Action: Aug. 17, 2015

 TMA Action Aug. 17, 2015   News and Insights from Texas Medical Association

Medicare Watch List Report Examines New Payment Systems
The ICD-10 Grace Period Up Close
Register Today: TMA Fall Conference Is Sept. 25-26
Check Your Meaningful Use Registration Details
Get Paid to Reduce Heart Attacks and Strokes
TMA Webinar Focuses on Role of Obesity in Cancer Treatment, Outcomes
New TMA Member Benefit Offers Help With ICD-10 Migration
Save on Travel With TMA's Group Discount Program
TMA Student and Resident Loans Available
AMA to Host Veterans Choice Program Webinar on Aug. 26
Summit Focuses on Hepatitis C Education, Awareness
This Month in Texas Medicine

Medicare Watch List Report Examines New Payment Systems

A new Medicare Watch List report from The Physicians Foundation examines the implications of the new Medicare Access and CHIP Reauthorization Act (MACRA) and future payment models established after the elimination of the Sustainable Growth Rate formula. 

By 2019, physicians will have the option of participating in one of two major payment tracks: the fee-for-service Merit-Based Incentive Payment System (MIPS), which increases or decreases physician pay based on quality and cost performance, or one or more alternative payment models (APMs), such as accountable care organizations, medical homes, bundled payments, or other initiatives. 

For more on Medicare's new payment systems, check out the September issue of Texas Medicine.

The report outlines long-term payment adequacy and factors used to calculate performance-based payment adjustments, among other topics. And it examines the immediate implications of the MACRA legislation and the ongoing evolution and future of the new payment models. 

The report includes discussion on these questions: 

  • How will MIPS affect practicing physicians and Medicare patients?
  • Is the new APM program — and the associated options within this program — a viable path forward for long-term payment sustainability?

For more information, visit The Physicians Foundation website

The ICD-10 Grace Period Up Close

The ICD-10 grace period says that for one year starting Oct. 1, 2015, Medicare will not deny claims solely on the specificity of the ICD-10 diagnosis codes as long as you use a valid code from the right family of codes. Let’s parse this statement.

“Family of codes” is the same as the ICD-10 three-character categories. ICD-10 comprises codes with three to seven characters. A top-level, three-character category code may be subdivided into clinically related conditions by the use of fourth, fifth, sixth, or seventh characters to provide greater specificity. For example, category H25 (Age-related cataract) is subdivided into codes that capture information on the type of cataract and the eye involved. 

Valid codes — also called “billable” codes — are those coded to the full number of characters available for that condition. If a code has more codes listed under it, it is not a valid code. For example, among the H25 divisions and subdivisions, is this:

H25 Age-related cataract

  H25.0 Age-related incipient cataract 

     H25.01 Cortical age-related cataract

           H25.011 … right eye
           H25.012 … left eye
           H25.013 … bilateral 
           H25.014 … unspecified

Among the codes shown here, only H25.011-H25.014 are valid (billable) codes. The higher-level codes are not valid because they are further subdivided.

During the grace period, say that you incorrectly code a Medicare claim with a diagnosis of H25.014 (unspecified) when the patient’s actual diagnosis was H25.011 (right eye). The claim should be acceptable because it is coded to the correct number of digits and is in the H25 family of codes. Medicare won’t deny the claim because it errs in selection of specificity. 

Don’t have your 2015 ICD-10 code book yet? It’s available in the TMA Education Center. TMA members also have free access to e-MDs' Code Search Tool (login required).

Specificity exceptions — National coverage determinations (NDCs) and local coverage determination (LCDs) that currently require a specific ICD-9 code will still require a specific ICD-10 code. You will need to stay up to date on these policies the same as always to be sure you code correctly. The NCD and LCD policies won’t require any greater specificity in ICD-10 than they already do with ICD-9, except for laterality (which doesn’t exist in ICD-9). If an LCD or NCD contains ICD-10 codes for right side, left side, or bilateral, CMS will not accept codes for “unspecified” side. 

You can preview applicable draft LCDs with ICD-10 codes. Select “Indexes” on the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database page. Choose an LCD list (by contractor, state, or alphabetically), and refine the search by choosing Future LCDs.

Since announcing the grace period, CMS has published these guidance documents:

Also, take advantage of these TMA resources to get ready for ICD-10:

  • TMA’s live seminars continue to make their way around the state — two seminars in one day for physicians and staff. Staff can perfect their new coding and auditing skills with hands-on exercises in Essentials for ICD-10 Coding. Physicians can find out how to change their documentation to support the new coding system in Essentials in ICD-10 Documentation, physicians can find out how to change their documentation to support ICD-10 codes. Register for a location near you.. 
  • Take specialty-specific, physician-developed three-hour online courses. Choose from 21 medical specialties. 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. Use coupon code 10DOCTMA to save $100 on the registration.
  • Register for on-demand recordings of ICD-10 planning and implementation courses.
  • Visit TMA’s ICD-10 Resource Center for tools and information. 

Register Today: TMA Fall Conference Is Sept. 25-26

Join us for the 2015 TMA Fall Conference at the Hyatt Regency Lost Pines Resort and Spa Sept. 25-26. This member benefit offers you the opportunity to reconnect with colleagues and TMA staff as well as hear a recap of this year's legislative session and participate in discussions about Texas health care. 

All meetings will take place at the Hyatt Regency Lost Pines Resort and Spa: 575 Hyatt Lost Pines Rd., Lost Pines, TX 78612.

The room block at the Hyatt Regency is sold out. An additional block of rooms at the Hampton Inn & Suites in Bastrop is available:

Hampton Inn & Suites Bastrop 
240 S. Hasler Blvd.
Bastrop, TX 78602

Call (512) 321-2898 or visit the TMA website, and use group code XMA to make your reservation no later than Sept. 3, 2015, to get the TMA discounted rate of $129.

Conference registration will take place:

Friday, Sept. 25, 7:30 am-7:30 pm, and
Saturday, Sept. 26, 6 am-12:30 pm.

Check Your Meaningful Use Registration Details

Do you remember which email address you provided to the Centers for Medicare & Medicaid Services (CMS) when you registered for the meaningful use program? If not, now is the time to refresh your memory. 

Medicare auditor Figliozzi and Company sends letters via email to physicians who are subject to an audit under CMS' meaningful use program. The auditor uses the email address provided during registration for the meaningful use program to provide notification of the audit. In the audit notice, Figliozzi and Company provides a deadline for a response. If the physician being audited doesn't respond by the deadline, the physician will fail the audit, and the opportunity for an appeal will pass.  

Be sure to check which email address you provided during meaningful use registration. If the email belonged to an office manager who no longer works with your practice, you won't receive the audit notification letter sent via email, and you won't realize anything is wrong until Medicare recoups your meaningful use incentive dollars. Don't let this happen to you.

CMS has additional details on the Medicare audit process. For information on meaningful use audits or other practice technologies, contact TMA's Health Information Department by email or by calling (800) 880-5720.

 TMLT Action Ad 4.13 

Get Paid to Reduce Heart Attacks and Strokes

The Centers for Medicare & Medicaid Services (CMS) wants to enroll 720 practices in the Million Hearts: Cardiovascular Disease Risk Reduction Model. This new value-based payment model supports the national Million Hearts initiative, which aims to prevent 1 million heart attacks and strokes. 

The model will be tested over a five-year period from January 2016 through December 2020. CMS will provide incentive payments to participating physicians, and the average practice potential is $32,000 for the duration of the trial. 

Model Overview

Model Design

  • Five-year model test
  • Randomized, controlled design
  • Total of 720 practices: 360 control and 360 intervention practices
  • Target population: 300,000 Medicare fee-for-service beneficiaries aged 18-79 years who have not had a previous heart attack or stroke   

Practice Eligibility 

  • Practice must have at least one health professional (medical doctor, doctor of osteopathic medicine, physician assistant, or nurse practitioner).
  • Practices must use a certified electronic health record (EHR) system.
  • Practices must have met the criteria for Stage 1 (meaningful use) of the EHR incentive program.   

Program Elements 

  • Risk stratified care
  • Population health management
  • Shared decisionmaking
  • Individual risk modification planning
  • Team-based care
  • Quality and clinical data reporting 

A letter of intent must be submitted online before starting the application process. The deadline is Sept. 10, and awards will be announced in November 2015. For more information, visit the CMS website and FAQ page. And read "Saving 1 Million Lives" in the June 2015 issue of Texas Medicine.   

TMA Webinar Focuses on Role of Obesity in Cancer Treatment, Outcomes

More than 25 percent of Texas adults are obese, meaning they have a body mass index of at least 30. Obesity is an established cancer risk factor, accounting for 14 percent to 20 percent of cancer mortality nationally and is also a major hindrance in the treatment of cancer. Talking to patients about their weight and its effect on their cancer treatment and potential outcome is of the utmost importance. 

TMA is offering an on-demand webinar continuing medical education course to help you do just that. Learn the role of obesity in cancer treatment, how to counsel and care for patients who may be affected by obesity and cancer, and determine patient-centered clinical approaches for screening for and managing obesity.

Thanks to a grant from the TMA Foundation, this course is available free to the first 20 physicians who visit the TMA Education Center and use coupon code STOPCANCER.

For questions or assistance, email the TMA Knowledge Center or call (800) 880-7955. 

New TMA Member Benefit Offers Help With ICD-10 Migration

To help with the transition to ICD-10 on Oct. 1, TMA is offering free access to a powerful new tool offered by e-MDs.

The e-MDs ICD-10 Code Search Tool offers TMA member physicians and their staff the ability to apply the right ICD-10 coding at the point of patient contact, improving the rate of accepted claims and reducing frustration. Using a combination of keyword filters, anatomical locations, gender, and age, the tool offers a highly intuitive way to build a narrow list of billable ICD-10 codes based on user preferences.

Free access to this new resource is just one benefit of being a TMA physician member. Practices with less than 100-percent membership can still use the tool but at a fee of $1,250 per nonmember.

If you would like to take advantage of this perk but you're not a TMA member, join TMA now, or call the TMA Knowledge Center at (800) 880-7955 for assistance. TMA members can get started immediately at no cost by visiting the TMA ICD-10 Resource Center and logging in to their TMA account for more information.

  TMAIT Action Ad 6.15

Save on Travel With TMA's Group Discount Program

With the end of summer drawing near, it's the perfect time to plan a last-minute getaway. Whether your trip is for work or pleasure, you can lock in an extra discount, compliments of your TMA membership. 

TMA members, friends, and family can access below-market rates on all hotels and car rentals around the world — similar to the leading online travel sites but with an additional discount of 10 percent to 20 percent. On average, TMA members have saved $48.39 per booking!  

Where is everyone going? The top 10 destinations booked by TMA members include popular cities like Las Vegas, New Orleans, Los Angeles, Seattle, and New York.

Visit (members only), and log in to start your search. Or call the TMA Knowledge Center at (800) 880-7955 for more information.

TMA's group discount programs allow you to leverage your membership in the largest state medical association in the country. These programs offer excellent value and can help save money on products and services you use every day. Not a TMA member? Join today.

TMA Student and Resident Loans Available

Need help funding your medical school education or residency training? Consider TMA's educational loan program.

TMA offers $4,000 student loans for Texas medical students and $3,000 resident loans at a fixed interest rate of 4.4 percent.

If interested, contact TMA at (800) 880-2828 to speak with a TMA representative. Visit the TMA website for more information.

AMA to Host Veterans Choice Program Webinar on Aug. 26

Congress established the Veterans Choice Program as a stopgap measure to give the U.S. Department of Veterans Affairs (VA) time to implement delivery reforms and to address workforce shortages. To learn more about the program, you can register for the American Medical Association's Aug. 26 Veterans Choice Program webinar, which takes place from 7 pm to 8 pm EDT.

AMA says the webinar will feature leading VA officials who will speak on new community-based care options for VA beneficiaries. Participants will learn how non-VA practitioners can sign up to deliver care through the program, understand the criteria for participation, and learn how to troubleshoot claims-processing problems and payment delays. 

Read more about the Veterans Choice Program.

 PC Action Ad June 13  

Summit Focuses on Hepatitis C Education, Awareness

The 2015 Texas Viral Hepatitis Summit will take place Aug. 26 from 8 am to 3:30 pm in the Capitol Extension Auditorium (E1.004) at the state Capitol. Held annually, the free statewide summit promotes education and awareness regarding viral hepatitis C and provides an interactive session for participants to develop strategies to address the disease in their communities. Register today.

Event cosponsors are the CHI St. Luke's Liver Outreach, the Austin Travis County Health Department, and other community-based organizations, such as the Wright House, Austin Travis County Integral Care, and AIDS Services of Austin. 

Physician speakers will provide hepatitis C treatment updates, information on improving access to care and treatment for hepatitis C, and strategies for preventing hepatitis C in communities.  

For more information, email Larry Cuellar or (512) 533-3124.

This Month in Texas Medicine

The August issue of Texas Medicine features a cover story on TMA's 2015 legislative victories. In the issue you'll also find information on public health gains this legislative session, a Texas Supreme Court decision that gives doctors greater protection against sham peer review, and enhancements to Medicaid's electronic enrollment portal.

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.  

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 


New Initiatives for Texas Medicaid Providers
Use coupon code THSEDU for free registration.

Conferences and Events

TMA Fall Conference
Sept. 25-26

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Last Updated On

December 12, 2016