• Payer

    • ACA Exchange Plans: Questions and Answers for Texas Physicians

      Confused by all you’ve heard about the Affordable Care Act marketplace insurance plans? Do you know whether you're in — or out — of the narrow networks? How will you tell if a patient is on an exchange plan? What happens to you if patients don't make their premium payments? What, if anything, can you do about all of this? TMA answers these and other tough marketplace exchange questions.


  • 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?

    • Perfecting the Portal: Medicaid Seeks to Improve Provider Portal
      The web-based Medicaid provider portal is undergoing a facelift that could mean expanded access to Medicaid patients' health history so doctors can deliver more efficient, well-rounded care. But the execution will be tricky, which is why physicians want to see the changes carefully tested to make sure the new system not only promotes patient care, but also minimizes hassles for physicians in the already administratively frustrating Medicaid program.
    • Ready to Fill Out the New CMS-1500 Claim Form?
      Starting on April 1, 2014, you must use the revised CMS-1500 claim form (02/12) for submitting paper claims to government and private payers (regardless of date of service).
    • Make Sure Novitas Can Open Your CDs
      If you need to send medical records to Novitas Solutions, the Medicare payer for Texas, make sure Novitas can access the encrypted information.
    • Private Payer Round-Up, March 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 paymentadvocacy@texmed.org for help, or call TMA Knowledge Center at (800) 880-7955.
    • Free Workers' Comp Education on Billing Changes
      The Texas Department of Insurance's (TDI's) Division of Workers' Compensation is hosting free education sessions on required new billing forms at its field offices around the state in February. Training will help workers' compensation system participants comply with mandatory changes regarding physician billing procedures that effect medical bills submitted on or after April 1.
    • Documenting the Home Health Face-to-Face Encounter for Medicare
      Medicare says it has identified overpayments for home health claims, most of them due to insufficient documentation of the face-to-face encounter required prior to certifying a Medicare patient's eligibility for the home health benefit.*
    • 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).
  • Medicare Updates

    • CMS Releases Medicare Physician Payment Data
      On April 9, the Centers for Medicare & Medicaid Services (CMS) gave the public unprecedented access to physician payments and charges for services and procedures provided to Medicare beneficiaries. The CMS online database contains information on more than 880,000 physicians and other health care professionals who collectively received $77 billion in Medicare Part B payments in 2012.
    • Document Time for Psychotherapy Services
      Year-old changes in psychiatry and psychotherapy CPT codes are still tripping up physicians. According to Medicare, distinguishing between evaluation and management services and psychotherapy is the key.
    • Code Carefully for Bilateral Procedures
      Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.
    • Eye E&M Codes Subject to New Medicare Coding Edit
      Medicare Correct Coding Initiative edits update quarterly, so it pays to monitor them. For example, a new edit may affect ophthalmological evaluation and management codes.
    • Congress Patches SGR, Delays ICD-10
      Congress has done it again. For the 17th time, lawmakers slapped yet another Band-Aid on Medicare to stave off a 24-percent physician payment cut under the fatally flawed Sustainable Growth Rate (SGR) formula. It sets the next SGR cliff for April 1, 2015.