+	HHSC reinstates transition period for PCCM primary care provider selection
+	Attention: Internet scam targets diplomates
+	Prior authorization for Medicaid imaging begins June 1
+	Coding and billing CME available
+	Check out SPARRC's new look
+	TAFP announces the winner of the state's anti-tobacco poster contest

HHSC reinstates transition period for PCCM primary care provider selection

In answer to physician inquiries, the state's contractor for Medicaid services has made it possible for a Medicaid patient in a Primary Care Case Management expansion area to see a physician who is not listed as their primary care provider. The Texas Medicaid Healthcare Partnership says the change, effective May 15, will remain in effect during an indeterminate transition period initiated by the Texas Health and Human Services Commission.

Under the transitional rules, when a patient presents to a physician who is not listed as their primary care provider on their Medicaid ID form, (Form H3087), the patient can select that physician as their new designated primary care provider at the point of service. The physician must verify this selection on the Primary Care Provider Change List, available on the TMHP Web site. For more information and to link to the PCP Change List, go to the TMHP news bulletin.

In the announcement, TMHP also clarified referral questions regarding obstetrical and gynecological services. "In this new transition period," reads the TMHP announcement, "clients in PCCM Expansion Areas may also select any Medicaid enrolled OB/GYN, family practitioner, or internal medicine provider for the following services:

·   One well woman examination per year

·   Care related to pregnancy

·   Care for all active gynecological conditions and

·   Diagnosis, treatment, and referral to a Medicaid enrolled specialist for any disease or condition within the scope of the designated professional practice of a licensed obstetrician or gynecologist, including treatment of medical conditions concerning the breasts."

Patients do not need a referral from their primary care provider to see a family physician, an OB/GYN or an internal medicine provider as long as the physician providing services is enrolled in Medicaid.

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Attention: Internet scam targets diplomates

The American Board of Medical Specialties issued an alert on April 7 to warn member boards of an Internet marketing campaign and practice that targets diplomates of ABMS. The false certification Web site, BoardCertified.com, sends fax messages to physicians with ABMS identifiers claiming to be "renewal notices." The messages state that physicians failing to complete the faxed form and pay the renewal fee to BoardCertified.com by a certain date will face an expired "membership" and a deactivated "online listing."

In an issued alert, ABMS states that BoardCertified.com is not a legitimate user of ABMS' name, acronyms, trademarks, logos, intellectual property or certification data. A failure to return the form or fee to BoardCertified.com will not result in any penalty, expiration of certification or removal from ABMS' official online directory, BoardCertifiedDocs.com, published by Elsevier. ABMS and the American Medical Association, whose trademarked name and acronym also appear on the site without permission, are evaluating the activities of BoardCertified.com and pursuing aggressive legal action. The ABMS staff assures members that the legitimate online database remains secure and protected.

If you have received a message from BoardCertified.com or if you have additional questions about BoardCertified.com's apparent misues of ABMS' intellectual property, contact Rob Nelson at ABMS by phone at (847) 491-9091, ext. 3005, or by e-mail at rnelson@abms.org.

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Prior authorization for Medicaid imaging begins June 1

On May 1, 2006, the Texas Health and Human Services Commission instituted a new policy that requires prior authorization for MRIs and other imaging services for Medicaid or Medicaid PCCM patients. Concerns about the extra burden to hospitals and physicians were immediately raised by several top medical organizations.

In response, HHSC has agreed to implement a 30-day grace period to last from May 1 to May 31 during which claims will continue to be paid regardless of prior authorization by a physician. HHSC will also not enforce the 2-day notification period for retroactive authorization of emergency services provided in a physician’s office or outpatient setting.

HHSC will use the grace period to hold meetings with the Texas Medical Association, the Texas Hospital Association, the Office of the Inspector General, MedSolutions and other concerned parties. Physicians are encouraged to begin using the new practices to acquaint themselves and their staffs to the policy.

Find more information on authorization details and procedure codes from the " Prior Authorization for Radiology Services."

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Coding and Billing CME available

The coding and billing system has seen a total of 458 code changes in 2006. Keep current on the updates that affect your practice’s bottom line by reading the updated "Strategies for Coding, Billing and Getting Paid Appropriately" monograph, now available in the education section of www.tafp.org. You’ll get great information on coding changes, 2006 Medicare changes and billing tips for family physicians plus up to four Prescribed credit hours by the American Academy of Family Physicians.

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Check out SPARRC’s new look

Are you a physician who is ready to do more for your patients and family medicine? Join the Statewide Primary Care Ambulatory Research and Resource Consortium (SPARRC), TAFP's research network, and participate in practice-based research to gather important data for the specialty and help the medical community move toward developing the highest-quality health care.

SPARRC membership is free of cost and volunteer-based. As a SPARRC member, you’ll be a part of a collaborative group that supports the funding and development of studies important to the advancement of family medicine. In addition to participating in or leading a research study, members and their colleagues can also review previously published studies on the SPARRC Web site. These include studies on diabetes, attitudes toward long-acting opiates and more. Contact Paige Newman for more information on SPARRC and stop by the redesigned SPARRC Web site.

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TAFP announces the winner of the state’s anti-tobacco poster contest

TAFP congratulates this year's Tar Wars Poster Contest winner, Sanjida Hoque of Denison, Texas. Hoque’s poster, "If you don’t ever start, you prove you’re smart," was selected for the grand prize from among many wonderful entries by a select panel of TAFP members. Her message reinforces the anti-smoking mission supported by the Texas Department of Health and the Academy. For the grand prize, TAFP will send Hoque, her family and her winning poster to Alexandria, Virginia, to compete in AAFP's Tar Wars National Poster Contest, which will be held in July.

Hoque is in Mr. Kris Ackerman's fifth grade class at Sam Houston Elementary School in Denison. She is the daughter of Sarwarul Hoque.

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Copyright 2006, Texas Academy of Family Physicians