TMA's Hassle Factor Log program recouped more than $1.8 million in unpaid insurance claims for physician members last year. If you have unresolved payment issues, know that your TMA membership gives you access to help to get you paid.
A physician hires a nonphysician practitioner and establishes a standing delegation order for a specific course of treatment. … Read the rest of the scenario. Can you answer the billing question correctly?
Following advocacy by the Texas Medical Association and much of organized medicine, the Centers for Medicare & Medicaid Services (CMS) has delayed its proposal to dramatically overhaul evaluation and management (E&M) coding for physician services, a proposal that TMA warned would make treating Medicare patients “even more challenging.”
Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code. However, as Blue Cross and Blue Shield of Texas (BCBSTX) explains in its Policy No. CPC013, adding modifier 22 doesn’t guarantee additional payment. You need to justify your use of the modifier.
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Various studies have estimated individual physicians can forego tens of thousands of dollars a year by undercoding. Many physicians undercode not only out of fear of penalties for overcoding or unbundling but also because they don’t fully understand how to bill for evaluation and management (E&M) services.
Billing or Coding questions? Email paymentadvocacy[at]texmed[dot]org or call:
Got Billing or Coding questions, call the Knowledge Center