Action: Nov. 2, 2015

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

Meaningful Use? Or Meaningless Abuse
New Mexico Court Urged to Heed Texas Tort Reforms
Medicine Fights Federal Mandates on Physicians
TMA Calls Out Insurance Companies Over Balance Billing
60 Days to Comment on Stage 3 Meaningful Use Rule
Tell CMS What You Think of MACRA
High Court to Hear Tobacco Tax Case
You Don't Have to Pay to Get Paid
Physicians: Reenroll in Medicaid by March 24, 2016
Medicaid Congress Tackles Physicians' Ire
How Will Your Practice Thrive in Post-SGR Medicare?
Pharmacy Delivery Option for Clinician-Administered Drugs
Get Ready for RSV and Synagis Season
Be a Preceptor and Help Shape the Next Generation of Medicine
Fist-Bump Your Doctor During Cold and Flu Season
This Month in Texas Medicine

Meaningful Use? Or Meaningless Abuse

The federal government never seems to tire in its campaign to heap more useless requirements onto physicians' practices. Despite the hard work of the Texas Medical Association and organized medicine, the Centers for Medicare & Medicaid Services insists on moving ahead with Stage 3 of the meaningful use electronic health record (EHR) incentive program.

"Now we've focused our efforts on the only body that can stop a federal bureaucrat: the U.S. Congress. Please write Sens. John Cornyn and Ted Cruz and your representative today and ask them to stop this costly intrusion into your practice," said TMA President Tom Garcia. Ask them to cosponsor and support: 

  • S 2141, the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 by Sens. Bill Cassidy (R-La.) and Sheldon Whitehouse (D-R.I.); and
  • HR 3309, the Flex-IT 2 Act, by Rep. Renee Ellmers (R-N.C.). 

For more information, check out: 


"No federal program ever bore a more inaccurate name than 'meaningful use,'" Dr. Garcia said. "The convoluted and tedious requirements for physicians' use of EHRs are certainly not meaningful to doctors nor our patients. The combination of EHRs and federal regulations — neither of which were designed with the realities of medical practice in mind — leaves us clicking more but achieving less."

For many physicians, health information technology is too expensive and too disruptive to patient care, and actually prevents physicians and other health professionals from sharing patient data in a timely, secure manner.

That's why TMA is calling on Congress to enact legislation that provides positive incentives for physicians to acquire and maintain health information technology. Until EHR systems truly add value to medical care, TMA wants Congress to reform the program and eliminate federal mandates that compel physicians to engage in unnecessary activities and reporting.

Please use the TMA Grassroots Action Center for a quick and easy way to email Senators Cornyn and Cruz and your local representative. 

"Help TMA put the meaning back in medical practice," Dr. Garcia said,

New Mexico Court Urged to Heed Texas Tort Reforms

A medical liability case involving a Texas physician who provided care to a New Mexico resident in Texas should not be governed by New Mexico's far weaker tort laws, TMA, the Texas Alliance for Patient Access, the New Mexico Medical Society, and dozens of other physician groups in both states wrote in a brief to the New Mexico Supreme Court

Access to health care is already challenging enough for New Mexico patients seeking care. New Mexico doctors and hospitals have long relied on referring or transferring sick and injured patients to Texas for specialized care. 

The willingness of Texas physicians and hospitals to receive those patients may be shaken if the New Mexico Supreme Court upholds a recent state appellate court ruling. That ruling is causing a significant liability risk for Texas doctors, forcing physicians here to consider what patients they will see and under what circumstances they will see them. Unless overturned, this decision will diminish access to care for thousands of Eastern New Mexicans.

For more on the case, read "Border Battle" in the November issue of Texas Medicine.

Medicine Fights Federal Mandates on Physicians

Since TMA's last visit to Capitol Hill, Congress has repealed the Medicare Sustainable Growth Rate (SGR) formula, and House Speaker John Boehner's announced retirement has created a free-for-all battle for House leadership positions. But TMA and the Coalition of State Medical Societies are still fighting to pry some of the regulatory burdens off of physicians' backs. When medicine's leaders returned to Washington last month, the TMA agenda was familiar to senators and representatives: 

  • Eliminate federal mandates, like the poorly named "meaningful use" program, that compel physicians to engage in unnecessary activities and reporting;
  • Stop the bounty-hunting Medicare Recovery Audit Program contractors (RACs);
  • Maintain the state-based system of licensing physicians;
  • Be prepared to act quickly to protect physician practices hurt by the new ICD-10 coding system; and
  • Clarify that there is not now and never will be a requirement for maintenance of certification to be a condition for state licensure or for participation in Medicare or Medicaid. 

TMA Calls Out Insurance Companies Over Balance Billing

The national health insurance lobby and their cronies in the Texas Association of Health Plans released their annual "report" citing physicians for what they called "exorbitant" bills for out-of-network services. TMA challenged the allegations publicly and earned some positive news media coverage. 

"This so-called report is nothing more than a desperate smoke screen to divert attention from the real problem," said TMA President Tom Garcia, MD. He not only pointed out the absurdity of using Medicare payments as a benchmark for "reasonable" charges, but he also directed reporters to a recent University of Pennsylvania study that found Texas is home to some of the narrowest physician networks in the country. "The health insurance industry games the system to keep more of patients' premium dollars by forcing patients to seek care out of network," Dr. Garcia said. "Then they have the gall to criticize what some doctors bill for that care."


60 Days to Comment on Stage 3 Meaningful Use Rule

After much anticipation among the medical community, the Centers for Medicare & Medicaid Services (CMS) finally released the meaningful use modification rule last month. The agency is allowing for a 60-day comment period to hear feedback on how Stage 3 can better align with the Merit-Based Incentive Payment System (MIPS) and alternative payment models. The rule combines modifications for meaningful use in 2015 to 2017, as well as the Stage 3 rule, which is optional in 2017 and required for all physicians in 2018.

TMA and the American Medical Association advocated many of the changes included in the modification rule but opposed finalizing Stage 3 due to a need to first assess the changes made to Stage 2 and a lack of alignment with the new MIPS.

CMS released the modification rule on Oct. 6. Given the lateness of the rule, AMA says it's difficult to educate physicians on the changes, including increased requirements for the public health and clinical data registry reporting objective. Physicians have until Dec. 15 to submit comments to CMS.

In response to AMA advocacy, CMS released an FAQ that explains how physicians can apply for a hardship exemption if they had difficulty meeting the meaningful use 2015 requirements due to the late release of the final modification rule.

While TMA staff members continue to comb through the meaningful use modification rule in detail, this much is clear in regard to your meaningful use 2015 reporting:  

  • Physicians participating in the meaningful use program can attest for any continuous 90-day period from Jan. 1, 2015, to Dec. 31, 2015. 
  • The requirement for 5 percent of your patients to view, download, or transmit their health information has changed to at least one patient seen by you during the electronic health record (EHR) reporting period. 
  • The requirement for 5 percent of patients to send a secure electronic message to their physician is now a yes/no statement attesting that the secure message functionality is enabled during the EHR reporting period. 

These charts show updated objectives and measures for meaningful use stages 1 and 2: 

  • Meaningful Use Stage 1: 2015 only 
  • Meaningful Use Stage 2: 2015-17  

Physicians have until Feb. 29, 2016, to report on their 2015 meaningful use measures. 

Details on the modification rule and the Stage 3 rule will be presented during TMA's fall Medicare: Now and Tomorrow seminar series, Nov. 3 to Dec. 3. Sign up now. 

If you have questions about the meaningful use program or other practice technologies, contact TMA's Health Information Technology Department by email or by calling (800) 880-5720.  

Tell CMS What You Think of MACRA

If you'd like to weigh in on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), now is your chance. The Centers for Medicare & Medicaid Services (CMS) has extended the comment period for the Request for Information (RFI) for MACRA

The comment period, which was originally 30 days and scheduled to close on Nov. 2, 2015, will now close on Nov. 17, 2015. TMA and the American Medical Association urged CMS to extend the comment period to allow physicians the opportunity to offer more thoughtful and meaningful comments. 

CMS' announcement includes the sections and questions CMS has prioritized. Read the RFI instructions for responding and the RFI extension document from the Federal Register

Physicians with comments may email Donna Kinney, director of TMA's Research and Data Analysis Department, to ensure their concerns are addressed in TMA's or AMA’s comments. 

High Court to Hear Tobacco Tax Case

The Texas Supreme Court has accepted an appeal of a lower court ruling that invalidated a tax the legislature applied to so-called "small tobacco." Back in 1998, the nation's five largest tobacco companies settled a case with Texas and 45 other states over the health care costs of cigarette smoking. They agreed to pay $10 billion a year indefinitely to the states. 

In 2013, state lawmakers enacted the "small tobacco" tax to "recover health care costs" from the tobacco companies that were not part of the settlement. TMA urged the high court to take the case. 

"Whether produced and sold by Small Tobacco or by Big Tobacco, tobacco products cause the same health problems and inflict the same physical and financial burdens upon Texas citizens and the State budget," TMA General Counsel Rocky Wilcox wrote in our amicus brief to the court. "Both should, therefore, have to pay their fair share of tobacco-related health costs whether that be through a judgment, settlement, tax or otherwise."

You Don't Have to Pay to Get Paid

Would you pay $50 to deposit $1,000 into your back account? You might be doing just that when health plans pay you with a virtual credit card (VCC). Many are paying that way, and you could be losing as much as 2 percent to 5 percent per transaction. For example, if you receive a $1,000 VCC payment from a health plan, you could lose $20 to $50 in processing fees. In essence, your charge for your services from that payer shrunk by that amount.

The December issue of Texas Medicine will have more information about VCCs. The article explains some health plans and third-party vendors that process plan payments are moving to VCCs, without warning and without much explanation of fees or opt-out procedures.

You don't have to accept payment via VCC. You have a right to request direct deposit, which costs just a few cents per transaction.

Since Jan.1, 2014, the Affordable Care Act has required health plans to offer electronic funds transfer (EFT) payments, essentially direct deposit, using the Automated Clearing House (ACH) Network to physician practices that request this method of claims payment. As a way to avoid using an ACH EFT, health plans began to issue VCCs. 

Most health plans don't ask physicians before sending VCC payments. They mail a virtual card number to the practice with no information about how to opt out of this payment method or the cost to the practice of processing the payment.

Office staff have to manually enter the virtual card number into the practice's credit card processing terminal (and then manually reconcile the payment to the explanation of benefits). When office staff key in a credit card number manually, that increases the fee the credit card vendor charges. 

And while physicians receiving VCCs must pay steep processing costs to receive payments, health plans often receive cash-back incentives from credit card companies for such transactions, according to the American Medical Association. Credit card companies may offer health plans up to 1.75-percent rebates for paying claims with VCCs, says AMA.

By most accounts, opting out of VCC payment may not be an easy task, but the effort will pay off in the end. "Office billing staff may need to be aggressive in denying acceptance of these forms of payment from payers," says ACP Internist

Here also are some suggestions from the field: 

  • Educate your staff to recognize VCC payments if you want to avoid authorizing these payments from health plans. Let your staff know a VCC payment can cost up to 5 percent of the total charged amount. (See AMA's 3 things physicians can do to avoid virtual credit card fees.)
  • Prepare a standard letter (or use the sample letter on the CAQH Committee on Operating Rules website) opting out of receiving payment via VCC and requesting payment via ACH EFT (or via written check).
  • Call the insurance company or health plan to ask to be removed from VCC payments. Then follow up with the merchant that issued the credit card payment to see that it was done. 

  Action TMLT Ad 10.15

Physicians: Reenroll in Medicaid by March 24, 2016

The Affordable Care Act requires all Medicaid health professionals to reenroll in the program at least once every five years (some professionals must reenroll more frequently). Physicians are next on the list and must reenroll by March 24, 2016. However, if you initially enrolled or reenrolled on or after Jan. 1, 2013, you will be required to reenroll by the date indicated on your enrollment letter.

The Texas Health and Human Services Commission and the Texas Medicaid and Healthcare Partnership (TMHP) have improved the electronic enrollment portal to make it easier for doctors to complete the reenrollment process. (Physicians newly enrolling in Medicaid can also use the portal.) The enhancements apply to applications submitted through the TMHP website on or after April 26, 2015.

The improved electronic application process allows you to:

  • Upload supporting documentation;
  • Sign the enrollment agreement electronically (e-sign);
  • Receive guidance as you work on the application and see more accurate error messages to avoid mistakes;
  • Receive instruction on how to upload documents and submit the application using an e-signature; and 
  • Expedite processing of your application by reducing the need for printing and mailing documents. 

For physicians currently enrolled in Medicaid, the portal will pre-populate the application with demographic data pulled from the physician’s current account.

To be considered fully reenrolled by the March 24, 2016, deadline, physicians must receive verification from TMHP that the application has been approved before that date. It currently takes about 32 days for applications to be processed. Thus, physicians should reenroll early to avoid gaps in enrollment. The reenrollment requirement also applies to physician assistants and advanced practice registered nurses.

To use the online application, you must have a TMHP user account and a user name (portal user ID). Refer to the TMHP Website Security Provider Training Manual for instructions on activating a TMHP user account. For more information about Medicaid provider reenrollment, visit the TMHP provider reenrollment page.

Medicaid Congress Tackles Physicians' Ire

Capturing the frustration of all the physicians in the room, San Antonio radiologist Adam Ratner, MD, asked a simple question with a very complicated answer at the Oct. 16 Texas Medicaid Congress meeting. "Why can't we just make this all simpler?" Dr. Ratner asked Texas Health and Human Services Executive Commissioner Chris Traylor. 

"It's like unraveling a bowl of spaghetti," responded Commissioner Traylor, whose administration of the $30 billion-a-year program is bound by federal and state laws and dozens of contracts with Medicaid HMOs. 

Despite the glutinous nature of the problems, members of the congress vowed to find ways to cut through the payment hassles, enrollment and credentialing morass, vexing drug formularies, and other obstructions that dissuade Texas physicians from participating in Medicaid. TMA Board of Trustees Chair Doug Curran, MD, and John Holcomb, MD, chair of TMA's Select Committee on Medicaid, CHIP and the Uninsured, led the meeting. The group will explore potential solutions in January at the 2016 TMA Winter Conference meeting of the Select Committee on Medicaid, CHIP and the Uninsured.

Read more about the Texas Medicaid Congress and efforts to simplify the administrative hassles that plague Medicaid managed care in the January issue of Texas Medicine

How Will Your Practice Thrive in Post-SGR Medicare?

The Sustainable Growth Rate (SGR) is gone, so now what's next? Is your practice ready for quality-based payment? Is that even the right direction for you to go? With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) taking effect and the Merit-Based Incentive Payment System on the horizon, making no changes may cost you, but implementing changes (the wrong way) may cost you more.

TMA's new seminar, Medicare Now and Tomorrow, will help you form short-term and long-term strategies on the best way your practice should move forward. The seminar will cover: 

  • What MACRA means to your practice — now and in the future;
  • Changes to the fee-for-service program;
  • Alternative payment options other than accountable care organizations;
  • Chronic care management: advantages, challenges, and case studies; and
  • Updates in health information technology, end-of-life counseling, fee schedules, and more.     

Reserve your seat today, and use coupon code EPROMO to save $20 on registration.

Pharmacy Delivery Option for Clinician-Administered Drugs

An optional delivery method, referred to as "white bagging," is available to physicians dispensing clinician-administered drugs in an outpatient setting for Medicaid patients. The white bagging option eliminates the up-front costs of buying the medication and then billing for it. 

White bagging allows physicians and other health professionals to submit prescriptions to pharmacies, which then ship or mail the prescription to the physician's office. The delivery method is voluntary for Medicaid-participating physicians. Medicaid managed care organizations can't require the use of white-bagging for clinician-administered drugs.

Physicians should follow these steps when choosing the white bagging delivery method:  

  • The treating physician identifies a Medicaid-enrolled patient.
  • The treating physician or treating physician's agent sends a single prescription, with no additional refills, to a Texas Medicaid-enrolled pharmacy and obtains any necessary prior authorizations. The physician must write a new prescription for any additional fills.
  • Once approved, the dispensing pharmacy fills the prescription and ships or mails an individual dose of the medication overnight. The prescription will arrive at the treating physician's office in the name of the Medicaid client. These medications may not be used for any other patient and can't be returned to the pharmacy for credit. 
  • The treating physician administers the medication to the Medicaid client in an office or outpatient setting. The physician bills for administration and any medically necessary office-based evaluation and management service provided at time of administration. The physician should not bill Medicaid for the drug, according to Texas Medicaid and Healthcare Partnership (TMHP). 

TMHP says the pharmacy contacts the physician each month, before dispensing any refills, to ensure the patient received all previously dispensed medication. 

Note: Physicians using this delivery method won't have to purchase the physician-administered drug. Therefore, the physician can administer the drug and should bill only for the administration of the drug, according to TMHP. 

For more information, call the TMHP Contact Center at (800) 925-9126. 

 PC Action Ad Sept 13

Get Ready for RSV and Synagis Season

The respiratory syncytial virus (RSV) season began Oct. 1 for many regions of the state and Nov. 1 for counties in the northern and western part of the state. The Texas Medicaid/Children's Health Insurance Program Drug Vendor Program says it will accept RSV medication prior authorization requests by fax. 

The start of the RSV season varies based on a Medicaid client's county of residence. Prior authorization forms and the season schedules are available on the Drug Vendor Program website. Prior authorization effective dates for palivizumab (Synagis®) will be based on the patient's county of residence at the start of the season. The Drug Vendor Program notes the option for physicians to purchase and bill through Texas Medicaid and Healthcare Partnership is not available for the 2015-16 RSV season.  

  • Under fee-for-service Medicaid, physicians must obtain palivizumab (Synagis) through the Vendor Drug Program for all eligible patients. They could begin using the "Fee-for-Service Medicaid Synagis Prior Authorization Request Form" on Sept. 25. To obtain prior authorization, the prescribing physician must complete the form and send it to the dispensing pharmacy. Pharmacy staff will then fax the form to the Texas Prior Authorization Call Center for processing. Physicians can call the Texas Prior Authorization Center at (877) 728-3927 for questions related to submitting forms
  • For Medicaid managed care, physicians should contact the patient's plan for forms and instructions by referring to the MCO Prescriber Resources
  • Under the Children with Special Health Care Needs (CSHCN) Services Program, physicians must obtain palivizumab (Synagis) through the CSHCN Services Program for all eligible patients and use the CSHCN Services Program "Synagis Prior Authorization Request Form." Physicians can call the CSHCN Services Program at (800) 252-8023 for questions related to submitting forms. 

Be a Preceptor and Help Shape the Next Generation of Medicine

The Texas Chapter of the American College of Physicians (TXACP) is seeking physician mentors for the summer 2016 General Internal Medicine Statewide Preceptorship Program (GIMSPP).  

Preceptors open the doors to their practice to provide a medical student with personal instruction, training, and supervision for three to four weeks. Students get the opportunity to observe the daily routine of the physician, experiencing the variety the practice of internal medicine provides. For physicians, benefits of preceptorship include:  

  • The opportunity to give back, while rekindling your passion for medicine; 
  • The ability to help advance primary care in Texas; and 
  • An enriching experience for the student and preceptor. 

"GIMSPP isn't just good for the students, it's good for the preceptors," said Susan Andrew, MD, TXACP member and long-standing preceptor. 

Preceptors must be board certified in internal medicine, possess a current Texas medical license with no restrictions from the Texas Medical Board, and practice at least 40 percent to 50 percent general internal medicine apart from any other subspecialties. 

For more information on the program or to download the preceptorship application, visit the TXACP website

Fist-Bump Your Doctor During Cold and Flu Season

Looking for a way to greet your patients but limit the spread of cold and flu? Citing a study published in the American Journal of Infection Control, TMA member Jason Marchetti, MD, has your answer!

His project for the TMA Leadership College is an outreach campaign reminding people about the need for hygiene measures, especially during flu season, and to introduce the fist bump as a scientifically validated greeting method that can decrease germ transmission dramatically during hand-to-hand contact. The campaign involves putting up educational posters in the waiting room and exam rooms to share this information with patients and encouraging this more hygienic greeting approach. In his own practice, Dr. Marchetti has found patients, young and old, have embraced the campaign enthusiastically.

A physical medicine and rehabilitation physician from Denton, Dr. Marchetti says, "This has all of the qualities of an ideal medical intervention: It's free, it's safe, and it can be done easily by everyone."

The study cited, "The Fist Bump: A More Hygienic Alternative to the Handshake," was published in August 2014 in the American Journal of Infection Control. Researchers at the Institute of Biological, Environmental and Rural Sciences at Aberystwyth University in Ceredigion, United Kingdom, conducted a basic experiment looking at the transmittance of benign bacteria between hands. They looked at a "regular" as well as "strong" handshake, and then compared them to a fist bump. Strong handshakes (firmer pressure, longer grip duration) had double the transmittance versus a regular handshake, while a fist bump (with low pressure, brief contact, less surface area) only had 25 percent the transmittance. Their conclusion: "For the sake of improving public health, we should adopt this more hygienic alternative to the handshake." 

A previous study, "Reducing Pathogen Transmission in a Hospital Setting. Handshake Versus Fist Bump: A Pilot Study," was published in 2013 in the Journal of Hospital Infection. Conducted at the West Virginia University School of Medicine, this study found that "as many as 80% of individuals retain some disease-causing bacteria after washing." They also noted the decreased surface area and contact time of a fist bump further reduced bacterial transmission compared to handshaking. Their conclusion was similar: "We have determined that implementing the fist bump in the health care setting may further reduce bacterial transmission between health care providers."

While the spread of viral transmission has not been specifically studied, common sense would suggest similar factors are at play with viruses (surface area, duration of contact, pressure) as far as transmittance factors.

"The only barrier to widespread adoption is removing the cultural stigma of the fist bump as uncouth. My aim with this campaign is to help reduce that stigma and to expose other medical providers to these data, which they might not have come across otherwise," says Dr. Marchetti.

"So far, in my own practice, I've been pleasantly surprised at the enthusiasm of patients; even my little old ladies smile and offer me a fist bump. I've printed flyers and put them in my exam rooms. Most patients notice them and even remind me to fist-bump in cases where I've forgotten and went to offer a handshake. It's been great!"

To download fist bump posters and flyers in various sizes for your office or waiting room, visit the TMA website.

This Month in Texas Medicine

The November issue of Texas Medicine features a cover story on the 2015 Texas Legislature's passage of a law that heeds TMA's call for improvements in the Office of Inspector General's (OIG's) Medicaid fraud investigations of physicians. The story chronicles one physician's ongoing battle with OIG over Medicaid overpayment allegations levied against him from 2005 to 2008. In the issue, you'll also find information on the Walk With a Doc fitness program; efforts some medical schools are undertaking to arm future doctors with the nutrition knowledge they'll need; the inaugural graduating class of TMA's Accountable Care Leadership Program; and TMA's request for reversal of a court ruling that allows a Texas negligence case to proceed in New Mexico.

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.      

Nov. 9, 2015

Humana Code Edit and Policy Change Notifications

Last Day to File an Informal Review Request to Appeal Errors in Your Medicare PQRS Feedback Report and QRUR

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 Now and Tomorrow
Nov. 3-Dec. 3

Conferences and Events

2015 TMA Advocacy Retreat
Dec. 4-5
Omni Barton Creek Resort in Austin

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Last Updated On

December 09, 2016