Mar 29, 2012

Medicine Warns of Brewing Regulatory Storm

Physicians face an "imminent storm" of mass confusion caused by overlapping regulatory mandates and reporting requirements from multiple federal programs unless federal officials do something to prevent it, TMA and other state and national medical societies warn in a letter to Centers or Medicare & Medicaid Services (CMS) Acting Director Marilyn Tavenner.

The groups are concerned about regulations and penalties associated with the value-based modifier, about penalties under the electronic prescribing program, Physician Quality Reporting System and electronic health record incentive program, and about the transition to the ICD-10 coding system.

Mar 28, 2012

McAllen Crowd Rallies to Stop Medical Emergency



Hundreds of patients and their doctors joined forces Tuesday in McAllen, Texas, urging state legislators to rescind budget cuts that are harming access to care for thousands of dual-eligible patients —  those who qualify for both Medicare and Medicaid.

Texas’ new payment policy on services doctors provide to these patients has created a medical emergency across the state. The problem has been particularly acute in the Rio Grande Valley, where severe poverty makes many Medicare patients eligible for Medicaid as well.

As a result of the new policy, many doctors face financial ruin, and their most vulnerable patients may lose their doctor. TMA President Bruce Malone, MD; Hidalgo-Starr County Medical Society President Victor Gonzalez, MD; and TMA Board Vice Chair Carlos Cardenas, MD, discussed the severity of the crisis at the huge rally and news conference. The physicians encourage everyone to sign the Medical Emergency petition urging the state to reverse its decision.



Mar 21, 2012

Live from McAllen: TMA House Call on Dual Eligibles

The state's new payment policy on services physicians provide to patients who are eligible for both Medicare and Medicaid coverage has prompted outrage from doctors all across the state. The problem has been particularly severe in the Rio Grande Valley, where severe poverty makes a lot of Medicare patients eligible for Medicaid as well.


On Tuesday, March 27, 2012, from 7 to 9 pm (CT), TMA and the Hidalgo-Starr County Medical Society are hosting a House Call for physicians to express their concerns on this issue. This is a meeting between physicians and the Texas Health and Human Services Commission and Texas legislators. Watch a live streaming broadcast of the House Call here or go to our UStream page.






Live video for mobile from Ustream

NOTE: This works a whole lot better on Firefox or Chrome browsers than it does on Internet Explorer.

NOTE 2: You have to come back Tuesday night between 7 and 9 pm to watch the live stream. Otherwise, you can see the video of our 2009 McAllen House Call on health system reform.

Mar 14, 2012

TMA Urges IPAB Repeal

TMA and 41 other medical organizations have written Congressional leaders and urged them to support legislation repealing the Independent Payment Advisory Board (IPAB). Created by the Affordable Care Act, IPAB is a 15-member panel appointed by the president that would recommend cuts in Medicare fees to physicians if federal spending on health care reaches certain levels.

Sign the Petition to Stop the Dual-Eligible Disaster



Medical Emergency Threatens Most Vulnerable Texas

Mar 13, 2012

ERS to Switch to United

More than 400,000 state employees, retirees, and their dependents will get a new health insurance company. The Employees Retirement System (ERS) is negotiating a new contract with UnitedHealthcare Services, replacing Blue Cross and Blue Shield of Texas as the party administrator for theself-funded HealthSelect of Texas health plan.

Mar 12, 2012

5010 Enforcement Grace Period About to End

March 31 is the final day of the government's 90-day grace period for enforcement of the Health Insurance Portability and Accountability Act version 5010 transaction standards. If you are not already using the 5010 standards, you must start or Medicare, Medicaid, and private insurers will reject your claims.

Mar 9, 2012

Dual-Eligible Glitches Fixed; Misguided Policy Remains

A combination of poorly informed government decisions and bureaucratic bungling is creating a medical emergency for thousands of dual-eligible Texans and the physicians who care for them. "Dual-eligibles" are people old enough to qualify for Medicare as their health insurer and poor enough to qualify for Medicaid assistance. Hundreds of thousands of them live across Texas. But budget cuts and bureaucratic bungling threaten their care – and more.

State Cuts Squeezing the Elderly Poor and Their Doctors

From today's New York Times:

Texas has cut its share of co-payments for such patients, and Dr. Javier Saenz's practice is suffering.

Mar 8, 2012

TMA Cancer Conference April 27

Learn about intimacy during and after cancer, genetic risk assessment for hereditary cancers, the Texas Cancer Registry, how to use online tools, and exercise for cancer survivors at TMA's Physician Oncology Education Program annual cancer symposium. This year’s event is at the Central Texas Medical Center, 1301 Wonder World Drive in San Marcos, on Friday, April 27, from 9 am to 1:30 pm.

Medical Emergency Threatens Most Vulnerable Texas Elderly and Physicians Who Care for Them

A combination of poorly informed government decisions and bureaucratic bungling is creating a medical emergency for Texas’ thousands of dual-eligible Texans and the physicians who care for them. "Dual-eligibles" are people old enough to qualify for Medicare as their health insurer, and poor enough to qualify for Medicaid assistance. Hundreds of thousands of these seniors live across Texas. But budget cuts and bureaucratic bungling are threatening their care -- and more.






Javier Saenz, MD, is a Rio Grande Valley family physician who cares for many of these patients. They make up about half of his practice. Since January, he’s treated these patients as always but has received no Medicare payments and very little in payments from Texas through Medicaid. As a result he is exhausting personal savings and turning to bank loans to make payroll and keep his medical practice open to serve his patients. He doesn't know how long he can hold out.

“If all I see are my most needy patients, I can’t stay in business,” Dr. Saenz told the Texas Medical Association. “If I can’t stay in business then I can’t help anybody.”

Dr. Saenz is not alone. Physicians who care for dual-eligible patients in poor communities from rural Texas to inner cities are caught in this vise.

The jaws of this vise are coming from several directions. As part of a cost-saving move the Texas Legislature ordered, and the Texas Health and Human Services Commission (HHSC) adopted, a new policy of not paying coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid.

Several serious Medicare and Medicaid computer errors have compounded the situation.

A trio of computer glitches were identified that resulted in claims paying $0 during the patients’ annual Medicare deductible period, even though physicians should have been paid up to the amount Medicaid would have paid for the service if the patient weren’t covered by both Medicare and Medicaid. One of the problems stemmed from a processing error in the state’s Medicaid claims payment system. In another, state and federal computers were not talking to each other properly because of problems tied to the new national rule requiring physicians, providers, and public and private insurers to use a new billing standard known as HIPAA 5010.

With TMA demanding action, state and federal officials say they corrected the computer problems and the claims Dr. Saenz and other filed for taking care of these patients will be reprocessed. But those officials have not yet announced when that will happen.

TMA is calling on state leaders to take emergency action to help these patients, and the doctors who care for them.

TMA argued against the change from the start. TMA spoke against the Texas Legislature’s decision to direct HHSC to make the cut as part of broader efforts to close the state’s $27 billion budget deficit.

Late last year, association President C. Bruce Malone, MD, presciently warned HHSC that the changes were about to "penalize the physicians who care for the sickest and frailest Medicare patients. They hit particularly hard practices in rural, inner-city, and border Texas, as those practices serve a disproportionate number of dually eligible Medicare patients. In addition to compromising the financial viability of these practices, we fear that the rules could result in fewer physicians willing to set up a practice in the communities that most need them."

Mar 7, 2012

HIEs Active in Texas

Health information exchanges (HIE) in Texas are being established with $28 million in federal funds Texas received as a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The Texas Health Services Authority (THSA), a public-private partnership whose board includes physicians, oversees distribution of the money.

Mar 6, 2012

AMA Joins TMA in Hospital Lawsuit

The American Medical Association Litigation Center is joining TMA to support a group of South Texas physicians in their ongoing legal battle with Knapp Medical Center in Weslaco. TMA and AMA are preparing to file an amicus curiae ("friend of the court") brief urging an appeals court to uphold a lower court ruling in the physicians' favor.


Thanks in part to TMA's legal arguments, State District Judge Israel Ramon Jr., ordered Knapp to release balance sheets; cash flow statements; management letters from the external auditor; compensation documentation for all employees; documentation of deferred executive compensation; Internal Revenue Service (IRS) Forms 990 for the years 2008-10; and other financial records.

Mar 5, 2012

Medical Board Will Consider Drug Shortages

Drug shortages and drug storage are mitigating factors in Texas Medical Board (TMB) investigations of physicians who use expired drugs, the board says.


TMB spokesperson Leigh Hopper said the board recently heard from a physician about a case in which doctors had to use expired emergency drugs to resuscitate a patient, thus raising the question of whether the board would consider the use of expired drugs a violation of the standard of care.

Mar 1, 2012

Rejected Medicare Claims May Have a Linkage Problem

With the implementation of the HIPAA 5010 standard for submitting electronic claims, some practices are running into a “linkage problem” with Medicare claims, which results in rejected claims.

This error will appear on your 277 Claims Acknowledgement as a 496 edit (submitter not approved for electronic claim submissions on behalf of this entity) in the message “A8:496:85.” TrailBlazer Health Enterprises says this edit can result from one of two types of errors, which you can correct on your end.