TMA Hot Topics

The Texas Medical Association and the American Medical Association report that many medical practices are seeing more of their claims rejected in recent weeks. The conversion to the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transaction standards on Jan. 1 could be the culprit.

Eliminating payments for Medicare Part B coinsurance and deductibles to those eligible for both Medicaid and Medicare will save the state millions but it will "come at the expense of the health and well-being of some of the state's most vulnerable citizens," TMA President C. Bruce Malone, MD, told the Texas Health and Human Services Commission earlier this month.

TMA joined the American Medical Association and dozens of other state and national medical organizations in urging Congress to permanently stop the fiscally irresponsible cycle of scheduled cuts and short-term patches to the Medicare physician payment system.

Physicians must begin using the new HIPAA 5010 transaction standards on Jan. 1 to submit claims or run the risk of private insurers, Medicare, and Medicaid refusing to pay them.

Would you rather leap from ICD-9 to ICD-10 – and risk a hard fall (that might be ICD-10 code W15.XXXA: Fall from cliff, initial encounter) – or cross over via a smooth bridge?

The failure of the Joint Select Committee on Deficit Reduction to agree on budget cuts means congressional action is the only thing that can stop Medicare from cutting physician payments by 27.4 percent on Jan. 1. Congress must act, or the Sustainable Growth Rate formula mandates that the cuts automatically take effect. Texas Medical Association and American Medical Association officials will conduct a conference call on Dec. 5 to plan strategy to persuade Congress to stop the cuts.

Despite the recent announcement from the Centers for Medicare & Medicaid Services, physicians still must begin transmitting claims using the new HIPAA 5010 format on Jan. 1. CMS is delaying "enforcement" of the 5010 standards, but TMA received clarification that "compliance" is still necessary for claim transactions. If you don't submit claims using this format, you risk not having claims paid by private insurers as well as Medicare and Medicaid.

The Centers for Medicare and Medicaid Services has paid $30 million in electronic health record incentive dollars to Texas physicians in 2011, according to a federal official.

Every two years, TMA conducts a major survey of all Texas physicians to identify emerging issues, assess physician priorities, and develop data to support advocacy efforts. The 2012 survey is now under way. Please help us by using the emailed survey invitation to tell us about your ideas and experience.

The Texas Medical Board (TMB) has implemented fairness provisions of a new state law – backed by TMA – that allows physicians named in complaints to resolve their cases with a "remedial plan" rather than a formal disciplinary action.

TMA and the American Cancer Society have teamed up in a landmark study aimed at reducing the impact of cancer.

Texas has more physicians meeting the federal meaningful use criteria in adopting electronic health records than does any other state, according to an analysis of Centers for Medicare & Medicaid Services data by the Institute for Health Technology Transformation.

The stakes facing physician practices are higher than ever, particularly because of ever-evolving state and federal regulations, new compliance standards, and insurance hassles imposed on practices. You're probably worried and feeling a bit frantic. In Texas, no one is better equipped to fight for and serve physicians than TMA.

Spurred by TMA, the American Medical Association in late January asked U.S. House Speaker John Boehner (R-Ohio) to stop the scheduled October 2013 implementation of the International Classification of Diseases and Related Health Problem, 10th Revision (ICD-10) diagnostic and procedure codes, and called on physicians and other interested groups to assess an appropriate replacement for the current ICD-9 code sets.

Brain Injury Awareness Month has moved to March. It previously was celebrated in October. TMA's Hard Hats for Little Heads program encourages physicians, medical students, and alliance members to give free helmets to children in their community during Brain Injury Awareness Month.

On March 12, Texas will complete statewide expansion of the Medicaid HMO model by requiring most patients living in rural and South Texas counties to obtain their health care services from physicians and providers participating in one of the Medicaid HMO networks.

Physician have until Feb. 29 to register and attest to meeting meaningful use requirements to receive payments for 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.

Congratulations to the North Texas Regional Extension Center (REC) for achieving 100 percent of its enrollment goal of 1,498 primary care physicians.

The Texas Medical Liability Trust (TMLT) started the $100 million TMLT Trust Rewards Program on Jan. 1 to reward policyholders for their loyalty. TMLT will fund a Trust Rewards Account, based on earned premium, for each policyholder in the program, and the money will be available upon retirement or other qualifying events.

The 2012 TMA Fall Conference is moving to Oct. 19-20 because the original date of Oct. 5-6 conflicted with the Texas-Oklahoma football game in Dallas.