• Payer

    • Guide to Preventive Services Covered Under the ACA

      Can you name all the preventive health services that commercial health plans must cover under the Affordable Care Act? Read more for links to preventive services for adults, women, and children.
  • Are you taking advantage of these resources?

    • Deadlines for Doctors

      Find out 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 HFL program 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

      TMA offers 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?

    • Dual Eligible Pilot Enrollment Starts April 1
      Patient enrollment in the Texas Health and Human Services Commission's (HHSC's) six-county Dual Eligibles Integrated Care Demonstration Project begins April 1. The project is a partnership between Texas and the Centers for Medicare & Medicaid Services (CMS) to test a new model for providing coordinated care to patients enrolled in both Medicare and Medicaid. Texas and CMS will contract with Medicare and Medicaid managed care plans to coordinate patient care across both programs.
    • 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!
    • Do You Prescribe Medicare Part D Drugs?
      A Medicare change that won't happen for nearly another year may require some action on your part in the next few months.
    • Payer Roundup, April 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 paymentadvocacy@texmed.org for help, or call TMA Knowledge Center at (800) 880-7955.
    • Physicians: Reenroll in Medicaid by March 24, 2016
      The Affordable Care Act requires all Medicaid health professionals to reenroll in the program at least once every five years (some professionals must reenroll more frequently). Physicians are next on the list and must reenroll by March 24, 2016. However, if you initially enrolled or reenrolled on or after Jan. 1, 2013, you will be required to reenroll by the date indicated on your enrollment letter.
    • 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.
    • Workers' Comp Seminar Focuses on Educating Office Staff
      The Texas Department of Insurance Division of Workers' Compensation (DWC) has announced the next program in a series of educational seminars. "Texas Workers' Compensation 101 for Medical Office Staff" is free and will take place at DWC's central office (7551 Metro Center Drive in Austin) on May 28 from 9 am to 4 pm.
  • Medicare Updates

    • Medicare: Delays, Documentation, and an Update Reminder
       These tips can help you get your Medicare revalidation application approved with the minimum delay possible, be prepared if Medicare asks for ordering/certifying documentation, and stay on top of claim adjustment reason codes and remittance advice remark codes
    • Medicare Pays for Chronic Care Management That Uses an EHR
      Medicare now pays for chronic care management (CCM) services, if your practice has a certified electronic health record (EHR). The CCM service as laid out by Medicare is extensive, and some components require the use of a certified EHR or other electronic technology.
    • AMA Provides SGR Repeal Bill Summary, Timeline
      The American Medical Association’s Legislative Counsel has prepared documents on the recently enacted Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), also known as HR 2.
    • It’s Time to Say Thank-You for SGR Repeal
      Texans in Congress played a huge role in getting HR 2, the bill that repealed Medicare’s Sustainable Growth Rate (SGR) formula, passed into law. These leaders, and all who voted for the bill, deserve our thanks. (Here’s the list — with phone numbers to call.)
    • Home Health Certification: Your Reasons Go in the Medical Record
      If you certify a patient for Medicare-covered home health services, you no longer have to sign and submit a form with a narrative description of the need. Your medical record becomes the basis for the home health agency’s payment for the services — as well as your corresponding payment for certifying/recertifying the patient.