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TOA
President's
Update
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By
David Teuscher, MD
President, Texas Orthopaedic Association
The
good news on our medical liability reforms enacted in 2003
continues to roll in. Lower premiums, less liability future
risk, easier recruitment of orthopaedists, and greater
access to care for our patients. Our current enthusiasm must
be tempered with the knowledge that those reforms are under
a constant and coordinated attack that
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may
ultimately lead to their undoing without our continuous
attention.
The
number of carriers in Texas writing professional medical
liability policies has increased from 4 to 36 since 2003.
This includes 8 admitted carriers, 19 risk retention groups,
and 5 surplus line carriers. Texas physicians insured by the
JUA have declined from a peak of 2,691 to 1,202 and are
expected to continue to decline further as private carriers
compete to write your policy. Claims filed in Texas that
averaged more than 400 per month before the huge load filed
just before the reforms took effect, are now averaging 175
per month in the past year. I doubt that any of us involved
in the reform efforts expected so much success this early.
Before
our tort reforms passed, the opponents claimed that the
crisis was due to greedy insurance companies that needed to
be regulated, bad doctors needing discipline, and bad
investments in a stock market downturn. After an interim
period of silence, these same opponents of tort reform are
now playing a steady drumbeat of criticisms that the reforms
went way too far, victims can’t find a lawyer because of
the caps, and the cap unfairly hurts the poor, young,
elderly, and disabled. I say that they were wrong about it
back then and they are still wrong today.
The
October issue of the American Bar Association Journal
featured an article about the Texas reforms titled “New
Laws and Med-Mal Damage Caps Devastate Plaintiff and Defense
Firms Alike”, should confirm our suspicion that the
organized Texas defense bar has openly joined the plaintiff
trial bar in seeking to change or challenge the non-economic
cap. What is their agenda? They want to index the cap to
inflation, raise it to a higher level, and/or create
exceptions that will blow a hole in the cap. They will run
stealth candidates as Republican and continue to try to
purge pro-reform Democrats, with an eye on weakening our
reforms in future legislatures. Even more insidious, they
will try to elect district and appellate judges that will
have great discretion on how to apply the law, or worse yet,
will rule parts of the reform unconstitutional. Not
on my watch!
What
am I asking of you? If you helped pass the reforms in 2003,
take a bow. If you are benefiting from the reforms, support
our TO-PAC and pro-reform candidates. If you want to make
the changes permanent, get to know the men and women who
want to be your representative, senator, judge, or justice;
and make sure they share your enthusiasm and vision for the
future of Texas. If you would like a copy of the article I
referenced above, email that request to info@toa.org.
The price of liberty is eternal vigilance.
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CMS
Focus On Fraud And Abuse Results In $2 Billion In Savings
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CMS has saved U.S. taxpayers more than $2 billion since 2004, according to an agency press release. The agency credits the savings to “more aggressive local oversight and specially targeted fraud and abuse initiatives.” In 2006, CMS expanded its Los Angeles and Miami
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offices, resulting in increased ability to target fraud, waste, and abuse in Medicare.
Additionally, CMS claims that its Los Angeles office, among other things, revoked the billing numbers of 117 fraudulent Medicare providers, resulting in a savings of $200 million. The agency’s Miami office claims to have saved more than $1 billion and begun 400 new investigations as a result of teaming with state and local law enforcement and licensing agencies.
Click here
for more information.
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Where
Is Your NPI?
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Provided
By Ann Hillius
Department B
Have
you applied for your NPI (National Provider Identification)?
It
will be necessary for you to share your NPI with all
providers to which you refer services and for all referring
physicians to share their NPI with you for billing.
Without the NPI on some services (consultations,
ancillary) your claim will not be paid.
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We
encourage you to apply for your NPI today. Currently, the
turnaround is about 15 days.
As more and more providers
apply,
it will prolong the process. Important dates and activities
of NPI use are October
2, 2006- May 22, 2007. During this time, CMS systems will accept an existing legacy Medicare billing
number and/or NPI on claims. If
there are any issues with the provider’s NPI and no Medicare legacy
identifier is submitted, the provider may not be paid for the claim.
Therefore,
Medicare strongly recommends that providers, clearinghouses, and billing
services continue to submit the Medicare legacy identifier as a secondary
identifier.
Medicare
will be capable of sending the NPI as primary provider identifier and legacy
identifier as a secondary identifier in outbound claim, claim status response,
remittance advice (electronic but not paper), and eligibility response
electronic transactions.
After
May
23, 2007, CMS systems
will only accept NPI numbers. Small
health plans have an additional year to be NPI compliant.
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T-Bones:
2006 Fall Meeting in Austin, TX
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By Michael A. Berkowitz
Administrator
I am pleased to
announce the Fall Meeting of the Texas Orthopedic |
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Administrators
Association (T-BONES) will be held Friday, November 10th, 2006 at the
Doubletree Guest
Suites Austin Hotel in downtown Austin.
On Thursday evening T-Bones Members and guest have been invited
to a dinner hosted for our members by Euflexxa, which will be held at
Cedar Street Courtyard located at 208 West 4th Street,
Austin, TX, 78701.
I have received
commitments from speakers who will provide valuable information to our
group. They will address a
variety of relevant topics.
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Michael Cushman is an attorney with Stone Loughlin & Swanson,
LLP in Austin. He will
address issues arising from changes in the Workers’ Compensation
system.
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Bill Darling is a Partner with Strasburger and Price, LLP in Austin.
He will be speaking about Pay for Performance.
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Duane Hill is the administrator of Beaumont Bone and Joint.
He will be discussing the importance of having a disaster plan
for an Orthopaedic practice.
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Lance Spivey is the Principal for RCFO in McKinney, Texas.
He will be discussing Benching and Key Performance Indicators.
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Brian White is the Counsel for Policy Development in the Office of
Injured Employee Counsel (OIEC) for the State of Texas.
He will be speaking about this new state agency.
I am enclosing a
tentative program as well as a registration form which will give
additional information about this meeting.
The expense for the Friday, November 10th, meeting is $75, which
includes breakfast and lunch. Please
send your registration form as
soon as possible since I must notify the hotel of the number of
registrants. Again, the meeting
will be held at Doubletree Guest Suites Hotel.
The hotel has agreed to reserve a block of rooms under the name
of T-Bones for those interested individuals, but there is a deadline for
reserving rooms at the convention rate.
Reservations need to be made through the Doubletree
Guest Suites Austin hotel by calling 512-478-7000 or by clicking on their
website link.
Please contact me at
281-440-6960 (office) or 713-728-4882 (home) if you have any questions
concerning this information. I
hope you will be able to attend this most important meeting. Thank you for your time and cooperation.
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Tired
of WC Peer to Peer Review? See
Information Forms
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TOA has
developed a Workers Compensation Peer to Peer Review hassle
factor log. Click here
to access either a Word document that can be completed and
returned by email or a Word document to be printed,
completed and faxed back. If you have a problem with
either Word document, please click here
and download the .PDF file to print and complete.
Please collect this information for a 30 day
period. All we need is one month to gather common complaints
for this Work Comp |
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process which is not working at this time.
We are asking physicians and/or clinic staff to participate in
collecting information. TOA will compile and take this
information to the
Texas Department of Insurance Division of Workers
Compensation.
Please remember - NO social security numbers or
patients’ names (HIPAA). Complete the questions regarding
insurance companies (i.e. Texas Mutual) and preauthorization
companies (i.e. Intracorp) and most importantly, the Peer
Reviewer’s information. The form can be filled out two ways.
There is the option of printing out each form to be completed
and faxed to 512-370-1515 or you can fill out the form in the
Word format and when completed send it by email to Donna
Parker.
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