Print This Page

Physicians and other businesses have more time to file their state franchise tax returns or seek a filing extension without having to pay a penalty.

Texas Comptroller Susan Combs says businesses that cannot meet the May 15, 2008, deadline to pay this new business tax now have an additional 30 days to file their returns or request an extension. Previously, businesses that did not file by May 15 would have to pay a 5-percent penalty.

A comptroller’s office news release said officials recognize "the complexity of the revised franchise tax and the newness of the enhanced electronic reporting methods have caused concern among tax practitioners and taxpayers statewide." For more information call (800) 252-1381, or go to http://www.window.state.tx.us/news2008/080422-ftaxextension.html.

Earlier this year, Texas Medical Association (TMA) helped reduce Texas physicians' potential liability under the business tax by convincing the comptroller's office to adopt revised rules.
The revisions allow physicians to deduct copayments and deductibles paid by Medicare, Medicaid, and other patients from taxable revenues. They also allow physicians to deduct expenses, such as employee compensation and benefits or cost of goods sold, that are associated with Medicare, Medicaid, and other excluded revenue.

Under the original rules published Dec. 28, physicians were allowed to exclude payments from Medicare, Medicaid, TRICARE, the Children's Health Insurance Program, and workers' compensation plans from their taxable revenue but would have had to pay tax on deductibles and copayments received from patients covered under those plans.

TMA argued that disallowing exclusion of deductibles and copayments from taxable revenue violated legislative intent. State Rep. John Otto (R-Dayton) also wrote a letter to Comptroller Combs stating that disallowing exclusion of compensation costs and cost of goods sold from taxable revenue was contrary to legislative intent.

TMA still is discussing uncompensated care issues with the comptroller and hopes for a resolution soon.

For more information on the franchise tax revisions, read the article Comptroller Revises Franchise Tax Rules from the Mar. 15, 2008 edition of TMA Action or click here .

Source: TMA

NPI only mandated for May 23

The Centers for Medicare and Medicaid Services (CMS) extended the mandate for National Provider Identifier (NPI) only to May 23, 2008. There will be no other extension, so if your practice is not ready for NPI only on May 23, your revenue will definitely be affected. You will not receive payment from Medicare, Medicaid or commercial insurance.

You should be testing your NPI only status. Medicare mandated on March 1 that you must file an NPI number with your legacy number (UPIN) in order to receive payment. Now is the time to test NPI only submissions since you can test one or two claims that will not affect your revenue. If you get paid on those one or two claims, then you should drop the legacy number permanently because you are fully compliant and do not need the legacy number.

Presented by the HCMS Board on Socioeconomics

Business Expo

The Harris County Medical Society (HCMS) is proud to offer many benefits to its members. Benefits include advocacy for physicians, which has resulted in reduced medical liability rates of at least 20 percent; assistance in collecting more than $13 million in physician reimbursements; and continuing medical education (CME) seminars that focus on practice management and the business of medicine.
The Medical Society realizes it takes more than being a good physician to have a healthy practice; thus, HCMS provides various forms of practice management education, which address the challenges of running a practice. One of our key initiatives in this area is the HCMS Business Expo. Offered in the Spring and in the Fall, each Business Expo offers three CME seminars (usually ethics) on the business side of medicine. The Expo showcases exhibitors that focus on the unique needs of physicians in private practice.

The upcoming Expo on Saturday, May 17, 9:30 a.m. to 3 p.m., at Reliant Center, offers three CMEs: “Creating a winning team,” focusing on how to recruit, train, retain, and terminate staff; “Essential accounting for physicians,” focusing on how to better understand practice financials; and “Group practice without walls,” focusing on alternative forms of practice formation.

The Expo also will have 60 exhibitors that provide products and services to meet the professional and personal needs of physicians, which can enhance physicians’ practices and patient care. The Expo and the CME seminars are free of charge for all HCMS members and their staff.
Registration is not required; however, those who register by Monday, May 12 will receive a free parking pass. To register, please call 713-526-7378 or register online .

President's Page

Dr. Tom Garcia

President's Page
Dr. Tom Garcia

Meetings with the “Big Six”

For the past 15 years, the Harris County Medical Society (HCMS) has been meeting with medical directors and other representatives from area health insurance companies, particularly the “Big Six” (i.e., Aetna, Blue Cross Blue Shield of Texas (BCBSTX), CIGNA, Humana, UniCare, and UnitedHealthcare) through the HCMS Managed Care Committee and private meetings. Rating physicians using data based on cost, a lack of transparency of data and administrative hassles are issues HCMS leadership has discussed many times with health insurance companies, to no avail.

Hence, in 2007, the HCMS leadership decided it was time to rate the Big Six to get a better picture of what the physician’s administrative impact was in dealing with health insurance companies. HCMS distributed a health insurance survey to the membership. The survey asked questions about administrative burdens because the greater the administrative burden to the physician, the greater cost to the physician’s practices and the health system.

Surprisingly, the results showed that all six health insurance companies were costing the physicians a lot of time, money and frustration, especially contracted physicians in the network. Because of these results, I sent a letter to the national CEOs of these six companies and invited them to come to HCMS to talk about the issues with HCMS physicians and staff. I received responses from all six insurance companies and the talks have begun.

On Feb. 12, we met with the President of CIGNA Health Care Corporation, David Cordani, and several of the CIGNA Texas representatives in the HCMS boardroom. Again, we discussed the issue of physicians’ ever-increasing administrative burdens as well as the issue of not paying for medically necessary care. As a result, CIGNA scheduled a meeting with MedSolutions, a third-party company that pre-certifies diagnostic imaging. We had a productive meeting with Curt Thorne, president & CEO of MedSolutions, and Gregg Allen, M.D., chief medical officer, in our boardroom on March 10. We now have an ongoing dialogue with this company.

In addition, CIGNA scheduled a meeting so we could review a Web portal, which is designed to assist in decreasing administrative burdens by having information available for multiple insurance companies in a common format. HCMS now has several point people at Cigna to work with on getting issues resolved.

We also have a point person at BCBSTX to work with on collaborative efforts. On March 24, we met with BCBSTX President Darren Rodgers, Chief Medical Officer Paul Handel, M.D., and Vice President of Physician Relations Dee Whittlesey, M.D. Again, the main issues were decreasing administrative burdens and paying for medically necessary care.
Aetna’s National Chief Medical Officer Troy Brennan, M.D., and the Aetna Texas team met with us April 1. Again, the main issues were physicians’ increased administrative burdens and not paying for medically necessary care. As a result of this meeting, Aetna and HCMS are working on several issues collaboratively.

Presently, HCMS is actively working with UnitedHealthcare to schedule a meeting. And, meetings with Humana and UniCare will be planned later in the year. We have sent the survey results to Texas Department of Insurance Commissioner Mike Geeslin. He would like to meet with us, but wants to wait until we complete the individual meetings with insurance companies.

As you can see, there is a lot of action at HCMS. This action would not have happened if it was not for the membership responding to the survey. By the way, the survey will be sent to the membership every two years so that outcome measures can be calculated and reported back to the health insurance companies. The next survey is scheduled for 2009.

With your help and input, we will continue to work with the health insurance companies to make changes in their policies so the health care system can work better for your patients and you!

Nominations due May 30

Nominations for 2009 elective positions within the Harris County Medical Society (HCMS) are due at HCMS by Friday, May 30. Elections will be held in October. The nominating board will consider qualified candidates for:
      • one position as president elect (one-year term);
      • one position as vice president (one-year term);
      • one position as secretary/treasurer (one-year term);
      • one position as a member-at-large on the Executive Board (four-year term);
      • two positions on the Board of Ethics (three-year terms). Candidates should have
          experience in peer review;
      • three positions on the Board of Medical Legislation (four-year terms);
      • three positions on the Board of Socioeconomics (three-year terms); and
      • alternate delegates to the TMA (two-year terms)

To nominate a member online, click here.

In Memoriam

Dr. Amado Ruiz-Razura, a plastic surgeon, died April 4. He had been a member of HCMS for 14 years.

Dr. Carlton Bruce Bell, an internist, died April 10. He had been a member of HCMS for 16 years.

Get rosters for HCMS & Galveston

The 2008 Harris County Medical Society/Houston Academy of Medicine Pictorial Roster is now available for sale. HCMS members received a complimentary copy. To take full advantage of its robust content and functionality, view these key pages:

     • Explanation of codes used in the biographical data of each physician listed in the
       roster—pgs. 20-23;
     • Zip code map and map of Harris County—pgs. 24-25;
     • List of member physicians by specialty and zip code to make for easy referrals
       —pgs. 26-62;
     • HCMS branches and related zip codes to enable physicians to find their branch
       —pgs. 603-605;
     • List of member benefits from HCMS and Texas Medical Association—pg. 609. Many
       of these benefits are free. For more details on the benefits, visit the HCMS Web site;
     • List of HCMS staff, who are available to assist physicians’ offices from 9 a.m. to
       5 p.m., Monday-Friday—pgs. 611;
     • List of legislative officials—pgs. 613-615;
     • List of health-related numbers—pgs. 616-619; and
     • Companies that serve physicians and their practices, which are listed
       (by products/services and alphabetically)—pgs. 620-623.

The 2008 Galveston Pictorial Roster also is available for purchase. HCMS physicians, interested in finding their Galveston colleagues may purchase a copy of the Roster for $23 including tax and shipping. To order your copy of the Galveston Roster, download an order form at  www.galveston.org or call Louise Geerts at 713-524-4267, ext. 265.

Both Rosters are great tools for patient referral, networking and information on companies that serve physicians. For questions or suggestions on how to improve the Rosters, call Ahuva Terk for HCMS Roster at 713-526-7378 or Louise Geerts for Galveston Roster at 713-524-4267, ext. 265.

LEDGER

Members who have information about these physicians should contact a member of the Board of Ethics by May 8. Members are: Dr. Judi A. Shaw-Rice, chair; Drs. Gary J. Sheppard; Benjamin Interiano; William J. Riley; Fred M. Sutton; Denis K. Hoasjoe; and Janet E. Macheledt.

CANDIDATES FOR VOTE:
May 8, 2008
Richard M. Avery, DO
William F. Avery, DO
Shailaja S. Behara, MD
Don B. Carmichael, MD
Sheela Chandra, MD
Brian J. Dunkin, MD
Mary E. Edgerton, MD
Christopher J. Freeman, MD
Sushma V. Gorrela, MD
Nandita Gupta, MD
Fawzia N. Javed, MD
Ataur-Rehman R. Khan, MD
Daniel H. Kim, MD
Sugene Kim, MD
Kristin C. Koush, MD
Yee-Pin Lin, MD
Mark A. Lorenzen, MD
Guohui Lu, MD

Aaron J. McClure, DO
Ernest J. Mendoza, MD
Samir K. Nath, MD
Bruce D. Packard, MD
Christopher J. Petit, MD
Jacqueline N. Rice, MD
Corey J. Scruggs, MD
Jatin J. Shah, MD
Umair A. Shah, MD
Maria K. Shepard, MD
Tonya T. Suffridge, DO
Nelson Tajong, MD
Valencia D. Thomas, MD
William T. Varner, MD
Luz A. Venta, MD
Anuja Vyas, MD
Christine G. Wei, MD
Amir Zegar, DO

Intern/Resident/Fellow:
Anitha T. Abraham, MD
Christopher M. Frank, MD
Joyce Li, MD
Vandana Raman, MD
Eric J. Trevino, MD

MembershipTransfer/
Withdraws:
Myrna Chavarria, MD
Thomas L. Crowder, MD
Darnel M. Durand, MD
Jonathan W. Hafner, MD
Linda H. Lin, MD
George J. Snipes, Jr., MD
Padmavathi N. Srinivasan, MD
John H. Williams, DO

CME meetings

The HCMS Branch Societies have CME credit and information for your practice. The branch meetings provide networking opportunities and an excellent way to develop and build your referral base. You can’t afford to miss the informative presentations developed just for you by the branch societies. To attend a meeting, make your reservations online or call HCMS at 713-524-4267.

NORTH BRANCH
6 p.m., Tuesday, May 6
Current Trends in Malpractice Litigation
Mary Angela Meyer, JD
1 hour Ethics CME; TMLT topic
Northgate Country Club

SOUTHWEST BRANCH
6 p.m., Thursday, May 8
So You Received a Letter from the TMB – What do you do now?
Sarah Fontenot, BSN, JD
1 hour Ethics CME; TMLT topic
BraeBurn Country Club

CENTRAL CITY BRANCH
6 p.m., Thursday, May 15
Group Practice Without Walls: An Alternative to Moving in Together
Dianne Love, PhD
1 hour CME
Trevisio

EAST BRANCH
6 p.m., Tuesday, June 3
So You Received a Letter from the TMB – What do you do now?
Sarah Fontenot, BSN, JD
1 hour Ethics CME; TMLT topic
Goose Creek Country Club

Public Health Focus

Measles outbreak in USA

The Centers for Disease Control and Prevention (CDC) reports that a measles outbreak linked to an importation from Switzerland currently is ongoing in Arizona. Through March 31, 2008, nine confirmed cases have been reported to the Arizona Department of Health Services, and there are two suspected cases (one in a Colorado resident) and hundreds of contacts under investigation.
In January and February 2008, San Diego experienced an outbreak of 11 measles cases, with an additional case-patient who was exposed in San Diego but became ill in Hawaii. The index case was an unvaccinated child who had recently traveled to Switzerland, where a measles outbreak is ongoing. Measles genotype D5 was identified from more than one case in the San Diego and Arizona outbreaks. This genotype is currently circulating in Switzerland. Confirmed measles cases also have been reported from New York City (involving genotype D4, which is identical to the genotype responsible for a large ongoing measles outbreak in Israel) and from Virginia (importation from India). In addition, two measles cases recently confirmed in unvaccinated siblings from Michigan may have resulted from exposure during a long stop-over in the Atlanta airport.

Although measles is no longer an endemic disease in the United States, it remains endemic in most countries of the world, including some countries in Europe. Large outbreaks currently are occurring in Switzerland and Israel. In the United States from Jan. 1 through March 28, 24 confirmed cases of measles resulting from importations from endemic countries have been reported to CDC.

These cases highlight the ongoing risk of measles importations, the risk of spread in susceptible populations, and the need for a prompt and appropriate public health response to measles cases. Because of the severity of the disease, people with measles commonly present in physician’s offices or emergency rooms and pose a risk of transmission to other patients and health care personnel. Physicians should remain aware that measles cases may occur in their facility. Transmission risks can be minimized by ensuring that all health care personnel have evidence of measles immunity and that appropriate infection control practices are followed. For more information on recommendations, visit the CDC Web site at http://www.cdc.gov.

Source: CDC Health Alert Network

Member Mentions

Dr. Max C. Butler will receive the Texas Medical Association’s Distinguished Service award during TexMed in San Antonio.

Dr. Glen O. Gabbard and Dr. George D. Santos received the Texas Society of Pshychiatrists’ Psychiatric Excellence Award for 2008.

Dr. Issam I. Raad was honored by the Houston Chapter of the Arab American Medical Association as the Ben Qurrah Award recipient for remarkable contributions to the field of medicine and/or science.

Medicare Corner

Payer ID change and New enrollment forms

Payer ID change for electronic claims

TrailBlazer's (Texas Medicare carrier) current Part B payer ID, 00900, will be changing to 04402, effective for claim files submitted on and after June 11, 2008.

This will affect electronic claims filing. Call your clearinghouse to see if the change will have any impact on any changes you may need to make within your practice management systems.

New enrollment forms - June 2008

The Centers for Medicare & Medicaid Services (CMS) issued revised CMS-855 Medicare enrollment applications in March 2008. With the exception of providers enrolling as a specialty hospital on the CMS-855A, Medicare contractors will continue to accept the 2006 version of the Medicare enrollment application through June 2008. Providers and suppliers should begin to use the new Medicare enrollment applications immediately. The actual changes are below along with links to the new applications.

Reminder: Any change to any information on any 855 form (i.e., address change, phone number change, add a physician, delete a physician, etc.) mandates the physician or group to file a new 855 application if you have not filed one since 2003. In addition, you must file with your NPI and you MUST accept payment by electronic funds transfer.

     • Electronic Funds Transfer (EFT) Authorization Agreement (mandatory completion)
        http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf
     • 855b Clinics/Group Practices and Certain Other Suppliers
        http://www.cms.hhs.gov/CMSforms/downloads/cms855b.pdf
     • 855i Medicare Enrollment Application - Physicians and Non-Physician Practitioners
        http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf
     • 855s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier
        http://www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf
     • 855r Reassignment of Medicare Benefits
        http://www.cms.hhs.gov/cmsforms/downloads/cms855r.pdf
     • 855a Institutional Providers
        http://www.cms.hhs.gov/cmsforms/downloads/cms855a.pdf

Changes to CMS 855 enrollment forms

     CMS-855I
     • Removed the requirement in Section 17 that providers attach their NPI notification that is received
       from the National Plan and Provider Enumeration System.
     CMS-855B
     • Removed the supplier type “Voluntary Health/Charitable Agency” from Section 2A.
     • Clarified reporting timeframes throughout the CMS-855B.
     • Added additional information about the NPI-legacy association and expanded the number of NPI –
       legacy combinations that a provider may enter in Section 4A from one to five.
     • Removed the requirement in Section 17 that providers attach their NPI notification that is received
       from the National Plan and Provider Enumeration System.
     • Required that an Independent Diagnostic Testing Facility (IDTF) submit copies of its comprehensive
       liability insurance policy in Section 17.
     • Added a list of the new IDTF standards found in 42 CFR 410.33(g) on a separate page in Attachment
       2.
     • Added instructions that explain the IDTF liability insurance requirements in 42 CFR 410.33(g)(6) to
       Attachment 2.
     CMS-855A
     • Revised Section 2A2 to include a specific box that specialty hospitals must check when completing
       the application. Instructions explaining the definition of a “specialty hospital” also were added to the
       form.

Source: Centers for Medicare and Medicaid Services
Presented by the HCMS Board on Socioeconomics

HCMS mourns the loss of former HCMS President
Dr. C. C. Shullenberger

Dr. Shullenberger

The Harris County Medical Society (HCMS) mourns the loss of former HCMS President Dr. C. C. Shullenberger, who died on April 1. Dr. Shullenberger, an internal medicine physician and a hematologist, had been a member of HCMS for 59 years.

Dr. Shullenberger was president of HCMS in 1976. He was admired and respected for his dedication to his patients and the community. He served as one of the first trustees of the Gulf Coast Regional Blood Center (GCRBC) and was its medical director from 1974 to 1984.

Dr. Shullenberger will be missed by all. He is survived by his wife of 65 years, Betty Lou.

Roster corrections

Your 2008 HCMS/HAM Pictorial Roster is the number one source for physician referrals for our members! Here are corrections to the 2008 Roster for Drs. Tanveer Syed (pg. 535), Ali A. Salehi (pg. 491) and Dudley D. Baker (pg. 101).

Sayed Baker Salehi

These images can be clipped and pasted over the corresponding pictures in the Roster. They also are located on the HCMS Web site .

Business of Medicine

“Source of injury” exclusions

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 allows plans to deny coverage for members who get hurt while participating in recreational activities the plan considers dangerous, but not for injuries that result from a medical condition or an act of domestic violence.

HIPAA regulations in 29 CFR 2590.702(b)(2)(iii) allow plans to exclude coverage for an injury from a specified dangerous activity, as long as the plan excludes coverage for all members injured that way and does not single out particular members. This is referred to as the “source of injury” exclusion. For example, a plan may cover head injuries but exclude head injuries sustained while an enrollee is participating in a plan-defined dangerous recreational activity, such as skydiving.

The rule that a plan may not deny benefits for treatment of an injury that results from a medical condition or an act of domestic violence was issued Dec. 13, 2006, under final HIPAA nondiscriminination regulations. This rule applies even when the medical condition was not diagnosed before the injury and applies for plan years beginning on or after July 1, 2007. (Thus, calendar-year plans must comply beginning Jan. 1, 2008.)

For example, if a patient received a head injury while attempting suicide because of undiagnosed depression, which is a medical condition, the plan would have to cover the injury, if it covers head injuries.

To protect your practice:

     • Find out if the plans you contract with have source-of-injury exclusions. (Do not rely on the plan
       to tell you unless you ask).
     • Review contracts. Check the definitions of “noncovered” service to ensure that the language is
       broad enough for you to bill the patient if your services are excluded from coverage by source of
       injury.
     • Update your verification process. Find out from the patient how the injury or illness occurred and
       be sure to document that in the patient’s record. When you verify coverage with the plan, check
       that treatment related to that activity is still covered.
     • Review patient financial forms. Make sure your patient financial forms let you bill and collect for
       these noncovered services.

Houston seminars

Practice Viability Part I: Managing Your Revenue Cycle

Declining revenues, rising practice costs, and mounting administrative burdens make it increasingly difficult to run a viable medical practice. In response, TMA has developed a two-part practice viability series to address the revenue and expense side of your practice's financial health. "Part I: Managing Your Revenue Cycle" addresses the revenue side of your practice with emphasis on revenue analysis, income projections, and collections. Later this fall, "Part II: Efficient Practice Operations" will address the expense side as we tackle office efficiency and overhead analysis.

Date/Time: Wednesday, May 14, 8:30 a.m. to 4 p.m.
Location: Hilton Houston Southwest, 6780 Southwest Freeway
CME: TMA designates a maximum 5.5 AMA PRA Category 1 credits.
Costs: $179 for TMA members or their staff, $259 for nonmembers. Enroll three or more people from the same office and pay $159 per person.
Contact: TMA 800-880-7955 or visit www.texmed.org and click on practice management.

Workers’ Compensation 2008

This seminar is for physicians who want to learn more about the workers’ compensation system, how to get paid appropriately, identifying patients by type, contracting with networks and safeguarding their practices with appropriate policies. Office administrators, staff or managers who want to learn the administrative details of navigating the workers’ compensation system should attend this seminar.
Date/Time: Thursday, June 26, 8:30 a.m. to 4 p.m.
Location: Hilton Houston Southwest, 6780 Southwest Freeway
CME: TMA designates a maximum 5.5 AMA PRA Category 1 credits.
Costs: $189 for TMA members or their staff, $249 for nonmembers. Enroll three or more people from the same office and pay $159 per person.
Contact: TMA 800-880-7955 or visit www.texmed.org and click on practice management.