Insurance

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. 

All Payers

How Health Plans Are Covering COVID-19 Testing and Treatment

Medicare

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)

CMS Offers More Flexibility, Financial Stability for COVID-19 Care

Flexibilities to Fight COVID-19 (CMS, March 30, 2020)

Federal Register: Medicare and Medicaid Programs: Policy and Regulatory Revisions (HHS, March 24, 2020)

Medicaid

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)

Feds Approve Texas’ Request for COVID-19 Medicaid Waiver

Commercial Insurance

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 Says

Coding

AMA Creates CPT Code for Coronavirus Test

MGMA Coding Cheat Sheet (MGMA)

ICD-10-CM Official Coding and Reporting Guidelines on COVID-19 April 1, 2020 - September 30, 2020 (CDC)

ICD-10-CM Official Coding Guidelines - Supplement Coding encounters related to COVID-19 Coronavirus Outbreak (CDC, Feb. 20, 2020)

Coding encounters related to COVID-19 Coronavirus Outbreak (CDC, Feb. 20, 2020)

New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), October 1, 2020 (CDC, Feb. 20, 2020)

Coding During the Coronavirus Pandemic (Physicians Practice, March 18, 2020)

AMA Coding Advice During COVID-19 (AMA, March 26, 2020)

AAP: Coding for Telemedicine Services (AAP, Jan. 2020)

ACP: COVID-19 Telehealth Coding and Billing Practice Management Tips (ACP, March 30, 2020)

Telemedicine Payment

Payer Policies for Telemedicine Services

Telemedicine Payments Promised, Regulations Eased

TMA Pushes to Increase Telemedicine Use in Medicaid

Texas Laws and Regulations Relating to Telemedicine

Medicaid Claims for Telephone (Audio Only) Medical Services (TMHP, March 20, 2020)

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 April 3, 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.

TMA physician leaders, along with their colleagues from California and the rest of the country, are on Capitol Hill this week, lobbying Congress to toss out a California-inspired provision from a rapidly moving health insurance 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.

The state’s new law allowing arbitration of payment disputes on certain out-of-network care carries concerns for physicians and uncertainty about what it will look like from an enforcement standpoint, a panel told the Texas Medical Association Winter Conference on Saturday morning.

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 Hassle Factor Log® 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.

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes.

Your personal stories of patient harm due to prior authorization request delays or denials can give the Texas Medical Association the ammunition it needs to fight this problem. 

President Donald Trump’s recent executive order on Medicare includes scope-of-practice language that is raising concerns among Texas physicians – including the president of the Texas Medical Association.

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.