• How Health Plans Are Covering COVID-19 Testing and Treatment

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    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 asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention guidance, and telemedicine visits.

    COVID-19 and Health Plans: What's Covered?  
  • Which Plans Pay for Telemedicine Services – and for How Long?

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    As you’re no doubt aware, telemedicine has made it possible for many physicians to continue seeing patients while reducing the risk of spread during the COVID-19 pandemic.

    Temporary changes to state and federal rules, particularly regarding payment for services, have helped push up the new demand for and use of telemedicine. 

    Find Out What Each Type of Plan Pays for Telemedicine Services  
  • Payer Policies for Telemedicine Services


    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 June 3, 2020

    View the Chart  
  • Telemedicine Payments Promised, Regulations Eased

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    To help Texas physicians safely and effectively treat patients during the COVID-19 pandemic, several changes to telemedicine visits have taken effect, including payment for services and which platforms can be used. 

    See What Changes Have Been Made to Medicare  
  • TMA Says “No” to Federal Scope Expansion Under President’s Medicare Executive Order

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    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.

    Read TMA's Concerns  
  • Fix Medicare Now, TMA Tells Feds

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    Unless the federal government increases physicians’ Medicare payments and overhauls Medicare’s hassle-laden Quality Payment Program (QPP), access to health care for millions of American seniors and people with disabilities “is at risk,” the Texas Medical Association told Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.

    More on This Unsustainable Trend  
  • Get Paid for End-of-Life Care Discussions With Patients

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    Have you talked to your patients about voluntary advance care planning? 
    Did you know that Medicare will pay for those discussions as either a separate Part B medically necessary service or an optional element of a patient’s annual wellness visit? 

    Get the Details  
  • Medicare Inquiries

    Do you have questions and need quick answers? Contact Novitas Solutions with questions.

    (855) 252-8782
    Mon.-Fri. (8 am-5 pm)

    You can also contact the TMA Knowledge Center at (800) 880-7955.

  • Medicare Lab Fee Includes Routine Venipuncture

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    If a patient is a Medicare beneficiary, can you bill Medicare for the routine task of drawing a blood sample? 
    The answer: It depends.

    Get the Details  
  • 75 Ways the Big Medicare Changes Are Very Bad for Physicians and Patients

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    Exactly two months ago, the Centers for Medicare & Medicaid Services unveiled a massive package of proposed new rules for the Medicare program with the promise that it would “increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare.”

    Read TMA's Painstakingly Detailed Comment Letter  
  • Three Things to Know About the New Medicare Cards


    New Railroad Retirement Board Medicare cards are in the mail, and new Medicare cards for Texans will “mail soon,” according to the Centers for Medicare & Medicaid Services. Here are three things to know about the new cards and the new Medicare Beneficiary Identifier.

    Learn More
  • Current Medicare News

    The Low-Down on Looking Up Medicare MBIs
    Now that Medicare has begun replacing patients’ Health Insurance Claim Numbers (HICN) with the Medicare Beneficiary Identifier (MBI), you might be wondering how you’ll find those MBIs.

    On Their Way: New Medicare Patient ID Numbers
    The New Medicare Card project is part of the Medicare Access and CHIP Reauthorization Act (MACRA) and requires CMS to remove the Social Security number from Medicare cards out of concerns over identity theft.

    Medicare-Eligible TRS Retirees Move to New Humana Health Plan
    If you were contracted with Humana MA, you will be paid your contracted rates. If you were not contracted with Humana and you elect to see patients covered under the new TRS-Care MA plan, Humana is required to pay you the Medicare-allowed amount.

    Can’t Say It Enough: Document, Document, Document
    When Medicare delves into claims errors, one stands out above the rest: insufficient documentation.

    Medicare Adds Telemedicine Codes
    The newly adopted 2018 Medicare Physician Fee Schedule has added a few new codes to the list of telehealth services Medicare will cover.

    Ten Services You Can Bill Medicare for Separately From a Surgical Procedure
    See which services fall outside “normal,” so you can bill Medicare for them separately from that surgical procedure.

    How to Identify Dual-Eligible Patients
    You must accept as payment in full the Medicare payment and Medicaid payment for services you provide to a patient enrolled in the Qualified Medicare Beneficiary (QMB) program.

    Ways to Avoid a Medicare Appeal
    Novitas Solutions reports receiving 1.7 million requests per year to correct minor errors or omissions of Medicare claim information. 

    Medicare Revalidation: It Begins Again 
    Medicare provider enrollment revalidation has entered phase two. The Centers for Medicare & Medicaid Services (CMS) has completed its initial round of revalidations under the Affordable Care Act (ACA) and will be resuming regular revalidation cycles — for physicians, that generally means revalidation every five years.

    Hospice Certification Form How-to
    Unclear about exactly what information a Medicare hospice certification or recertification form must contain? CMS offers guidance on essential elements the form must have.

  • Medicare Member Benefits

  • What could a TMA membership mean for you, your practice, and your patients?