Action: June 15, 2017

TMA Action June 15, 2017   News and Insights from Texas Medical Association

Deadline Looming to Comply With Medicaid Enrollment Requirement
You Have MACRA Questions? TMA Has Answers
MIPS Deadline: Register by June 30
Additional Newborn Gene Screen Costs No Green

Officials: Tuna Products Test Positive for Hepatitis A
EHR Company Settles Federal False Claims Suit – How Will It Affect You?
Need TMAF Grant Support? Deadlines Approaching!
This Month in Texas Medicine

Deadline Looming to Comply With Medicaid Enrollment Requirement

What are you doing this summer? Planning a trip? Relaxing by the pool? Just going to keep working?

That all sounds good. 

But if you or your practice orders or refers for Medicaid patients — even if you do not otherwise participate in Medicaid — here’s something you better do: Enroll in Medicaid before Oct. 1.

If you already have a Medicaid provider number or have already enrolled as an ordering and referring-only practice, you’re way ahead of the game. Go kick up your feet.

If you haven’t, you’d better get on it — Enrollment is required under the Affordable Care Act, and Oct. 1 will be here before you know it.

Enrollment applies to physicians, advanced practice registered nurses, physician assistants, and other health professionals and providers — anybody in your practice who orders or refers for Medicaid patients.

It also applies to physicians who only care for dual-eligible patients — those who are eligible for Medicare and Medicaid — and who order Medicaid-only services for those patients (the requirement does not apply to crossover claims). If that’s you, you must enroll as an ordering and referring physician.

“Good to know, but how do I enroll?” you ask? Click on the Texas Medicaid and Healthcare Partnership (TMHP) website. It’ll give you way more information than I can here.

Now, if you’re a physician whose only relationship with Texas Medicaid is to order or refer services to Medicaid clients, TMHP has developed an abbreviated enrollment application, which you can find here.

But wait, there’s more. There always is, isn’t there?

If you’re submitting a claim for services that require an order or a referral, you must include the National Provider Identifier (NPI) of the ordering, prescribing, or referring provider on the claim.

Furthermore, residents and interns at your practice will be able to order and refer using the supervising physician’s NPI, or they can use their own if they have one.

Very importantly, after Oct. 1, Medicaid patients who attempt to fill a prescription will be unable to do so if the ordering and referring physician or provider is not enrolled. Other examples of services that require an order or referral include: 

  • Clinical, radiological, or laboratory services;
  • Home health agency services;
  • Durable medical equipment (DME);
  • Eyeglasses; and 
  • Hearing aids.   

The requirement applies to whether a patient is enrolled in Medicaid managed care or fee-for-service. 

So now you know. Enroll now so you can have a beach umbrella hanging over your head this summer instead of a deadline. 

If you have questions about any of this, call TMHP at (800) 925-9126.

You Have MACRA Questions? TMA Has Answers

You’re welcome. We were thinking about you.

We knew you’ve been looking high and low for a comprehensive set of educational tools to help you figure out the MACRA Quality Payment Program (QPP) payment rules for the new pathways: the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). 

(By the way, MACRA = the Medicare Access and CHIP Reauthorization Act of 2015.) 

So when the Physicians Advocacy Institute (PAI), in collaboration with health care consulting firm Healthsperien, asked us to work closely with them and other state medical associations to create a free MACRA Quality Payment Program (QPP) education initiative, we jumped at the chance. (TMA is a charter member of the PAI.)

Earlier this month, that resource center went live online. It includes: 

  • Recorded webinar tutorials available on-demand at your convenience;
  • Summary and in-depth information on all aspects of the QPP, including a guide to acronyms, a guide to reporting mechanisms, and an explanation of how the QPP affects Medicare Part B payments;
  • A step-by-step guide for physicians on how to navigate the QPP’s MIPS and APM pathways; and 
  • A searchable Frequently Asked Questions section. 

“PAI is sharing this comprehensive array of resources free of charge to help any physician practice, regardless of its level of readiness or knowledge, assess its preparedness and determine the best approach to succeed under the MACRA QPP payment rules,” PAI said in a statement.

So click around, get lost in it, find out what you need to know. 

And don’t forget about the TMA MACRA Resource Center. It’s just one of the ways TMA will continue to update you with the latest information to help you succeed in the QPP.

Action TMLT Ad 10.15

MIPS Deadline: Register by June 30

If you’re in a physician group that participates in MIPS, gather everybody together soon and ask this question: “How are we going to report data under the new Quality Payment Program?”

Why should you do this soon? Because you’re bumping up against a June 30 deadline, depending on how you choose to report. Yep, that’s two weeks from now.

So let’s get down to it:

In general, if you participate in MIPS (the Merit-Based Incentive Payment System), you have six options for reporting Quality Performance Category data to the Centers for Medicare & Medicaid Services (CMS). And that all comes down to whether you report as a group or you want to “go rogue” and report as individuals. You rebel, you.

But only two of those options require registration by June 30: the CMS Web Interface and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.

What’s the difference between them? Well, among other things described in the links above, the CMS Web Interface is for physician groups of 25 or more. CAHPS is for groups of two or more.

The other four choices, which don’t have that pesky June 30 deadline, are via claims (for individuals only), qualified registry, qualified clinical data registry (QCDR), and electronic health record (EHR).

And remember the old Physician Quality Reporting System (PQRS)? Well, unlike that system, groups do not need to register with CMS if they plan to report Quality Payment Program data via qualified registry, QCDR, or EHR.

In addition, if your group registered for the Group Practice Reporting Option (GPRO) Web Interface in 2016 to report quality data for the PQRS program, CMS automatically registered your group to use the CMS Web Interface in 2017 for MIPS. (How about that?!)

But, if your group would like to use a different reporting mechanism, you must cancel this registration by June 30.

You can learn a lot more about the registration process, or how to cancel your group’s registration, through the CMS website. For questions, contact the CMS Quality Payment Program Service Center by phone at (866) 288-8292 or by email. You can also check out the CMS Quality Payment Program website for more information, and don’t forget about the TMA MACRA Resource Center. It’s MACRA-tastic. 

Additional Newborn Gene Screen Costs No Green

Newborns. They’re adorable: All sleepy and little, with their chubby toes, fingers, and cheeks. You just want to pinch 'em.

As a physician, you also have to stick them as part of the newborn screening program.

Starting June 1, the Texas Department of State Health Services (DSHS) began offering additional molecular testing to identify variants in the very long-chain acyl-CoA dehydrogenase (VLCAD) gene.

See, every newborn in Texas is screened for VLCAD deficiency using tandem mass spectrometry — which is basically a multistep process to identify specific ions by fragmenting atoms, molecules, etc. (Look it up, it's cool.) What's new is that specimens that come back as "possible VLCAD" will now undergo a second-tier sequencing analysis. A separate VLCAD DNA report will then be sent to the submitting physician or health care facility.

You should interpret those results in the context of the patient's VLCAD clinical findings, family history, and other laboratory data, DSHS cautions.

And here's the best news: That second-tier analysis and separate report will all be done for free. However, if you're screening anyone other than newborns, this service will cost them.

If you need more information, call the DSHS Newborn DNA Analysis Laboratory at (512) 776-6699 or email the lab.

TMAIT Action Ad 6.15

Officials: Tuna Products Test Positive for Hepatitis A

Nobody wants Hepatitis A. Seriously. You don’t want it. Your patients don’t want it. Your mom doesn’t want it. It’s not good.

But we all want that sushi. 

And that might be a problem.

Think back over the past two weeks. Have any of your patients displayed symptoms of hepatitis A after eating raw or undercooked tuna? If you answered yes, it’s possible that their tuna roll was contaminated with the hepatitis A virus.

You see, in mid-May, Hawaii-based Hilo Fish Co. began recalling tuna products that had tested positive for hepatitis A. Some of that tuna was distributed to restaurants and stores throughout Texas as well as Oklahoma and California. 

Therefore, you should consider a hepatitis A diagnosis if any of your patients display even some of the symptoms of the disease. Symptoms include fever, headache, malaise (malaise!), and vomiting along with jaundice or elevated serum alanine aminotransferase or aspartate aminotransferase levels.

Furthermore, it’s a good idea to check the immunization status of all your patients and offer the vaccine to anyone who is not up to date. The Centers for Disease Control and Prevention (that’s the CDC to you and me) also advises postexposure prophylaxis for unvaccinated people whose exposure occurred in the past two weeks.

It’s all part of an effort by state health officials to monitor and prevent spread of the disease.

As of June 1, no cases have been linked to tuna consumption, according to the Texas Health and Human Services Commission.

If you need a refresher course, hepatitis A is a contagious liver disease that is a result of exposure to the virus, which can happen by ingesting contaminated food or water, or via unvaccinated family members, sexual partners, or close contacts. (This paragraph doesn’t count as CME, by the way.)

A lot more information can be found at the HHS’s website, including laboratory confirmation testing, managing close contacts, and infection control. You can also find out more on the U.S. Food and Drug Administration website.

And just so you know, in Texas, you are required to report a diagnosis or even a suspicion of hepatitis A within one workday. “Do not wait for laboratory confirmation to report suspect hepatitis A cases,” HHS said in a statement. Hepatitis A reports should be sent to your local health department or by calling (800) 705-8868.

EHR Company Settles Federal False Claims Suit – How Will It Affect You?

If your practice uses eClinicalWorks to maintain electronic health records (EHR), you’re going to want to pay attention to this.

The U.S. Department of Justice recently announced that eClinicalWorks will pay the federal government $155 million to settle a federal False Claims Act lawsuit. The suit alleged that eClinicalWorks fraudulently obtained certification for its EHR system and provided kickbacks to customers who promoted their product. 

In order to pass the federal certification requirements, eClinicalWorks was alleged to have falsified its software in the following ways: 

  • Sixteen drug codes necessary for certification testing were "hardcoded" rather than programming the product to retrieve any drug code from a complete database;
  • Audit logs did not accurately reflect user actions;
  • In certain situations, diagnostic imaging orders and drug interaction checks were not accurately recorded; and
  • Data portability requirements that were intended to allow the transfer of patient records from eClinicalWorks software to another EHR were not met.  

If you are an eClinicalWorks customer, know your rights! As part of the settlement, eClinicalWorks must adhere to a five-year corporate integrity agreement, which imposes the following requirements:  

  • An independent software quality oversite organization must perform an assessment of eClinicalWorks’ software quality control systems;
  • Notice of any safety-related issues must be promptly communicated to eClinicalWorks users;
  • Software updates will be available at no cost to customers;
  • Customers who want eClinicalWorks to transfer data to another EHR vendor will incur no service charges or penalties; and
  • An independent review organization will review eClinicalWorks' agreements with physicians and providers to ensure compliance with the antikickback statute

Be aware that changing EHR vendors can present major problems, so if you are an eClinicalWorks customer and you're considering moving to another EHR vendor, please: 

  1. Carefully review EHR vendors that will best suit your practice. 
  2. Calculate the "getting started" and "ongoing" costs of the new EHR system.
  3. Carefully review the new EHR contract before signing. Have an attorney review it if you're not comfortable with evaluating the contract on your own.
  4. Calculate the time required to transfer patient data and fully implement the new EHR software.
  5. Calculate the time and expense involved in properly training staff and physicians on a new EHR system. 

You can direct questions related to EHRs and other office technologies to TMA's Health Information Technology Department by phone at (800) 880-5720 or by email

  PC Action Ad July 13 

Need TMAF Grant Support? Deadlines Approaching!

Let’s jump in the way-back machine, and travel to … 2016.

Last year, the Paris-Lamar County Health District partnered with the Lamar-Delta County Medical Society, along with other community groups, to give 360 flu shots to drivers and passengers at a "Drive Thru, Prevent the Flu" initiative.

At about the same time, The University of Texas Medical Branch at Galveston worked with several organizations to provide flu vaccines to underserved and uninsured residents of Galveston and surrounding counties.

Think about that: Hundreds of Texans who might not otherwise have received flu vaccines were protected against the virus thanks to the work of a county medical society and a student chapter.

"That’s amazing," you say. "How'd they pull that off?"

Well, they got financial help in part through the TMA Foundation's Medical Community Grants and Medical Student Leadership Grants programs. 

Now, let's start thinking about the future. Encourage your TMA county medical society, alliance, or medical student chapter to apply for a grant to support a community health improvement initiative that you, your colleagues, and community partners want to carry out. 

There are two deadlines to apply for this year's grants: Aug. 15 and Dec. 15. 

County societies and alliance chapters may apply for up to $7,500, and medical student chapters may apply for up to $3,000. 

More information, including how to apply, can be found on the TMA Foundation webpage

This Month in Texas Medicine

The June issue of Texas Medicine recaps a Houston cardiothoracic surgeon's years-long battle over Memorial Hermann Memorial City's alleged smear campaign against him. A jury awarded Miguel Gomez, MD, $6.4 million in a civil case that started after the Texas Supreme Court compelled the release of peer review documents Dr. Gomez said would prove his case. The June issue also includes stories about how the TMF Health Quality Institute can help smaller practices navigate MACRA's Quality Payment Program; a study on health disparities across Texas; and the Galveston National Lab at The University of Texas Medical Branch, the only facility on a college campus rated to handle the most deadly and exotic pathogens, such as Ebola, bubonic plague, and Zika.

Check out our digital edition

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. 

CMS Quality Payment Program Deadlines

Last Day to Register for the CAHPS for MIPS Survey Reporting Option for the 2017 MIPS Performance Year

Last Day to Register or Cancel Registration for the CMS Web Interface Reporting Option for the 2017 MIPS Performance Year

Last Day of the Final Determination Period for 2017 Advanced Alternative Payment Models

Last 90-Day Period for the 2017 MIPS Performance Year

Last Day of the 2017 MIPS Performance Year

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.  


Take Back the Power: Payer Contract Negotiations
Live webcast: June 20

Modern Marketing for Five Star Reviews
July 28

On-Demand Webinars

Innovation in Education for Cardiovascular Risk Patients: Heart Healthy Diet and Lifestyle

Making Discussions About Death and Dying Easier

HIPAA Training for Medical Office Staff

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Last Updated On

June 26, 2017