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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?
Perfecting the Portal: Medicaid Seeks to Improve Provider Portal
The web-based Medicaid provider portal is undergoing a facelift that could mean expanded access to Medicaid patients' health history so doctors can deliver more efficient, well-rounded care. But the execution will be tricky, which is why physicians want to see the changes carefully tested to make sure the new system not only promotes patient care, but also minimizes hassles for physicians in the already administratively frustrating Medicaid program.
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!
HHSC Transitioning to New Medicaid Claims Administrator
The Texas Health and Human Services Commission (HHSC) is working to move the Medicaid claims administration contract from Xerox to Accenture. HHSC is reviewing Accenture's readiness to take over the contract, which also includes processing claims for the Children with Special Health Care Needs Services Program and vendor drug services.
Private Payer Round-Up, June 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 Expansion News
People with intellectual and developmental disabilities covered by Medicaid will need to choose a STAR+PLUS health plan this summer for their doctor, hospital visits, and medications. Starting Sept. 1, these people will get their basic medical services through STAR+PLUS.
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).
What “Confined to the Home” Means Under Medicare
The Centers for Medicare & Medicaid Services has clarified its definition of a patient as being “confined to the home” under the Medicare home health benefit. Patients can leave the home under some circumstances and still be considered confined to the home.
Medicare Will Be Looking for These Documentation Deficiencies
Paying attention to CERT audit findings is one way to avoid denied Medicare claims down the road. Here are some documentation elements that warrant your attention.
Use Modifier 50 to Code Medicare Bilateral Surgery Claims
Are you billing Medicare correctly for bilateral surgical procedures? Remember this rule to avoid denied claims.
Child Immigrant Influx to Top Border Health Conference
Physician leaders from Texas, along with federal legislators and government officials, gather in Washington, D.C. for the 9th Annual Border Health Conference, sponsored by Texas Medical Association’s Border Health Caucus.
Avoid These Common Paper CMS-1500 Medicare Claim Errors
Novitas Solutions, the Texas Medicare administrative contractor, says paper Medicare billers continue to make certain errors. Expect Novitas to return such incorrectly billed claims as unprocessable.
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