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TOA
President's
Update
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By John T. Gill, MD
President, Texas Orthopaedic Association
If your Board Certification
expires in 2010 and you are planning to recertify, pay
particular attention to this article. The amount of effort
required and the proximity of deadlines will amaze you. It
amazed me when I began to dig deeper. The FIRST thing you
need to do is go to
www.abos.org and register to get a username and
password. Then have a good look at the process. |
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We have
known it was coming, but now Maintenance of Certification (MOC) is
upon us. The class of 2010 will be the first to recertify under the
new process. If you were hoping to take your test in 2008, forget
it. You have already missed the deadline. We are now half way
through the process to apply for the 2009 test. Just to clarify, MOC
did not originate from the AAOS, nor is it an Academy activity. It
originated from the American Board of Medical Specialties, the mother
board of the 24 specialties, and is administered to us via the
American Board of Orthopaedic Surgeons (ABOS).
To sit for
the 2009 Computer Examination, the first critical deadline you
need to circle on your calendar is 12/15/2007. By this date
you must have submitted to ABOS copies of CME certificates proving 120
hours of ACCME accredited Category 1 CME that was done in calendar
years 2005-2007. Of those 120 hours, at least 20 hours must be scored
and recorded self assessment exams, meaning you must submit your
answer sheet for scoring rather than self scoring.
Also by
12/15/2007, you must have completed submission of a 3 month case
list of consecutive cases, up to 75, performed in 2007. Each of these
cases must be entered individually on the password protected ABOS
website in great detail, including almost two screens of dropdown
menus, ICD-9 codes, CPT codes, questions on pre-operative planning and
follow-up, and a brief narrative of the case.
If you
successfully complete the steps above by 12/15/2007, the application
for the 2009 Examination will be available to you on the ABOS website
starting 1/15/2008. The application and fee must be completed and
submitted by 5/1/2008. Once you receive your acceptance to sit
letter, you have until 12/15/2008 to submit your computer pathway
confirmation. The examination takes place in 2009. The requirements
and deadlines for the MOC Oral Examination Pathway are slightly
different so check the ABOS website for details. Whew!
The
hurdles here are the Self Assessment Exam and the case list. I
strongly suggest that you choose three months between January and June
of 2007 and start entering your cases now. It will take a lot of
time. The AAOS, as well as the specialty societies, have scored and
recorded SAE’s available, but don’t wait until the end of the year as
you may not receive your scoring certificate back in time for the
12/15/2007 deadline. Good luck.
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AAOS
Web Site Has All You Need To Know About PQRI
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The CMS Physician Quality Reporting
Initiative (PQRI) is a voluntary program in which physicians collect
and report their practice data in relation to a set of 74 performance
measures. The new AAOS Web page devoted to PQRI provides members with
an overview of PQRI, links to |
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information on 10 orthopaedic-related
quality measures, and worksheets that include the CPT and
ICD-9 codes related to the specific measures. These
worksheets will be updated as new quality measures are
identified and approved. The PQRI program begins July 1,
2007 and runs through December 31, 2007. To qualify for up
to a 1.5% bonus on all your Medicare billings (excluding
charges for x-ray, DME or PT) during that period, you must
report at least three performance measures on 80% of the
eligible patients. The AAOS PQRI page can be viewed
here.
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate / Memos: Thu May 31 & Tue
May 29, 2007
TOA Online Version: All Memos
May 31, 2007, Thursday
So far, there
are eight candidates for Speaker in 2009. In addition to Speaker
Craddick, Republican Representatives Fred Hill, Delwin Jones,
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Jim Keffer, Brian McCall, and Jim Pitts have filed the required
paperwork to run for Speaker. On the Democratic side of the
aisle, Representatives Senfronia Thompson and Sylvester Turner
have thrown their hats into the ring.
The action in Austin now focuses on the Office of the Governor.
Bills received by Governor Perry during the last 10 days of
session must be signed, vetoed or allowed to go into effect
without the Governor’s signature by Sunday, June 17th. Governor
Perry also has line-item veto authority over the state budget
and in the past, he has not been shy about using this authority.
May 29, 2007, Tuesday
After the latest
Sine Die in recent years, the 80th Regular Session of the Texas
Legislature is complete. The budget went down to the wire in
both the House and the Senate but passed both by comfortable
margins. With the budget and SB 792, the transportation bill
hurriedly passed in the last few weeks of session, it looks like
we have avoided a special session…at least this summer.
The final unofficial numbers have been released. Out of 4140
House Bills filed, 953 were passed. Out of 2058 Senate Bills
filed, 525 were passed. The Legislature also managed to pass 17
Joint Resolutions, one of which was voted on by Texans earlier
this month. The remaining 16 will be on a statewide ballot in
November.
End of Session Legislative Reports will be on their way soon.
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Workers'
Comp: Legislature Clears Out Final Comp Measures
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By Michael Reed
TMA Director of Managed Care Delivery Systems
Legislation to
require that a health care provider be certified in a relevant
specialty to evaluate the care given an injured worker by
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another health
care provider was among the last measures sent to Gov. Rick Perry by
the Texas Legislature.
Lawmakers ended
their 140-day session Monday and are not scheduled to meet again until
January 2009 unless called into a special session by the governor. Perry
has until June 17 to veto, sign or allow legislation to go into effect
without his signature.
Before the session
convened Jan. 9, legislative leaders reported they did not anticipate
making any major changes to HB 7, the reform measure passed in 2005, in
order to give the changes sufficient time to be implemented.
But this year's
session saw the introduction of more workers' compensation measures than
was expected, although most proposals for changes died in committee.
Among the failed proposals were bills to provide carve-out pilot
programs in the construction industry, to change the basis for
calculating medical fee schedules, and to provide court-appointed
attorneys for claimants who prevail in administrative proceedings but
are unrepresented in appeals to district court.
The final days of
the session also saw provisions from some bills which had failed to pass
being included in other measures as amendments. For example, HB 724 by
Rep. Burt Solomons, (R) Carrollton, began as a measure providing
administrative appeals in workers' compensation medical disputes. But it
was approved and sent to the governor after provisions were added to
provide for payment of death benefits to non-dependent parents of
deceased workers and for handling of subclaims.
The Legislature
approved the following bills:
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HB 34, Solomons
Prohibiting kickbacks or inducements regarding
workers' compensation claims.
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HB 473, Solomons
Payment of workers' compensation benefits and
interlocutory orders.
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HB 724, Solomons
Workers' compensation claims and death
benefits.
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HB 886,
Giddings
Optional preauthorization program for
return-to-work pilot program for small employers.
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HB 888,
Giddings
Free medical records for ombudsmen.
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HB 1003,
Giddings
Licensing requirements for doctors performing
independent medical reviews.
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HB 1005,
Giddings
Timely submission of claims by health care
providers.
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HB 1006,
Giddings
Licensing requirements for doctors performing
peer reviews.
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HB 1602, Rep. Corbin Van Arsdale,
R-Tomball
Venue requirements
under the Jones Act.
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HB 2004,
Giddings
Specialty certification requirements for peer
and utilization review doctors.
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SB 458,
Sen. Kirk Watson, D-Austin
Workers' compensation
coverage for damaged prosthetic and orthotic devices.
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SB 1169, Sen. Kyle Janek,
R-Houston
Reimbursement of workers'
compensation carriers for overpayments and interlocutory orders.
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SB 1627, Sen. John Carona,
R-Dallas
Allowing prosecutors to seek
increased penalties in workers' compensation fraud cases.
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Guarantee Your
Patient Payment - Use Easy Pay
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By Jerry Bridge
President, Bridge Practice Management
Traditionally, most healthcare offices bill insurance companies and
balance bill patients for the difference in coverage (except where the
provider is contracted to accept the insurance payment as payment in
full). From there, the office simply sends the bill to the patient,
the patient pays and we all live happily ever after…right? WRONG!!!
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A ‘long time ago and
far away’ in a time when only one spouse needed to work to support the
family, before credit cards and cable TV; when healthcare (insurance)
was relatively inexpensive, your patients got the bill and paid it!
Those days are long gone. In the current business climate the doctor
bill routinely falls to the bottom of the pile of bills to be paid each
month. In fact, among the list of the top 25 household bills to be paid
each month the doctor bill is 24th -one notch above the
lawyer’s bill and 14 places behind cable TV!
Many offices have
their patients sign the financial policy stating their promise to
pay. Ever notice how little that promise means for some when it comes
time to pay? We’ve all heard the excuses; “my insurance was supposed to
cover it, you people take care of it”, “I’m not happy with the service”;
“it sounds like all you people are interested in is the money (in your
case-yes!)”. The only real way to guarantee your payment is by
having patients provide account information that can be used to balance
bill. Otherwise, you’re operating like a bank offering nothing but
unsecured loans! Scary!
Guarantee Patient
payments -Try using ‘Easy Pay’
The
only way to guarantee patient balances, co-pays and deductibles is by
maintaining credit, debit or check information on file. Blockbuster
Video does it, so why can’t your office implement the same policy? Think
of your own experience; when you joined the video club (or Health club,
or purchased the term life insurance, or bought the exercise bike) using
your credit card and making easy monthly payments. If you’re
like most of us, you probably never gave a second thought to the
process…you gave your credit card number to the teenager at the video
club or to the STRANGER OVER THE PHONE!
Educating your
patients
Some
of you might be thinking… “My patients will never go for this; they will
be upset; I can’t even get them to give me their social security number!
; As a matter of fact, I’m not even sure if I’d do this and I work in a
doctor’s office!”
Resistance is futile.
We are living and working in an age driven by internet technology;
racing towards a ‘paperless economy’. Your patient’s health history and
bank information will be read from the bio-metric scanner that sits
where your credit card machine used to be!
Over the past 12
years I have worked with over 40,000 healthcare offices on improving
collections while keeping patients happy; each office has its own unique
challenge when it comes to re-educating patients on your new
financial policy. Generally, I recommend that you make EASY PAY
an option for existing patients that like to get a bill and pay the
bill. For new and problem patients however, EASY PAY should be
mandatory!
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Recap: 80th
Legislative Session
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Accomplishments
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Blocked
efforts to roll back tort reform – Stopped SB 468 by
Sen. Rodney Ellis from being debated by the full Senate
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Provided
critical adjustments to previous Workers’ Compensation
reforms:
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HB 1003
will require an independent review organization that uses
doctors to perform reviews of health care services in workers’
compensation cases to use only doctors licensed to practice in
Texas. Effective 9/1/07
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HB 1005
provides that a health care provider of workers' compensation
health care services does not forfeit the provider’s right to
reimbursement if the claim for payment is timely filed, but
erroneously filed with the wrong insurer. This bill
passed and has been sent to the Governor.
o
HB 1006
will require doctors performing utilization review,
retrospective review, and peer review to be licensed in
Texas. Effective 9/1/07
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HB 2004
would require a doctor reviewing a workers' compensation case
to be certified in a specialty appropriate to the type of care
an injured employee is receiving. This bill passed and has
been sent to the Governor.
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Podiatry – Defeated all attempts to have legislation
introduced related to the definition of the foot.
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Podiatry – HB 1477 by Rep. Sylvester Turner would have allowed
parity in reimbursement rates for podiatrists with those of
physicians. Left pending in committee.
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Physician Credentialing
– HB 1594 by Rep. John Zerwas expedites health plan
credentialing for physicians new to an established physician
practice. Passed.
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Smart Card Technology – HB 522 by Rep. Beverly Woolley would
authorize the Department of Insurance to develop a pilot for
smart card technology. Passed.
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Funding
for the Texas Medical Board – an additional $1.2
million was appropriated to the Texas Medical Board to
facilitate review of physician applications. Passed
in HB 15.
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Radiology – Defeated attempts to mandate that physicians
disclose and report certain information about their
ownership interests of diagnostic imaging services. Also,
would have required the physicians to pay a fee to the
state.
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Pathology – SB 1832 by Sen. Robert Duncan was amended to only
require certain disclosure of charges related to anatomic
pathology services. Language that would have allowed direct
billing by pathologists was removed.
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Joint Entities
– HB 3035 by Rep. Sylvester Turner would have
authorized Chiropractors and physicians to co-own
organizations that provide health care services. Died in
Senate Health and Human Services.
See Ya Next Session
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