• 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, June 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.
    • 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

    • Top Docs to Top Lawmakers: Scrap ICD-10 or Soften Its Blow
      Physician leaders from the Texas Medical Association (TMA) and three other states are urging congressional leaders to help doctors dodge “pending disaster” by either scrapping the ICD-10 medical billing and coding system, or adopting a two-year, penalty-free grace period to transition to it.
    • Texas Physicians Seek Grace Period From Looming Disaster
      Physician leaders from three states have joined the Texas Medical Association (TMA) in asking the federal government to help doctors dodge disaster by adopting a two-year, penalty-free grace period to shift to the new ICD-10 medical billing and coding system.
    • Technical Assistance Required
      Medicare's Quality and Resource Use Reports help doctors gauge their performance in federal quality reporting mandates. But unraveling the mystery of scattergrams and composite scores is not easy.
    • TMA's 2015 Legislative Victories Build on Past Successes
      In a 2015 legislative session marked by new state leadership, new money, and big shifts in how Texas' major health care agencies oversee care delivery, the house of medicine remained as steady as ever in its mission to ensure physicians can give their patients the best care possible. That resolve paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.
    • Medicine (Mostly) Wins Big in 2015 Legislature
      Medicine's advocates walk away from the 2015 Texas Legislature, which ends today, with heads held high. The physicians who contacted their representatives and senators, the dozens who testified before committees, the hundreds who took part in First Tuesdays at the Capitol, and the staff at TMA, county medical societies, and state specialty societies all played important roles.