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Coding with Care: Knowing Billing Codes for Complex Care Can Maximize Revenue, Access to Care - 04/30/2024

Knowing billing codes for complex care can maximize revenue and access to care.

Cigna to Deny Claims Without Z-Code Documentation - 04/24/2024

Starting July 14, Cigna Healthcare will deny certain claims that are billed with a Z code and without documentation, a move that could add to physicians’ administrative burden.

Aetna Set to Pay Medicare Advantage G2211 Claims - 03/27/2024

The list of health plans providing payment for Medicare’s new add-on “G” code continues to grow with Aetna as the latest insurer to cover G2211 for Medicare Advantage claims Aetna confirmed with Texas Medical Association coding experts that its Medicare Advantage claims platform was updated in March to allow payment for the code, used to document the coordination of care for patients with complex or serious conditions. For now, the plan’s policy is only accessible through a physician’s Aetna portal.

Quality of Life: Pay-for-Quality Programs Increasingly Address Nonmedical Drivers of Health - 03/15/2024

Insurance payers seldom give physicians incentives to address nonmedical drivers of health, especially in traditional fee-for-service payer contracts. Those incentives remain rare even in pay-for-quality programs that emphasize value-based care, but they are gaining traction.

Coding Changes in Fee Schedule Promote More Accurate Payment for Complex Visits - 03/05/2024

The 2024 Medicare physician fee schedule allows physicians to list G2211 in addition to codes used in office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians also can use it for telehealth visits.

Novitas Makes Mass Payment Adjustment for Telehealth Claims - 02/27/2024

Thanks to the vigilance of the Texas Medical Association’s payment specialists, Medicare administrative contractor Novitas Solutions updated its system to ensure all claims billed with place of service (POS) code 10 will be paid correctly.

College Students: Put Required Vaccination on To-Do List - 02/21/2024

As young adults make final preparations for college, the physicians of the Texas Medical Association remind college-bound students to put the meningitis vaccination on their to-do list.

Practice e-Tips on Coding - 02/20/2024

Get practice tips on all things coding. Learn about coding methods, correct coding, resources, coding related to Workers' Comp and more.

Talk to Patients About: Measles - 02/20/2024

Few Americans today remember when measles was deadly. But before the measles vaccine was introduced in 1963, the disease killed about 2.6 million globally each year. By 2016, vaccination programs cut that number to about 89,000.

Your Billing and Collections Checklist for 2024 - 12/19/2023

TMA’s Reimbursement Services staff work year-round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2024 to keep your billing and collections on track throughout the year.

Add-On Payment Code for Complex Visits to Start in 2024 - 12/08/2023

Beginning in January, physicians will be able to receive more accurate payment for complex visits with Medicare add-on code G2211. But the Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.

CMS to Implement Street Medicine Code - 10/25/2023

Following advocacy from the Texas Medical Association and medical student members, the Centers for Medicare & Medicaid Services (CMS) created a place of service code for street medicine, making it possible for physicians to get paid for services provided to people who are currently unhoused effective Oct. 1.

Code Carefully for Bilateral Procedures - 10/04/2023

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.

Texas is No. 1 in “Hotspots” For Vaccine Exemptions - 09/11/2023

Houston, Fort Worth, Plano, and Austin are among the cities in the nation with the highest number of kindergartners who have not received vaccinations because of nonmedical reasons, according to the study published this week in the journal PLOS Medicine.

Here’s Everything You Need to Spread the Word About Flu Vaccines - 09/06/2023

Today is Texas Influenza Awareness Day, which the Texas Department of State Health Services designated to stress the importance of every Texan over 6 months old receiving a seasonal flu vaccine. The Texas Medical Association’s Be Wise – Immunize program has created several tools and resources you can use to get the word out today and throughout flu season.

Encourage School Vaccinations with Prewritten Letters to the Editor - 08/31/2023

To help you spread the word to families who might have missed or avoided vaccinations during the COVID-19 pandemic, the Texas Medical Association’s Be Wise – Immunize program and the Texas Pediatric Society have created four prewritten letters to the editor you can send to your local newspaper.

Another Dubious Distinction: Texas Tops Unvaccinated List - 08/31/2023

According to WalletHub, Texas is No. 50 on its “2019's States that Vaccinate the Most” report, which also includes the District of Columbia. The report analyzed 18 key metrics – from share of vaccinated children to people without health insurance, and reported outbreaks such as measles – to determine each state’s ranking.

Here’s What Medicare Pays for Flu Shots This Season - 08/23/2023

The Centers for Medicare & Medicaid Services recently published 2019-20 payment rates for personal flu vaccines and their administration. The effective dates for these rates are Aug. 1, 2019, to July 31, 2020.

Billing Errors to Avoid: Pulmonary, Mohs Procedures - 08/21/2023

Medicare audits have revealed recurring errors in billing for pulmonary procedures and Mohs surgery. Here are some guidelines for correct billing.

Medicare Coding Errors to Avoid: Add-on, Place of Service, and Modifiers - 08/21/2023

Medicare audits have revealed recurring errors in billing with add-on and place-of-service codes as well as claims that appear to be duplicate because they lack an appropriate modifier. Here are some guidelines for correct billing.

Use Modifiers to Override Correct Coding Initiative Edits - 08/21/2023

Correct Coding Initiative Edits Now Free on Internet

More Medicare Payment Updates for 2015 - 08/21/2023

Find out changes affecting pneumococcal vaccine, preventive and screening services, and new waived tests, plus a revalidation tip and how to learn more about Physician Compare.

Payers Axe Consultation Codes - 07/25/2023

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.

E&M Coding — Are You Under, Over, or on Target? - 07/20/2023

E&M Coding — Are You Under,Over,or on Target?

Document Time for Psychotherapy Services - 07/20/2023

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.