Action: July 17, 2017

 TMA Action July 17, 2017   News and Insights from Texas Medical Association

Here’s How to Avoid Medicare Payment Penalties
eClinicalWorks Customers Won’t Have to Pay Back Incentives, Feds Say
TexasBenefitsCard: A One-Stop Resource for Patient’s Medicaid Information
New Medicaid Enrollment Deadline: Your Questions Asked and Answered
TMF Provides MACRA Support for Small Practices

Town Hall Meetings to Discuss Prescription Drug Abuse
Get the Info You Need on Zika Risk in Pregnant Women
Get the Skills You Need to Distance Yourself From Disruptions
Register for TMA’s Fall Conference
This Month in Texas Medicine

Here's How to Avoid Medicare Payment Penalties

People learn things in different ways. Some of us just need to be told something to understand it. Others need to physically do an activity to learn it. Still other people are visual learners: They need to see in order to do.

If you're in that latter, visual group, and you're still trying to wrap your brain around the Merit-Based Incentive Payment System (MIPS), you should check out a new video developed by the American Medical Association. It's fairly short — 3 minutes, 27 seconds — and explains step-by-step how you can avoid a 4-percent Medicare penalty in 2019.

If you want to watch, check it out here. If you learn by reading, continue below.

As we've been telling you, the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program has two paths: MIPS and advanced alternative payment models (APMs). If you are not in an advanced APM and are not exempt from MIPS in 2017 (here's where you can figure that out), you can avoid a 4-percent penalty in 2019 by reporting on just one quality measure for one patient this year.

Seriously, that's all you have to do to avoid losing money.

If you want more information, you can find links to the Centers for Medicare & Medicaid Services’ quality measure tools and an example of a completed 1500 billing form on the AMA website.

If you want even more information, TMA has a wealth of online resources to help you understand and manage MACRA.

eClinicalWorks Customers Won’t Have to Pay Back Incentives, Feds Say

We love good news. You love good news. Everybody loves good news. You wouldn't want to meet somebody who doesn't love good news.

Now that we've established that, let's get to some good news.

Remember back in mid-June when we told you that eClinicalWorks is going to pay the federal government $155 million to settle a federal False Claims Act lawsuit? For those who don't remember, eClinicalWorks had been accused of fraudulently obtaining certification for its electronic health records system and providing kickbacks to customers who promoted their product. 

That’s not the good news. Be patient.

Here’s the good news: If you were/are an eClinicalWorks customer, the Centers for Medicare & Medicaid Services (CMS) has said you won't have to pay back federal incentive payments if you used its software to attest to meaningful use criteria in good faith.


"Providers that in good faith successfully attested using eClinicalWorks software and received an incentive payment will not have to repay the incentive payment," a CMS spokesperson told Healthcare IT News. "CMS realizes that providers may rely on the software they use for accuracy of reporting. CMS does not plan to audit eClinicalWorks providers based on the settlement."

TexasBenefitsCard: A One-Stop Resource for Patient’s Medicaid Information

Imagine this: You're trying to treat a Medicaid patient and would like to know her health information, including past Medicaid visits, health events, vaccines, and prescription and lab data.

You'd also like to verify her eligibility, and view and print her Medicaid ID card. Oh, and you'd like to do all of this from a tablet or smartphone.

Now imagine there was a central online hub where you could do all of that and more.

Sounds crazy, right? The kind of thing that exists only on television or in Robin Cook novels?

Well, prepare to have your mind blown because that very resource already exists —­ for free — at

That’s right, one central hub now aggregates Medicaid data from disparate sources for managed care and fee-for-service plans.

"All of this information is collected and displayed in a consolidated health summary form with the ability to see more details," the Texas Health and Human Services Commission said in announcing the portal. "The portal helps patients and providers by better coordinating patient care and reducing duplication of services, providing patients' current prescription medicines or serious health conditions before performing procedures."

Texas Medicaid is conducting a pilot to integrate (YTBC) with participating managed care organizations' (MCOs') and dental management organizations' (DMOs') provider portals. 

"The integration is not intended to replace functions already existing in the current MCO/DMO portals, but rather to expand the functionality those portals provide by making the YTBC provider portal accessible through a single click," the commission said. 

Medicaid patients also can use the portal to view their benefit and case information, print or order Medicaid ID cards, set up and view Texas Health Steps alerts, and more. Encourage them to sign up.

If you still have questions, email or call the commission's help desk at (855) 827-3747.

TMAIT Action Ad 6.15

New Medicaid Enrollment Deadline: Your Questions Asked and Answered

Remember that old adage that the only stupid question is the one not asked? 

Well, with that in mind, the Texas Medicaid & Healthcare Partnership (TMHP) has published frequently asked questions and answers on the new Medicaid enrollment requirements.

What am I talking about?

If you or your practice orders or refers for Medicaid patients — even if you do not otherwise participate in Medicaid, you must enroll in Medicaid before Oct. 1.

OK, so who should enroll?

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.

Anybody else?

It also applies to physicians who care only for dual-eligible patients — those who are eligible for Medicare and Medicaid — 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.

And why is that?

Because 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. 

Anything else?

You certainly have a lot of questions. Seriously, visit TMHP’s Ordering, Referring, and Prescribing Providers Frequently Asked Questions for information about who, what, when, why, and, of course, how to enroll.

Can't I just talk to somebody?

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

Is that all?

For now, yes.

TMF Provides MACRA Support for Small Practices

If you are a solo physician or are part of a practice with 15 or fewer clinicians and are eligible for the Merit-Based Incentive Payment System (MIPS), you probably would like a better understanding of Medicare's new Quality Payment Program. (Honestly, I think we all would, regardless of practice size.)

Well, listen up: The TMF Health Quality Institute, the physician-led nonprofit health care consulting company in Austin, has been contracted by the Centers for Medicare & Medicaid Services (CMS) to help practices just like yours prepare for and participate in the new payment program.

In fact, TMF has a bunch of educational resources, including live webinars, infographics, fact sheets, and frequently asked questions, as well as technical support.

"Surely, I’ll have to pay a lot of money for that," you say.

Oh no, my cost-conscious friend. All of TMF's resources are completely free. 

See, CMS last year announced that it would divide up to about $100 million over five years among 11 organizations nationwide, including TMF, to help educate and train small and solo practices on the payment program. TMA wrote all about that and TMF's services in the June issue of Texas Medicine

The TMF Quality Payment Program Network website has all the information you can handle so you can get a handle on QPP. You can also email TMF or call (844) 317-7609 if you want to speak to somebody. 

  Action TMLT Ad 10.15

Town Hall Meetings to Discuss Prescription Drug Abuse

Let's get serious for a moment and talk about how you can talk and learn about the best ways to prevent prescription drug misuse statewide as well as in your community.

The Texas Health and Human Services Commission is conducting a series of regional town hall meetings to discuss best practices and solutions to this growing problem.

"The goal of the Town Halls is to develop a statewide strategic plan and community-based social marketing/public education plan to increase awareness of prescription drug misuse, the need for a coordinated approach, and promote increased use of Prescription Drug Monitoring Program data," the commission said in a statement.

In May, the U.S. Department of Health and Human Services announced that Texas will receive more than $27 million to combat opioid addiction. We told you about that because we're committed to keeping you informed.

But you don't need us to tell you that prescription drug abuse is a problem: Of the more than 33,000 opioid-related deaths in the United States in 2015, 1,186 were in Texas, according to the commission. That's a rate of 4.7 per 100,000 people, way up from 1.5 per 100,000 in 1999, according to the Centers for Disease Control and Prevention.

So if you're now wondering how you can make your voice heard, check out the three meetings planned around the state: 

  • San Antonio: 2 to 5 pm on Tuesday, July 18, Oblate Whitley Theological Center, 285 Oblate Dr.;
  • Beaumont: 2 to 5 pm on Wednesday, July 19, MCM Elegante Hotel, 2355 Interstate 10 South; and
  • Weslaco: 6 to 8 pm on Tuesday, July 25, Weslaco City Hall, Economic Development Corp., 255 S. Kansas Ave.

You can just show up if you wish to attend, or you can register online.

Get the Info You Need on Zika Risk in Pregnant Women

You're looking for resources and clinical guidance for assessing Zika risk in pregnant women in Texas, aren't you? You're particularly interested in areas of the state with elevated risk for Zika transmission and how to evaluate newborns when you suspect maternal Zika infection.

How do we know? We just do. We're that good. We can also tell you how to find what you're looking for.

The Texas Department of State Health Services (DSHS) is holding its summer 2017 Grand Rounds this month, and the topic is "Zika Testing and Clinical Management in Maternal and Infant Populations." Just what you've been looking for.

The free presentation — by TMA member Catherine Eppes, MD, of Baylor College of Medicine and Texas Children’s Hospital — will cover the status of Zika cases and preparation in Texas as well as Zika testing and management.

"Dr. Eppes will also educate providers about systems of care that assist pregnant women with evidence of Zika infection as well as families whose infant has been impacted by congenital Zika syndrome," DSHS said in announcing the presentation.

And get this: The seminar will count for 1.5 continuing education credits.

If you're interested, carve out time from 11 am to 12:30 pm on Wednesday, July 19, and go to the DSHS campus at 1100 W. 49th St. in Austin. If you can't make it to Austin that day, you can watch it as a live webinar. Convenient!

So there you go. Register online on the DSHS Grand Rounds website. If you still have questions, email DSHS

Oh, and don't forget to check out TMA's Infectious Diseases webpage, which has just about all the information on Zika and other diseases that you could possibly want. 

  PC Action Ad Aug 13 

Get the Skills You Need to Distance Yourself From Disruptions

Stop me if you've heard this one before:

An orthopedic surgeon walks into her clinic and starts preparing to drain the fluid from her patient's knee. As she's sterilizing her hands, the practice manager walks up and says: "Hey, do you have a minute to go over these Medicaid codes from last month?" The doctor turns to the manager and says, "Can't this wait until after I'm finished?" And the manager says ….

If you're waiting for a punch line, you're not going to get one because this is no joke: These types of interruptions happen all the time for physicians.

If you want to gain the skills to deal with disruptions like these and/or minimize their occurrences, you're going to want to be part of TMA's Physician Health and Wellness fall conference in October.

Set for Oct. 6–7 at Galveston's Moody Gardens Hotel, Spa, and Convention Center, the conference will teach strategies for minimizing disruptions and responding ethically and effectively to patients who exhibit disruptive behavior without jeopardizing professional boundaries. That's even its name: Physician Interrupted: Disruption Comes in Many Forms. Snappy.

Presented by TMA's Committee on Physician Health and Wellness, the conference has been accredited for a maximum of 9 AMA PRA Category 1 Credits™, 8 of which are designated as ethics and/or professional responsibility education. That's the continuing medical education you can't get enough of (because it's required).

Presentation topics will include: 

  • Disruption Defined and Stress Multiplied,
  • Challenging Patient Encounters, 
  • Hospital Disruptions,
  • Professionalism in Medicine, and
  • Creating and Maintaining Work-Life Balance.

If you're interested in attending, preregistration is strongly recommended. 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

Register for TMA’s Fall Conference

Registration is now open for the 2017 TMA Fall Conference, which is scheduled for Sept. 15-16 at Hyatt Regency Lost Pines Resort and Spa. This free member benefit lets you reconnect with colleagues and learn more about what's new in Texas health care.

This year's programming will feature a recap of the 85th Texas legislative session. It also will include a discussion of the long- and short-term effects of abuse and neglect and other adverse childhood experiences. 

Register today and make your room reservation at the Hyatt Regency Lost Pines. For more information about the conference, visit the TMA Fall Conference webpage

Questions? Email the TMA Knowledge Center or call (800) 880-7955 Monday through Friday, 8:15 am to 5:15 pm CT.

This Month in Texas Medicine

The July issue of Texas Medicine continues to dig into medical disparities in Texas, with a focus on getting more black and Hispanic students into the state’s medical schools. One 2015 JAMA study found that African-Americans made up just under 4 percent of practicing physicians, 6 percent of trainees in graduate medical education, and 7 percent of medical school graduates. Meanwhile, U.S. Census data show that 15 percent of the total population was black. Statistics for Hispanics are similar. The July issue also includes stories about how the Physician-Focused Payment Model Technical Advisory Committee has been accepting proposals for alternative payment models from physicians participating in MACRA; primary care physicians who opt to open “urgent care” facilities or add urgent care services to their practices; and the potential impact in Texas if interstate health plan sales were to become more of a reality, including potential pitfalls and benefits..

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 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.  


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Last Updated On

July 17, 2017