• 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?

    • Medicaid Transformation Waiver Extension Request Due Sept. 30
      Texas's five-year 1115 Medicaid Transformation Waiver will expire Sept. 30, 2016. To extend or renew the waiver, the Texas Health and Human Services Commission (HHSC) has to submit a request to the Centers for Medicaid and Medicare Services (CMS) by Sept. 30, 2015.
    • 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, July 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.
    • Mandatory Medicaid Reenrollment Is Underway
      There's no point in procrastinating: If you enrolled in Texas Medicaid before Jan. 1, 2013, you need to complete a reenrollment by March 24, 2016, to stay in the program.
    • 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

    • Humana Again Terminating Texas Physicians From Medicare Advantage Network
      TMA has learned Humana is terminating 422 physicians in 17 Texas counties from its Medicare Advantage Plan network, effective Jan. 1, 2016. Humana sent termination notices to physicians on July 1.
    • Revised LCDs Give Updated Medicare Coverage Information
      Revised local coverage determinations (LCDs) from Novitas Solutions recently took effect or will take effect Aug. 13, 2015. See if any apply to your practice, and read their guidance for submitting correct Medicare claims to Novitas for payment.
    • Medicare Payments to Physicians Increased 0.5 Percent on July 1
      Doctors' Medicare payments increased 0.5 percent on July 1 under the Sustainable Growth Rate formula repeal bill. To replace the SGR, the Medicare Access and CHIP Reauthorization Act of 2015 created an alternative set of annual payment updates.
    • 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.