Action: May 2, 2016

TMA Action May 2, 2016   News and Insights from Texas Medical Association

Delegates Vote to Preserve Billing Rights, Fight MOC Coercion
MACRA: Weigh In on New Patient Relationship Categories
TMA Opposes Dental Board's Sleep Apnea Treatment Rules
TMA to House: Reduce Costs, Cut Red Tape, Boost Medicaid Pay
PQRS: Start GPRO Registration Process Now
Tips for Acing a Meaningful Use Audit
Physicians Foundation Survey Gauges Your Satisfaction
Use These Medicaid Tools to Help Get Paid More Efficiently
When Disaster Strikes, Ask for a Claims Filing Extension
Register for the Texas Primary Care and Health Home Summit
Learn About HIV Screening at Test Texas Coalition Summit
This Month in Texas Medicine

Delegates Vote to Preserve Billing Rights, Fight MOC Coercion

The Texas Medical Association "has the green light to fight for state legislation that will address two crucial issues for Texas physicians," thanks to the TMA House of Delegates, Council on Legislation Chair Ray Callas, MD, wrote in a letter to all TMA member physicians.

Meeting in Dallas at TexMed 2016, the house on April 30 unanimously approved what Dr. Callas called:

  • "The TMA Board of Trustees multi-faceted plan to preserve physicians' right to bill for services provided to our patients; and
  • A Harris County Medical Society proposal that would free us from the pressure of the American Board of Medical Specialties' maintenance of certification [MOC] requirements."

"As chair of the TMA Council on Legislation, I am tremendously excited by these actions, and I pledge to you that your TMA leadership will follow through," Dr. Callas wrote.

He pointed out that lawmakers in other states have enacted laws to ban physicians from billing for services provided to patients out of network. These laws fall short of helping patients hold the very insurers who sell policies with narrow networks accountable for the lack of access to in-network physicians and health care providers. The Obama administration and several presidential candidates have proposed similar nationwide measures.

"We will not let it happen here in Texas," Dr. Callas said.

"The plan the House of Delegates approved calls on TMA to push for legislation that holds insurance companies accountable for their inadequate and narrow networks. It extends the applicability of Texas' exemplary mediation program for $500-or-more balance bills to all out-of-network physicians and providers and facilities. It keeps physicians aligned with patients' needs and best interests."

Read more about the plan and the extensive research that supports it in the cover story of the May issue of Texas Medicine.

The MOC proposal grew out of a new law that Oklahoma Gov. Mary Fallin signed last month. It would ban the use of MOC "as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital" in Oklahoma.

Dr. Callas said "several key Texas legislators … are quite interested in pursuing a similar measure here. The TMA house followed through perfectly."

The resolution delegates adopted calls on TMA to "pursue legislation that eliminates discrimination by the State of Texas, employers, hospitals, and payers based on the American Board of Medical Specialties' proprietary MOC program as a requirement for licensure, employment, hospital staff membership, and payments for medical care in Texas."

Other highlights from TMA's 2016 annual meeting include:

Look for more detailed coverage of TexMed 2016 and the House of Delegates activities in coming issues of Action and Texas Medicine.

MACRA: Weigh In on New Patient Relationship Categories

Beginning Jan. 1, 2018, you will have to report new patient relationship categories and codes on all Medicare claims. Before the codes can be developed, the Centers for Medicare & Medicaid Services (CMS) wants your input on a series of questions pertaining to the new categories. Review the draft categories, and weigh in by sending your comments to TMA at macra[at]texmed[dot]org by Aug. 1, 2016.

Provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) call for the new patient relationship categories and codes. MACRA will soon require physicians to choose between two major payment tracks: the Merit-Based Incentive Payment System (MIPS) and eligible alternative payment models (APMs) beginning in 2019. The intent of the new categories and codes is to describe your relationship to each patient to CMS for the purposes of attribution and cost measurement under the new payment tracks. 

CMS' five draft categories are:

  1. Clinician who is the primary health care provider responsible for providing or coordinating the ongoing care of the patient for chronic and acute care.
  2. Clinician who provides continuing specialized chronic care to the patient.
  3. Clinician who takes responsibility for providing or coordinating the overall health care of the patient during an acute episode.
  4. Clinician who is a consultant during the acute episode.
  5. Clinician who furnishes care to the patient only as ordered by another clinician.

TMA would like your input and will consider your opinions and feedback for inclusion in its comment letter. CMS will review all public comments and consider them in development of the operational list of patient relationship categories and codes. CMS will publish the final version in April 2017.

To submit comments directly to CMS, email patientrelationshipcodes[at]cms[dot]hhs[dot]gov by Aug. 15.

TMA is taking a two-pronged approach to the regulations coming from MACRA. TMA Vice President of Advocacy Darren Whitehurst and the TMA lobby team met with U.S. Rep. Michael Burgess, MD (R-Lewisville), medicine's good friend and the chief author of MACRA. Dr. Burgess shares TMA's concerns with how CMS is implementing MACRA. He is one of several congressional leaders who will be closely monitoring the agency's activities. At the same time, a TMA task force will develop tools and educational materials to help physicians understand and prepare for the new law. 

For more information, read "SGR Is Gone. Now What?" in the September 2015 issue of Texas Medicine.

TMA Opposes Dental Board's Sleep Apnea Treatment Rules

TMA is fighting the Texas State Board of Dental Examiners' (TSBDE's) proposed rule changes for dental treatment of obstructive sleep apnea. The association told TSBDE in a letter that TMA "strongly opposes any attempt to expand the dentists' scope of practice through the promulgation of rules that TMA contends not only lack support in, but also conflict with, the applicable law passed by the Texas Legislature. Unfortunately, this opposition extends to the rules adopted to be effective on June 11, 2014, and the new March 18, 2016, rule proposal."

TMA supports the Texas Medical Board's (TMB's) Position Statement on the Practice of Sleep Medicine and Dentists, which clearly states "the diagnosis and treatment of sleep apnea are the practice of medicine."

TMA's letter, signed by TMA President Tom Garcia, MD, and Texas Neurological Society President Deborah Carver, MD, stresses the importance of a Texas-licensed medical doctor making sleep apnea diagnoses "to protect the health and safety of Texas patients." The letter cites the Texas Dental Practice Act, which "limits the practice of dentistry to the teeth, oral cavity, alveolar process, gums, or jaws. Sleep apnea and other sleep disorders, however, clearly fall outside of this scope. Sleep apnea is a medical disorder, which is diagnosed with a sleep test."

The letter concludes by contending the proposed rules "would be in violation of the Medical Practice Act and the Dental Practice Act. We urge the TSBDE to consider these comments and modify its proposed rules as recommended in this letter, in conformity with the Dental Practice Act, the Medical Practice Act, and the policy statement of the TMB."

TMA to House: Reduce Costs, Cut Red Tape, Boost Medicaid Pay

TMA joined with seven state specialty societies in a letter urging Texas House budget writers to take strong action to improve Medicaid. The House Appropriations Subcommittee on Health and Human Services held two days of hearings in April examining the Medicaid program. 

Medicine's joint proposal outlined three broad principles:  

  1. Reduce Medicaid costs through better management of postpartum/interconception care and a more aggressive approach to reducing obesity and tobacco use;
  2. Attract more physicians to the program by directing the Texas Health and Human Services Commission to slash Medicaid's tangle of bureaucratic red tape; and
  3. Boost physicians' Medicaid payments to a close-to-reasonable level. 

In the 2015 legislative session, the Appropriations Committee recommended Medicare payment parity for primary care Medicaid services. The Senate shot down that proposal. "We are calling upon you again to champion competitive Medicaid payments to ensure our most vulnerable Texans have access to services they need to stay healthy and productive," TMA's letter said.

Last year, Texas Medicaid officials asked for physicians' input on red-tape relief in the program when they met at TMA with doctors from diverse specialties and geographic regions across Texas. Read "Message Received" in the January 2016 issue of Texas Medicine.

  TMAIT Action Ad 6.15       

PQRS: Start GPRO Registration Process Now

It's more alphabet soup from the feds. You have until June 30, 2016, to register with the Physician Value-Physician Quality Reporting System (PV-PQRS). Group practices with two or more eligible professionals (EPs) interested in participating in the 2016 PQRS program year under the group practice reporting option (GPRO) should register now. 

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will soon require physicians to choose between two major payment tracks: the Merit-Based Incentive Payment System (MIPS) and eligible alternative payment models (APMs) beginning in 2019. MIPS will consolidate and incorporate features from the PQRS, value-based payment modifier (VM), and meaningful use programs. These programs, however, remain in effect through the end of 2018. To avoid Medicare pay cuts in 2018, all solo physicians and group practices that get paid under or based on the Medicare Part B Physician Fee Schedule must comply with quality reporting requirements in 2016.

To determine if the GPRO is right for your practice, visit the GPRO webpage. To learn about the registration process, visit the PQRS GPRO Registration webpage. Group practices that previously reported under the GPRO and plan on reporting PQRS data again via GPRO must register every year. If you plan to report your data on quality measures as an individual EP and not under the GPRO, you do not need to sign up or register anywhere to participate in the 2016 PQRS program year. 

If you are not sure where to begin for the 2016 PQRS program year or do not know which reporting mechanism to select when registering under the GPRO, visit the CMS How To Get Started webpage.

For help with your PQRS reporting, turn to the TMF QIN-QIO Value-Based Improvement and Outcomes Network. TMA is collaborating with TMF QIN-QIO (TMF Quality Innovation Network-Quality Improvement Organization) to connect members to free services that help them avoid penalties and maximize value-based payments. For samples of expert guidance, check out TMF QIN-QIO's Six Things to Know About Reporting PQRS and Setting Up Your EIDM Account — What You Need to Know

Once the Centers for Medicare & Medicaid Services finalizes regulations governing MACRA implementation, TMF will offer additional services to help physicians transition to the new payment tracks.

For more, visit the TMA PQRS Resource Center. 

Tips for Acing a Meaningful Use Audit

A meaningful use audit that ends badly for you could mean you have to forfeit your meaningful use incentive dollars from the Centers for Medicare & Medicaid Services (CMS). Don't let this happen to you.

CMS conducts both prepayment and post-payment meaningful use audits. "Some are random. Some are based on complex algorithms," says TMA’s director of health information technology, Shannon Vogel. "If you participate in meaningful use, document everything."

You’ll want to be able to support your attestation data for meaningful use objectives and clinical quality measures. Medicare requires you to keep documentation (paper and electronic) for six years; make sure several members of the office staff and the physician(s) know where the documentation is filed.

Ms. Vogel also suggests taking screen shots of your reports generated at the time of attestation. In addition, screen shots from your certified electronic health record (EHR) system can validate attestation for nonpercentage-based meaningful use objectives. An example is a screen shot of a drug formulary check dated from the relevant EHR reporting period.

Audit notification comes to you in an email at the address you submitted during EHR incentive program (meaningful use) registration. Ask for an extension if you need more time to respond than what’s specified in the email, advises Ms. Vogel — better to mount a thorough defense up front than have to file an appeal with CMS later. You have 30 days to appeal (from the date of the audit result notification letter) if you receive an adverse determination from the auditor.

To find out more:

Published Nov. 25, 2015

TMA Practice E-Tips main page

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.

  Action TMLT Ad 10.15       

Use These Medicaid Tools to Help Get Paid More Efficiently

Medicaid’s new e-signature capability and its portal for verifying patients’ Medicaid eligibility and accessing their available health information are two ways to help cut down on the busywork in your office.

Texas Medicaid Accepts E-Signatures
As of April 1, 2016, Texas Medicaid Healthcare Partnership (TMHP), the administrator for Texas Medicaid and the Children with Special Health Care Needs Services Program, accepts electronic or digital physician signatures on prior authorization forms and supporting documentation.

The signature must be derived using software that creates a digital signature logo with a system-generated date and time stamp or includes the logo of the digital software used. Examples of such software are RightSignatureTM, Adobe® eSign, and electronic health record software; there are others (neither TMA nor TMHP endorse any particular e-signature software).

TMHP won’t accept a handwritten, electronic, or digital signature if it is among other disallowed forms: a photocopy of a handwritten signature, an ink stamp of a handwritten signature, or a typed signature without a digital stamp.

For transactions processed by a Medicaid/Children’s Health Insurance Program (CHIP) managed care organization (MCO), refer to the MCO for information about prior authorization.

Portal Provides Health Info, Eligibility is a dual portal for verifying patients’ Medicaid eligibility and accessing their available health information. On one portal, Medicaid physicians and their staff can view information on a patient’s Medicaid eligibility, services, and treatments. On the second portal, patients can view their benefit and case information, print or order a Medicaid ID card, set up and view their Texas Health Steps alerts, and more.

Physicians can view such information as vaccination information, prescription drugs, past Medicaid visits, diagnoses and treatments, and lab data, and Texas Health Steps alerts. In addition, the portal provides access to the Blue Button functionality to request a Medicaid patient’s available health information in a single tool.

Follow the instructions contained in the Initial Registration Guide for Medicaid Providers to get started. To set up an account, you’ll need to have handy the following numbers: billing National Provider Identifier, billing taxonomy number, billing tax ID, and an internal claim number or encounter number. For more information, you can download the Welcome Packet from the initial Login page of

Visit TMA’s Medicaid/CHIP Resource Center for information and resources related to these programs. And, visit the TMA Education Center for a free webinar from Texas Health Steps, New Initiatives for Medicaid Providers. TMA provides many such benefits and services designed to help you get paid.

Published April 14, 2016

TMA Practice E-Tips main page

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.

Register for the Texas Primary Care and Health Home Summit

Be part of the fourth annual Texas Primary Care and Health Home Summit June 9–10 at the JW Marriott in Houston. The event, presented by the Texas Medical Home Initiative and Texas Health Institute and cosponsored by TMA, provides a learning laboratory for primary care transformation in Texas. 

Sessions include fundamentals of the adult and pediatric health home, using telemedicine in your office to better manage chronic conditions, integrating behavioral health into the primary care office, improving chronic pain management, leveraging technology for better patient engagement, and elements of a successful accountable care organization.

This year's summit will feature three keynote addresses, three in-depth presummit courses, 23 breakout sessions, and breakfasts with faculty members. You may register online


Learn About HIV Screening at Test Texas Coalition Summit

Do you want to learn more about routine HIV screening in health care settings? You'll have the chance at the 2016 Test Texas Coalition Summit on May 13 in Austin at the Doubletree by Hilton. Register today for the summit, hosted by the Texas Department of State Health Services. 

The meeting will focus on lessons learned from successful routine HIV screening programs in Texas and in other states, including how HIV is affecting health care in Texas and the importance of routine HIV screening in health care settings. Other topics include linking HIV positive patients to medical care, HIV testing technology, and preexposure prophylaxis.

This Month in Texas Medicine

The May issue of Texas Medicine features a cover story on balance billing, a matter TMA is studying in preparation for the 2017 legislative session. TMA research shows narrow networks and other health plan practices -— not physician billing -— are bearing down on patients in the form of unexpected, out-of-network balance bills. In the issue, you’ll also find a Match Day photo essay and information on a United States Pharmacopeia proposal that physicians say will mess with an allergy treatment system that's worked for more than a century; problems physicians are running into with a meaningful use objective that requires public health reporting; and a profile of the Texas Department of State Health Services' new commissioner, John Hellerstedt, MD.

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.   

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.  


E&M Coding Made Easy Workshop
E&M Services From the Physician Perspective
Human Resources Skills Development Workshop 

Conferences and Events

TMA Fall Conference 2016
Sept. 23-24
Hyatt Regency Lost Pines

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Last Updated On

December 07, 2016