• Billing and Coding

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      Are Your Claims Being Rejected?

      The Texas Medical Association and the American Medical Association report that many medical practices are seeing more of their claims rejected in recent weeks. The conversion to the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transaction standards on Jan. 1 could be the culprit. 

      Find out what you need to do to register a complaint.

  • Are you taking advantage of these resources?

    • Have coding or billing questions?

      Contact TMA’s certified coders at paymentadvocacy@texmed.org for assistance. 

    • Deadlines for Doctors

      Find out about upcoming state and federal compliance timelines and key health policy issues that impact Texas physicians.
       

    • Practice Consulting

      Need a coding and documentation review? Contact TMA’s Practice Consulting. 

    • ICD-10 Implementation Date Announced

      The Centers for Medicare & Medicaid Services (CMS) has officially announced that the ICD-10-CM implementation date is changed: October 1, 2014. To find out more information, click here.

  • The Ins and Outs of Billing and Collections

    • Transition to ICD-10: Role of Clearinghouses
      Practices should not expect clearinghouses to provide the same level of support for the ICD-10 transition as they did for the upgrade from Version 4010 to Version 5010 upgrade. But they can help with testing. Also: Keep an eye on your commercial payers’ websites for their ICD-10 news and updates.
    • Extra Fee, Extra Hassle: Charging Patients Extra Fees May Hurt, Not Help
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      As physician practices struggle to stay viable, some have resorted to charging additional patient fees to make up for declining payments, rising costs, and scarce time that stack the odds against many doctors.
    • Sending Patient Accounts to Collections
      We have several patient accounts (due to no insurance, insurance termed, patient co-insurance) that are extremely high-dollar accounts. On most of them, the patients pay minimal monthly payments, e.g., $10 or $20. Some are even on “monthly budgets” set up long ago to pay these amounts. Can we legally turn these accounts over to collections to reduce our accounts receivable? 
    • Medicare E&M Audits Coming
      The Centers for Medicare & Medicaid Services (CMS) gave Region C Recovery Auditor Contractor (RAC) Connolly, Inc. the green light to begin auditing Medicare coding for CPT 99215 -- evaluation and management of an established patient -- in physician offices Texas and several other states.
    • How to Avoid a 496 Edit
      Since the HIPAA 5010 electronic claims standards took effect in January, some practices are running into a problem that causes TrailBlazer Health Enterprises to send back their Medicare claims with a 496 edit (submitter not approved for electronic claim submissions on behalf of this entity). TrailBlazer says this happens because the practice either is not properly linked to a clearinghouse or vendor in the Medicare system or has made an error in the claim.  
    • Recovery Audit Contractors
      Connolly Healthcare, the RAC for Texas, is on the cusp of reviewing physician claims. Do you know what your rights are? Do you know where you can find the issues that Connolly will be auditing for? Listen to a TMA hosted call featuring Connolly and CMS for further details. 

  • Coding

    • TMA Offers ICD-10 Transition Toolkit
      Wish you had someone to hold your hand through the changeover to ICD-10? TMA's new Simple Solutions ICD-10 Transition Toolkit will guide you step-by-step through learning, planning, organizing, implementing, and analyzing your practice's ICD-10 transition. It includes all the tools – including budgets, organization surveys, and impact assessments – needed for a successful transition.
    • Transition to ICD-10: Role of Clearinghouses
      Practices should not expect clearinghouses to provide the same level of support for the ICD-10 transition as they did for the upgrade from Version 4010 to Version 5010 upgrade. But they can help with testing. Also:  Keep an eye on your commercial payers’ websites for their ICD-10 news and updates.
    • New Patient Visit: Three Years Is a Key
      Centers for Medicare & Medicaid Services auditors have identified claims coded for “new patient” evaluation and management services that don’t fit the definition for new patient services. Be sure to avoid this coding error.
    • Use AT Modifier for Tetanus Shots
      Novitas Solutions says it won't pay Medicare claims for administering tetanus shots that do not have the modifier AT (acute treatment) appended to the code. The medical record must support the need for the service and the use of modifier AT.
    • A Local Solution for ICD-10 Training
      Physicians and medical practice staff should work now to make sure employees, office technology, and internal operations are ready to make the switch to ICD-10 on Oct. 1, 2014. However, if you haven't started your preparations or don't know quite where to begin, you're not alone.
    • New: Transitional Care Management CPT Codes
      Two new CPT codes for transitional care management services are in effect, and Medicare accepts them. But read the Medicare rules carefully because they vary from the CPT guide.
    • Fiery Water Skis? There's an ICD-10 Code for That!
      Over the course of your career, you've undoubtedly treated countless patients suffering from burns caused by their water skis catching fire. In the past, these all-too-frequent tragedies were complicated even more by the shortcomings of an outdated and ambiguous coding standard. No longer! You'll be happy to know the new ICD-10 coding system scheduled to take effect Oct. 1, 2014, will have an ICD-10 code for that.
    • ICD-10 Video Vault
      The requirement to use the ICD-10 coding system takes effect Oct. 1, 2014. If your practice hasn’t developed an implementation plan, the time to start is now. The transition to a new coding system will be the most challenging initiative yet since the inception of medical coding. Preparation is more than learning the new code set and upgrading office technology. TMA will be offering a variety of training opportunities including live seminars, hands-on workshops, live and on-demand webinars, and software. In addition to these videos, please check the other ICD-10 transition materials from TMA.