Action: Jan. 18, 2016

 TMA Action Jan. 18, 2016   News and Insights from Texas Medical Association

TMA Asks CMS to Delay Meaningful Use Stage 3
TMA: Marriage, Family Therapists Can't Diagnose
When Disaster Strikes, Ask for a Claims Filing Extension
Don't Miss the TMA Winter Conference Jan. 29–30
PQRS: Report 2015 Data Now to Avoid 2017 Penalties
Tips From TMA to Help You Survive a Meaningful Use Audit
Take Part in New CMS Clinical Care, Social Services Model
TMA Educates Doctors on Vaccine Exemptions
Vaccinate Your Adolescent Patients Against HPV
Earn CME at TMA's Physician Health and Wellness Conference
HHSC Holds Information Sessions on STAR Kids Program
This Month in Texas Medicine

TMA Asks CMS to Delay Meaningful Use Stage 3

TMA is "disappointed and frustrated" with the Centers for Medicare & Medicaid Services' (CMS') insistence on going forward with Stage 3 meaningful use and its resistance to significantly reform Stage 2. "These rules will only serve to penalize physicians who participate in Medicare and hinder progress on the adoption of EHRs and the exchange of information," TMA and the medical associations of California, Florida, and New York told CMS Acting Administrator Andy Slavitt in a Dec. 15 letter

TMA wants the electronic health record (EHR) incentive program to have "feasible and attainable requirements to help physicians achieve these goals rather than act as a burden and hindrance to EHR use by physicians."

TMA urges CMS to immediately delay the Stage 3 meaningful use program. The letter states that it "does not make sense to move to Stage 3 when the vast majority of physicians are not meeting Stage 2." The letter also states "the move would be premature when CMS has not yet adopted regulations to implement the new Merit-Based Incentive Program (MIPS) under the new Medicare payment reform law (MACRA) that Congress passed earlier this year [in 2015]."  

TMA wants CMS to implement reforms for Stage 2 of the meaningful use program, requesting that CMS eliminate the "all-or-nothing approach and give physicians proportional credit for the measures that are successfully completed." TMA and the other three medical associations also want an expansion of the hardship exemptions and a focus on interoperability, asking CMS to prioritize "implementation of an infrastructure to exchange health care information and ensure that certified EHR technology is capable of meeting the Meaningful Use requirements." 

Meanwhile, in an address last week to the J.P. Morgan Healthcare Conference in San Francisco, Mr. Slavitt declared, "The Meaningful Use program as it has existed, will now be effectively over and replaced with something better. … The focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients."

TMA: Marriage, Family Therapists Can't Diagnose

On Dec. 31, 2015, TMA filed a response brief with the Supreme Court of Texas in regard to Texas State Board of Examiners of Marriage and Family Therapists and Texas Association of Marriage and Family Therapy v. Texas Medical Association. The brief examines whether the Texas State Board of Examiners of Marriage and Family Therapists' (MFT's) rule authorizing marriage and family therapists to diagnose any and all known mental disorders falls within the scope of practice set forth in state law. In the brief, TMA argues the plain meaning of the Licensed Marriage and Family Therapist Act doesn't include diagnosis.

"The common, ordinary meaning of the words used in the statute and the accepted definition of diagnosis do not provide authority for marriage and family therapists to diagnose mental disorders or for MFT board to adopt a rule authorizing them to do so," TMA's brief states.

Previously, the Third Court of Appeals ruled the MFT board's diagnostic assessment rule exceeds the scope of marriage and family therapy "because it authorizes marriage and family therapists to diagnose all known mental disorders, not just evaluate and remediate dysfunction in marriage and family systems." In the brief, TMA states that the expansive authority given to marriage and family therapists via the rule "authorizes marriage and family therapists to engage unlawfully in the practice of medicine." 

TMA says the Court of Appeals ruled correctly, making the MFT board's statute void. TMA requests the MFT board's petition for review be denied.

When Disaster Strikes, Ask for a Claims Filing Extension

You know Texas weather. In 2015, floods, blizzards, tornadoes, and windstorms plagued the state. Some physician practices experienced severe damage, and they had to scramble to get back on their feet. Under Texas prompt payment laws, you may be able get an extension of the 95-day claims filing deadline if you believe you will not be able to meet it for some claims because of a catastrophic event, like a tornado. 

But you must act quickly after the disaster. You must notify the Texas Department of Insurance (TDI) of your inability to meet claims filing deadlines by letter within five days after the catastrophic event. 

Let TDI know your practice address, contact information, and the names of the physicians in the practice. Mail the letter to Life/Health and HMO Intake Team, Texas Department of Insurance, PO Box 149104, Mail Code 106-1E, Austin, TX  78714-9104.

Once your practice has returned to normal business operations, you'll need to notify TDI of this fact within 10 business days of resuming normal operations via a notarized letter certifying:  

  1. The specific nature and date of the catastrophic event that caused you to be unable to meet the timely filing deadlines, and
  2. The length of time the catastrophic event caused an interruption in your claims submission or processing activities. 

The deadlines are delayed by the period you certify under bullet No. 2 above.  

You might consider drafting both letters in advance so that you'd just have to fill in the specifics and print them out if a time comes when you need to use them. 

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Don't Miss the TMA Winter Conference Jan. 29–30

The art of medicine involves adapting to change in a positive way and molding change according to your vision for medicine. Join your colleagues to explore the elements that shape Texas medicine at the 2016 TMA Winter Conference at the Hyatt Regency Austin Jan. 29–30. This member benefit also offers you the opportunity to earn continuing medical education credit. Register now.

The group room rate at the Hyatt Regency is no longer available, but you can still reserve a room at the prevailing rate. Make a reservation online, or call (888) 591-1234.

Meetings will take place Friday, Jan. 29, at the Hyatt Regency Austin and the TMA building (401 W. 15th St.). A shuttle will be provided. The first shuttle will leave the Hyatt at 6:30 am. The last shuttle will leave the TMA building at 10 pm. All meetings on Saturday, Jan. 30, will take place at the Hyatt.

Attend the General Session, "Shaping Texas Medicine," Saturday from 8:30 am–noon to learn about demographic changes affecting Texas, the balance billing debate, physician activity at the national level, and the shake-up technology is bringing to medicine. 

Saturday's 7:30 am Dawn Duster session looks at how a recent U.S. Supreme Court ruling may bring big changes to professional licensing agencies like the Texas Medical Board.

On-site conference registration is available Friday at the TMA building from 7:30 am to 7:30 pm or at the Hyatt Regency from 8 am to 7:30 pm. Registration is open at the Hyatt Regency Saturday from 6 am to 12:30 pm.

For more information and a full schedule of events, visit the TMA website.

PQRS: Report 2015 Data Now to Avoid 2017 Penalties

If you plan to participate in Medicare's Physician Quality Reporting System (PQRS) and value-based payment modifier (VBM) programs for the 2015 performance period, now is the time to submit your data on quality measures. Depending on the reporting mechanism used, deadlines vary from February through March 2016.

According to the Centers for Medicare & Medicaid Services (CMS), all eligible professionals who get paid under the Medicare Part B Physician Fee Schedule (MPFS) must comply with quality reporting requirements annually. In 2017, Medicare payment under the MPFS will be based on 2015 quality and cost performance, assessed under the PQRS and VBM programs. Failure to report data will result in an automatic 2-percent pay cut under PQRS, plus another automatic 2-percent to 4-percent pay cut under VBM. To see how much these penalties will affect your practice in 2017, visit the TMA PQRS Resource Center to access the Medicare payment adjustment calculator. To avoid the penalties, choose a reporting mechanism that best fits your practice, and submit your 2015 data by the deadline. 

Submission Deadlines for the 2015 PQRS Reporting Period  

Note: Data submitted to PQRS do not automatically satisfy the clinical quality measure component of the meaningful use program. However, the option to report data only once for Medicare's quality programs is available and requires a specific submission process. For complete details, see this CMS guide and visit the CMS website

Get Free Help from TMF

Do you report PQRS data and need some help, or are you new to PQRS and don't know how to get started? Join the TMF Value-Based Improvement and Outcomes Network for no-cost technical assistance, education, and consulting services on how to navigate Medicare's requirements to successfully participate in the PQRS and VBM programs. Read more about TMF in the December 2015 issue of Texas Medicine

More Information

Stay informed about the latest PQRS news by subscribing to the free CMS PQRS listserv. For PQRS questions, contact the CMS QualityNet Help Desk, Monday through Friday, 7 am to 7 pm CT, by phone, (866) 288-8912 (select option 3, then 7), or email. For VBM questions, contact the CMS Physician Value Help Desk, Monday through Friday, 7 am to 7 pm CT, by phone (888) 734-6433 (select option 3), or email. You also can contact the TMA Knowledge Center by phone, (800) 880-7955, or email. Visit TMA's PQRS Resource Center for more information on how to participate in the PQRS and VBM programs. 

Tips From TMA to Help You Survive a Meaningful Use Audit

The Centers for Medicare & Medicaid Services (CMS) conducts prepayment and post-payment meaningful use audits. Some are random; some are based on complex algorithms. If you participate in the meaningful use program, document everything indicating that you have met all meaningful use criteria.

TMA has these recommendations to help you:  

  • Take screen shots of electronic health record (EHR) reports indicating you met a meaningful use measure. If you try to re-create a report at a later date, the EHR may return a different result. 
  • When the meaningful use criteria specify "more than," that doesn't mean "equal to." For example, if the criteria indicate you need to record demographics for more than 80 percent of your patients, then your denominator and numerator should be such that they don't total 80 percent. They must total more than 80 percent. 
  • Keep a meaningful use file (paper or electronic) with all documentation, and know where that file is. Staff turnover could mean the person who created the file is no longer working for you when the audit request comes. 
  • CMS sends audit requests via email to the email address you used when registering for the meaningful use program. Be sure this email address is active and regularly checked. 

The Garden City, N.Y., accounting firm Figliozzi & Co. conducts the audits for CMS. The firm sends letters via email asking for documentation supporting the meaningful use attestation. 

Physicians and others selected for the audits have two weeks to submit their documentation. The audits don't involve site visits. If you need more time to gather the documentation, request an extension. 

For questions about audits, the meaningful use incentive program, and other health information technology matters, contact TMA's Department of Health Information Technology at (800) 880-5720 or by email

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Take Part in New CMS Clinical Care, Social Services Model

The new Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) model bridges clinical care and social services to help address Medicare and Medicaid beneficiaries' health-related social needs. Physician practices are among the list of eligible applicants who can take part in this new CMS model.  

The U.S. Department of Health and Human Services announced a funding opportunity of up to $157 million to test a five-year model to fill a critical gap in health care. The CMS innovation model focuses on increasing awareness of and referrals to community services, assisting with community service navigation, and encouraging collaboration among clinical and community services.

The AHC model identifies and addresses health-related social needs in areas such as housing instability and quality, food insecurity, utility needs, violence, and transportation needs. By targeting these areas, CMS will test if systematically screening for such needs and attempting to address them at the local level can improve health, enhance quality of care, and reduce health care costs.  

To learn more and evaluate whether this new funding opportunity is right for your practice, visit the CMS website and register for an informational webinar taking place this month. To participate in the new AHC model, submit a letter of intent by Feb. 8 and apply by March 31.

TMA Educates Doctors on Vaccine Exemptions

Texas remains one of 19 states that allow medical exemptions and conscientious objections to any required vaccines for children enrolled in school. Many state legislatures have considered or passed new laws related to exemptions, including a repeal of philosophical exemptions and a requirement for exemption data to be published. 

TMA's Committee on Child and Adolescent Health and Committee on Infectious Diseases have prepared a resource for physicians on vaccine exemptions in Texas. The committees encourage all physicians to have conversations with their patients about vaccines.

"Vaccine Exemptions in Texas" features Texas student conscientious exemption data and information on adult exemptions, herd immunity, medical contraindications and precautions, talking points doctors can use with patients, and more. 

Physicians recognize immunization requirements are one of the most reliable ways to help guarantee a well-vaccinated population. Physicians also recognize the need for medical exemptions for vaccines for contraindications as outlined by the U.S. Centers for Disease Control and Prevention. TMA's policy opposes conscientious objections to required vaccinations.

Vaccinate Your Adolescent Patients Against HPV

During the next year, more than 1,000 Texas women will be diagnosed with cervical cancer, and nearly 400 will die from it. During Cervical Cancer Awareness Month in January, TMA is offering new tools to help physicians prevent their adolescent patients from getting this cancer down the road. A continuing medical education (CME) course and an infographic on human papillomavirus (HPV), the cause of most cervical cancers, assist physicians in urging their patients to get vaccinated against HPV. 

The new CME program, Don't Wait — Vaccinate! The Prevention of HPV Cancers, discusses the burden of HPV-related cancers (oropharyngeal, cervical, vulvar, and penile, among others) and helps physicians improve their communication with patients and their families on the need for HPV vaccination. Texas' HPV vaccination rates lag: In 2014, only 50.7 percent of the state's 13- to 17-year-old girls and 36.6 percent of boys the same age had received one or more of the three recommended doses of HPV vaccine. 

TMA's Committee on Cancer joined with TMA's Be Wise — ImmunizeSM program, the TMA Committee on Child and Adolescent Health, and the Texas Pediatric Society to produce the two-part online CME series, sponsored in part by the MD Anderson Cancer Center and the TMA Foundation. For more information or to download the CME programs, visit the TMA online course catalog

And to help you educate your patients and their families, TMA's Be Wise — Immunize program created an infographic on HPV (in English and Spanish) to download to your website or Facebook page, or post in your waiting room. A more detailed HPV fact sheet also is available. 

To order HPV materials, contact Tammy Wishard, TMA's outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470 or by email.

Be Wise – Immunize is a joint initiative led by TMA physicians and medical students, and the TMA Alliance. It is funded in 2016 by the TMA Foundation thanks to major gifts from H-E-B and TMF Health Quality Institute, along with generous contributions from physicians and their families. 

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

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Earn CME at TMA's Physician Health and Wellness Conference

Integrative Medicine and Physician Health is the theme of TMA's Physician Health and Wellness Training Session and 23rd Annual Retreat, which will take place Feb. 26–27 at Lakeway Resort and Spa in Austin. Presented by the TMA Committee on Physician Health and Wellness (PHW), the conference is accredited for a maximum of 11.25 AMA PRA Category 1 Credits™, 8.25 designated as ethics and/or professional responsibility education.

The conference targets physicians of all specialties; members and consultants of state and county medical society PHW committees; district coordinators; and hospital representatives, including chiefs of staff, medical staff coordinators, and members of hospital-based peer assistance committees. Those who attend will learn about complementary and integrative medicine as an augment to conventional treatment, the correlation between physician health and patient care, and how to respond to patients who ask about medicinal marijuana.

Presentations during the conference include An Introduction to Integrative Medicine: A Look at the Evidence and Ethics; Spirituality and Medicine; How to Give an Effective Presentation; Yoga and Psychiatry Therapy; Taking Care of Ourselves Through Nutrition and Exercise; Yoga (interactive session); Be Here Now! Practice in Incorporating Mindfulness in the Workplace; Transcendental Meditation; Meditation Is the Medicine of the Mind; Integrative Medicine and Cancer Care; and Medical Marijuana: Current Issues. 

Register online. To request a brochure or for additional information, contact Linda Kuhn at (800) 880-1300, ext. 1342, or (512) 370-1342, or by email

HHSC Holds Information Sessions on STAR Kids Program

The Texas Health and Human Services Commission (HHSC) has scheduled information sessions at various locations around the state this month and in February to educate doctors and families on the new STAR Kids program. 

The new managed care program will provide Medicaid benefits to those younger than 21 who have disabilities and who receive a Medicaid waiver or Supplemental Security Income benefits in the Medicaid program. 

Visit the HHSC website for session dates and locations. If you're unable to attend a session, you can register online for a March 4 webinar from 11 am to 1 pm. 

This Month in Texas Medicine

The January issue of Texas Medicine features a cover story on Texas Medical Board chronic pain treatment rules and the obstacles Texas physicians are running into when attempting to adhere to them. In the issue, you'll also find information on potential relief from Medicaid's administrative roadblocks; conducting an office policies and procedures manual makeover; a TMA-hosted forum to help hospitals, medical schools, and others take advantage of $53 million in grant money to create new residency training slots; and a TMA proposed resolution to raise awareness of human trafficking.

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.  

3/16/16
Last Day for PQRS Registry Reporting

3/31/16
Last Day for PQRS Qualified Clinical Data Registry Reporting (using XML format)

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.  

On-Demand Webinar

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

Podcasts

Electronic Medical Records Implementation: Successful Strategies from the Front Lines  

Overcoming Barriers to Medical Home Implementation  

Use coupon code THSEDU for free registration for both podcasts.

Conferences and Events

2016 TMA Winter Conference
Jan. 29-30
Hyatt Regency Austin

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Last Updated On

August 17, 2017