Action: July 15, 2015

TMA Action July 15, 2015   News and Insights from Texas Medical Association

ICD-10 Grace Period Eases Burden But Doesn't Delay Implementation
CMS Posts Full Year of 2014 Open Payments Data Totaling $6.49 Billion
Medicare Payments to Physicians Increased 0.5 Percent on July 1
Doctors: Get Ready to Accept Chip Credit Cards in Your Practice
Begin Participation in the Medicaid EHR Incentive Program by 2016
Texas’ Medicaid Transformation Waiver Extension Request Due Sept. 30
PQRS and the Value Modifier: How to Get and Understand Your Quality Report
HHS Awards Teen Pregnancy Prevention Grants to Six Texas Organizations
All Mobile-Friendly CME Discounted 20 Percent This Month
Give a High Five to Outstanding Health Reporting
Apply Now for TMA Foundation Grant Support
This Month in Texas Medicine

ICD-10 Grace Period Eases Burden But Doesn't Delay Implementation

Last week, the American Medical Association and the Centers for Medicare & Medicaid Services (CMS) jointly announced elements of a "grace period" for the Oct. 1, 2015, implementation of the ICD-10 medical billing and coding system. This is good news but not the complete deliverance physicians were hoping for. 

Here is what the grace period is and is not. 

It is not a delay of ICD-10. Starting Oct. 1, you still must use ICD-10 codes on your claim forms, and you must use an ICD-10 code from the right family of codes. Medicare will not pay you if you don't use ICD-10 codes for services provided on or after Oct. 1. This means you must continue your ICD-10 preparation apace. You and your coding staff still need to learn how to use the codes, and your practice still must make system changes to accommodate the codes and test with Novitas Solutions to make sure your claims will process smoothly.

The move by AMA and CMS is "a giant burden slightly eased," in the words of TMA President Tom Garcia, MD. The grace period gives practices and Medicare payers time to adjust to the new system and work out problems without threat of crippling payment delays or penalties for physicians. 

CMS says the grace period entails the following: 

  • For one year starting Oct. 1, Medicare will not deny claims solely on the specificity of the ICD-10 diagnosis codes as long as the physician submits an ICD-10 code from an appropriate family of codes. In addition, Medicare will not audit claims based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. 
  • To avoid potential problems with midyear coding changes in CMS quality programs (Physician Quality Reporting System, value-based payment modifier, and meaningful use) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed. 
  • CMS will establish an ICD-10 ombudsman to help receive and triage physician problems that need resolution during the transition. 
  • CMS will authorize advance payments if Medicare contractors such as Novitas Solutions are unable to process claims within established time limits because of problems with ICD-10 implementation. 

See CMS' FAQs for more information. Remember: The sooner you learn to code claims and document services to the full level of specificity, the sooner you can get paid most accurately for your services.

Here's how TMA is helping: 

  • Registration is open for TMA's live seminars: ICD-10 Essentials — two seminars in one day. In Essentials in ICD-10 Coding, staff can perfect their coding and auditing skills with hands-on exercises using ICD-10. In Essentials in ICD-10 Documentation, physicians can find out how to improve their documentation to support increased code specificity and set up their staff for success. These seminars run Aug. 4 through Sept. 16 in cities around the state. 
  • Specialty-specific, physician-developed three-hour online courses. Choose from 21 medical specialties to learn physician documentation tailored to your specialty. Each self-paced course shows you critical documentation elements you'll need to maintain payment under ICD-10 and features the top clinical conditions for each specialty with emphasis on their associated documentation and coding requirements. Complete this online documentation training now. Use coupon code 10DOCTMA to save $100 on the registration. 
  • Register for on-demand recordings of ICD-10 planning and implementation courses. View the on-demand webinar list
  • Visit TMA's ICD-10 Resource Center for tools, information, and links to on-demand webinars, including specialty-specific webinars.
  • Call (800) 523-8776 to learn more. 

CMS Posts Full Year of 2014 Open Payments Data Totaling $6.49 Billion

The Centers for Medicare & Medicaid Services (CMS) published 2014 Open Payments data detailing transfers of value by drug and medical device makers to health care professionals. The data include information about 11.4 million financial transactions attributed to more than 600,000 physicians and 1,100 teaching hospitals, totaling $6.49 billion. 

Acting CMS Administrator Andy Slavitt said in a release, "Consumer access to information is a key component of delivery system reform and making the health care system perform better. In year two, Open Payments is now a highly searchable resource to provide transparency to over one-and-a-half years' worth of financial transactions between drug and device companies and physicians and teaching hospitals. This is part of our larger effort to open up the health care system to consumers by providing more information to help in their decision making."

For 2014 and 2013 data, CMS was able to validate that 98.8 percent of all records submitted in the Open Payments system contained accurate identifying information about the recipient. CMS rejected and did not process records that could not be verified. CMS will continue to update the Open Payments website annually with data collected from the previous year. 

The Open Payments program, created by the Affordable Care Act, requires drug and device manufacturers to report transfers of value (payments, honoraria, or research grants) to health care professionals, as well as other industry-related investments they may have. The program relies on voluntary participation by physicians and teaching hospitals to review the information submitted by these companies. Registered physicians and teaching hospitals reviewed nearly 30 percent of the total value of the reported data. 

CMS will update the Open Payments data at least annually to include data disputes and other data corrections made since the initial publication. Drug and device manufacturers and group purchasing organizations (GPOs) submitted the financial data available through Open Payments. The submitting manufacturer or GPO attests to the accuracy of all data included in Open Payments reporting.

Before publication of any Open Payments data, physicians and teaching hospitals have the opportunity to register with the Open Payments system to review and dispute data submitted about them by applicable manufacturers and GPOs. With this data release, the 2014 and 2013 financial records are now available as part of the Open Payments dataset. 

CMS will refresh and publish an update to the full calendar year of 2014 financial data in early 2016. For more information, visit and

Medicare Payments to Physicians Increased 0.5 Percent on July 1

Doctors' Medicare payments increased 0.5 percent on July 1 under the Sustainable Growth Rate (SGR) formula repeal bill. To replace the SGR, the Medicare Access and CHIP Reauthorization Act of 2015 created an alternative set of annual payment updates. 

Physicians received a 0.5-percent increase that remains in effect until the end of this year. From 2016 to 2019, Medicare physician payments will increase 0.5 percent each year. Medicare physician fee-for-service payments will remain at 2019 levels from 2020 to 2025.

The Medicare Access and CHIP Reauthorization Act passed in April. In addition to charting a new path for physician payment, the law contains provisions that protect state liability reforms and ensures the care standards and guidelines in the Affordable Care Act, Medicare, or Medicaid statutes can't be used to create new causes of legal action against physicians. 

TMAIT Action Ad 6.15   

Doctors: Get Ready to Accept Chip Credit Cards in Your Practice

The looming switch to ICD-10 this fall isn't the only financial transition affecting medical practices in the future. U.S. banks are stepping up security to reduce fraud by switching from strip-based to microchip-based cards by the end of the year. 

That means you need to think about buying and reconfiguring your credit-card processing equipment and software. According to a May 22 Modern Healthcare article, a typical countertop terminal runs $200 to $300.

While the federal government hasn't mandated that private businesses convert to microchip-based cards, many patients will want to pay with them. And many businesses, including medical practices, will feel pressure to adopt the more secure payment method. According to the Modern Healthcare article, hospitals and medical practices still using an older magnetic strip reader after October 2015 will be liable for charge-backs. Businesses accepting chip cards through chip terminals would be protected from financial liability through their agreements with credit card issuers.

Watch out for scams. Earlier this year, the TMA Knowledge Center became aware of physician offices receiving calls from a "credit card company" saying they needed to switch to a "medical credit card system" and pay for training. Instead, when you are ready to change over to EMV technology, turn to your payment processing service (for example, TMA's endorsed vendor, TransFirst) or whatever reputable seller or equipment leaser you would normally go to for a payment terminal.

Begin Participation in the Medicaid EHR Incentive Program by 2016

Physicians interested in receiving incentives for participation in the Medicaid electronic health record (EHR) incentive program need to begin by adopting, implementing, or upgrading a certified EHR by 2016. It is the last year physicians may begin participation in the program to qualify for an incentive, which pays out until 2021. 

Non-hospital-based eligible professionals with at least 30 percent Medicaid volume could receive up to $63,750 over a six-year period.

  Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Adopt, implement, or upgrade a certified EHR $21,250  
Successfully attest to meaningful use program requirements   $8,500 per year for the next five years

Non-hospital-based eligible pediatricians with at least 20 percent Medicaid volume could receive up to $42,500 over a six-year period.

  Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Adopt, implement, or upgrade a certified EHR $14,167  
Successfully attest to meaningful use program requirements   $5,667 per year for the next five years

To qualify, physicians must meet the volume requirements each year. When calculating the volume, physicians must choose a sample 90-day period from the year prior to participation. Therefore, you must meet the Medicaid volume requirement in 2015 to participate in 2016. 

In the first year, participants receive the incentive payment for adopting, implementing, or upgrading a certified EHR. In all remaining years, participants must meet meaningful use requirements, just like the Medicare program. Physicians who already are participating in the Medicare EHR incentive program may not switch to the Medicaid program.

Texas Medicaid eligible professionals (EPs) must be enrolled as performing or billing providers to participate in the EHR incentive program. The enrollment process can be lengthy and may take up to 60 days to complete. If you do not initiate the enrollment process early by completing and submitting the Texas Medicaid Provider Enrollment Application, you may not receive your Medicaid provider credentials in time to meet EHR program deadlines. If you already are enrolled, make sure all credentials are up to date. Read this article from Texas Medicaid & Healthcare Partnership for additional information on the Medicaid enrollment requirements for the EHR incentive program.

For additional assistance with the Texas Medicaid EHR Incentive Program, email HealthIT[at]tmhp[dot]com, or call the Contact Center at (800) 925-9126 (option 4).

For more information about meaningful use, contact the TMA Health Information Technology Department by phone at (800) 880-5720 or by email.

Texas’ Medicaid Transformation Waiver Extension Request Due Sept. 30

Texas's five-year 1115 Medicaid Transformation Waiver will expire Sept. 30, 2016. To extend or renew the waiver, the Texas Health and Human Services Commission (HHSC) has to submit a request to the Centers for Medicaid and Medicare Services (CMS) by Sept. 30, 2015. 

Texas received a waiver in 2011 to allow it to expand Medicaid managed care statewide, establish a new uncompensated care pool for safety net hospitals and providers, and to establish and fund innovative projects to improve availability and quality of services to Medicaid and uninsured Texans. The waiver is funded via federal and state funds, with the state share provided primarily by large hospital districts.

Visit the HHSC website to view the 1115 Waiver Extension Application Draft, attachments, and public notice. HHSC will take comments on the draft during July at statewide public meetings. If you're unable to attend a public meeting, you can complete an online survey about the 1115 Waiver Extension Application Draft, specifically the Delivery System Reform Incentive Payment program and Uncompensated Care requests for the extension period. Physicians can also ask questions or submit comments via email by Aug. 5. 

Within the coming week, TMA will be submitting comments in favor of renewing or extending the waiver, the funding from which is critical to Texas' health care safety net. At the same time, TMA believes the transformation envisioned by the waiver remains elusive because of the lack of meaningful and ongoing input from community-based physicians. CMS and HHSC must undertake changes to the waiver to rectify lack of true collaboration among facilities and physicians. Texas also must increase Medicaid payments to physicians to sustain any delivery system changes achieved by the waiver.

For more information about the 1115 Medicaid Transformation Waiver online.

 TMLT Action Ad 4.13 

PQRS and the Value Modifier: How to Get and Understand Your Quality Report

The TMF Health Quality Innovation Network Quality Improvement Organization (QIN-QIO) is hosting an open forum on Quality and Resource Use Reports (QRURs) on Tuesday, July 21, from 12:30 pm to 1:30 pm CDT. This open forum is free and will provide you with information on how to access and better understand your QRUR. 

What is a QRUR?

The QRUR is a component of the Centers for Medicare & Medicaid Services (CMS) Value-Based Payment Modifier (VBM) program. The VBM aligns with and is based on your participation in the CMS Physician Quality Reporting System (PQRS). The QRUR provides detailed information on your quality and cost performance and how you compare with your peers. Read more about QRURs in the July 2015 issue of Texas Medicine.


To register, go to the event page. Before the open forum, please review the 2013 QRUR Interpretation and Quality Improvement Guide. Participants should bring their questions to the open forum or email them in advance to ensure they are answered during the webinar.

Technical Assistance

Under contract with Medicare, the TMF QIN-QIO provides free consulting services and technical assistance to eligible physicians, physician groups, and other health care professionals for Medicare's quality programs. Create a free website account, and join their networks to learn more about how you and members of your practice or hospital can benefit.  

More Information

Stay informed for the latest PQRS news by subscribing to the PQRS listserv. For continuing medical education credit, learn about PQRS and how it relates to the VBM program from the TMA Education Center and earn 1 AMA PRA Category 1 Credit™ (enduring) and 1 ethics credit. Or watch a CMS video presentation for an overview of PQRS and to learn how your participation in PQRS in 2015 will determine how the VBM will be applied to physicians' payment in 2017. For more information about the PQRS and VBM programs, visit the TMA PQRS Resource Center.

HHS Awards Teen Pregnancy Prevention Grants to Six Texas Organizations

The U.S. Department of Health and Human Services Office of Adolescent Health (OAH) awarded more than $86 million in teen pregnancy prevention grants to nonprofit organizations, school districts, universities, and others. The 81 new grants will serve more than 291,000 youths each year in communities where teen birth rates remain high.

Six Texas institutions and organizations received grant funding, including Texas Women's Healthcare Coalition member Healthy Futures of Texas. The nonprofit received $869,902 to implement and evaluate Big Decisions, an abstinence-plus approach to preventing teen pregnancy that has produced promising results for Hispanic low-income, urban youth. Healthy Futures will use the funding to demonstrate the curriculum's efficacy for that population in rural communities and small cities. TMA is also a member of the Texas Women's Healthcare Coalition.

The OAH grants support replication of evidence-based teen pregnancy prevention programs in communities with the greatest need; increase capacity in communities to serve vulnerable youth, including homeless youth, parenting youth, and those in juvenile detention and foster care; fill gaps in the knowledge of what works to prevent teen pregnancy; and test innovative approaches to combating teen pregnancy. These awards provide the first year of funding for a five-year grant period.

Learn more about OAH's Teen Pregnancy Prevention Program.

All Mobile-Friendly CME Discounted 20 Percent This Month

Need continuing medical education (CME)? Now's the perfect time to visit the TMA Education Center! 

For the entire month of July, you can take an additional 20 percent off all mobile-friendly CME courses, which can be completed anywhere, anytime, and on any device. This includes PDF publications, on-demand webinars, and podcasts. Dozens of courses are eligible for the discount, including popular programs covering ethics, risk management, coding, and practice operations. 

To take advantage of the sale, visit the TMA Education Center and enter the coupon code MOBILE20 at checkout to activate the discount.

Action Ad Summit 7.15

Give a High Five to Outstanding Health Reporting

The measles outbreak, new vaping legislation, a state Ebola action plan, the death of the SGR: These are just a few of the health stories that have made headlines in 2015. If a medical story in your hometown has caught your attention, nominate it for the TMA Anson Jones, MD, Awards for excellence in health reporting. 

The Anson Jones, MD, Awards recognize journalists in print, broadcast (television and radio), and online media. The Physician Excellence in Reporting category also recognizes physician journalists who write a medical column for a local newspaper or a health care blog, host a radio health show, or do a weekly medical segment on TV.

It's easy to nominate your local journalists:

  1. Email your nomination to ansonjones[at]texmed[dot]org. All we need is the reporter's name, name of article or story (if available), date of broadcast/publication, and the media outlet. Please try to include a URL. 
  2. TMA will send the reporter a postcard with a handwritten note to let the reporter know you nominated him or her and for which story.  

For more than 50 years, TMA has honored Texas journalists with the awards, named for pioneer physician Anson Jones, MD, the last president of the Republic of Texas. 

Visit the Anson Jones webpage for contest rules and an entry form. If you have questions, email ansonjones[at]texmed[dot]org or call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470.

Apply Now for TMA Foundation Grant Support

The TMA Foundation is accepting applications to its 2015-16 Medical Community Grants and Medical Student Leadership Grants programs.

TMA county medical societies and alliance and medical student chapters may apply for a grant to support their health improvement initiatives focused on any of TMA's priorities — tobacco use; obesity and metabolic syndrome; mental health and substance use disorders; violence, victimization, and unintentional injuries; vaccine-preventable diseases (immunizations); unplanned pregnancy; and environmental health (or hazards).

Society and alliance chapters may apply for up to $7,500, and medical student chapters may apply for up to $3,000. Find out more, including summer deadlines, on this TMAF webpage

This Month in Texas Medicine

The July issue of Texas Medicine features a cover story on Medicare mistakes TMA uncovered and helped to resolve, with key input from member physicians. In the issue, you'll also find information on new medical records rules adopted by the Texas Medical Board; growing numbers of subspecialists and the concern over adequate access to general care; failed legislation that would have required student athletes to have an EKG before participating in school athletics; TMA Practice Consulting's practice setup services; and Medicare's Quality and Resource Use Reports.

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.

PC Action Ad May 13  

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.  

ICD-10 Implementation Compliance   

First-Year Participants' Last Day to Begin 90-day Reporting Period of Meaningful Use for the 2015 Medicare and Medicaid EHR Incentive Programs

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.  


Essentials in ICD-10 Coding   
Essentials in ICD-10 Documentation 

Conferences and Events

TMA Fall Conference
Sept. 25-26

About Action       

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Last Updated On

December 12, 2016