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Here’s How You’ll Get Paid for Dual-Eligible Patients
Help Patients Get Preexisting Condition Coverage
Physicians Receive ACA Grace Period Notice Letters
Some Texas physicians have notified TMA they have received letters from Blue Cross and Blue Shield of Texas (BCBSTX) notifying them that a patient is in the second or third month of the Affordable Care Act (ACA) 90-day grace period. The grace period is triggered once a patient with subsidized marketplace coverage misses a premium payment. Instead of immediately terminating the policy, health plans must give the patient 90 days to catch up.
Are you taking advantage of these resources?
Deadlines for Doctors
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
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
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?
TMA: CHIP Managed Care Plans Responsible for Out-of-Network Payments
Because federal law prohibits patients covered by the Children's Health Insurance Program (CHIP) from paying anything other than a copay, the state of Texas should require managed care organizations in CHIP to cover the costs for out-of-network physicians. That's the position TMA takes in a formal letter to the Texas Health and Human Services Commission.
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!
Medicare Revalidation: Watch, Respond, and Track
Medicare latest enrollment revalidation mailings from Novitas Solutions began on Oct. 14, 2014. Follow these steps to make sure you remain enrolled in the Medicare system without delay.
Private Payer Round-Up, October 2014
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
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 Claim Form Adopted for Workers' Compensation
Texas Commissioner of Workers' Compensation Rod Bordelon adopted rules requiring the use of the newly updated 1500 Health Insurance Claim Form Version 02/12 (CMS-1500).
Doctors Worried About Nonphysician Entities Providing Medicare Wellness Visits
TMA officials remind physicians they can provide Medicare annual and first-time "Welcome to Medicare" wellness visits to their patients and warn that nonphysician health care entities may be beating doctors to the punch, albeit legally. "Welcome to Medicare" visits occur within a patient's first 12 months of having Medicare Part B coverage.
Home page for Healthy Vision 2020, Second Edition, the strategic roadmap for TMA's state and federal advocacy initiatives for the remainder of the decade.
Medicare Revalidation: Watch, Respond, and Track
Medicare’s latest enrollment revalidation mailings from Novitas Solutions began on Oct. 14, 2014. Follow these steps to make sure you remain enrolled in the Medicare system without delay.
For Correct Billing and Collections: Three Medicare Updates
Two upcoming Medicare changes and a recent change affect Medically Unlikely Edits, reporting on certain claims where the physician or supplier is under another Medicare payer jurisdiction, and revised lab fees you may want to adjust retroactively.
CMS: Medicare Beneficiary Open Enrollment Ends
Dec. 7, 2014, is the last day Medicare beneficiaries may select a different Medicare plan option for 2015.
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