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Courses and Publications
Here’s How You’ll Get Paid for Dual-Eligible Patients
Help Patients Get Preexisting Condition Coverage
Your Payer Contracts: Money Makers or Money Drains?
A 2014 TMA survey of Texas physicians revealed that Texas doctors have a median of six preferred provider organization contracts and one HMO contract, and a majority are contracted with at least one of the five major payers. The question is: Is each of your contracts profitable for your practice?
Are you taking advantage of these resources?
Deadlines for Doctors
about upcoming state and federal compliance timelines and key health policy issues that impact Texas physicians.
TMA’s Hassle Factor Log (HFL)
Has a payer upheld a claim denial, even after an appeal? The TMA
is here to help.
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.
Attend a TMA seminar/webinar
CME accredited seminars and webinars
to educate you and your staff.
REMINDER: Novitas Solutions has all new street and post office mailing addresses in Mechanicsburg, Pa. The post office will forward mail addressed to the old Camp Hill, Pa., address, but that may delay delivery. Be sure to send your Medicare-related correspondence to the appropriate post office box and ZIP code. For mailings that can’t go to a PO box, use the new street address: 2020 Technology Pkwy., Ste. 100 Mechanicsburg, PA, 17050.
What are the Payers up to?
Don’t Miss New and Revised LCDs From Novitas
Take a look at these new and revised Medicare local coverage determinations (LCDs) and article updates from Novitas Solutions. Remember, Novitas will reject claims that don’t adhere to LCDs, so be sure to stay abreast of all LCDS — as well as national coverage determinations (NCDs) from Centers for Medicare & Medicaid Services — that affect your practice.
Medicare Do’s and Don’ts
The do’s and don’ts in this list may apply to you, depending on your specialty and/or circumstances. Note that some are timely!
SGR Is Gone. Now What? Preparing for Medicare's New Payment Paradigm
Sooner than later, physicians will have to prepare for participation in one of the new quality-focused payment pathways set to replace Medicare's Sustainable Growth Rate (SGR) formula, which Congress eliminated in April via the Medicare and CHIP Reauthorization Act (MACRA).
Payer Roundup, September 2015
In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. If you have questions about billing and coding or payer policies, contact the specialists at
for help, or call TMA Knowledge Center at (800) 880-7955.
Mandatory Medicaid Reenrollment Is Underway
There's no point in procrastinating: If you enrolled in Texas Medicaid before Jan. 1, 2013, you need to complete a reenrollment by March 24, 2016, to stay in the program.
United's New Reports Target Physician Outliers
If UnitedHealthcare (UHC) identifies you as an outlier among its physicians, you may receive a new type of report from UHC that details tests, procedures, referrals, and/or billing patterns in your practice that may be inconsistent with certain evidence-based medicine criteria.
HHSC Launches Policy Feedback Webpage
The Texas Health and Human Services Commission (HHSC) has a new webpage that features a list of proposed Medicaid policy changes.
News From Novitas: Draft LCDs, Forms, and Errors to Avoid
Don’t miss an opportunity to comment on draft local coverage determinations that might affect your practice. Also, EDI enrollment forms have an update. And — Is your practice making any of the most common claims submission mistakes?
Want to Get Paid $75,000 For Something You Already Do?
Of course, you do. Medicare now pays separately for chronic care management (CCM) services under the Medicare Physician Fee Schedule. CCM services are non-face-to-face activities you or your clinical staff perform to manage and coordinate patient care. Perhaps you've long provided these services at your own expense. But, now, Medicare will pay you for your time on a monthly basis.
It’s Flu Season 2015-16
The Centers for Medicare & Medicaid Services has published Medicare payment amounts for flu vaccines and their administration for the 2015-16 flu season.
PQRS: Last Day to File an Informal Review Request to Appeal Errors in Your Medicare PQRS Feedback Report and QRUR
Last Day to File an Informal Review Request to Appeal Errors in Your Medicare PQRS Feedback Report and QRUR
Free TMF Webinar: Improving Medicare Immunization Rates
The TMF Health Quality Innovation Network Quality Improvement Organization will host an informational webinar on Improving Immunizations for Medicare Beneficiaries from noon to 1 pm CDT on Sept. 29.
Texas Medical Association Payment Advocacy Department
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