Action: March 2, 2015

TMA Action March 2, 2015   News and Insights from Texas Medical Association


Feds Delay Final Medicare Overpayment Rule
The Truth About Balance Billing
TMA to Congress: Protect Texas Tort Reform Gains
Annual HEDIS Data Collection Roundup Launches
Avoid 2016 Pay Cuts; Meet Next Round of PQRS Deadlines Now
TexMed 2015 Registration Is Now Open — and It’s FREE!
Help Your Patients Plan for End-of-Life Care
Measles Outbreak Adds 33 Cases to Reach 154
Let the Prepping Begin for ICD-10
Good-bye Strips, Hello Chips
TMAF Grant Funding Hits Record High
This Month in Texas Medicine

Feds Delay Final Medicare Overpayment Rule

The Centers for Medicare & Medicaid Services (CMS) announced last week it needs another year to finalize rules on reporting and returning Medicare overpayments. First issued three years ago to implement parts of the Affordable Care Act, the proposed rule (better known as the 60-day rule) requires physicians and other health care providers to report and refund overpayments within 60 days from the date the overpayment is identified or the date the corresponding cost report is due.

CMS's definition of when a payment is "identified" and the 10-year look-back period on claims that had not been identified garnered much industry criticism and pushback.

In its announcement explaining the year extension, CMS cited exceptional circumstances, including the rule's complexity and significant policy and operational issues raised by comments to the proposal, that need to be resolved.

With or without final rules, CMS warned stakeholders of their responsibility to return overpayments according to existing federal statutes or face penalties that include False Claims Act violations and exclusion from Medicare.

For more Medicare information, visit TMA's Medicare Resource page. For help with Medicare payment issues, email paymentadvocacy[at]texmed[dot]org, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Also, visit the TMA Payment Advocacy Services webpage and TMA's Payer page for more resources and information.

The Truth About Balance Billing

A pair of newly developed TMA resources examine how insurance plans' network designs and payment decisions are leaving many Texans with "surprise bills" for health care services.

Inadequate and limited physician networks that insurers sell today are leaving patients with unpaid bills and making the news. Unfortunately, when Texas consumers most need coverage, especially in emergencies, they are discovering the limitations of the coverage they have purchased. The consumer is no longer satisfied with the not-very-well-explained, varying levels of savings that insurance network products create, especially if that means a greater financial burden in emergencies. Yet, despite network shortcomings, consumers do not want to be left without the choice of managed care health plans that offer network benefits.

A new TMA white paper, "Putting the Pieces Together: Network Inadequacy and Unfair Discrimination in Insurance," explains how insurers limit their losses at the expense of the consumer. It also offers health policy solutions that will provide insurance consumers the opportunity to buy the coverage they expect and demand.

TMA staff has also prepared a detailed spreadsheet of network information gathered from Blue Cross and Blue Shield of Texas, Humana, and UnitedHealthcare health plans as of December 2014. To use the spreadsheet: 

  • Click on the tab for the individual carrier at the bottom of the spreadsheet to access the information for that individual carrier. 
  • You may sort by hospital/facility, city, county, or provider(s) in each of these specialties: anesthesiology, pathology, radiology, and/or ER physician/group. 

TMA to Congress: Protect Texas Tort Reform Gains

TMA President Austin I. King, MD, reached out last week to Congress asking that lawmakers protect hard-won tort reform gains in Texas by not passing federal statutes that could water down or supersede state law. 

Additionally, he asked legislators to support specific bills that would bar any other federal law from establishing a legal standard of care for physicians or health care providers in medical professional liability lawsuits or preempting state medical professional liability laws.

Although medical liability reform was not addressed in the Affordable Care Act, federal law, both under ACA and in statutes predating ACA, contains language that could be construed to create a legal standard of care for health care professionals. 

"These standards that were intended to improve quality and contain costs could have the unintended consequence of impacting tort liability," Dr. King said in a letter last week to U.S. Rep. Kevin Brady (R-Texas). "There are concerns that language in federal health care law will be misinterpreted to create new claims that interfere with existing state medical malpractice laws." 

Dr. King also asked Representative Brady to support the Standard of Care Protection Act that is expected to be reintroduced with support from numerous Texas congressmen and to include language from that act in any Medicare Sustainable Growth Rate (SGR) replacement legislation.

The letter was cosigned by Robert Donohoe, president and chief executive officer of the Texas Medical Liability Trust, and Howard Marcus, MD, board chair of Texas Alliance for Patient Access.

   TMAIT Action Ad Sept 14 

Annual HEDIS Data Collection Roundup Launches

Health care payment plans started sending letters to physician offices in February to begin this year's annual Healthcare Effectiveness Data and Information Set (HEDIS) data collection process. No two health plans collect their HEDIS data exactly the same way, but most follow similar processes. 

Health plans typically first want to know your preferred delivery method, such as fax, email, or secure access to your electronic medical record system, for sending requested patient records. You also may be asked to schedule an on-site visit with a plan representative. If you receive a medical records request, make sure you respond within the requested time frame.

Refer to your contract before charging a health plan for expenses related to medical record data collection. 

You can view notices to providers about HEDIS data collection and more information from some major health plans:  

  • The Blue Cross and Blue Shield of Texas (BCBSTX) HEDIS data collection methods may include an on-site visit from a BCBSTX nurse. 
  • Cigna may send you its medical records review list of patient names in its initial letter with a deadline for submission.
  • UnitedHealthcare (UHC) first sends a general notification letter to the offices of all contracted physicians and providers. If your patient(s) is selected for review, a UHC representative will contact your office to schedule a date for collecting the data and, on that same day, will fax you a list of patient names. You can choose electronic or on-site data collection, fax, mail, or email. You may be contacted by one of UHC's medical record vendors: Altegra Health, Enterprise Consulting Solutions, Inc., HealthPort, or Record Flow.
  • Aetna's medical records vendors, HealthPort or MedSave, may contact your office to schedule data collection. For more information, see page 6 of this Aetna newsletter.
  • Tricare's HEDIS program information is on page 3 of this newsletter.  

The National Committee for Quality Assurance develops and maintains HEDIS quality measures that are used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. HEDIS consists of 81 measures updated yearly across five domains of care.

If you have questions about HEDIS, email TMA's specialists or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Also, visit the TMA Payment Advocacy Services webpage and TMA's Payer page for more resources and information.

Avoid 2016 Pay Cuts; Meet Next Round of PQRS Deadlines Now

Get help from TMA and the TMF Health Quality Institute to understand and navigate the Physician Quality Report System (PQRS), and get your reporting done.

Medicare and TMA's endorsed PQRS registries have extended their submission deadlines. Physicians still have time to comply with the reporting requirements for the 2014 PQRS program year. Depending on the reporting method used, submission deadlines vary. 

Deadlines for the 2014 PQRS Program Year  

What's at Stake?

Failure to report for the 2014 PQRS program year will result in a 2-percent Medicare payment cut in 2016 under PQRS for all physicians, plus another 2-percent cut under the Value-Based Payment Modifier program for group practices with 10 or more eligible professionals (EPs). Refer to this graph to see how PQRS participation affects the value modifier (VM). In 2017, all physicians who participate in fee-for-service Medicare will be subject to PQRS and VM payment adjustments based on data reported for the 2015 PQRS program year. 

How TMA Can Help

Physicians who are unable to report through an EHR system and didn't report via the claims-based reporting method should use an online registry. Registry reporting would take a few hours to complete in one sitting, but could be spread out in the two weeks left before the March 13 deadline. It is open to all physicians and group practices of any size. Choose one of TMA's endorsed, cost-effective registries (PQRSwizard or Covisint PQRS) and get a TMA-member discount. Read more about the benefits of registry reporting in the November 2014 issue of Texas Medicine

Get Free Technical Help With PQRS From TMF

The TMF Health Quality Institute is under contract with Medicare to serve as the state's quality innovation network-quality improvement organization (QIN-QIO). Medicare authorizes and funds the TMF QIN-QIO to help physicians and others at no cost with their quality reporting to advance quality improvement efforts in programs such as meaningful use, PQRS, and VM. 

The TMF QIN-QIO provides technical assistance to eligible physicians and physician groups, health care providers, inpatient/outpatient hospital departments, acute care and critical access hospitals, rural hospitals and clinics, inpatient psychiatric facilities, ambulatory surgery centers, and prospective payment system-exempt cancer hospitals.

Create a free website account and join the TMF QIN-QIO Value-Based Improvement and Outcomes Network to learn more about how you and members of your practice or hospital can benefit. 

For questions about TMF QIN-QIO services, contact one of their expert consultants: 

Tracy Swoboda
Program Manager
(361) 258-1053

Christine Allen
Project Resource Consultant
(800) 439-8863 

More Information

For answers to PQRS and VM questions, contact the Center for Medicare & Medicaid Services (CMS) QualityNet Help Desk, Monday through Friday, 7 am to 7 pm CT, by phone, (866) 288-8912, or email. You also can contact the TMA Knowledge Center by phone, (800) 880-7955, or email. For complete details, visit CMS' PQRS and VM webpages. 

TexMed 2015 Registration Is Now Open — and It’s FREE!

Register today for TMA's free annual conference, and join thousands of your fellow Texas physicians, as TexMed 2015 arrives in Austin May 1-2 for a weekend of advocacy, education, and collaboration. 

TexMed is TMA's largest event of the year, offering free continuing medical education (CME), an extensive gathering of exhibitors to help with every aspect of your practice, and, because we're in Austin, a special Thursday event at the Capitol.

See all the details and register online.

At TexMed 2015, you can meet with elected officials face-to-face to voice the priorities for medicine this legislative session, participate in your choice of more than 80 hours of free CME including two general sessions, and mingle and network with your colleagues from across the state. There's nothing quite as impactful as thousands of Texas physicians coming together in one place to form one unified voice.

The latest in your colleague's quality improvement initiatives will be on display during the third annual TexMed Poster Session — an author-hosted walk-through on Saturday from 8 am to 9 am. Categories have been expanded this year to offer physicians and medical practice staff more opportunities to participate. For additional information or to submit your own application to participate, visit the poster session webpage.

For a full schedule of events, CME, exhibitors, lodging information, fun things to do in and around Austin, and how to get more involved in TMA policy creation, visit the TMA website. Be sure to register and make your hotel reservations today so that you can enjoy this free benefit of your TMA membership.

TMLT Action Ad 4.13    

Help Your Patients Plan for End-of-Life Care

Join a March 5 live webcast to learn how to talk to your patients about death or incapacity and help them plan for the end of life.

The U.S. population aged 65 and older has more than tripled over the past century. One in four Americans aged 75 and older say they have not given very much or any thought to their end-of-life wishes.

Personal preferences for medical treatment differ by age, race, religion, and even level of education. Physicians need to know how to discuss planning for end of life with their patients so they can best coordinate care in a way that honors the patient's wishes. Advance care planning is especially important if a patient does not want aggressive treatment.

As caregivers, physicians also need to consider what would happen to their patients if the physician becomes incapacitated or dies unexpectedly. Planning for the unexpected is a necessary step in providing care for patients.

On March 5, from 6:45 pm to 8:15 pm, TMA will broadcast a live webcast of the Travis County Medical Society event Planning for Death or Incapacity: The Physician's Dual Role. This program will prepare you to: 

  • Discuss the sensitive issues of incapacity and end-of-life care with patients;
  • Prepare patients to decide on a proactive plan for incapacity and end-of-life care; and
  • Compose a proactive plan for your own incapacity and end-of-life care so that in the event of death or incapacity, your medical practice can continue to function and current patients will receive uninterrupted medical care. 

Register today, and join us for this important live event.

Measles Outbreak Adds 33 Cases to Reach 154

In response to the growing 2015 measles outbreak, which at press time stood at 154 U.S. cases, the Centers for Disease Control and Prevention (CDC) has beefed up its website to include resources to help physicians in their practice.

The CDC's main Measles webpage is a portal organized by audience. A webpage under the health care providers portal contains resources on talking to patients about vaccines and a clinical article about the 2015 outbreak that started in a California amusement park, as well as an article for physicians and a link to a video interview of Admiral Anne Schuchat, MD, a CDC director, discussing measles and the importance of vaccinations.

Resources for parents and child care providers include an infographic about symptoms and handouts about the MMR vaccine and about how to prevent outbreaks and what to do if a measles case occurs in a child care facility.

CDC updates measles case information weekly

TMA's Vaccination Resources for Patients

TMA's Be Wise — ImmunizeSM program offers free vaccination fact sheets to help physicians educate patients and send the message that vaccinations are safe, important, and effective. The childhood vaccination fact sheet includes information about the MMR vaccination.

Fact sheets also are available on adolescent vaccinations, adult vaccinations, flu, pertussis, human papillomavirus, and meningococcal disease. To request free copies of these fact sheets for your patients, contact Tammy Wishard, TMA's outreach coordinator, at (512) 370-1470, or (800) 880-1300, ext. 1470. Or use the Be Wise order form to request additional educational materials, such as posters for your office.

The December Disneyland nationwide measles outbreak and the 2013 outbreak in North Texas — all primarily among unimmunized persons — bring new attention to a disease once thought to be eliminated in the United States. TMA has collected a host of useful information for you and your patients on our new, online Combating Measles Resource Center.

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

Let the Prepping Begin for ICD-10

With ICD-10's implementation closing in, it's never too soon to get ready for the Oct. 1 transition. By now, you probably have a good idea of what ICD-10 is and how the codes are changing, but how ready are you, really, to make the switch? Have you taken the crucial steps you'll need to survive ICD-10? More important, have you positioned yourself to not just survive, but thrive with ICD-10?

TMA's upcoming live seminar series ICD-10: Will You Just Survive, or Will You Thrive? will test your practice's readiness and prepare you for obstacles during the transition process by: 

  • Presenting expense planning strategies,
  • Discussing ICD-10 documentation and staffing issues,
  • Offering instruction on end-to-end testing, 
  • Showing you how to gauge practice vendor preparedness, and
  • Distinguishing what to do if there’s another delay.

The live, half-day seminars are taking place in six Texas cities this March and will fill up fast. Register today to reserve your seat. 

  PC Action Ad Aug 13

Good-bye Strips, Hello Chips

Get your practice ready for changeover this year to new microchip-embedded debit and credit cards, or assume liability for any fraudulent transactions. 

The U.S. credit card industry is determined to ditch its outdated magnetic-strip credit card technology this year and join the rest of the world in using the more secure processing system called EMV® — short for EuroPay, MasterCard, and Visa — which is the global standard for cards equipped with computer chips and the accompanying technology to verify transactions. 

Major U.S. credit card issuers have set an Oct. 15 deadline for banks and retailers to upgrade their card-reading equipment. After Oct. 15, if a fraudulent transaction occurs in a business that has not converted to the new system, the business incurs the liability.

The United States is the last major market still to use the old-fashioned swipe-and-sign system. This system is so vulnerable to theft that while only about one-quarter of all credit card transactions happen in America, our market accounts for almost half of the world's credit card fraud – to the tune of some $8.6 billion per year.

After Europe adopted the system a decade ago, fraud dropped drastically, and experts believe that's why credit card fraud in the United States has doubled in the last seven years as criminals abandon countries using the more secure technology and flock to easier pickings here.

"Chip and Pin" Versus "Swipe and Sign"

EMV-enabled payment cards have embedded microchips that store the cardholder's information, and users must enter a PIN to complete a transaction. After a cardholder inserts the card into a card-reader slot and enters a PIN, the new system uses a multistep authorization process that involves cryptographic technology to authorize a transaction. A cryptogram that changes with each transaction makes EMV cards more secure to use, unlike magnetic strips that are static and easy to counterfeit.

Find out how to become EMV-ready with TransFirst, a TMA-endorsed member service for payment processing, to avoid liability and save money.

You'll not only avoid liability for fraudulent transactions by upgrading to EMV-compatible equipment, you also might lower your processing expenses by potentially reducing compliance fees. Mention your TMA membership to receive exclusive pricing and contract terms for all services.

TransFirst is offering new customers an EMV-ready terminal for $199; call (800) 613-0148 for more information.*

For more information on TMA-endorsed vendor services, visit TMA's website or call 800-880-1300, ext. 1406.

*$199 terminal purchase offer valid for new TransFirst customers only. Terminal offer expires March 31, 2015. All accounts subject to credit approval; some restrictions or exclusions apply. EMV is a registered trademark in the United States and other countries and an unregistered trademark in other countries, owned by EMVCo. TransFirst is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek, Calif., and Synovus Bank, Columbus, Ga., for Visa and MasterCard transactions only.

TMAF Grant Funding Hits Record High

Thanks to its generous donors, the TMA Foundation (TMAF) will reach more Texans than ever this year with a record-high $575,000 in grant funds supporting some 24 programs to improve the health of Texans. 

TMAF grants support local and statewide programs ranging from vaccination drives and bicycle helmet giveaways to awards for excellence in teaching science and scholarships for first-year, minority medical school students. 

TMAF is the 501 (c)(3) charitable arm of TMA. Grants are made possible thanks to donations from individuals, corporations, and foundations. To learn more about the initiatives that TMAF supports or to make a tax-deductible gift, visit the TMAF website or call (800) 880-1300, ext. 1466, or (512) 370-1466.

This Month in Texas Medicine

In the March issue of Texas Medicine, read about CPRIT's role in funding cancer prevention projects and recruiting top cancer researchers to the state; new standardized prior authorization forms for health care services and prescription drugs; the proposed Interstate Medical Licensure Compact, which would make it easier for physicians to move from state to state or to practice telemedicine; how to navigate purchases for small-business insurance; recommended improvements to the state's prescription drug monitoring database; and using Choosing Wisely to avoid the overuse of unnecessary and possibly harmful tests and procedures.

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.  


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

TexMed 2014
May 1-2

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 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

December 20, 2016