The Harris County Physician Newsletter

March 15, 2006

Welcome to the Harris County Physician Newsletter Online!

In this issue. . .

Cut Expenses

HCMS Resolutions 

Member Mentions

Spring Business Expo 

April Calendar

News and Updates

Coverage for Retired Docs 

CME, Networking for Young Physicians 

Business of Medicine

Medicare Corner: March National Colorectal Cancer Awareness Month

Medicare Corner: Why go electronic? 

Medicare Corner: Top five billing errors

Classifieds

Cut expenses, TMLT discounts available

If you are a Texas Medical Liability Trust (TMLT) policyholder, did you know that you can receive a 3 percent premium discount – up to $1,000—for successful completion of a TMLT risk management education course? TMLT allows you to take two approved CME courses a year, for a maximum discount of 6 percent (up to $2,000). The discount is applied to the next eligible policy period. 

You also could earn a 5 percent premium discount by scheduling an onsite practice review for risk management assessment and an additional 2.5 percent premium discount for using electronic medical records in your office. 

During an onsite practice review, TMLT risk management professionals will:

• Examine the office for physical safety concerns;

• Review your practice policies and procedures;

• Evaluate your medical record documentation; and

• Provide you with a written, confidential, follow-up summary.
  

Physicians who complete the process may be eligible to receive a 5 percent premium discount after the review recommendations are met. Physicians who use electronic medical records or electronic medical prescribing in their offices for a minimum of one year, and have been assessed to meet specific risk management criteria, may also be eligible to receive an additional 2.5 percent discount. Thus, an onsite practice review could total up to a 7.5 percent discount.

Contact Natalie Gilmore of the TMLT Risk Management Department at 1-800-580-8658, ext. 5911, to get started on the CME courses or to schedule an onsite practice review. You also have the option of registering online at http://www.tmlt.org/newcme/login.html for the online risk management CME courses. 

Source: TMLT
Presented by the HCMS Board of Ethics

HCMS Resolutions call for TMA study on
Medical Board and PBMs

In response to member concerns, HCMS is submitting a package of resolutions to the Texas Medical Association (TMA) House of Delegates, TMA’s policy-making body, at TexMed, TMA’s annual meeting, held May 4-6, at the George R. Brown Convention Center in Houston.

In one resolution, HCMS is asking for a TMA study on the Texas Medical Board’s disciplinary practices for minor and administrative infractions. In another resolution, HCMS is asking TMA to review the administrative burdens placed on physician practices as a result of the operations of pharmacy benefit managers (PBMs).

A number of physicians have voiced concerns about complaints filed with the Texas Medical Board and the Board’s aggressive handling of non-meritorious complaints as well as sanctions related to minor administrative violations. (Click here for President's Page)

“Physicians absolutely want a strong Medical Board and one that moves quickly and decisively against a physician who endangers patients,” said HCMS President Dr. Diana Fite. “But the HCMS continues to receive numerous contacts from member physicians who are or have been investigated and fined for seemingly minor infractions.”

The resolution is asking for TMA to study and monitor the Texas Medical Board’s disciplinary actions, “documenting the application of overly harsh punishments - by fine and publicity - for minor infractions, and suggest alternatives that could be advanced to the Board in terms of possible changes in Board actions that would be more appropriate for minor and administrative violations.”

The issue of PBMs and the administrative burdens placed on physicians stems largely from Medicare Part D problems but also from a growing trend by commercial pharmacy managers to require often extensive pre-authorization processes before a patient’s prescription drug benefits will apply. Physicians report that it is not unusual for the pre-authorization process to consume as much as an hour per patient, depending on the plan and the extent of the information demanded by the plan.

HCMS is asking TMA to “gather evidence of the administrative burden placed on physicians and patients by the policies and operating practices of PBMs for the purpose of documenting the impact on medical practices and a determination of whether or not the business practices of PBMs comply with state laws and regulations.”

Other HCMS resolutions: address flu vaccine distribution—to place a priority on early vaccine distribution to CDC-determined high-risk patients and their physicians; continued efforts to reduce non-meritorious lawsuits; advocate for a review process for expert testimony in liability cases; seek the American Medical Association’s involvement in national efforts to encourage reimbursement for on-call physicians responding to emergencies involving indigent patients; and legislation to define the practice of diagnostic (needle) EMG as the practice of medicine.

Presented by the HCMS Board of Medical Legislation

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President's Page - Dr. Diana L. Fite
The Medical Board

The Texas Medical Board (TMB) is charged by law with enforcing the state’s Medical Practices Act, which means as a state agency it is the body that licenses physicians and disciplines those who are in violation of the Act. There is not a physician in Texas who does not want a strong Medical Board and one that moves quickly and decisively against a physician who endangers patients by lack of skill, bad medical practice, or who harms a patient by unethical or unprofessional conduct.

One of the principle issues that led to the formation of the HCMS in 1903 was the need to define the practice of medicine and to license physicians. HCMS advocated for the formation of the Medical Board and the Medical Practices Act.
In the last couple of years, multiple physicians have received letters from the Medical Board investigating all sorts of complaints, of which many make little or no medical sense to investigate. We are not informed who the complainant is, and it may not be clear at all what the complainant has accused us of doing. Whereas we used to be threatened by an occasional patient that they were going to “call Marvin Zindler”, we are now being threatened that the patient not getting what he/she wants will “inform the Medical Board.”  It appears that the Texas Medical Board looks into every complaint (unless it is anonymous) by sending us a somewhat nasty-sounding letter requesting medical records and an immediate explanation of our behavior. 

In December of 2005, in an attempt to gather information and come to grips with some of these issues, the HCMS staff met in Austin with TMB staff and the executive director, Dr. Donald Patrick. Here, in a nutshell, is an overview of the Medical Board’s process.

Texas law requires the Medical Board to perform a preliminary screening of each complaint it receives within 30 days. To accommodate the front end and back end processing, there will be only 14 days for the physician to respond (even if the physician is out of town and does not know about the letter).

But respond you should! Your timely reply is one of the key factors in whether or not the complaint is filed. If you do not respond to this letter in the time prescribed, or if your response does not clear up the matter, the complaint is officially filed. By law, the Medical Board is required to complete its investigation of the filed complaint within 180 days. You will have an opportunity to provide more information about the complaint during the investigation phase.

Last year, about 6,000 complaints against physicians were filed with the Medical Board. Of these, nearly two-thirds were dismissed within the first 30 days because they were not justified. The filed complaints, according to the Medical Board, breakdown this way: 70 percent related to standard of care issues; 10 percent related to unprofessional conduct; 3 percent to prescribing errors; 2 percent to alleged impairment; and 15 percent dealt with administrative violations. Any standard of care issue must be reviewed by two physicians in the same specialty as the physician against whom the complaint has been filed. Of the complaints, which resulted in judgments against physicians, the Medical Board imposed some 300 disciplinary actions ranging from fines to probations to outright license revocations.

It is our understanding that beginning with the next Medical Board newsletter, physicians who are disciplined for administrative infractions will be reported in a separate section apart from those sanctioned for standard of care or ethical issues. By law, there are due process protections for physicians to which the Medical Board must adhere. And a look at the overall numbers does not necessarily imply overzealous Medical Board action. Yet we continue to hear many personal and second-hand anecdotes from colleagues.

For these reasons, we have submitted a resolution to the TMA House of Delegates, which meets this May in Houston. We are asking the TMA to look at the Texas Medical Board’s disciplinary processes, to document instances where overly harsh punishments have been handed out for minor infractions, and to suggest alternatives that could be advanced to the Medical Board in terms of possible changes in the Medical Board’s processes that would be more appropriate for minor and administrative violations.

As a start, we propose to collect information from you. Please go to our Web site at www.hcms.org and follow the link to our Survey on the Texas Medical Board. We’ll share the results back with you.

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CMEs & prizes at HCMS Biz Expo

The Spring 2006 HCMS Business Expo on Sat. April 1, 2006, 9:30 a.m. to 3 p.m., at the George R. Brown Convention Center, will include free CME seminars that offer helpful practice information as well as products and services that can benefit you and your practice.

Physicians may attend three free CME seminars, with two having ethics credit. The seminars are: Culture & Medicine on how understanding culture can reduce health disparities; Technology & Patient Communications on the impact of technology on practice revenue; and Health Savings Accounts on how HSAs affect payment and collection.

Also, there will be more than 30 door prizes given away. Come and register to win:

• 4 tickets to the Broadway show The Lion King;

• 2 club-level front row Astros tickets (donated by Enhanced Laser Products);

• $200 gift certificate to Tony’s Restaurant (donated by Zybec Corporation);

• A family plus membership to the Houston Zoo;

• 1 month (8 sessions) of  private fitness training sessions (donated by 1st Class Training); and

• TaylorMade r7 driver golf club (donated by Yancey-Hausman)

• And much more….
  

Come to learn how you can enhance your practice and patient care.  

To register, call 713-526-7378, or visit www.hcms.org and select “Business Expo” to download a registration form.

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April Calendar

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News and Updates
Branches have ethics CMEs

All of the upcoming HCMS branch society meetings have ethics CME credit as well as information to help your medical practice. To attend a meeting, call HCMS at 713-524-4267.  

CENTRAL CITY BRANCH
6 p.m., Thursday, April 27
“Business of Medicine Part III: Quality Measures-Impact on the Business of Medicine”
1 Hour Ethics CME
Pat Harris, RN
Marriott Medical Center Hotel

EAST BRANCH
6 p.m., Tuesday, May 2
“Don’t be a Sitting Doc”
1 Hour Ethics CME
Nancy Steinmarcher, TMLT
Goose Creek Country Club

NORTH BRANCH
6 p.m., Tuesday May 9
“Business of Medicine Part II: Making Your Practice Profitable”
1 Hour Ethics CME
Pat Harris, RN
Northgate Country Club

SOUTHWEST BRANCH
6 p.m., Thursday, May 18
“Business of Medicine Part III: Quality Measures-Impact on the Business of Medicine”
1 Hour Ethics CME
Pat Harris, RN
BraeBurn Country Club

SOUTHEAST BRANCH
6 p.m., Thursday, May 23
“Physician Stress & Burn Out”
1 Hour Ethics CME
Eugene Boisaubin, MD
Bay Oaks Country Club

Immunizations, cost being covered?

If a health plan is not paying at least the cost of a vaccine, please let HCMS know.
Please fax the following information to HCMS at 713-528-0951.

• Physician’s Name 
• Specialty   
• Phone Number 
• Health Plan 
• Vaccine 
• Cost of Vaccine
• Payment 
  

Upcoming Seminars 

20 Ways to Beat the Reimbursement Blues
Date/Time: Tuesday, March 28, 1 p.m. to 4 p.m.
Location: Hilton Houston Southwest, 6780 Southwest Freeway
This seminar is for physicians, office managers, administrators, and coding staff in all specialties who are interested in improving reimbursement rates and understanding how reimbursement laws impact your practice reimbursement policies.
CME: TMA designates a maximum of 3 category one credits towards the AMA PRA.
Cost: $149 for TMA members or staff, $219 for nonmembers and $119 for web registrants.
Contact: 1-800-880-1300, or visit www.texmed.org and click on CME.

TexMed in Houston
Date: Thursday - Saturday, May 4-6
Location: George R. Brown Convention Center
Texas Medical Association’s 139th annual session, expo, and educational showcase offers more than 130 hours of CME programming, an expansive exhibit hall featuring 150 vendors, and opportunities to network with colleagues. It also offers a Physician Art Contest (deadline April 15) and TMA Foundation Annual Benefit, led by chairs Dr. and Mrs. A. Tomas Garcia III, on May 5.
CME: More than 130 hours offered
Cost: Free to TMA physicians
Contact: 1-800-880-7955 or visit http://www.texmed06.texmed.org

JUA offers retired docs “defense only” coverage

The state’s Joint Underwriting Authority (JUA) has begun writing a “defense only” policy for retired physicians involved in charity care. The development of the policy helps to address one of the barriers keeping a number of retired physicians from volunteering in charity clinics. Even though volunteers are protected from damages under Texas and federal charitable immunities laws, the possibility is always there that a lawsuit could draw a volunteer physician into court.

The JUA’s policy carries an annual premium of $250 and provides up to $25,000 for defense costs. The coverage is on an occurrence basis so that if a physician ceases volunteer work there is no coverage lapse and no tail coverage to purchase. For information, contact the Texas Joint Underwriting Associa-tion at 512-452-4370. Ask for Carrol Hendricks.

CME & networking for young physicians

Learn how to reduce your potential for malpractice liability during the HCMS Council of Young Physicians seminar featuring 1 hour ethics CME on Risk Management Update & Current Trends in Malpractice Allegations, being held Thursday, April 20, at the Houston Medical Center Marriott, located at 6580 Fannin. Networking and registration begin at 6 p.m., followed by dinner and program at 6:30 p.m. Bring your business cards to network.

This seminar will teach you how to respond to inquiries; document defensively; identify liability risks associated with the practice of medicine; and respond to managed care denial of payment for necessary procedures.

The HCMS Council of Young Physicians is for all HCMS member physicians under the age of 40 or in their first eight years of practice. The Council of Young Physicians offers a variety of educational programs and provides a forum to discuss issues that are unique to physicians who are in their early to mid-career stages of practice.

The meeting cost is $15 per person. Reservations are required. For more information, contact HCMS at 713-524-4267, ext. 243, or e-mail regina_palasota@hcms.org.

Medicare Corner
March - National Colorectal Cancer Awareness Month

March is National Colorectal Cancer Awareness Month. Colorectal cancer is the third most common type of cancer, and the second leading cause of cancer death. Like many other diseases, older adults are at greater risk for colorectal cancer. The Centers for Medicare & Medicaid Services (CMS) is asking health care professionals to encourage their Medicare patients who are 50-years-old and older to get screened for colorectal cancer. Medicare covers colorectal cancer screening tests and procedures, specifically:
 

• Fecal Occult Blood Test;

• Flexible Sigmoidoscopy;

• Screening Colonoscopy; and

• Barium Enema.
  

For more information about Medicare’s colorectal cancer screening benefit, including coverage, coding, billing, and reimbursement, refer to The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals, located at www.cms.hhs.gov/MedlearnProducts/downloads/PSGUID.pdf on the CMS Medicare Learning Network (MLN) Web site. Also, to review the CMS’s Special Edition Medlearn Matters article SE0613 on colorectal cancer screening, click on the following link www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0613.pdf.

Top five billing errors & occurences

Here are the top five Medicare billing errors and occurrences from Oct. 5 –Dec. 5, 2005.

1. Duplicates – Occurrences 1,739,581 - Description:  Claims submitted are exact duplicates of previous claims submitted. Claims are often denied as duplicates for the following reasons:

• Claim previously processed (i.e., no payment made, allowed amount applied to deductible on the initial claim).

• Physician refiles the claim to “correct” the claim.

• Second claim submitted is a duplicate as the initial claim was processed correctl

• Physician “automatically” refiles claim to seek payment if initial claim has not beenpaid within 30 days.

Resolution:

• Physicians should not refile the claim until they know a new claim is necessary.

• Call 866-211-5708 for non-payment questions. Call the Interactive Voice Response (IVR) system at 877-392-9865 to check claim status before refiling the claim.

• Check claim status before refiling a new claim. The claim could be pending in the Medicare system for payment or for additional information needed to complete processing.
  

2. Non-Covered Services - Occurrences 295,086 - Description: Billing for services not covered under the Medicare program.

Resolution:

• Medicare exclusions: Personal comfort items; self-administered drugs and biologicals (i.e., pills and other medications not administered by injection); cosmetic surgery (unless to repair an accidental injury or improvement of a malformed body member); eye exams for purpose of prescribing, fitting or changing eyeglasses or contact lenses in absence of disease or injury to eye; routine immunizations (except flu, pneumonia, Hepatitis A, and Hepatitis B); routine physicals; lab tests and x-rays performed for screening purposes – except screening mammogram; screening Pap smears and various other mandated screening services; hearing aids; routine dental (care, treatment, filling, removal, or replacement of teeth); supportive devices for feet; routine foot care (cutting or trimming of corns or calluses, unless inflamed or infected, routine hygiene or palliative care); custodial care, services furnished or paid by government institutions; services resulting from acts of war; and charges to Medicare for services furnished by a physician to his immediate relatives or members of his household.
  

3. Medical Necessity – Occurrences 282,711 - Description:  Services billed and deemed not medically necessary by the payer.

Resolution:

• The claim will be denied because the payer does not deem the procedure for this diagnosis to be a “medical necessity.

• Check the Medicare newsletters for the list of covered diagnoses for a particular sevice

• Check the Local Coverage Determination (LCD) on the TrailBlazer Web site for listing of covered diagnoses for a particular service.
  

4. Bundled Services - Occurrences 227,948 - Description: Payment for “B” status code services is always bundled into payment for other services. There will be no relative value units (RVUs) or payment amount established for these codes and no separate payment is ever made.

Resolution:

• Access the Medicare Physician Fee Schedule Database (MPFSDB) to determine if the procedure codes being billed are “B” status codes.

5. Beneficiary Eligibility – Occurrences 213,142 – Description: Claims submitted for processing but the beneficiary/patient does not have Medicare eligibility. Claims often deny for eligibility for the following reason:

• Beneficiary Medicare number is invalid on the claim.

• Beneficiary is not eligible to receive Medicare benefits.

• Beneficiary’s claims must be filed to another insurance plan.

Resolution:

• Physicians should screen their patients. Verify the Medicare number on the patient’s Medicare card and file the claim exactly as it is printed on the card.

• Verify the patient’s effective date for Medicare Part B from his/her Medicare card. Medicare cannot pay for services prior to the patient’s effective date and will not pay for services if the patient has terminated his Medicare benefits.

• Beneficiaries who enroll in a Medicare “replacement” HMO must be submitted to that insurance plan instead of Medicare Part B.

• To verify Medicare eligibility, call the IVR at 877-392-9865.
  

Source: TrailBlazer Health
Presented by the HCMS Board on Socioeconomics

Why go electronic?

A new law, economic benefits and available assistance are all good reason why you should go electronic when it comes to Medicare claims.

• Medicare now will take longer to pay paper claims. A new federal law changed the minimum number of days from 27 to 29 days that Medicare has after receiving a paper claim before it will pay the claim. This extension is a result of the Deficit Reduction Act of 2005, which became law on Feb. 8, 2006.
  
• It’s faster and cheaper to go electronic. The CMS states electronic data interchange (EDI) — electronic claims — allows you to submit transactions faster and be paid faster. It also is cheaper than paper or manual transactions.
  
• TrailBlazer Health Enterprises, the Texas Medicare contractor, can help you begin exchanging EDI transactions by giving you enrollment and connectivity information, system access numbers and passwords, and information on those transactions supported by Medicare. TrailBlazer also will test transmissions to make sure you are using the correct EDI formats. The Medicare Part B EDI Helpline toll-free number for Texas is 866-749-4302.
  

Source: TrailBlazer Health & CMS
Presented by the HCMS Board on Socioeconomics

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