• 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, March 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.
    • 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.
  • Medicare Updates

    • Huge Victory for Medicine: No More SGR!
      Shout it from the rooftops: Success (finally)! Last night, medicine achieved the biggest victory since the passage of Texas' 2003 tort reform liability protections. Just hours before a 21-percent pay cut to physicians was set to take effect, the Senate approved the bill to repeal Medicare’s fatally flawed Sustainable Growth Rate (SGR) formula, permanently and immediately. After 12 years and 17 temporary, cut-averting patches, both sides of the political aisle and both chambers of Congress worked together to pass the Medicare Access and CHIP Reauthorization Act, which was awaiting President Obama's signature early Wednesday morning.
    • Medicine's Bills Pick Up Speed
      With roughly six weeks to go in the Texas Legislature, lawmakers near the finish line in drafting a state budget for the next two years with significant improvements over last session that march the house of medicine closer to accomplishing its goals. With House and Senate committees in full swing as well, TMA is tracking a plethora of bills on the move that could help or hurt medicine's agenda.
    • CMS Open Payments Registration, Data Review Now Active
      The Centers for Medicare and Medicaid Services (CMS) developed the Open Payments Program to comply with the Physician Payments Sunshine Act, which requires CMS to publicly report data on items of value given annually to physicians and teaching hospitals.
    • TMA Statement: “Disappointment Is Not Defeat”
      TMA Statement on the U.S. Senate’s decision to delay until after its Easter recess consideration of the Medicare and CHIP Reauthorization Act that passed the House of Representatives by an overwhelming margin on Thursday. 
    • 5 Reasons Conservatives Should Support the SGR Repeal
      Texas physicians, of course, are applauding the recent announcement from Washington of bipartisan plan to repeal Medicare’s Sustainable Growth Rate (SGR) formula. If history is any guide, the current threatened pay cut – 22.4 percent scheduled to take effect April 1 – won’t take effect. Recent editorials in the Journal and Forbes, and from Americans for Tax Reform, the American Action Forum, and the National Center for Policy Analysis give us five solid reasons real conservatives should embrace this plan and lobby hard for its passage: