeliness standards. In addition to posting compliance tips online, CMS has added a provider relations coordinator position to help physicians resolve problems.

  TMAIT Action Ad Sept 14    

TMLT Adds $15 Million to Trust Rewards Program

The Texas Medical Liability Trust (TMLT) allocated an additional $15 million this month to its Trust Rewards Program for 2015, bringing the program's total to $165 million. TMLT started the program in 2012 to reward policyholders for their loyalty.

Funds are set aside annually for eligible policyholders in their Trust Rewards accounts and are distributed to policyholders when they retire or at other qualifying events. "The $15 million allocation is just one of many ways we recognize and reward our policyholders," said TMLT President and Chief Executive Officer Robert Donohoe. "No other carrier offers this much to Texas physicians."

This latest allocation is in addition to other industry-leading benefits, including cyber liability and Medefense coverage. TMLT also provides policyholders with tools and services needed to enhance patient safety and prevent medical liability claims.

The largest medical liability insurance provider in Texas, TMLT serves more than 17,500 TMA member physicians. Rated A (Excellent) by A.M. Best Company, TMLT is the only medical professional liability insurance provider created and exclusively endorsed by TMA.

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.

Dual Demonstration Training Opens This Month

The Texas Health and Human Services Commission (HHSC) will conduct two provider training webinars on Jan. 21 and Feb. 6 on the Texas Dual Eligibles Integrated Care Demonstration Project that launches in six Texas counties March 1. The webinars will be recorded and available for later viewing on the HHSC website.

The demonstration project is a partnership between Texas and the Centers for Medicare and Medicaid Services (CMS) to test a new model for providing care to patients enrolled in both programs. In the project, Texas and CMS will contract with Medicare and Medicaid managed care plans to coordinate patient care across both programs. The project begins March 1 in Bexar, Dallas, El Paso, Harris, Hidalgo and Tarrant counties. Find more information about the project on the CMS website and in a May 2014 Texas Medicine article

HHSC Training on Dual Eligible Demonstration Webinars (Both cover the same content.)

Wednesday, Jan. 21
2-4 pm
Register online.  

Thursday, Feb. 26
2-4 pm
Register online.  

 TMLT Action Ad 4.13  

Get Tweeting! Hashtag #TMASMA

Silly as its name sounds, Twitter is a social media tool of choice for the Texas Legislature. Groups that most effectively use this social network to influence the legislative process have trained their supporters to faithfully echo the organizations’ Twitter messages. This tactic substantially increases the groups’ Twitter reach … and impact.

While TMA has been active on Twitter for years and has a large and growing following, our tweets don’t get enough reinforcement from TMA members. As part of TMA’s plan to better engage the 84th Texas Legislature at all levels, the association is asking TMA leaders and member physicians to join the TMASMA (TMA Social Media Advocacy) campaign in the Twittersphere. 

Here’s what TMA is asking you to do

  • Sign up for and start using Twitter (if you’re not already) or reactive your old account.
  • Take Lessons 1-4 (as needed) of the TMA Twitter Academy materials (see below).
  • Grow your follower list — be sure to add your own state representative and senator and statewide elected officials.
  • Pay specific attention to TMA tweets and retweet them as you can. 
  • Pay VERY specific attention to TMA tweets marked with the #TMASMA hash tag and be sure to retweet them.
  • Look for — and retweet — news stories supportive of TMA's advocacy agenda/Healthy Vision 2020

For those new to Twitter, TMA has posted four step-by-step TMA Twitter Academy videos that walk you through the process: 

  1. Setting up Your Twitter Account
  2. Following and Being Followed
  3. How to Tweet
  4. Twitter Tools and Tips 

The materials include lists of elected officials, news organizations and reporters, medical organizations (including TMA), and Texas physicians you’ll be sure to want to follow on Twitter.

Get tweeting … and make a difference under the dome!

Save 20 Percent on All Online CME This Month Only

TMA members already receive exclusive pricing on all TMA continuing medical education (CME) courses as a membership benefit, but for the entire month of January, the discounts have gotten even bigger – 20 percent bigger! 

The TMA Education Center offers more than 80 CME courses covering a wide variety of topics, including some 50 offering ethics credit, making it easy to find 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 CME purchase. This exciting offer applies only to current TMA members and their staff and excludes live programs.

For questions or more information about TMA seminars, contact the TMA Knowledge Center. Call (800) 880-7955 from 8:18 am to 5:15 pm CT, or email.

TMA Calls for Tougher HMO Network Adequacy Rules

TMA and 11 state specialty societies filed a 34-page letter with the Texas Department of Insurance  (TDI), commenting on the network adequacy and out-of-network payment provisions of TDI’s informal working draft rule proposal on HMOs. The letter says the draft proposal would reduce the value of HMO products available to consumers and increase consumer out-of-pocket expenses.

"If health plans are not inclined to prioritize network adequacy requirements, as is implied by plan failure to comply with the most basic network adequacy reporting requirement, then it becomes much more important for the Department to make the health plans prioritize network adequacy through strong regulatory and enforcement actions," TMA President Austin King, MD, and the presidents of the 11 other societies wrote. 

It is important to note that the working draft proposal is subject to further revision before publication of a final rule proposal. TMA and the specialty societies will continue to monitor the rule’s development and will provide additional comments when TDI proposes the rule formally, which is not expected until after the legislative session. 

PC Action Ad July 13 

Bone Up on New Medicare Mandates at TMA's Annual Medicare Seminar

Prepare for the gush of Medicare's new 2015 quality measurements, payment formulas, and pay cuts by attending one of TMA's live Medicare 2015 seminars running Feb. 3-25 in cities across the state.

Learn about the latest changes and future trends in:  

  • Compliance and audits, including a review of the Office of Inspector General 2015 Work Plan;
  • Alternative payment models, including how to prepare for quality-based payment; and
  • Information technology, including reviews of the meaningful use program and the Physician Quality Reporting System.  

The half-day course is open to both TMA and non-TMA members for 3.25 AMA PRA Category 1 Credits™; 2.25 credits of education in medical ethics and/or professional responsibility. Use coupon code EPROMO at checkout to save $20 when you register on the TMA website. Can't attend in person? Register for the live webcast on Feb. 25 and participate from the comfort of your home or office. For more Medicare information, tools, or practice help, visit TMA's online Medicare Resource Center.

Register Today for TexMed 2015, TMA's Premier Annual Event

Join thousands of fellow Texas physicians in Austin May 1-2 for a weekend of advocacy, education, and collaboration at TexMed 2015, TMA's annual conference and largest event of the year. TexMed 2015 offers more than 80 hours of free continuing medical education (CME), special guest speakers, and an extensive gathering of exhibitors to help with every aspect of your practice.

Bring your white coat, and come a day early for TexMed at the Capitol on Thursday April 30, from 2 to 4 pm. TMA has planned a day of advocacy at the Capitol and has lined up opportunities for you to meet face-to-face with state representatives and senators and their staff. This is a great chance to impact the conversation during the legislative session and help strengthen the unified voice of Texas physicians.

For a full schedule of events, CME, exhibitors, lodging information, and fun things to do in and around Austin, visit the TexMed 2015 webpage. Register online to reserve your spot and enjoy this free benefit of your TMA membership.

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.        

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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.     

Feb. 28, 2015: HIT: Medicare EHR Incentive Program Attestation Deadline for 2014 Payment Year Participation

 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
How to Talk to Patients About Tobacco Cessation
10 Ways to Turn Satisfied Patients Into Loyal Patients 

Conferences and Events

2015 Winter Conference
1/30-31    Austin     

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Last Updated On

December 20, 2016