"Preauthorization Denial: What’s your recourse?" Has a health plan denied a preauthorization request for a patient’s treatment? What options do you have?  This article contains useful, practical information to help physicians combat one of the most vexing parts of running a medical practice. 

Telemedicine: DCMS resources for the expanded the use of Telemedicine and Tele-health

TMA ICD-10 Toolkit
TMA’s resource page for all ICD-10 member only tools and updates

In May 2016, TMA unveiled their first patient education piece on the root causes of unexpected medical bills.  View "Why Did I Get That Medical Bill” and share it with patients.

Physician’s Foundation 2016 Comprehensive Patient Survey. This new research shows that nine out of 10 adults report high levels of satisfaction with their PCP.

AMA Code of Medical Ethics – First of Its Kind  In 1847, physicians representing 22 states and the District of Columbia came together to establish America’s first national professional association for physicians, the American Medical Association (AMA). As one of its first acts, the AMA created the first national codification of ethics for any profession anywhere in the world. As the first of its kind, the 1847 AMA Code was reprinted by medical societies in Berlin, London, Paris, Vienna, and around the world. Throughout the rest of the 19th century, it was the most commonly printed medical document in the English language. Today, the AMA Code remains the only codification of professional conduct for all US physicians regardless of their medical specialty, practice type or location. A commemorative, leather-bound edition of the modernized AMA Code is available.


 
Frequently Asked Questions:

 How to Discharge a Patient  CHECKLIST for Closing a Practice, Retiring, or Selling a Practice
 What to do with Patient Records  Starting a Practice
 How long must I keep my medical records?  Understanding Your Payer Contracts
 Sample Clauses for Transfer and Custody of Medical Records  Strategies for Negotiating Your Contracts
 Example Schedule Management Policies  



How to discharge a patient 

The physician should give the patient notice via a letter stating that the physician is terminating the relationship (except for in emergent cases) as of a certain date. That date must be at or beyond 30 days of the notice. It is a good idea to outline the reason for discharge, possibly citing office policies to which the patient did not adhere. Please refer to the most recent Texas Medical Board rules

SAMPLE Terminating Patient-Physician Relationship Letter

SAMPLE Authorization to Release Medical Records Letter
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Example Schedule Management Policies 

POLICY
To notify patients of a possible financial penalty for failure to cancel a scheduled appointment. All offices will document in the medical record when a patient no-shows an appointment or cancels an appointment on short notice. 

Failure to give 24-hour notice of cancellation of an appointment or no-showing an appointment can result in a charge of $25 on the patient's account. Patients should be advised of this when scheduling their appointment. This charge cannot be billed to the insurance company. Failure to pay a no-show fee will be treated according to our policy on unpaid balances, with the exception of collection accounts. 

Medical care will not be withheld for a medical emergency. No-showing 3 appointments can result in the patient being discharged from the practice, at the physician's discretion. 

PURPOSE
To make the patient aware that missed appointments have an impact on the physician's schedule as well as possible health risks for the patient.

PROCEDURE 
I. Documentation 
All missed appointments will be documented in the patient's medical record. A copy of any correspondence will be kept in the patient's medical record. All no-show policies will be enforced on a "by site" basis and not by individual physicians within a site. 
Enter the no show in the appointment module. 
When posting the charge, enter "no show" and a $25 charge will automatically appear.

II. Notification 
All patients will be notified of our no-show policy at the time of making their appointment and at appointment confirmation. Signs will be posted in the office waiting area and/or exam rooms. As appointment cards are reprinted, it will be written on the card that a charge "could be" incurred for failure to cancel or for late cancellation. Patients may be warned that they have violated the policy by phone or by letter, if the physician chooses.

SAMPLE Appointment Cancellation Policy Letter
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What to do with patient records

Please inform DCMS of any additional information concerning where your patients' records will be stored. The information will be put in your file. Any information about who will be taking over your practice can be kept in your file to help patients who call the DCMS offices for information.

SAMPLE Authorization to Release Medical Records Letter

Steps to transfer patient records:
  1. Outline steps
  2. Define charges allowed (different in some cases)
  3. Describe alternative options
    1. EHR capabilities
    2. Outsourced through a separate company
  4. Paper vs. Fax vs. Electronic
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How long must I keep my medical records?

The Texas State Board of Medical Examiners has established the length of time patient records must be maintained.

  • Each licensed physician of the board shall maintain an adequate medical record documenting or memorializing the history, diagnosis, and treatment, for each patient.
  • A licensed physician shall maintain adequate medical records of a patient for a minimum of seven years from the anniversary date of the last treatment by the physician.
  • If a patient was younger than 18 years of age when last treated by the physician, the medical records of the patient shall be maintained by the physician until the patient reaches 21.
  • A physician may not destroy medical records that relate to any civil, criminal or administrative proceeding if the physician knows the proceeding has not been finally resolved.
  • Physicians shall retain medical records for such longer length of time than that imposed herein when mandated by other federal or state statute or regulation.
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CHECKLIST for closing a practice, retiring, or selling a practice

SAMPLE Closing Practice Notification Letter

  • Notify patients
  • Notify employees.
  • Practice Change Sample Forms
  • Evaluate the terms of the lease and give notice to landlord as required, or consider options to renegotiate if the lease is of longer duration than the time the physician wishes to remain in practice.
  • Investigate sources to sell or dispose of medical and office equipment.
  • Make arrangements to store or transfer custody of medical records.
  • Inventory drugs and dispose, sell, transfer, or donate according to federal and state requirements. Contact the Drug Enforcement Administration (DEA) for specifics.
  • Send letter to DEA six weeks in advance, notifying the agency of the change, along with old and new addresses. Mail to the following branch:

Drug Enforcement Administration
Dallas
10160 Technology Blvd, East
Dallas, TX 75220
(888) 336-4704
(214) 366-6900

  • Review the Texas Medical Board rules on medical records.
  • Send notification of change to DCMS membership department via email to linda@dallas-cms.org or FAX information to 214-946-5805. DCMS staff will then notify the Texas Medical Association and American Medical Association of membership changes.

If the physician is retiring or relocating:


  • Notify DEA in writing and enclose DEA Controlled Substance Certificate and controlled substance order forms (cross out and write "void" on forms before sending).
  • Send letter stating plans to the Texas Department of Public Safety, Regulatory Services Division

    Texas Department of Public Safety
    Regulatory Services Division
    Texas Prescription Program
    P.O. Box 15888
    Austin, Texas 78761-5888

  • See "Texas Medical Board Annual Registration Rules"
  • "TMA Membership and Your Retirement," available through the TMA Knowledge Center by calling 1-800-880-7955.
  • "Transitions: Legal Considerations in Selling or Closing a Medical Practice" is available from the TMA Library by calling 1-800-880-1300.
  • "A Physician's Guide to Gearing up for Retirement" is available from the AMA by calling 1-800-262-3211.
  • Send written notification to:
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If the physician is changing office address:

  • Notify the Texas Department of Public Safety (DPS). Include full name and DPS number on all correspondence. Send information to:

  • Texas Department of Public Safety
    Controlled Substance Registration
    PO Box 4087
    Austin, TX 78773-0001
    (512) 424-7293

  • If the physician has practiced under a name other than his or her own (e.g., "Doctor's Westside Clinic"), he or she should have filed an assumed name certificate with the county clerk. The physician should contact the county clerk to deactivate this assumed name if he or she is closing the practice without a buyer or if someone else is assuming the practice under that name.
  • If the physician is in solo practice as a professional association, a lawyer must file "Articles of Dissolution" with the Texas Secretary of State's Office in Austin. In addition, a lawyer or accountant should contact the comptroller of public accounts to pay any annual franchise taxes that may be due.
  • If the physician and other physicians have practiced as a professional association and the professional association will continue in existence after the physician's retirement or departure, shares of ownership must be transferred to another physician licensed in Texas. A lawyer should be consulted for this matter.
  • If the physician and other physicians have been practicing as a partnership (or have had an operating agreement like a partnership to share office space) and the partnership will continue after the physician's retirement or departure, then withdrawing from the partnership or otherwise transferring the partnership interest is necessary. The departing physician should consult a lawyer regarding this matter.
  • If the physician has operated X-ray and/or mammography equipment in the office, the physician holds a license from the Texas Department of Health and must maintain a record of the transfer or disposal of such equipment. For details, contact:

  • Texas Department of Health
    Bureau of Radiation Control
    1100 W. 49th St.
    Austin, TX 78756-3189
    (512) 834-6688

  • Send written notification of retirement or a change of practice address to Medicare and Medicaid. Include the effective date of the retirement or address change. Information may be sent to the following addresses:

  • Medicare:
    Novitas Solutions
    Mailing address list for
    Enrollment, Claims and Appeals
    1-855-252-8782
    Medicaid:
    Texas Medicaid and healthcare partnership
    Attn: Provider Enrollment Dept.
    PO Box 200795
    Austin, TX 78720-0795
    (800) 925-9126 use option 2
    or (512) 514-3000
    Tricare South (Humana Military Healthcare Services):
    Contract Network Providers
    (800) 444-5445

  • Advise professional liability insurance carrier of the physician's change in status. If the physician has a "claims made" policy, consider purchasing additional insurance to cover claims that may be filed after the coverage lapses. (This additional insurance is known as a "tail policy.") If the physician will be practicing part-time, insurance coverage may still be advisable. (See "TMA Insurance Information for Physicians Who Plan to Retire,") The Texas Medical Liability Trust maintains a liability insurance hotline to assist physicians in determining their insurance needs: (800) 880-8658.
  • Information on life, health, disability, and office overhead coverage also is available to TMA members through the Texas Medical Association Insurance Trust, 401 W. 15th St., Austin, TX 78701-1680; (800) 880-8181.
For more information about the process, read Closing or Selling a Medical Practice.
 
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Tips on starting your practice

TMA offers 1-day workshops for physicians and residents entering practice. These are designed to give you step-by-step procedures needed for a successful practice, whether you are starting your own practice or joining an established one.

The workshops include practical information you can use immediately, including:

  • Practice alternative—solo, group or HMO/PPO
  • Practice setting and practice marketing techniques
  • Financing your practice and practice buy-ins
  • Medical records
  • Patient management/scheduling
  • Personnel management
  • Financial management techniques
  • Legal aspects of medical practice in Texas
If you are interested in these workshops, contact the TMA Division of Practice Management at 1-800-880-1300 or 512-370-1300 for dates, or visit texmed.org.

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Are you a physician new to Texas?

Click here for your one-stop location to get information on the licensure process, physician demographics, credentialing application, establishing your practice, state and federal agencies, resources for your practice, and much more.

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Understanding Your Payer Contracts


To get a better picture of what your payers are paying, start working the numbers. Review payment data for a six month period and put it in a simple spreadsheet that examines your top five payers and code utilization. Compare the following:

  • Percentage of total revenue for each payer. This will tell you if you are top-heavy and, therefore, vulnerable.
  • Average reimbursement by payer for each of your top ten CPT codes, compared to your fee schedule. Also calculate average reimbursement by payer when the top ten codes are combined. In other words, where are you taking the biggest hit?
  • Analyze reimbursements against your average cost to see a patient. This can be estimated by dividing total revenue (over a six month period) by the number of patient visits in the same period.
  • Compare your average costs and reimbursements per patient to the national average using data available through your specialty society, MGMA’s cost survey for physicians, or the Physicians Practice Fee Schedule Survey (this requires a paid subscription).

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Strategies for Negotiating Your Contracts


Here are a few points to consider:

  • How much does your payer need you? If you are only one of a few physicians in your specialty serving a large pool of patients, this is a big advantage.
  • What do you do well? Are your emergency admittance rates and days in the hospital lower than comparable practices in your area? Are your patient satisfaction scores stellar? If you offer open access scheduling or some other patient-retaining service, tout it.
  • If negotiation fails, consider dropping your worst payers. Remember, this doesn’t mean you are abandoning your patients. You can see patients out of network; just make sure you send out a letter informing your patients that you are no longer contracting with their insurance plan, but would like to continue their care. Be careful not to paint an unfavorable picture of their insurer.

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