In the past, Medicaid covered the full
amount of the dual-eligible patient’s de- ductible. But under the new policy, Med- icaid pays only up to the Medicaid allow- able charge. So, where the doctor would have received $100 in the example, he or she may now receive only $50, de- pending on what Medicaid pays for that particular service. Affected Texas physicians watching
their balance sheets say the combined 20-percent cut in copayments and the reductions to the deductible mean phy- sician’s reimbursement is slashed to 37 percent, depending on the diagnosis. Texas is not alone in implementing
this new payment policy. Some 20 other states have done the same. While hits of that magnitude are bad
enough for medical practices with high dual-eligible populations, the bad news got even worse. At the same time Medic- aid implemented the new payment poli- cies, HHSC also converted to the new Health Insurance Portability and Ac- countability Act (HIPAA) Version 5010 electronic transaction standards. Helen Kent Davis, director of TMA’s
Office of Governmental Affairs, says it became clear as early as mid-January that the 5010 conversion impacted the crossover of claims from Medicare to Medicaid. “What it meant was that doctors
would submit the claim to Medicare, and Medicare would apply the amount to the deductible and then send the claim to Medicaid,” Ms. Kent Davis said. “But Medicaid was paying zero because of the problem with the 5010 conversion.” Dr. Saenz says his practice lost about
$50,000 in Medicaid deductible pay- ments in just four weeks. He sought a line of credit to keep his doors open un- til the situation is resolved. Houston cardiovascular surgeon
Emilio Hisse, MD, also sees a large number of dual-eligible patients in his practice. He says he has experienced a “60-percent hit” in his revenues from the dual-eligible patient population since the first of the year. And Edinburg gastroenterologist Car-
ols Cárdenas, MD, vice chair of the TMA Board of Trustees, says Dr. Saenz and other physicians lost thousands of dol-
Online Lab Results.
Online access to DSHS Laboratory results and Newborn Screening Remote Data Services is now available to all Texas Health Steps medical providers. Online lab and newborn screening results will help you minimize common errors related to specimen collection, reduce the need for re-collection and re-testing, and cut the waiting time for results.
To access these services, visit
www.dshs.state.tx.us/lab/remoteData.shtm
Taking New Steps June 2012 TEXAS MEDICINE 39
lars more in the intervening weeks. “You can’t survive on nothing, and you can’t keep your doors open on nothing,” Dr. Cárdenas said. “Yet, at the same time, you can’t turn your back on the people you’ve made a community commitment to serve. It’s an untenable situation. That’s where a lot of the fellows on the front lines are right now.”
Solution sought In addition to the rally, TMA hosted a physician town hall meeting on the issue in McAllen. At that meeting, Billy Mil- wee, the state Medicaid director, said HHSC is trying to resolve some of the problems. The computer issues are fixed, and
HHSC will pay previously denied de- ductible payments, he said. HHSC ex- pected to catch up on those payments by mid-April, Mr. Millwee said. Dr. Cárdenas, however, said in early April that he had not heard of any phy-
sician in the Valley receiving payments. Mr. Millwee also said HHSC Execu-
tive Commissioner Tom Suehs is looking at other ways to lessen the impact of the copayment cuts. “The commissioner has some authority to make some exceptions for access to care,” he said. In fact, HHSC did two things officials
say should help. First, Commissioner Suehs decided to exempt services per- formed by psychiatrists and psycholo- gists from the copayment cuts. He did so, in part, because the Medicare copayment for mental health services is 40 percent, not 20 percent as with other services. Also excluded were two codes for trans- porting portable x-ray machines. Those changes took effect May 1. And, HHSC agreed to increase Med-
icaid payment rates for cancer chemo- therapy medications to 100 percent of the current Medicare rate. That change came after oncologists convinced HHSC officials they could actually save Medic-
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