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AD DIRECTORY


Baylor Scott & White Health .......................28 Capital Farm Credit .....................................55 Children’s Connections Inc. ........................ 41 Dept. of State Health Services .......34, 36, 47 First United Bank.........................................34 Frost Bank ...................................................53 Gray Reed & McGraw ..................................27 Houston Methodist Hospital .......................57 Humana ....................................................... 12 Kindred Healthcare ................................... IBC Leichter Law................................................33 Lexicon Medical ..........................................48 REC — North Texas .....................................42 Regions ........................................................5 Rx Security ..................................................57 Shannon’s Hope Foundation .......................53 StratMedical ...............................................50 TEAMHealth ................................................63 Texas Cardiac Center ..................................48 Texas Health Services Authority ................. 19 Texas Health Steps ...............................35, 43 Texas Medical Association Bank of America........................................58 Be Wise — Immunize ................................ 14 Choosing Wisely .........................................8 Classifieds ..................................................7 Foundation ................................................63 Practice Consulting ..................................42 Publications .............................................49 Seminars ..................................................56 TexMed 2015 ...............................................3 TexMed Poster Session Call for Posters ...39 TEXPAC .................................................... 44


Texas Medical Association Insurance Trust ......................................................... BC


Texas Medical Liability Trust ......................IFC Texas Mutual Insurance Co. .........................17 The Menniger Clinic ......................................6 Vidaurri, Lyde, Rodriguez & Haynes, LLP ....58 West, Webb, Allbritton and Gentry, PC ....... 19


Classified ads are accessible on the TMA website, which experiences more than 71,000 visitor sessions each month. Your self-administered online classified ad can be purchased for as little as $25. Visit http://classifieds.texmed.org, and create your account today.


“If health plans are not inclined to prioritize network adequacy require- ments, as is implied by plan failure to comply with the most basic network adequacy reporting requirement, then it becomes much more important for the Department to make the health plans prioritize network adequacy through strong regulatory and en- forcement actions,” TMA President Austin King, MD, and the presidents of the 11 other societies wrote. It is important to note that the


working draft proposal is subject to further revision before publication of a final rule proposal. TMA and the specialty societies will continue to monitor the rule’s development and will provide additional comments when TDI proposes the rule formally, which is not expected until after the legislative session.


Feds say they cut burden of RAC audits


IN RESPONSE TO INDUSTRY FEED- BACK, the Centers for Medicare & Medicaid Services (CMS) late last year released 20 improvements to its Recovery Audit Program (RAC) to reduce its burden on physicians, en- hance oversight, and increase trans- parency. The changes take effect when the next recovery auditor contracts are awarded and are listed on the CMS website. Addressing one of physicians’ chief complaints, CMS will shorten the look-back period for patient status re- views from three years to six months from the date of service, as long as the hospital submits its claim within three months of that date. Another change will adjust the number of case reviews


— which CMS calls additional docu- ment requests (ADRs) — physicians undergo, and base them on physi- cians’ compliance with Medicare rules. Where before there was no differenti- ation, now, physicians with low claims denial rates will have fewer ADRs.


18 TEXAS MEDICINE March 2015


Instead of physicians waiting 60


days for a determination in a com- plex review, RAC auditors must now complete them and notify providers of their findings in 30 days. Also, CMS increased the post-determination dis- cussion period. RAC auditors must now wait 30 days after their determi- nation before sending claims to Medi- care administrative contractors for ad- justment. This gives physicians time to submit a discussion request with- out forcing them to choose between initiating a discussion and submitting an appeal. The extra time allows for modifications to improper payment determinations before submitting the claim for adjustment. To increase system accountability,


CMS now requires RAC auditors to maintain an overturn rate of less than 10 percent at the first level of appeal and an accuracy rate of 95 percent on automated reviews; otherwise, they face a corrective action plan that could include lower ADR limits. RAC auditors will not receive a contingency fee until after the second level of ap- peal is exhausted. Previously, they were paid immediately upon denial and recoupment of the claim. CMS also will increase public re-


porting on data such as appeals, qual- ity assurance activities, and timeliness standards.


Attorney to physicians: Keep minors’ records longer than 10 years


AS WE REPORTED in the December 2014 Texas Medicine story “Equal Jus- tice For All,” which is available online at www.texmed.org/EqualJustice, the Supreme Court of Texas upheld the statute of repose — part of the Tort Reform Act — that bans patients from filing medical liability lawsuits more than 10 years after an injury. In Tenet Hospitals Limited v. Eliza- beth Rivera, the court addressed the


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