Jan 31, 2013

State Finally Paying Dual-Eligibles’ Medicare Deductible

The Texas Health and Human Services Commission (HHSC) restored the Medicare Part B deductible payment on Jan. 25 for patients eligible for both Medicare and Medicaid, also known as "dual eligibles."

Learn how it works -- and what about all of January's claims?

Jan 29, 2013

Time to Decide About Medicare

Time is running out to decide if you will participate in Medicare this year. Feb.15 is the deadline to make a decision. TMA will help you decide with a new webinar discussing your three options.

Read on to learn about your three options and how to exercise them.

Jan 28, 2013

Texas Clinics Repay Medicare for Improper Claims

Several Texas dialysis clinics in El Paso and the Dallas-Fort Worth area have had to repay Medicare for treating people in the country illegally.

Read more.

Jan 24, 2013

How to "Deidentify" Personal Health Information

Q. I need to provide an insurance company a deidentified sampling of medical records from my practice for initial credentialing. What, precisely, defines a “deidentified” record?

A. Physicians may need to use deidentified records for various purposes, such as research, demographic and public health studies, or operational purposes like credentialing. Deidentified health information as defined by HIPAA is not protected health information (PHI) and thus is not covered by the HIPAA Privacy Rule.

To create a deidentified record according to HIPAA, you must remove all of the following information about a patient, as well as similar information about the patient’s relatives, employer, and household members:

Read the list and more tips.

Jan 23, 2013

“Other qualified health care professionals” and other 2013 CPT changes to note

The new year brings new and revised CPT codes. TMA’s Payment Advocacy staff highlighted the changes most likely to affect the most practices in 2013.

Eighty-two evaluation and management (E&M) codes were revised to include “other qualified health care professionals.” This phrase also was added to several non-E&M services in various sections of the guidelines.

Find out what that means and check out the other CPT coding changes we've flagged.

Jan 22, 2013

Medicare in 2013: Are You In or Out?

You have less than a month to decide if you will participate in Medicare this year. Feb. 15 is the deadline to make a decision. The Texas Medical Association will help you decide with a new webinar discussing your three options.

Learn more.

El Paso Physicians ... Join Us

Dr. Speer (left) administers the oath of office to Dr. Pazmino

On. Jan. 16, 2013, TMA President Michael E. Speer, MD, traveled to El Paso to swear in Patricio Pazmino, MD, as the new president of the El Paso County Medical Society. Dr. Pazmino took over after the year-long term of Richard M. Applebaum, MD. Below are Dr. Speer's comments to the assembled audience.



Thank you Dr. Applebaum … and let me be the first to congratulate Dr. Pazmino and wish him well. You are taking over the reins of a proud, 115-year-old organization of physicians.

Just as the Texas Medical Association does statewide, the El Paso County Medical Society stands tall for its physicians and your patients, advocating for better health care for the people of El Paso. We do this well not only because of the energy and commitment of leaders like Dr. Applebaum and Dr. Pazmino, but also because of the legions of superb physicians who stand with us.

Your Society represents your 1,090 members admirably.

I like to believe that TMA represents all 47,000 members equally as well.

But think how much more we could do if the El Paso County Medical Society counted 12 … or 13 … or 14 hundred members. Think how much more we could do if the TMA counted 48 … or 49 … or 50,000 members.

If each of you were to leave here and … tomorrow morning … try to recruit a non-member colleague, what would you say? What is your sales pitch to convince them to join TMA and the El Paso County Medical Society? I think it’s pretty obvious.

For example, thanks to the hard work of El Paso physicians like Manny Alvarez and Manny Acosta and your Executive Director Patsy Slaughter, you’ve built the Border Health Caucus into a powerful force in Austin and Washington, DC.

For example, you’ve made the Paul L. Foster School of Medicine a reality, right here on the border.

For example, we’ve reversed part of the disastrous cut in payments for dual-eligible patients. … And we are determined to overturn the rest of it in the Texas legislative session that began last week.

For example, we understand that Medicaid – which covers such a huge share of the population here in El Paso – is badly broken. El Paso doctors like Gil Handel and David Palafox and Jose Burgos and Maureen Francis served on TMA’s Physicians Medicaid Congress to help us find ways to make that broken system work again for you and your patients. The Congress’ long list of excellent recommendations will come before the TMA Board of Trustees in two weeks.

For example, TMA and the Border Caucus and the El Paso County Medical Society have already delivered a strong message to a legislature that needs to listen.

Physicians … we said … are critical to a cost-effective health care system in Texas. Otherwise, the state’s efforts to increase preventive care … to improve medically necessary treatment for the chronically ill … to reduce inappropriate emergency department visits … will fail.

We are attempting to impress on state leaders that cutting physicians’ Medicaid and CHIP payments is not an effective tool for controlling health care costs. That … quite the contrary … it exacerbates the cost of care.

We are asking them to ensure Texans of all income levels have access to preventive, routine, and emergent care.

We are asking them to ensure competitive Medicaid and CHIP payments for physicians.

We are asking them to increase funding for cost-effective, community-based mental health care and substance abuse.

And lastly, “Remember Tort Reform!” That great law you helped to create has resulted in every physician in this state paying one-third to one-half less every year in liability premiums compared to 2003.

That is just a small portion of what … together … we’ve done and we are doing. But I think it’s plenty to convince more El Paso physicians to join us.

And I urge you to try it out.

Thank you.

Jan 21, 2013

ICD-10: What Should I Do Now?

Although ICD-10 implementation doesn't kick in until Oct. 1, 2014, you can take steps now to help minimize your stress level in the months leading up to it. Time is on your side, but you must begin preparations to transition your practice soon.

In a recent video interview, TMA Practice Management Consultant Heather Bettridge sat down with Steve Arter, the chief executive officer of Complete Practice Resources (CPR), and CPR President Denny Flint to get their take on the necessary steps physicians should be taking now.

Read more.

Jan 16, 2013

Health Care in President's Gun Control Bull's-Eye

While his proposal for a new law to ban the sale of assault weapons is grabbing the early headlines, a number of pieces of President Obama's plan to reduce gun violence involve physicians and the health care system.

Already drawing controversy, for example, is the president's announcement that he will "clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes."

In an article entitled "Obama: Doctors Should Ask About Guns in Homes," the conservative NewsMax publication says that provision "sounds like George Orwell’s 1984." From the other side, The Atlantic reported that "the order actually just preserves a legal expectation for doctors to report on their patients that has existed for 37 years."

All in all, a review of the president's 23 executive actions and nine legislative proposals reveals much that will -- or could -- impact physicians and patients and the health care system. (See below for the official White House press briefing on the pieces of the plan.)

One piece is already a formal executive order signed by the president:

The Secretary of Health and Human Services (Secretary), through the Director of the Centers for Disease Control and Prevention and other scientific agencies within the Department of Health and Human Services, shall conduct or sponsor research into the causes of gun violence and the ways to prevent it. The Secretary shall begin by identifying the most pressing research questions with the greatest potential public health impact, and by assessing existing public health interventions being implemented across the Nation to prevent gun violence.

"And while year after year, those who oppose even modest gun safety measures have threatened to defund scientific or medical research into the causes of gun violence," the president said at his news conference, "I will direct the Centers for Disease Control to go ahead and study the best ways to reduce it -- and Congress should fund research into the effects that violent video games have on young minds. We don't benefit from ignorance. We don't benefit from not knowing the science of this epidemic of violence."

The other six executive actions related to health care are:

  • Address unnecessary legal barriers, particularly relating to the Health Insurance Portability and Accountability Act, that may prevent states from making information available to the background check system. 
  • Release a letter to health care providers clarifying that no federal law prohibits them from reporting threats of violence to law enforcement authorities.
  • Release a letter to state health officials clarifying the scope of mental health services that Medicaid plans must cover.
  • Finalize regulations clarifying essential health benefits and parity requirements within ACA exchanges.
  • Commit to finalizing mental health parity regulations.
  • Launch a national dialogue led by Secretaries Sebelius and Duncan on mental health.

And the two pertinent pieces of President Obama's legislative agenda on gun violence are:

  • Help ensure that young people get the mental health treatment they need.
  • Ensure health insurance plans cover mental health benefits.

The first item, according to the White House press briefing, is aimed at training teachers, school counselors, social workers, and others who routinely work with students and young adults. We'll be curious to see more details on the second item.


White House Gun Proposals by Matt Sullivan

Jan 15, 2013

And Arizona Makes 19

Yesterday's announcement that Arizona Gov. Jan Brewer will push for Medicaid expansion there brings to 19 the number of states that are expanding -- or plan to expand -- their Medicaid programs under the Patient Protection and Affordable Care Act.

Just before that announcement, the Health Care Reform Memo, Jan. 14, 2012, Deloitte Center for Health Solutions publication released its latest count:

As of January 10, 2013, 18 states and the District of Columbia will expand, 12 states will not participate or are highly unlikely to participate, and 20 states are undecided/undeclared:

Participating in Medicaid expansion Not participating Medicaid expansion
Undecided/ Undeclared
AR, CA, CO, CT, DE, DC, HI, IL, MD, MA, MN, MO, MT, NM, NV, OR, RI, VT, WA AL, GA, ID, LA, ME, MS, OK, SC, SD, TX, UT, VA AK, AZ, FL, IN, IA, KS, KY, MI, OH, PA, NC, NE, ND, NH, NJ, NY, TN, WI, WV, WY

Note: states do not have a deadline to make a decision on Medicaid expansion and may opt in or out of participation at any time.

Jan 2, 2013

Medicare Payments Frozen for Another Year

One day after the official deadline, the U.S. Congress yesterday stepped away from the so-called "fiscal cliff" and slapped another one-year patch on physicians' Medicare payments.

The 13th-hour deal averts the 26.5-percent cut in Medicare payments that was scheduled to take effect on Tuesday by freezing the current rates for 2013. It finances the $25 billion cost of the freeze with a package of cuts in Medicare payments to hospitals, pharmacies, and end-stage renal disease treatment.

Read all the details of this sadly annual event.