Action: April 1, 2016

 TMA Action April 1, 2016   News and Insights from Texas Medical Association

TMA Warns Physicians: Be Prepared for Cyber Attacks
Feds Launch Phase 2 of HIPAA Compliance Audits
Coming Soon: Credentialing Help From TMA
Help Your Patients Prevent Zika Virus Transmission
Medicaid Restores Payment Levels for Child Vision Services
New TMA White Paper Paints Path to Patient Engagement
Act Now to Avoid Losing Your Medicaid Enrollment Status
Physicians Foundation Survey Gauges Your Satisfaction
Get a Free Quick Consult at TexMed 2016
TMA Member Services Help You Get Paid
TMA's PQRS Endorsements Discontinued
CDC: Health Facilities No Longer Need to Screen for Ebola
This Month in Texas Medicine

TMA Warns Physicians: Be Prepared for Cyber Attacks

TMA has been alerted that a South Texas physician member is the victim of a cyber attack in which a thief hacked into the physician's computer and is demanding money in exchange for the key to access the encrypted information.  

Unfortunately, this physician's experience isn't uncommon. Eighty-one percent of health care executives say their organizations have been compromised by at least one malware, botnet, or other cyber attack during the past two years, and only half feel they are adequately prepared to prevent attacks, according to the 2015 KPMG Health Care and Cyber Security Survey. More concerning, 16 percent of health care organizations say they cannot detect in real time if their systems are compromised.

"TMA would like to again warn our members of cyber hackers and the possibility of ransom requests for the return of your patients' billing information and medical records," said TMA President Tom Garcia, MD. "Please consider reviewing your liability coverage to include this risk, because it is a risk."

John Southrey, manager of Consulting Services at Texas Medical Liability Trust (TMLT), says the company is "committed to protecting physicians in all areas of practice, and cyber crime is a critical concern. To combat this rising threat, TMLT includes comprehensive cyber liability coverage in all of our policies. We also offer customized services to help large groups, small offices, or individual physicians arm themselves against online threats." Learn more about TMLT's cyber liability coverage

If you are the victim of a cyber crime, report it to the FBI.

Physician practices aren't the only groups targeted by cyber criminals. ABC News reports the FBI is investigating a malware attack on Medstar Health Inc. Following the attack, the hospital chain had to use paper systems, and patients couldn’t book appointments. According to the report, the hospital doesn’t believe the thief stole or compromised any patient information. 

Malware is the most frequently reported line of attack, according to 65 percent of KPMG survey respondents. Botnet attacks, in which computers are hijacked to issue spam or attack other systems, and "internal" attack vectors, such as employees compromising security, were cited by 26 percent of respondents in the KPMG survey.

Areas with the greatest vulnerabilities within an organization include external attackers (65 percent), sharing data with third parties (48 percent), employee breaches (35 percent), wireless computing (35 percent), and inadequate firewalls (27 percent). 

TMA says physicians should protect themselves against ransomware and other malware by making sure their computer systems are backed up on a regular basis to an external drive or backup service. In addition, physicians should consider setting up their email accounts to deny emails sent with executable files (.exe file extensions), patch or update their software on a regular basis, and enable automatic updates whenever possible. Computer systems should have a reputable anti-malware software, as well as a software firewall implemented to help detect threats. Taking these precautions should allow you to avoid infection or quickly recover from a malware attack.

For more information, read "Cyber Crimes" in the July 2014 issue of Texas Medicine

Feds Launch Phase 2 of HIPAA Compliance Audits

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has launched Phase 2 of its HIPAA audit program. FCi Federal will be conducting the audits for OCR. The new round of audits will assess physicians' compliance with HIPAA's patient privacy provisions.

According to a March 21, 2016, Law360 article, after emailing physicians and business associates to verify their contact information, OCR will create a "pool of audit targets," including physicians, health plans, health care clearinghouses, and business associates. "Serious compliance issues" could lead to further investigation resulting in violators paying financial penalties and agreeing to strengthen HIPAA compliance.  

"It was not immediately clear how many audits the OCR intends to conduct," the Law360 article stated. "The agency did say that most of the reviews will be remote 'desk audits,' although some in-person audits will take place. All the desk audits will be finished by the end of 2016, according to the OCR."

Here are some steps you can take toward HIPAA compliance:

  • Adopt comprehensive privacy policies and procedures that are up to date and specific to your practice.
  • Carefully train everyone on your staff, especially new hires, according to your policies and procedures.
  • Perform a risk analysis on your practice's data security, and set up reasonable safeguards as necessary.
  • Develop a risk management plan to ensure ongoing security.
  • When staff violate practice policies and procedures, take appropriate action, and document it.   

TMA has tools to help you comply with HIPAA: 


Coming Soon: Credentialing Help From TMA

Concerns among physician members about the burden of credentialing and enrollment with hospitals and health plans have prompted TMA to take action. TMA is evaluating credentialing verification organizations that will assist physicians with the credentialing, verification, and enrollment process. 

TMA wants to affiliate with a company that streamlines the flow of information to all plans operating in Texas, including Medicaid HMOs and hospitals. Stay tuned for the launch of this service, which aligns with TMA's work on network adequacy and the need for health plans to maintain accurate provider directories.

The Council for Affordable Quality Health (CAQH) launched DirectAssure, which works in concert with the CAQH ProView tool physicians may now use for credentialing. The free DirectAssure tool reduces administrative burden by eliminating the need for redundant updates from multiple health plans.  

Physicians credentialed with health plans that participate with CAQH will be reminded at least quarterly to update and verify information that will be updated with those participating plans. While the solution is available to all health plans, not all health plans are participating members, which may limit the value. Learn more about this new CAQH initiative and view the health plans currently participating.

Questions about TMA's credentialing project may be directed to Shannon Vogel in TMA's Health Information Technology Department.

 Action TMLT Ad 10.15   

Help Your Patients Prevent Zika Virus Transmission

To help prevent the spread of Zika virus in Texas, the Texas Department of State Health Services (DSHS) has developed flyers and door hangers (available in English and Spanish) you can use in your office to educate your patients on protecting themselves from the disease. DSHS is testing for Zika virus at its public health lab in Austin. The U.S. Centers for Disease Control and Prevention (CDC) encourages Texas physicians to report suspected Zika virus cases to DSHS.

CDC recently issued Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016. CDC's recommendations apply to men who have traveled to or reside in areas with active Zika virus transmission and their sex partners.

As of March 23, 2016, CDC reported a total of 273 travel-associated Zika cases in the United States. Of these, 19 are in pregnant women, and six were sexually transmitted.

According to DSHS, Aedes aegypti mosquitoes, which carry Zika virus, can be found in Texas, particularly in urban areas in the south and southeast portions of the state. While there is no evidence of local transmission by Texas mosquitoes now, state health officials have implemented Zika virus prevention plans in anticipation of increased mosquito activity and the potential for local mosquito transmission.

To help ensure Texas physicians have all they need to diagnose the virus, DSHS updated its website with a supplemental testing information form and polymerase chain reaction (PCR) and serology specimen criteria form. The PCR test can confirm the presence of Zika virus. Serologic testing can detect Zika infection in people who may not have had symptoms, and the test can be conducted up to 12 weeks after infection. DSHS says a positive serologic test result requires confirmatory testing to pinpoint Zika because it can cross-react with other viruses, such as dengue.

DSHS is working with local officials in the Rio Grande Valley area, a potential hot spot for Zika virus transmission, to monitor mosquito activity. The agency reports spot trapping in the area in February yielded no Aedes aegypti mosquitoes. DSHS urges communities to consider expanding their surveillance in coordination with local mosquito control efforts.

The disease can cause fever, rash, muscle and joint aches, and red eyes, and also has been linked to the birth defect microcephaly and other poor birth outcomes in some women infected during their pregnancy.

A health advisory on the sexual transmission of Zika virus sent to physicians by the Dallas County Department of Health and Human Services (DCHHS) advises clinicians to consider Zika virus infection in patients (including pregnant women) with two or more compatible symptoms (fever, rash, conjunctivitis, or joint pain) within two weeks of travel to an area with active Zika virus transmission. The department says the infection also should be considered in patients with compatible clinical syndrome but without travel history who report recent unprotected sexual contact (within the previous two weeks) with a person with a compatible history of illness and history of travel.

TMA and the Texas Association of Obstetricians and Gynecologists have prepared guidance for physicians on the Zika virus and pregnant patients.

State health officials continue to encourage people to follow travel precautions. CDC is advising pregnant women to delay travel to foreign countries where Zika is being transmitted. 

More Information 

General information about Zika virus  
Information for clinicians  
Protection against mosquitoes 
Zika virus travel notices
Key messages

Medicaid Restores Payment Levels for Child Vision Services

Thanks to TMA advocacy, Medicaid is restoring physician payments for 50 pediatric eye codes to higher levels paid prior to July 1, 2015. The increase, which takes effect April 1, averages 6.6 percent across all codes.  

For a comparison of fees, see this chart. Several Medicaid HMOs declined to enact the cuts. For HMO payment rates, refer to each plan's fee schedule

For the past nine months, TMA and the Texas Ophthalmological Association (TOA) advocated strongly to restore the payments, meeting with senior officials from Texas Medicaid to urge a special hearing to review the impact of the lower payments on access to care for children. Anecdotal data collected from TMA and TOA indicated the lower payments had a swift and profound negative impact on low-income children's ability to obtain timely vision services. The lower payments resulted in many ophthalmologists making the painful decision to limit or discontinue Medicaid participation. At least one physician practice along the border laid off staff and closed its Saturday clinic to make up for the cuts. 

Medicaid implemented the reduction under a routine review of Current Procedural Terminology (CPT) ophthalmology codes and CPT codes for a dozen other physician services. Medicaid rules require all CPT codes to be reviewed at least once every two years. Reviews can result in decreases, increases, or no change in physician payment.

The pay cuts enacted last year also apply to physician vision services for adult patients. The higher payments taking effect on April 1, however, apply only to children's services. TMA and TOA will continue to vigorously campaign to restore payments for adult services, too. 

New TMA White Paper Paints Path to Patient Engagement

Technology is giving patients many new ways to create, access, and control their health information. A new TMA white paper, "Electronic Patient Engagement Tools: A Guide for Physicians," shows physicians how to make the most of the changes.

Patient engagement is closely aligned with, but not identical to, patient-centered care, the white paper explains.

"Patient-centered care is about the actions of the physician and care providers, whereas patient engagement is about the actions of patients regarding their own care." The white paper includes definitions, examples, and even scripts showing how physicians and office staff can encourage patients to take part.

Act Now to Avoid Losing Your Medicaid Enrollment Status

Thanks to lobbying from TMA and organized medicine, the Centers for Medicare & Medicaid Services extended the deadline for physicians and other health professionals, including advanced practice nurses and physician assistants, to reenroll in Medicaid to Sept. 25, 2016. The initial deadline for reenrollment, driven by a provision in the Affordable Care Act (ACA), was March 24. 

According to the Texas Health and Human Services Commission (HHSC), all physicians participating in Medicaid who have not met all ACA revalidation requirements must do so through reenrollment by Sept. 24, 2016. To avoid disenrollment and possible claims payment disruption, Texas Medicaid officials urge physicians to submit a reenrollment application before June 17, 2016.  

The reenrollment requirement applies to physicians and other health professionals who participate in Medicaid managed care, traditional fee-for-service Medicaid (each active Texas Provider Identifier suffix), the Texas Vendor Drug Program, and in long-term care services administered through the Texas Department of Aging and Disability Services. 

If an application has deficiencies but is submitted by June 17, HHSC says there will not be gaps in payment after Sept. 24, if the physician makes a good faith effort to resolve application errors. Applications submitted after June 17 will be processed, but HHSC cannot guarantee those applications will be completed by Sept. 24, which could result in physician disenrollment from Texas Medicaid and denial of payment.

TMA and Texas Medicaid officials encourage Texas physicians to get ahead of the complex reenrollment process.

More Information

Acute Care Physicians Reenrolling Through Texas Medicaid and Healthcare Partnership  

Ordering- and Referring-Only Physicians

Ordering- and referring-only physicians are those whose only relationship with Texas Medicaid involves ordering or referring services for Medicaid clients. They also must enroll with Texas Medicaid as participating physicians. 


 TMAIT Action Ad 6.15     

Physicians Foundation Survey Gauges Your Satisfaction

How satisfied are you with the current state of medicine? The Physicians Foundation is surveying you and your 650,000 physician colleagues across the country to determine just that. The survey asks for your thoughts on health reform, electronic health records, new physician payment methods, ICD-10, and a variety of other topics. Take a few minutes to complete the survey

A full copy of the final survey report will be emailed to all physicians who participate, and participants will also be entered to win one of five $500 Amazon gift cards and one $5,000 Amazon gift card. Additionally, the Physicians Foundation is offering a $5,000 grant to the state medical society that achieves the most total survey responses and a $5,000 grant to the state medical society that achieves the highest per capita response. As a founding member of the Physicians Foundation, TMA expects to be in the running to win both of those grants. 

"This is the one national survey that allows physicians to share their perspective on the state of the medical profession," said Walker Ray, MD, Physicians Foundation president. "We'd like to hear from as many physicians as possible so we can accurately understand — and share with the public — physicians' perspectives on the most significant issues in medicine and health care today."

A nonprofit, grant-making organization, the Physicians Foundation is determined to strengthen the patient-physician relationship and help physicians sustain their medical practices in today's practice environment. The Physicians Foundation focuses on physician leadership, physician practice trends, physician shortage issues, and the impact of health care reform on physicians and patients.

To access previous Physicians Foundation surveys, visit the foundation's website.

Get a Free Quick Consult at TexMed 2016

TMA staff experts will be on hand at TexMed 2016 to provide free, one-on-one problem-solving covering a variety of topics. 

Attendees can sign up for a free 15-minute quick consult discussing health information technology, quality and patient safety, payment advocacy, HIPAA, human resources, or general practice questions. During your consult, TMA experts will address your specific questions and needs and provide next steps for your practice. 

Quick Consults will take place in the TMA Member Services booth, number 263. Appointments are limited, so reserve your space today

This year, TMA is offering complimentary registration for nonmember physicians attending TexMed for the first time and for practice managers and staff. To attend free of charge, you must register in advance. TexMed 2016 will be held April 29–30 at the Hilton Anatole in Dallas. 

TMA Member Services Help You Get Paid

TMA offers a number of members-only services designed to help you get paid. One of these services, TMA's Hassle Factor Log, helped members recover more than $1.3 million in 2015. 

The Hassle Factor Log program goes to bat for members by helping resolve insurance-related payment problems. TMA also meets regularly with Medicare, Medicaid, health care payment plans, and large insurers to discuss specific problems that members bring to our attention. 

TMA offers additional services that help you get paid for your hard work, including:  

  • Coding and documentation review: TMA's certified and professional coders and auditors will review your coding and records to determine whether your practice is following payers' guidelines for appropriate billing. 
  • Billing and coding hotline: Members may contact TMA's certified coders by email or by calling (800) 880-1300, ext. 1414, for assistance. 
  • Education: TMA offers a wealth of practice E-tips, white papers, continuing medical education, and FAQs on getting paid fairly. 
  • Discounts: TMA endorsed vendors, such as I.C. System and TransFirst, offer discounts on products and services designed to save your practice money. 
  • Free Quick Consults: TMA staff experts will be at TexMed 2016 April 29–30 at the Hilton Anatole in Dallas to offer free 15-minute consults on a variety of topics, including payment advocacy. Reserve your spot here.  

Learn all about the ways TMA can help you get paid.  

TMA's PQRS Endorsements Discontinued

In 2011, TMA endorsed two online registries for Physician Quality Reporting System (PQRS) submissions: PQRSwizard and DocSite (now Covisint PQRS). Both are qualified PQRS registries and are the top two most used electronic health record (EHR)-agnostic registries operating in the market. TMA members received a significant discount on reporting done through one of these registries as a benefit of membership.

The Centers for Medicaid & Medicare Services (CMS) has introduced the Merit-Based Incentive Payment System (MIPS), which will incorporate new criteria and benchmarks for quality reporting. Currently, 100 PQRS qualified registries and 50 qualified clinical data registries (QCDRs) are certified to submit data on quality measures to CMS for these purposes. However, as with EHR vendors, these certifications, as well as functionalities for each product, are constantly changing. 

As the PQRS mandate from CMS has shifted from offering incentives for submissions to levying penalties for unsatisfactory reporting on PQRS measures, it has become more important for TMA to be cognizant of the potential pitfalls related to the reporting process, rather than to endorse these types of vendors. For those reasons, TMA physician leaders have elected to discontinue endorsement of both PQRSwizard and Covisint PQRS following the 2015 reporting period, which ended in March 2016. 

In lieu of endorsement, TMA will continue to inform members about the quality and value-based reporting options available to Texas physicians. TMA also will continue to develop education and services that help guide physicians' decisionmaking when choosing a PQRS, MIPS, or other vendor to comply with Medicare mandates. Visit TMA's PQRS Resource Center for PQRS information and updates.

Current users of PQRSwizard and Covisint PQRS should contact those vendors directly for information on pricing and availability of services for the 2016 reporting period.

View a full listing of PQRS qualified registries and QCDRs.

CDC: Health Facilities No Longer Need to Screen for Ebola

The U.S. Centers for Disease Control and Prevention (CDC) has released updated guidance — in the form of frequently asked questions — on Ebola screening in health care facilities. CDC says U.S. health facilities "no longer need to screen patients specifically for Ebola virus disease" but should regularly review CDC travel notices, obtain a complete travel history before the patient exam, and "adjust screening practices for acutely ill patients."

"Because of the constant risk for travel-associated diseases (such as malaria, dengue, vaccine-preventable diseases) and emerging pathogens (MERS-CoV, chikungunya, Zika virus, etc.), a travel history should remain part of routine patient evaluation, including during entry to the facility," CDC's guidance states.

CDC also advises health care facilities to post signs and posters (in appropriate languages) in high-traffic patient areas to inform patients of the need to provide physicians with their travel history and to take precautions to prevent infection.

This Month in Texas Medicine

The April issue of Texas Medicine features a cover story on new funding and a streamlined state approach to women's health that could improve access to screenings and family planning services for low-income women and girls. In the issue, you'll also find information on The University of Texas at Austin Dell Medical School's course that teaches residents some of the business and job-hunting basics they'll need; mining electronic health record data to improve patient care; the two prestigious speakers TMA has secured to headline the TexMed 2016 General Session; Teladoc's lawsuit against the Texas Medical Board; and the first set of new, national standardized quality measures.

Click to launch the digital 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.   

2016 UnitedHealthcare Administrative Guide Available

Apply for Meaningful Use Hardship Exception

Medicaid Reenrollment Deadline

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 Webinars

Dealing With Difficult Patients
HIPAA Training for Medical Office Staff
New NPP Regulations: Rules You Need to Know

Conferences and Events

TexMed 2016
April 29-30
Dallas Hilton Anatole

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

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If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Crystal Zuzek, Action editor.

Last Updated On

December 07, 2016