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Here’s How You’ll Get Paid for Dual-Eligible Patients
Help Patients Get Preexisting Condition Coverage
Annual HEDIS Data Collection Roundup Launches
Health care payment plans started sending letters to physician offices in February to begin this year's annual Healthcare Effectiveness Data and Information Set (HEDIS) data collection process. No two health plans collect their HEDIS data exactly the same way, but most follow similar processes.
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!
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.
Private Payer Round-Up, February 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
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 Comp Fee Guideline Conversion Factors Available
The Texas Department of Insurance (TDI) has posted the annual change to the Medical Fee Guideline conversion factors. The most current reimbursement methodologies, models, and values or weights used by the Centers for Medicare & Medicaid Services are the basis of the fee guidelines adopted by the Texas Division of Workers' Compensation (DWC) for non-network services and approved out-of-network services.
Feds Delay Final Medicare Overpayment Rule
The Centers for Medicare & Medicaid Services announced last week it needs another year to finalize rules on reporting and returning Medicare overpayments. First issued three years ago to implement parts of the Affordable Care Act, the proposed rule (better known as the 60-day rule) requires physicians and other health care providers to report and refund overpayments within 60 days from the date the overpayment is identified or the date the corresponding cost report is due.
PQRS Registries Extend Submission Deadline
You still have time — about two weeks — to report 2014 Physician Quality Reporting System (PQRS) measures via registry this year.
Medicare Updates You May Have Missed
More Medicare updates and changes are rolling in for 2015, including a new time frame for response to additional documentation requests, and revised local coverage determinations.
TMA PSO Seeks Health Care Service, Software Providers(1)
Texas Medical Association’s Physician Services Organization for Patient Care today issued a Request for Information (RFI) for service and software vendors that wish to help the new organization develop and deliver to doctors the survival tools they need to compete in today’s health care marketplace.
Texas Physicians Urge Lawmakers: “Help Us Care for Our Patients”
Texas physicians today asked state leaders asked for big changes to ensure low-income patients receive care in the most efficient manner. “The best place to provide care to Medicaid patients is in our practices — not in expensive emergency departments,” said Dr. King. “Texas has the power to make needed changes.
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