Educational Quick Tips

Billing and Coding Tips, Tools, and Resources

With varying and constantly changing billing and coding requirements, how can you and your staff know what to do? TMA’s payment specialists are here to help. Use these TMA curated educational resources to help you keep current.

Educational Sheets 

• Care Management
• Claims Appeal Reference Guide
• Clinical Laboratory Improvement Amendments (CLIA)
• Credentialing Guide
• Employing and Billing for Midlevels
• End of PHE Telehealth Chart

• "Incident-to" Billing

• Medicare and Medicaid National Correct Coding Initiative (NCCI) Edits
• Medicare Initial Preventive Physical Examination and the Annual Wellness Visit Education Sheet
• Medicare Participation: The Basics
• Negotiating Contracts
• New Patient Forms
• Nonphysician Practitioner Comparison Tool
• Prior Authorization
• Physician Designation Programs
• Refunds and Overpayments
• Substitute Physician Arrangements (Locum Tenens)
• Telemedicine Billing and Coding Quick Reference Chart by Payer

Case Studies

• Modifier 25: TMA Practice Well Case Study
  This case study demonstrates how practice staff are involved in arriving at the correct modifier to use on a claim.
• Reimbursement Review and Resolution Case Study
  This case study demonstrates how TMA’s Reimbursement Review and Resolution service helped a member resolve hassles related to an insurance payment.

Coding Concepts

• Nonmedical Drivers of Health (NMDOH)
  This document explains the coding of npnmedical drivers of health (NMDOH) in your practice.

Pocket Guides 

Print, fold, and laminate: three easy steps to help you organize and simplify your at-a-glance resources.

• Bilateral Billing
• Chronic Care Management
• Common Modifiers
• Transitional Care Management (TCM)

Billing and Collections

• At-a-Glance Billing Guidelines
• Collecting Payment for Noncovered Services
• Filing a Complaint With the Texas Department of Insurance (TDI)
• How to Calculate Underpaid Amount in Prompt Pay Rules
• Instructions for Deleting Data Elements on NPI Applications
• Late Fees Under Prompt Pay — How Much and When
• New Patient Visit: Three Years Is a Key
• NPI Entity Type 1/Type 2 and Medicare Provider Numbers
• Out-of-Network and What It Means
• Physicians Can Get Paid During Credentialing Process
• Preauthorization: What If the Diagnosis Changes?
• Take Our Billing and Coding Quiz
• The Service Is Verified; Do I Need to Send a Clean Claim?

Claims

• Appealing Claims Can Have Appealing Results
• CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15
• Duplicate Claims Filing Is Costly
• Follow These Five Tips When You Follow Up on Claims

• It Takes a Team to Produce a Good Claim

• Know State and Payer Rules for Clean Claims
• Sample Letter: Enlisting Patients Assistance for Claims Payment

• What's My Line (Taxonomy Code)?

Coding

• Code Carefully for Bilateral Procedures
• Coding a Cancelled Procedure
• Correct Code for Billing a Routine Venipuncture
• How to Use Modifier 59 in Medicare Claims
• Know When to Use Modifier 26 in Medicare Claims

• Make modifiers work for you

Documentation

• Can’t Say It Enough: Document, Document, Document
• CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15

• Electronic Medical Record Documentation Pointers