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It’s Medicare Participation Time for 2015
The annual Medicare participation enrollment program for calendar year 2015, now underway, runs through Dec. 31, 2014. Keep in mind that current Medicare fee schedule amounts are set through March 31, 2015; potential cuts won't happen until April 1, 2015.
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?
TMA: CHIP Managed Care Plans Responsible for Out-of-Network Payments
Because federal law prohibits patients covered by the Children's Health Insurance Program (CHIP) from paying anything other than a copay, the state of Texas should require managed care organizations in CHIP to cover the costs for out-of-network physicians. That's the position TMA takes in a formal letter to the Texas Health and Human Services Commission.
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!
Medicare Revalidation: Watch, Respond, and Track
Medicare latest enrollment revalidation mailings from Novitas Solutions began on Oct. 14, 2014. Follow these steps to make sure you remain enrolled in the Medicare system without delay.
Private Payer Round-Up, November 2014
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.
STAR+PLUS Expands to Rural Areas
On Sept. 1, the STAR+PLUS Medicaid managed care program expanded to 164 rural counties not currently participating in the model. The expansion requires elderly patients eligible for Medicaid long-term care services and supports (LTCSS) and adult patients with disabilities to enroll in a STAR+PLUS plan. Children with disabilities may enroll voluntarily.
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.
New Claim Form Adopted for Workers' Compensation
Texas Commissioner of Workers' Compensation Rod Bordelon adopted rules requiring the use of the newly updated 1500 Health Insurance Claim Form Version 02/12 (CMS-1500).
New Comp Fee Guideline Conversion Factors Available
The Texas Department of Insurance (TDI) has posted the annual change to the Medical Fee Guideline conversion factors. The most current reimbursement methodologies, models, and values or weights used by the Centers for Medicare & Medicaid Services are the basis of the fee guidelines adopted by the Texas Division of Workers' Compensation (DWC) for non-network services and approved out-of-network services.
Make Your Medicare Participation Selection by Dec. 31
Don't forget the Dec. 31 deadline to determine whether you’ll be a participating or nonparticipating physician in the Medicare program next year is just around the corner.
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.
Novitas: New Fee Schedule Look-Up Tool; New and Revised LCDs
Notivas has introduced a new and improved Medicare Physician’s Fee Schedule Code Search & Downloads tool. Novitas says it is a one-stop shop for all your fee schedule needs.
PQRS: You Still Have Time to Comply in 2014
Medicare payment cuts are in the works, but you still may be able to stop some of them.
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