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Applying for an NPI
Apply RIGHT NOW! DO NOT DELAY!
• The Centers for Medicare & Medicaid Services (CMS) estimates that it may take up to 120 days to implement the NPI in current business practices;
• Apply on the Web https://nppes.cms.hhs.gov;
• Apply by completing a paper application and mail it to the NPI Enumerator, 1-800-465-3203; and
• An organization (such as a Medical Group or an IPA) might apply for an NPI on physician’s behalf.
Must share your NPI with:
• Medicare, Medicaid and contracted commercial health plans (right now you need to be sending your NPI number with your legacy numbers on your electronic claims); and
• Other physicians and providers may need your NPI number because you are: a rendering or performing physician or supervising, operating or referring physician.
New CMS 1500 claim form
First significant revision of the form since 1990;
• Modified to accommodate the NPI;
• Date of implementation April 2, 2007. (After this date the old claim form will not be accepted, even if the original claim was filed with the old form and you are appealing after April 2, 2007); and
• TDI issued proposed rules changing the definition of a “clean claim” to accommodate the NPI. (This means if you file paper claims, in order for the claims to be clean in Texas, you must have an NPI number.)
Health Plans’ links to communicate NPI numbers
Aetna
www.aetna.com/provider/NPI_talking_points.html
Amerigroup
https://www.amerigroupcorp.com/providers/ProviderPortalWeb/publicpages/NPIAssist.aspx
BCBSTX
www.bcbstx.com/provider/npi.htm
CIGNA
www.cigna.com/health/provider/medical/national_provider_identifier.html
Community Health Choice
www.communityhealthchoice.org/en/providers/NPI.htm
Evercare of Texas
www.evercarehealthplans.com/health_professionals.jsp
(or refer to United Healthcare information)
Great-West Healthcare
https://www5.greatwesthealthcare.com/providers/NPIMain.html
Humana
www.humana.com/providers/hipaa_transaction_resource.asp
Molina Health Care
www.molinahealthcare.com/common/hipaa/tx/npi.htm
Texas Children’s Health Plan
http://www.texaschildrenshealthplan.org/providers/News.aspx
Texas HealthSpring
http://www.myhealthspring.com/providers.php
TMHP - Texas Medicaid & Healthcare Partnership
http://www.tmhp.com/C13/NPI%20Announcements/default.aspx
TrailBlazer Health
www.trailblazerhealth.com/notices.asp?category=43&action=Find+It
Unicare
https://npi.wellpoint.com/npi/online/onlinesubmit.jsp
United Healthcare
https://www.unitedhealthcareonline.com
UTMB
http://www.utmbhcs.org/chip/english/NationalProviderIdentifier.pdf
Source: TMA and CMS
Presented by the HCMS Board on Socioeconomics
NPI seminar April 17
The National Provider Identifier (NPI) implementation is less than 70 days away. The Harris County Medical Society and Texas Medical Association in partnership with Houston Community College (HCC) are having an NPI night on April 17, at the HCC Auditorium at 6100 Main Street. Free parking and hors d’oeuvres will be served. One hour of CME in ethics will be given to all physicians in attendance. Attend and learn more about this crucial change in office payment administration. For more information, go to www.hcms.org.
Presented by HCMS Board on Socioeconomics
Medserv Spotlight
Attend Business Expo for CMEs and practice info
Spend a few hours focusing on the business side of your medical practice at the HCMS Spring Business Expo on Saturday, April 14, 9 a.m. to 3:15 p.m., at Reliant Center. The entire event, including the CMEs and parking with a voucher, is free to HCMS members.
More than 60 exhibitors will be there to share with you information about products and services that can benefit your medical practice. There also will be seminars for CME credit and many door prizes will be given away!
Free Seminars:
• Legislative Update, 9:15 a.m. to 9:45 a.m.— Dan Finch, director of legislative affairs at Texas Medical Association, will give an update on current legislative action that can affect your practice.
• EMRs and Risk Management, 10:15 a.m. to 11:15 a.m., for one hour ethics CME—Dr. David W. Bauer, director of Memorial Family Medicine Residency Program, will give a physician’s perspective on how you can utilize EMRs to lower your risk exposure, while increasing efficiency and decreasing expenses.
• Texas Overview of Part D Medicare, 12 p.m. to 1 p.m., for one hour of CME—Dr. Abe Delgado, medical director of TMF Health Quality Institute, and Jim Turpin, quality improvement consultant of TMF Health Quality Institute, will discuss where Part D came from and how it is proceeding in Texas. You also will learn about available TMF Part D resources and how to access the CMS formulary appeals process.
• Avoiding the Courthouse: Ten Practice Pitfalls, 1:45 p.m. to 2:45 p.m., one hour of ethics CME—Stacy Agnew, risk management department manager of Texas Medical Liability Trust, will discuss practical ways to reduce the potential for malpractice liability.
To register and receive your free parking pass, call Medserv at 713-526-7378, ext. 200. For more information, visit www.hcms.org.
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Kudos to First Tuesday doctors
We say it all the time – it is very important to participate in First Tuesdays. But do we give enough praise to those who give up time in their practice to make the trek to Austin to communicate medicine’s message to our legislators?
Here is a list of the physicians who registered and attended the Feb. 6 First Tuesday at the Capitol. They each deserve a pat on the back and heartfelt thanks for their sacrifice and dedication: Drs. Arlo F. Weltge, Mark D. Barhorst, Diana L. Fite, Victor Miranda, Mark A. Cesta, Andrew P. Kant, Alan D. Rosen, Kourosh Jafarnia, Betty Jo Edwards, N. Berkeley Powell Jr., J. Cary Moorhead, Mary W. Geda, and A. Tomas Garcia III.
For those of you who gave your time and are not listed, we thank you, too. There are still two more First Tuesdays left in the session. It is an exciting and rewarding experience as well as a great help to your colleagues and your patients. Sign up for April or May at http://www.texmed.org/Template.aspx?id=5211.
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President's Page - Dr. Michael V. Kelly II
Keep medicine’s voice strong—Now and in the future
It’s reassuring to know that while we physicians are working to treat patients and save lives, the Harris County Medical Society (HCMS) and Texas Medical Association (TMA) are ferociously advocating on our behalf.
HCMS and TMA have been highly successful in this endeavor. This is due, in part, to the fact that HCMS and TMA are the largest county and state medical societies in the nation, representing eight out of 10 Texas physicians. When we speak, others listen.
You say, “What have HCMS and TMA done for me?” Let me tell you. This fall, in response to demands by TMA and HCMS, Blue Cross and Blue Shield of Texas agreed to suspend its controversial rating system, BlueCompare. What else, you ask? We worked hard to put and keep in place the tort reforms in 2003, which have resulted in at least a 20 percent drop in medical liability premiums and a huge reduction in filed lawsuits from 1,300 in 2003 to 221 in 2005 and more competition from liability carriers.
These are just two examples of how successful and hard HCMS and TMA work for you. There are many more. Visit the HCMS Web site at www.hcms.org and click on membership to see more benefits and accomplishments of HCMS and TMA.
Your membership is what keeps us strong to protect and advocate for you and your patients. Still not convinced that being a member is important? Let’s talk about some of the benefits you receive through your membership.
HCMS and TMA have taken the lead in educating physicians on practice management because we realize it takes more than being a good doctor to keep your practice healthy. Our Business of Medicine seminars are held throughout the county for physicians, medical students and residents. HCMS also holds Business Expos in the spring and fall to display the latest products and services for your practice and provide practice management seminars with CME, all free for members. The next one is April 14, and I encourage you to attend.
We realize that Texas needs more graduate medical education slots to train the number of physicians needed to meet our health care needs and prevent a dependence on other states. We are working to support adequate funding for additional GME slots in Texas, restore Medicaid funding cuts to GME and support full-formula funding for GME.
Physician members’ pictures and information are included in the HCMS Pictorial Roster, which is the ultimate medical/health reference book for Harris County and is an invaluable reference tool for physician referrals, hospitals and pharmacies. Medserv, a subsidiary of HCMS, also provides assistance with hiring administrative and clerical staff at a discounted member rate.
Other valuable services include free membership to the Houston Academy of Medicine-Texas Medical Center Library, which is one of the leading biomedical libraries in the nation. And through TMA Insurance Trust and Texas Medical Liability Trust, members can receive major medical, disability and liability insurance. Also, HCMS and TMA offer free or low-cost CME seminars in medical liability, asset protection, ethics, and practice management.
HCMS works on medical issues, such as emergency department overcrowding, blood donation shortages, managed care issues, and the like, through its many committees and councils. Your dues dollars make all this happen and more. And HCMS dues are much lower than any other county medical society’s dues in the nation. HCMS dues are $180 compared to the dues of Dallas $285, Los Angeles $450, New York $350, and Detroit $310.
With all that’s going on in our profession, you can’t afford not to be a member. Through your membership, you do have a voice in how medicine will be practiced today and in the future. We have many issues facing us today—tiered networks, scope of practice, GME funding, Medicaid reform—to name a few. Make sure you are part of the solution.
If you have not paid your dues, please pay HCMS and TMA dues now. The drop date is April 1! If you notice that one of your colleagues isn’t in the Pictorial Roster, encourage him or her to join the team.
It takes all of us to keep medicine’s voice strong.
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In Memoriam
Dr. Daniel J. Feinstein, a general surgeon and pediatric surgeon, died Feb. 13. He had been a member of HCMS for 57 years.
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April Calendar
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TUESDAY 3
First Tuesday at the Capitol, Austin
FRIDAY 6
Good Friday
HCMS & Museum offices closed
Museum open
MONDAY 9
6:30 p.m., Houston Dermatological Society, Trevisio
THURSDAY 12
6:30 p.m., Houston Society of Plastic Surgeons, Trevisio
SATURDAY 14
D-Tag Tattoo Removal Program
9 a.m. – 3:15 p.m., HCMS Business Expo, Reliant Center
TUESDAY 17
6:30 p.m., Houston Pediatric Society, Ruth Chris Steakhouse
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WEDNESDAY 18
6 p.m., HCMS Council of Young Physicians, Trevisio
6:30 p.m., Gulf Coast Hematology Society, Trevisio
6:30 p.m., Houston Surgical Society, Trevisio
THURSDAY 19
6:30 p.m., Houston Orthopedic Society, La Colombe d’Or
6:30 p.m., Texas Gulf Coast Gastroenterological Society, TBA
TUESDAY 24
6 p.m., North Branch, Northgate Country Club
6:30 p.m., Houston Society of Otolaryngology – Head & Neck Surgery,Brennan’s
THURSDAY 26
April 26 – 28, TexMed 2007, Dallas
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News and Updates
TMA Foundation Benefit during TexMed 2007
The TMA Foundation goes to the circus this spring to support the Texas Medical Association (TMA) and TMA Alliance health and wellness programs! Join the evening’s ringmasters, Dr. and Mrs. Fred Ciarochi of Duncanville and Dr. and Mrs. Rex Hyer of Fort Worth, in this magical evening of fun and excitement. Clown around with friends and colleagues, and enjoy an enchanting evening of dinner, dancing, and “Big Top” entertainment.
Gala proceeds benefit TMA Foundation and the TMA and TMA Alliance programs it supports, including Be Wise — ImmunizeSM, Hard Hats for Little Heads, Ernest and Sarah Butler Awards for Excellence in Science Teaching, and TMA’s Minority Scholarship Program.
For more information, go to www.tmaf.org or contact donna.daugherty@texmed.org or 512-370-1466.
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Dealing with behavioral issues? Attend Sex, Drugs & Rock ‘N Roll
The HCMS Central City Branch is hosting Sex, Drugs & Rock ‘N Roll on Tuesday, March 27, at 6 p.m., at Trevisio Restaurant. Attorney and MDNews Legal Columnist Cynthia Marcotte Stamer will show you how to handle and respond to times when private lives affect performance. She will discuss and provide a blueprint on how to handle such issues as chemical dependency, financial distress, sexual harassment, depression, domestic violence, depression, and disability.
To attend the meeting, make your reservation online at www.hcms.org and click on “Meeting RSVPs” in the left-hand margin or call HCMS at 713-524-4267.
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Dissolve by July 1 to avoid new business tax
Although the Texas Office of the Comptroller has not yet issued rules to implement the new business tax law passed by the legislature last year, it is offering some public statements about the complicated transition rules for new taxpayers.
Its interpretation of the law indicates that taxpayers who are dissolving newly taxable entities, including professional associations and limited liability partnerships, will not owe any tax if the dissolution is completed before July 1.
Please discuss this with your accountant prior to making any decisions.
Source: TMA Action – February 2007
Presented by the HCMS Board on Socioeconomics
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TexMed 2007 set for April in Dallas
Take a giant step toward building a better practice at Texas Medical Association’s (TMA) annual conference, TexMed 2007, Thursday through Saturday, April 26-28, at the Hyatt Regency Hotel in Dallas. The conference is free to TMA members.
What’s New at TexMed 2007?
• A free reimbursement mini-consultation with TMA Payment Advocacy staff. Appointments are limited, so contact the TMA Knowledge Center at 800-880-7955.
• The new Health Information Technology track with electronic medical record demos on Thursday.
• A drawing in the Expo Hall for a two-year lease on a 2007 Mini Cooper Convertible!
While you’re at TexMed, you can explore current trends in the prevention, screening and treatment of breast, cervical, skin, and colorectal cancer; get the latest on such hot topics as herbal remedies, vaccines for HPV and shingles, methicillin-resistant infections, and more. Also, learn from the Texas Medical Association Insurance Trust about ways to reduce the risk of identify theft in your professional and personal lives.
Kevin Carroll, author of Rules of the Red Rubber Ball, is the keynote speaker for the Thursday General Session, and Lucian Leape, MD, will present The Power of Apology at the Saturday General Session.
The conference offers 120 hours of free continuing medical education (CME) programming; a sizeable Expo Hall, featuring more than 150 exhibits; and endless opportunities to network with colleagues from across the state.
Here are a few other reasons you should attend TexMed 2007:
• Register your medical office staff at a discounted rate of $75, which allows entry to all TexMed events, such as technology and practice management workshops, and a trip to the Expo Hall.
• Take advantage of opportunities to earn a professional liability discount from the Texas Medical Liability Trust (TMLT).
• Explore the Expo Hall, highlighting hundreds of new products for enhancing your practice.
• Help set association policy at the TMA House of Delegates meeting and at TMA and specialty society business meetings.
You can register for the conference on the TMA Web site, www.texmed.org.
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Trends Economic survival tops physicians’ concerns
Texas physicians have named stagnant or declining reimbursement, combined with increasing practice costs, as the biggest challenge facing them, stated a recent Texas Medical Association (TMA) survey.
TMA conducts the physician survey every other year. The 2006 survey included responses from 1,617 physicians and has a margin of error of plus or minus 3.5 percent with a 95 percent confidence level.
While low and declining reimbursement ranked at the top, 13 percent of physicians cited economic survival as the biggest challenge. That was followed by the uninsured and underinsured, 11 percent; managed care/insurance issues, 9 percent; and quality of care/access concerns, 7 percent.
Fifty-five percent of physicians surveyed said their income had declined over the past two years, while another 29 percent said there was no change. Only 16 percent said their income had increased.
Meanwhile, nearly three-fourths said they were experiencing slow payment and related cash-flow problems. Of those, 39 percent said they had drawn from personal funds, and 32 percent had secured commercial loans to fund practice operations.
The financial constraints are forcing some physicians to limit their practices, especially for low-paying government programs such as Medicaid. In 2006, only 38 percent of physicians said they accept new Medicaid patients, down from 45 percent in 2004 and 67 percent in 2000.
Sixty-nine percent of physicians said they limit their Medicaid and Children’s Health Insurance Program participation because fees are too low, while 19 percent said administrative burdens were too high.
To view the survey, go to http://www.texmed.org/uploadedFiles/Governmental_Affairs/Texas_Legislature/SURVEY.FINAL.PDF.
Source: TMA Action, Feb. 2006
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Charity clinics
The Harris County Medical Society Web site has a list of charity clinics just in case our members are in need of the information. The list contains information on primary care, pediatric care, immunization, prenatal care, and dental services. To review the list, go to http://www.hcms.org/Template.aspx?id=356.
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Installation photos available online
The photographs from the 2007 HCMS/HAM Installation of Officers are available to view and buy at www.hcms.org.
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TMA Seminar
The Verdict Is In Part II
Date/Time: Wednesday, April 4, 5:30 p.m. to 9 p.m.
Location: Houston Hilton Westchase & Towers, 9999 Westheimer Rd.
This seminar is developed for physicians, practice administrators, compliance officers, and billing/coding personnel who are involved in the submission of claims and interested in improving the practice’s bottom line.
CME: TMA designates a maximum of 3 AMA PRA Category 1 credits.
Costs: $79 for TMA members or their staff and $129 for nonmembers.
Contact: 1-800-880-7955, or visit www.texmed.organd click on CME.
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Business of Medicine
Is it time for your practice to adopt an EMR?
Every health care journal these days seems to highlight the national interest in electronic health records (EHRs). Since publication of the 1999 Institute of Medicine report, “To Err Is Human: Building a Safer Health System,” politicians and health care officials have touted EMRs as a way to increase quality, encourage savings and reduce errors. In 2004, President George W. Bush launched a federal initiative to make electronic health records available to most Americans by 2014.
Where medicine has embraced technology, once unimaginable diagnostic tools and treatment models now are commonplace. However, medicine’s adoption of health information technology (HIT) — among physicians, hospitals, other health care professionals, and patients — has not kept pace with the business community.
• What is driving the push for HIT in physician practices?
• How can physicians respond to the drivers?
• Is an EMR the answer for your practice?
• Are there alternatives that will meet your needs?
Texas Medical Association (TMA) has developed a white paper to aid physicians in navigating the variable and rapidly changing field of HIT. TMA’s Health Information Technology Department is dedicated to helping physicians with the successful implementation of office technologies. For more information, contact TMA at 800-880-5720 or HIT@texmed.org. For additional HIT information, click on the Health Information Technology section of the HCMS Web site, www.hcms.org, located on the left column.
Source: TMA
Presented by the HCMS Board on Socioeconomics
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