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Here’s How You’ll Get Paid for Dual-Eligible Patients
Help Patients Get Preexisting Condition Coverage
Medicare 2015 Fee Schedules Delayed
The American Medical Association reports that Medicare claims-processing contractors removed the 2015 physician fee schedules from their websites in late December. A notice on the sites indicated that technical corrections are being made to the payment rates and that they will be posted no later than Jan. 20, 2015. On Dec. 29, the Centers for Medicare & Medicaid Services issued a related announcement regarding Medicare claims for 2015 dates of service being held for the first two weeks of the year.
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!
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.
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 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.
E-Prescribing, Controlled Substances, and Meaningful Use
Do federal and state laws allow for e-prescribing of controlled substances? Do controlled substances qualify as “permissible prescriptions” under meaningful use?
Find out what CME courses TMA has available on billing topics.
Bone Up on New Medicare Mandates at TMA's Annual Medicare Seminar
Prepare for the gush of Medicare's new 2015 quality measurements, payment formulas, and pay cuts by attending one of TMA's live Medicare 2015 seminars running Feb. 3-25 in cities across the state.
Feds Say They Cut Burden of RAC Audits
In response to industry feedback, the Centers for Medicare & Medicaid Services (CMS) last month released 20 improvements to its Recovery Audit Contractors (RAC) program to reduce its burden on physicians, enhance oversight, and increase transparency. The changes take effect when the next recovery auditor contracts are awarded and are listed on the CMS website.
Performance Scores Added to Physician Compare Website
Patients can now look online to see how some physician practices performed on certain Medicare rankings. The Centers for Medicare & Medicaid Services this December posted new performance scores to its Physician Compare website on four quality measures from the 2013 Physician Quality Reporting System program reporting year.
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