• 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?

    • Medicaid Not Jumping at TMA’s 1115 Waiver Ideas
      State Medicaid officials offered a lukewarm response to TMA's recommendations to increase physician involvement in Medicaid transformation plans, boost physicians' Medicaid payment rates, and design a privately based plan to cover more uninsured, low-income Texas adults.
    • 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, July 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.
    • 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.
  • Medicare Updates

    • Red Tape Kills Venerable Medical Practice
      After 40 years of service and more than 20 years together, the physicians at Austin Internal Medicine Associates (AIMA) will be closing their doors for good Sept. 4. The physicians cited burdensome regulations ― including electronic health record (EHR) requirements and the looming switch to a new medical billing and coding system called ICD-10 ― as factors in their decision to close.
    • 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.
    • Don't Miss Out! Medicare Pays for Chronic Care Management
      Do you manage patient referrals and care transitions between and among physicians and health care settings? Do you spend time reconciling medication lists and managing prescription refills for your patients? Do you take calls during and after office hours to address patient care needs? If the answer is yes and you're not billing for these types of services, you're missing out on a new CPT code and practice revenue opportunity from Medicare.
    • Medicare Pays for Chronic Care Management
      As of January, the Centers for Medicare & Medicaid Services began paying for chronic care management of patients with two or more conditions under its Chronic Care Management program. The payment applies to patients in traditional fee-for-service and noncapitated Medicare Advantage plan arrangements. Texas Medical Association leaders caution the program has some hefty requirements.
    • SGR Is Gone. Now What?
      Physicians will have to prepare to participate in one of the new payment systems that will replace Medicare's Sustainable Growth Rate formula, which Congress eliminated in April via the Medicare and CHIP Reauthorization Act. Come 2019, physicians can participate in one of two major payment tracks: the fee-for-service Merit-Based Incentive Payment System, which boosts or docks physician pay based on their quality and cost performance; or one or more alternative payment models, such as accountable care organizations, medical homes, bundled payments, or other initiatives.