Action: Nov. 15, 2017

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

Are You Exempt From MIPS in 2018?
Stop the Denials: Enroll in Texas Medicaid Program Before Jan. 15
Remind Your Patients to Review Their Options for Health Care Coverage Now
TMA, Other States to Congress: Lift Bans on Physician-Owned Hospitals
Congenital Zika Syndrome Found in 15 Texas Pregnancies

Funding Available for Community Health Projects
Start Thinking About Unnecessary Antibiotics
Three Reasons to Step Away From the Fax Machine
Learn, Network, Earn CME at Texas Immunization Conference
This Month in Texas Medicine

Are You Exempt From MIPS in 2018?

There’s possibly more to be thankful for this November: You just might be exempt from MIPS next year under the newly released final rule for the 2018 Quality Payment Program (QPP).

You read that right. See, an increase in the low-volume threshold will make an estimated 63 percent of clinicians who bill Medicare exempt from the Merit-Based Incentive Payment System (MIPS) next year, according to the Centers for Medicare & Medicaid Services (CMS).

You got to like those odds. But that’s not all. There are quite a few changes to the final rule, which CMS released this month as required by the Medicare Access and CHIP Reauthorization Act (MACRA). 

The 2018 QPP rule covers both MIPS fee-for-service payments and the Alternative Payment Model (APM) programs — both of which could boost or cut your Medicare payments in 2020. 

TMA submitted formal comments on the rule in August. A preliminary review by TMA staff experts shows that CMS accepted several of our 50-plus recommendations. 

Major policy changes include: 

  • The new low-volume threshold for 2018 would exclude physicians and other eligible clinicians with $90,000 or less in Medicare Part B allowed charges, or 200 or fewer Medicare Part B beneficiaries — this is up from $30,000 or 100 in 2017. (TMA supported an increase to the low-volume threshold.)
  • Physicians still can use the 2014 or 2015 electronic health record (EHR) edition or a combination to meet requirements for the advancing care information category. CMS also will add a hardship exception to this category for small practices. (TMA supported these policies.)
  • Texas physicians in Hurricane Harvey disaster-designated areas can be exempt from the 2017 MIPS performance period without submitting a hardship exception application. (In a separate formal letter in September, TMA had asked that physicians in those areas be given the option to be exempt from MIPS.)
  • Beginning in 2019, physicians could become Qualified APM Participants through some arrangements with non-Medicare, Other Payer Advanced APMs such as Medicaid APMs and Medicaid Medical Home Models, as well as other models described in the regulations.  

For more information and a comparison of 2017 and 2018 policies, refer to the CMS fact sheet and executive summary

Visit the TMA MACRA Resource Center to keep up with the latest information. If you don’t know where to start, review this TMA article for guidance on how to master the QPP and where to get help. To learn about 2018 QPP requirements and options, sign up for upcoming webinars on the CMS website

Also, take advantage of TMA’s Medicare and MACRA seminars underway now at multiple locations throughout the state. To reserve your spot, register for an upcoming live event at a city near you or register to participate in the live webcast on Dec. 7. 

Stop the Denials: Enroll in Texas Medicaid Program Before Jan. 15

Imagine this: You prescribe warfarin to a Medicaid patient at risk for stroke. Or you order durable medical equipment for a child with special health care needs. However, the pharmacy or home health agency can’t fill the prescription because the claim did not contain your National Provider Identifier (NPI) and you are not enrolled in Medicaid.

To avoid these scenarios, there are several steps you need to take right away: 


  1. Enroll in Medicaid as a physician who only orders, refers, or prescribes on behalf of Medicaid patients by completing the abbreviated ordering/referring enrollment application. Federal law requires physicians to enroll, though doing so will not obligate you to actively accept Medicaid patients.
  2. The requirement also applies to physicians who order or refer on behalf of patients enrolled in Healthy Texas Women or the Children with Special Health Care Needs Program.
  3. Make sure any claim for items and services you order, refer, or prescribe on behalf of Medicaid, HTW, or CSCHN patients contains your NPI. 
  4. Ensure that any residents you directly supervise include your NPI on orders, referrals, or prescriptions for Medicaid patients.  


As I said, you should act soon because starting Jan. 15, any Medicaid claim that doesn’t contain the ordering physician’s NPI will be denied.

Now, this doesn’t apply to all circumstances. New federal guidance exempts out-of-network physicians who order, refer, or prescribe on behalf of Medicaid managed care patients.

And although there’s that Jan. 15 deadline hanging over your head, the Texas Health and Human Services Commission (HHSC) announced a three-month grace period so that non-compliant claims can be reprocessed.

If this sounds familiar, it’s because these changes were set to become effective Oct. 1, however, HHSC pushed back the effective date to Jan. 15 after Hurricane Harvey.

So get on it: If you haven’t already, enroll in Medicaid, Healthy Texas Women, and the Children with Special Health Care Needs services program on the Texas Medicaid & Healthcare Partnership website.

For more information, check out TMHP’s Order and Referring Only Information. Updated FAQs will be published soon.

Remind Your Patients to Review Their Options for Health Care Coverage Now

Among the many ways you can help keep your patients healthy in 2018 is to make sure they have access to health care.

Therefore, this is a good time to remind those who do not have coverage through an employer that open enrollment in plans sold on or off the Affordable Care Act exchanges is occurring right now. 

Also, your patients who are currently enrolled in Medicare now have the opportunity to make changes to their Medicare coverage. Any changes in both of these programs will be effective Jan. 1. 

To assist your patients with any potential changes, make sure they are aware of the health plans with whom you are in-network.

Open enrollment for ACA runs through Dec. 15, and Medicare closes on Dec. 7.

And to help make sure insurance claims for services you provided get filled correctly the first time, make sure your staff always asks patients for copies of their insurance cards, especially at the start of the new year.

More information on ACA can be found at, while details on Medicare are at

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TMA, Other States to Congress: Lift Bans on Physician-Owned Hospitals

The Affordable Care Act’s moratorium on physician-owned hospital growth has limited patients’ access to high-quality health care and unnecessarily increased costs for the Medicare program and its patients, a coalition of state medical associations told federal lawmakers last month.

In a letter to House and Senate leaders, the Coalition of State Medical Societies — which includes TMA — urged lawmakers to support legislation that would lift the moratorium on physician-owned hospitals (POHs) written into the ACA.

“With doctors at their helm, POHs are able to provide patient-centered care that has produced better health outcomes for Medicare beneficiaries while reducing unnecessary readmissions,” the letter states. “Lifting the POH moratorium also would inject much-needed competition into the hospital market, which in turn would improve patient choice and reduce spending for the Medicare program and beneficiaries.”

Meanwhile, TMA sent its own letter signed by President Carlos J. Cardenas, MD, to all Texas lawmakers in Washington, urging them also to support lifting the POH moratorium. 

Among other things, the ACA provision prohibits new doctor investment in hospitals that take Medicare patients and requires doctors to tell patients about any financial connections with hospitals they send them to for treatment.

Earlier this year, U.S. Rep. Sam Johnson (R-Richardson) introduced a bill in the U.S. House to repeal ACA bans on new construction of POHs and calls for them to participate in Medicare and Medicaid.

“We believe that lifting this moratorium would advance Congress’ bipartisan goals of reducing burdens on physicians and providers, improving patient choice, and promoting higher quality, lower cost care,” the coalition’s letter concludes

TMA in 2011 supported an unsuccessful lawsuit, Physician Hospitals of America and Texas Spine & Joint Hospital v. Kathleen Sebelius, filed in a federal court in Tyler, that challenged that provision. 

Congenital Zika Syndrome Found in 15 Texas Pregnancies

Although the number of Texas Zika virus cases has been significantly lower in 2017 than in 2016, state health officials continue to monitor the spread of the virus and Zika infections during pregnancies.

As of Nov. 3, laboratory testing has identified 243 women in Texas who have had evidence of a Zika infection during pregnancy, officials with the Department of State Health Services (DSHS) said. DSHS has information on the pregnancies of 207 of those women.

Of those 207 cases, 15 infants and fetal losses (7 percent) had birth defects consistent with Congenital Zika Syndrome, DSHS said. This is on par with the national rate of 5 percent reported by the U.S. Pregnancy Registry.

Four of those cases were identified through laboratory testing of fetal or infant tissue, nine had laboratory testing that did not identify Zika virus infection, and two did not have complete laboratory testing, officials said.

As of Nov. 7, 40 Zika cases have been reported in Texas during 2017. Those cases are spread throughout Texas, though Cameron County at the southern tip of the Texas Gulf coast has the most cases with 11.

There were 315 cases reported in 2016, mostly in heavily populated counties, officials said.

More information and resources on Zika and other infectious diseases can be found on TMA’s Infectious Diseases webpage.

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Funding Available for Community Health Projects

Let’s talk about the good things some of your colleagues are doing to keep their communities healthy, shall we?

Over in Northeast Texas, the Lamar-Delta County Medical Society is partnering with the Paris-Lamar County Health District and other community groups to offer a “drive-thru” influenza shot clinic. That clinic is expected to protect about 400 area residents who are 18 and older.

Meanwhile, members of the Tarrant County Medical Society and Project Access Tarrant County will donate their time and expertise to care for uninsured patients in the Fort Worth area. This community collaboration is made up of volunteer physicians (including TMA members), hospitals, ancillary services, charitable community clinics, and other providers.

These are just two of the community health projects made possible through grants approved this fall by the TMA Foundation.

County medical societies, alliance and medical student chapters are encouraged to apply for financial assistance for similar projects. The second and final 2017 deadline to apply to the TMAF grant programs is Dec. 15.

Applications will be acted on at TMAF’s Jan. 26, 2018 meeting. 

Go to to learn more about requirements and apply. 

Start Thinking About Unnecessary Antibiotics

Hey, what are you thinking about?

Dinner? Your favorite TV show? Your holiday plans?

Well, here’s something to think about this week: antibiotics.

Did you know that each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics? At least 23,000 Americans die each year as a result of those infections.

But wait, there’s more.

Studies have shown that 40 percent to 75 percent of antibiotics prescribed in nursing homes may be unnecessary or inappropriate.

If that’s not enough to get you thinking about how to properly prescribe antibiotics, the Centers for Disease Control and Prevention has designated Nov. 13-19 as its annual U.S. Antibiotic Awareness Week. Basically, this is an opportunity for you to educate yourself and your patients on when you should – or should not – prescribe antibiotics.

If you’re wondering what you can do to help prevent antibiotic resistance, start with this simple formula: Use the right antibiotic, at the right dose, for the right duration, at the right time.

If you’re looking for more, check out all of the resources and information on the CDC’s website. Also, be sure to check out TMA’s webpage on antimicrobial stewardship, where you can find a wealth of information and resources, including a poster to share with your patients to let them know that you are committed to providing the best care by using antibiotics appropriately. 

Three Reasons to Step Away From the Fax Machine

If you hadn’t noticed, we’re almost 20 percent of the way through the 21st Century.

And although we’ve seen a lot of technical advances — you might be reading this on a computer that you pulled out of your pocket — we’re still not quite where many of us thought we’d be at this point. (Seriously, where’s my flying car?)

Anyway, here’s one way you can determine whether your practice is moving forward: When’s the last time you used the fax machine to deliver or receive patient records?

If you answered with a snicker or, better yet, with confusion, you’re on the right track.

But if you couldn’t think of the answer because that shrill fax-connection sound was drowning out any rational thoughts, you might want to rethink your office tech.

With that in mind, here are a few reasons to move you and your staff away from the fax machine and onto the DocBookMD app for mobile devices: 

  1. Free access to 50,000 Texas Physicians. That’s right, as a TMA member, you receive free access to the DocbookMD app — all you have to do is claim your profile. And, because the TMA Physician Directory is built into the DocbookMD app, it’s a breeze for you to contact all 50,000 TMA members. Need additional app services for your practice? Use the 50-percent discount code 50TMA100 to upgrade to a team or enterprise service plan. But you better move quick. The deadline is Dec. 31.
  2. Texting with full HIPAA Compliance. The DocbookMD app allows for entire care teams to communicate securely with each other, even across practices. This means, you, your staff, and other medical offices can easily share and save important information on any patient matter. Plus the app now allows for message auditing, a personalized practice directory, and even remote wipe capabilities. 
  3. You don’t have that pager anymore. Don’t wait until you’re between patients to fax that x-ray to a colleague or follow-up on your latest referral. With DocbookMD, you can prevent delays at the point of care by using your cell phone to send and receive lab reports instantly, access discharge paperwork, or reply to answering service pages. The app is available for iPhone, iPad, and Android devices, as well as PC and Mac.  

Join more than a quarter of TMA members who are currently using DocbookMD in their practice, and be sure to take advantage of discounted pricing for a full year on plan upgrades using coupon code 50TMA100 (again, the deadline is Dec. 31).

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Learn, Network, Earn CME at Texas Immunization Conference

If you still don’t have plans for the days after Thanksgiving, and you want to be more involved in immunization efforts in Texas, register now for the 2017 Texas Immunization Conference.

As I told you back in October, the conference provides a way for public health experts, physicians, health care providers, and advocates to share information, discuss current issues, and recommend strategies to improve immunization rates across Texas.

Topics to be discussed include: 

  • Texas immunization law and the future of Texas immunizations,
  • HPV data and trends, and cancer prevention promotion,
  • Adult immunizations,
  • Communicating with parents confidentially,
  • Federal policy updates, and
  • Storage and handling. 

And if that’s not enough to get you excited, the conference also offers continuing education credits for multiple disciplines – up to 12.25 hours for physicians.

So do yourself a favor and register now for the conference on the Texas Department of State Health Services website.

And of course, you’ll want to check out TMA's immunizations webpage, which includes the latest news, schedules, information, and requirements as well as how you can host your own vaccination event through our Be Wise — ImmunizeSM program.

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

This Month in Texas Medicine

The November issue of Texas Medicine takes an in-depth look at Hurricane Harvey and the devastation the storm caused to the coast as well as countless medical facilities and practices. Although some short-term health concerns related to the storm might be easy to spot, the longer-term effects — those associated with stress and environmental issues — can be harder to spot. Other articles discuss adjustments insurers have made to prescription drug policies in the wake of the opioid epidemic; a UT Health Science Center data center's use of Medicare claims data; and what rural communities can do when hospitals and other practices close.

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 on the TMA website (may not work with all browsers). Or, download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite, to have the feed delivered to your desktop or mobile device. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action

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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, also is available as an RSS feed. This is a valuable resource for your office staff, as well.

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 Elect to Participate in a Virtual Group for the 2018 MIPS Performance Period

Last Day to File an Informal Review Request to Appeal Errors in Your Medicare PQRS Feedback Report and/or QRUR

Last Day to Preview Your PQRS Performance Scores Before They Are Reported Publicly on Physician Compare

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.  

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

November 15, 2017