Many health insurers in Texas are waiving patient costs associated with COVID-19. Last week in a news release, Gov. Greg Abbott and the Texas Department of Insurance (TDI) asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention (CDC) guidance, and telemedicine visits.
Health Plans to Cover Costs of Administering COVID-19 Vaccines
A Quick Guide to Each Payer’s Coronavirus Changes and Waivers
Payers Extend Prior Authorization Windows During COVID-19
Payers Ease Credentialing During COVID-19
Confused by Each Payer’s COVID-19 Policies? TMA is Here to Help
Payer Updates in the Time of COVID-19 (Webinar)
How Health Plans Are Covering COVID-19 Testing and TreatmentMedicare
Medicare to Pay for Counseling Patients to Self-Isolate During COVID-19 Testing
Medicare Coverage and Payment Related to COVID-19 (CMS, March 5, 2020)
FAQs to Assist Medicare Providers With Billing and Coding for COVID-19 Testing (CMS, March 6, 2020)
Medicare: Coverage and Payment Related to COVID-19 (CMS, March 23, 2020)
Flexibilities to Fight COVID-19 (CMS, March 30, 2020)
Federal Register: Medicare and Medicaid Programs: Policy and Regulatory Revisions (HHS, March 24, 2020)Medicaid
Texas Medicaid, CHIP Changes Extended Into November
Update: Portal to Apply for Medicaid and CHIP Relief Funds Open
Texas Medicaid Will Pay for Well-Child Visits Via Telemedicine in May
Medicaid Disaster Response Toolkit
Medicaid and CHIP Coverage and Payment Related to COVID-19 (CMS, March 5, 2020)
Medicaid Claims for Telephone (Audio Only) Medical Services (TMHP, March 20, 2020)
Medicaid Audio Only HTW and FPP (TMHP, March 25, 2020)Commercial Insurance
Payers Extend Claims Filing Deadlines
How Health Plans Are Covering COVID-19 Testing and Treatment
Individual and Small Group Market Insurance Coverage (CMS, March 5, 2020)
TDI: Coronavirus (COVID-19) Updates and Preparations (TDI, March 30, 2020)
Cigna's Response to COVID-19 (Cigna 2020)Workers' Comp
Workers’ Comp COVID-19 Claims Require Work-Related Connection, Officials Say
Late Medical Bills Won’t Be a Reason for Workers’ Comp Claims Denials, State SaysTelemedicine Payment
Health Plans Extend Telemedicine, Cost-Share Waivers
Payer Policies for Telemedicine Services
COVID-19 Telemedicine Deadlines for Doctors
Which Plans Pay for Telemedicine Services – and for How Long?
Telemedicine Payments Promised, Regulations Eased
TMA Pushes to Increase Telemedicine Use in Medicaid
Texas Laws and Regulations Relating to Telemedicine
FQHC Reimbursement for Telemedicine (Physician Delivered) and Telehealth (Non-Physician-Delivered) Services (TMHP, March 18, 2020)
AMA Quick Guide to Telemedicine in Practice (AMA, March 26, 2020)
TMB FAQs Regarding Telemedicine During Texas Disaster Declaration for COVID-19 Pandemic (TMB, March 19, 2020)
AAP: Coding for Telemedicine Services (AAP, Jan. 2020)
ACP: COVID-19 Telehealth Coding and Billing Practice Management Tips (ACP, March 30, 2020)
In the wake of COVID-19, TMA is getting calls about which payers are covering telemedicine. TMA developed this quick reference guide to help you navigate telemedicine reimbursement. This table now reflects Medicare’s waiver of the geographic and place of service restrictions for Medicare (which means patients can now be at home).
Additionally, the Governor directed TDI to issue an emergency rule related to the payment of telemedicine to allow state-regulated plans (about 20% of the commercial market in Texas) to allow telephone and telemedicine visits to be paid at the same rate as in-office visits. If you are not sure which patients are regulated by TDI, check this guide. Stay tuned for more detail.
Updated July 27, 2020
The American Medical Association has created a Current Procedural Terminology (CPT) code, 87635, to report laboratory testing services that diagnose the presence of the novel coronavirus.
Two recent studies suggest expanding Medicaid will not only save Texas money, but add to the Lone Star State’s coffers.With another opportunity for the Texas Legislature to debate Medicaid expansion on the horizon, the Texas Medical Association sees the Episcopal Health Foundation reports as evidence to support efforts to expand meaningful coverage for the state’s poor and vulnerable populations.
The Centers for Medicare & Medicaid Services on Monday withdrew a proposed rule that would’ve restricted how states fund their share of Medicaid, causing serious cuts in services.
Leaders of the Texas Medical Association and four large primary care specialty societies on Wednesday painted for senior Medicaid officials the bleak fiscal picture of many physician practices, and requested immediate financial assistance.
The American Medical Association is opposing the latest “No Surprises Act” and urging more vetting of the bill, which was agreed upon this week by key House and Senate committee leaders.TMA agrees with AMA’s assessment of the bill.
Blue Cross and Blue Shield of Texas (BCBSTX) will pay a $10 million fine for providing consumers incorrect information, delays in out-of-network claims processing, and errors in marketing materials, the Texas Department of Insurance (TDI) has announced.
As part of a TDI enforcement order, BCBSTX also will repay consumers who seek restitution.
One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.
TMA’s Reimbursement Review and Resolution Service (formerly known as the Hassle Factor Log program) helps you resolve insurance-related problems. TMA meets regularly with Medicare, Medicaid, health plans, and large insurers to discuss the specific problems that you bring to our attention.
Credentialing with the government and health insurance companies continues to be a complex and time-consuming management function for practices of all sizes. At Nationwide Credentialing, we work with you from start to finish on the credentialing process, which allows physicians and their staff to focus on patients and other important aspects of their practice.
Many physicians assume that attempting to negotiate a health plan contract is hopeless — but that is a myth. Survey data from TMA show that physicians’ negotiation attempts often are successful. Respondents report winning both payment and term changes in their contracts.
It didn’t matter that the charges against me were ludicrous. The potential consequences were only too real, and potentially catastrophic. Had the State Medical Board decided against me, I could have lost my license. I hired a lawyer, sinking more than $8,000 into legal fees. I was cleared by a unanimous committee vote. But other physicians facing similar situations may not be as lucky.
Every day, patients pay a hefty price for their health care, and many are quick to blame rising costs and climbing insurance premiums on the first person that comes to mind: usually the “well-paid physician.”
Don’t let your patients place blame on you unfairly.
TMAIT offers medical, life, income protection, office overhead, and ancillary insurance to TMA member physicians and their group managers. We work with you online, on the phone, or in person to determine the right plan to meet your current career needs. That’s coverage you can count on. Phone: (800) 880-8181
TMA went into this session looking to attack insurer network inadequacy and health plans’ use of care-impeding prior authorization demands.
On both fronts, medicine scored solid legislative wins that will make it easier for patients and physicians to know who’s in network, and provide needed transparency on preauthorization requirements. And on surprise billing, medicine turned what could’ve been a disastrous bill into something more palatable.
TMLT is a unique, not-for-profit health care liability claim trust owned by its physician policyholders, and is the only professional liability carrier exclusively endorsed by the Texas Medical Association. Created in 1979, TMLT has grown to be the largest medical liability provider in the state, protecting more than 14,500 Texas physicians. Phone: (800) 580-8658
The Texas Medical Association’s Healthy Vision 2025 – released this week – seeks to draw a roadmap for how legislators can hold insurance companies accountable for the products they sell to patients.
Waive Budget Neutrality Requirements for a Year(Interim Written Comments on HR 8505, Oct. 26, 2020)
Driving Down the Cost of Health Care in Texas (Written Comments on Interim Charge 1, Select Committee on Statewide Health Care Costs, Oct. 1, 2020)
Drug Price Transparency, Balance Billing, and Coverage (Written Comments on Interim Charge 1 House Committee on Insurance, Sept. 8, 2020)
Fix Surprise Billing and You’ll Fix the Need to Report Collections(Written Testimony on Senate Bill 1037 by Jason Terk, MD, April 23, 2019)
Medical Debt and Credit Reports(Testimony on House Bill 2732 by David Bryant, MD, April 16, 2019)
Transparency in Prior Auth and Physician Referrals(Testimony on House Bill 3828 by John Flores, MD, April 16, 2019)
Eliminate Prior Auth for In-Network Physicians(Testimony on House Bill 3232 by John Flores, MD, April 16, 2019)
Require Network Directory Accuracy(Testimony on Senate Bill 1742 by Rick Snyder, MD, April 9, 2019)
Require Timely Updates to Network Directories(Testimony on House Bill 1880 by John Scott, DO, April 9, 2019)
Protecting Patients From Balance Bills(Testimony on House Bill 2967 and House Bill 3933 by Ray Callas, MD, April 2, 2019)
Enforce Network Adequacy(Testimony on House Bill 3911 by Ray Callas, MD, April 2, 2019)
Prohibit PA on Mandated Benefits(Testimony on House Bill 2408 by Debra Patt, MD, March 26, 2019)
Bring Transparency to Prior Authorization(Testimony on House Bill 2327 by Doug Curran, MD, March 26, 2019)
Utilization Reviews Should Be Done by Texas-Licensed Physicians(Testimony on House Bill 2387 by Doug Curran, MD, March 26, 2019)
Plans Should Inform Patients of Network Status When Requiring PA(Testimony on House Bill 2520 by Debra Patt, MD, March 26, 2019)
Plan Directories Should Cross-Reference Physician Network Status(Testimony on House Bill 2630 by Rick Snyder, MD, March 26, 2019)
Prevent Non-Medical Switching by Plans(Written Testimony on House Bill 2099, March 26, 2019)
Protect Patients From Inadequate, Narrow Networks(Testimony on Senate Bill 1264 by Jason Terk, MD, March 21, 2019)
Expand Access to Care to All Texans Who Need It (Testimony on House Bill 565 by Doug Curran, MD, March 5, 2019)
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Hold HealthInsurers Accountable
Some Texans receive medical bills they did not anticipate, even though they have health insurance. Their insurance might not cover that care or provide as much benefit as they assumed.
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