• Billing and Coding

    • Are Your Claims Being Rejected?

      Has a payer upheld a claim denial, even after an appeal? The TMA Hassle Factor Log program is here to help.  

      The collection and analysis of TMA member complaints continues to benefit members by allowing TMA to document and respond to reimbursement hassles. Ultimately, participation by physician members in the Hassle Factor Log Program enhances TMA's ability to make reimbursement less of a hassle for all Texas physicians. 

      See user information and additional HFL program resources for more details.

  • Are you taking advantage of these resources?

    • Have coding or billing questions?

      Contact TMA’s certified coders at (800) 880-1300, ext. 1414 or 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. Learn about topics including the new ICD-10-CM implementation date on October 1, 2015.
    • Practice Consulting

      Need a coding and documentation review? Contact TMA’s Practice Consulting. 
    • 30-Minute Billing Cure

      TMA staff experts provide free half-hour consultations to member physicians and their employees at the county society headquarters. Contact your CMS to see when mini-consults will be in your area.
  • The Ins and Outs of Billing and Collections

    • Ready to Fill Out the New CMS-1500 Claim Form?
      Starting on April 1, 2014, you must use the revised CMS-1500 claim form (02/12) for submitting paper claims to government and private payers (regardless of date of service).
    • Fees for Copying Medical Records
      ow much may physicians charge patients for copying medical records? The answer to this frequently asked question now includes information about electronic copies.
    • 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.  
    • Private Payer Round-Up, March 2014
      In case you missed these — here is a roundup of coding, payment, and policy changes and tips from commercial payers, compiled by TMA’s reimbursement specialists. If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy@texmed.org for help, or call TMA Knowledge Center at (800) 880-7955. 
  • Coding

    • Document Time for Psychotherapy Services
      Year-old changes in psychiatry and psychotherapy CPT codes are still tripping up physicians. According to Medicare, distinguishing between evaluation and management services and psychotherapy is the key.
    • Code Carefully for Bilateral Procedures
      Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.
    • Eye E&M Codes Subject to New Medicare Coding Edit
      Medicare Correct Coding Initiative edits update quarterly, so it pays to monitor them. For example, a new edit may affect ophthalmological evaluation and management codes.
    • Virtual ICD-10 Training in Your Office
      With ICD-10 preparation well underway and the transition date less than eight months away, it's time to determine how the new coding system will fit into your practice's daily operations. How does your current documentation stack up to the new guidelines, and what changes do your staff members need to make to their standard workflow to ensure a seamless transition and steady payment flow? Your practice's success is in the details.
    • Novitas Webinars Help With Puzzling Coding Topics
      Did you know Novitas offers free webinars about coding for Medicare Part B and other topics? The March 2014 schedule includes three topics that TMA often receives questions about.
    • List Cost on Medicare Radiopharma Claims
      When billing Medicare for radiopharmaceutical procedure codes, you must list the total acquisition cost on the claim.
    • Seminar Trains Your Staff on ICD-10 Documentation
      TMA's new seminar, ICD Documentation and Auditing: Success Is in the Details, offers hands-on, detailed ICD-10 training for your staff. Participants will learn how to navigate the expansive ICD-10-CM code book, how to apply the new coding guidelines when assigning codes, and how to avoid denied claims through proper documentation and audit methods.
    • ICD-10 Testing Coming in March
      Medicare will conduct national tests for submitting claims using the ICD-10 coding system March 3-7. Starting Oct. 1, 2014, you must begin using the ICD-10 system on claims to Medicare and all other payers or you will not be paid.