TMA Puts $1 Million in Your Pocket

Thanks to the persistence of the Texas Medical Association Payment Advocacy staff, TMA has helped members recover more than a $1 million from health plans this year. This includes money TMA has helped practices recover from incorrectly processed claims, lost or delayed Medicare enrollment applications, educating staff on how to resolve ongoing billing issues with health plans, and various other advocacy efforts. For instance, TMA staff efforts helped one practice recover $84,000 in improved drug benefits.

However, the benefits of Payment Advocacy efforts aren't limited to claim-by-claim endeavors. For example, TMA persuaded Blue Cross and Blue Shield of Texas to suspend the Procedure Plus Evaluation and Management Service Reimbursement Methodology that was to be effective on Sept. 1. This would have paid the evaluation and management service at 100 percent of the allowable amount; any procedure performed at the same time would have been considered the secondary service, payable at 95 percent of the allowable amount. The suspension of this policy has an enormous impact across multiple specialties.

TMA physician leaders and staff expressed the association's concerns at the July Texas Physician Advisory Council meeting and provided additional information to Blue Cross to explain the disagreement with this methodology.

Many of the reimbursement issues came to TMA's attention through the Hassle Factor Log program, emails to Payment Advocacy staff, and inquiries to the TMA Knowledge Center.

Also available to members is the TMA Mini-Consultation Program. Working with county medical societies, TMA staff experts provide free, half-hour consultations to member physicians and their employees at the county society headquarters. Topics include Medicare, Medicaid, managed care, workers' compensation, and general payment-related coding and billing issues.

Visit the Practice Help page on the TMA website for more information about how TMA can help you.


Action, Sept. 1, 2011


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