• Payer

    • Your Payer Contracts: Money Makers or Money Drains?

      A 2014 TMA survey of Texas physicians revealed that Texas doctors have a median of six preferred provider organization contracts and one HMO contract, and a majority are contracted with at least one of the five major payers. The question is: Is each of your contracts profitable for your practice?
  • Are you taking advantage of these resources?

    • Deadlines for Doctors

      Find out about upcoming state and federal compliance timelines and key health policy issues that impact Texas physicians.
    • TMA’s Hassle Factor Log (HFL)

      Has a payer upheld a claim denial, even after an appeal? The TMA HFL program is here to help. 
    • 30-Minute Billing Cure

      TMA staff experts provide free half-hour consultations to member physicians and their employees at the county society headquarters. Contact your CMS to see when mini-consults will be in your area.
    • Attend a TMA seminar/webinar

      TMA offers CME accredited seminars and webinars to educate you and your staff. 
  • REMINDER: Novitas Solutions has all new street and post office mailing addresses in Mechanicsburg, Pa. The post office will forward mail addressed to the old Camp Hill, Pa., address, but that may delay delivery. Be sure to send your Medicare-related correspondence to the appropriate post office box and ZIP code. For mailings that can’t go to a PO box, use the new street address: 2020 Technology Pkwy., Ste. 100 Mechanicsburg, PA, 17050.
  • What are the Payers up to?

    • CMS Relaxes Lookback Period for Medicare Overpayments
      The Centers for Medicare & Medicaid Services (CMS) has spoken, finalizing a controversial rule and relaxing the lookback period physicians must adhere to when returning Medicare overpayments. In 2012, CMS proposed requiring physicians to return Medicare overpayments going back 10 years. The agency announced last week the required lookback period will be six years.
    • Medicare Do’s and Don’ts
      The do’s and don’ts in this list may apply to you, depending on your specialty and/or circumstances. Note that some are timely!
    • TMA Member Services Help You Get Paid
      TMA offers a number of members-only services designed to help you get paid. One of these services, TMA's Hassle Factor Log, helped members recover more than $1.3 million in 2015.
    • Payer Roundup, March 2016
      In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy@texmed.org for help, or call TMA Knowledge Center at (800) 880-7955.
    • Mandatory Medicaid Reenrollment Is Underway
      There's no point in procrastinating: If you enrolled in Texas Medicaid before Jan. 1, 2013, you need to complete a reenrollment by Sept. 25, 2016, to stay in the program.
    • Medicare Delayed Part D Rule; Don’t Delay Your Enrollment
      The Centers for Medicare & Medicaid Services (CMS) has again delayed its deadline for physicians, nonphysician practitioners, and others who write prescriptions for Part D drugs to be enrolled in Medicare* for the prescriptions to be covered under Medicare Part D.
    • Medicaid Restores Payment Levels for Child Vision Services
      Thanks to TMA advocacy, Medicaid is restoring physician payments for 50 pediatric eye codes to higher levels paid prior to July 1, 2015. The increase, that took effect April 1, averages 6.6 percent across all codes.
  • Medicare Updates

    • Nonstandard CT Equipment Yields Medicare Pay Cut
      Medicare has reduced payment for computed tomography (CT) services furnished to patients using equipment that doesn’t meet the CT equipment standard. Use the new modifier CT when warranted.
    • MACRA: Weigh In on New Patient Relationship Categories
      Beginning Jan. 1, 2018, you will have to report new patient relationship categories and codes on all Medicare claims. Before the codes can be developed, the Centers for Medicare & Medicaid Services wants your input on a series of questions pertaining to the new categories. Review the draft categories, and weigh in by sending your comments to TMA by Aug. 1, 2016.
    • CMS: Open Payments Review and Dispute Period Ends May 15
      CMS: Open Payments Review and Dispute Period Ends May15 CMS 2016-04-15 The Centers for Medicare & Medicaid Services (CMS) has been charged with implementing the Open Payments Program and has announced the beginning of the 45-day Open Payments review and dispute period. After the conclusion of the re
    • Dual Eligibles
      Eliminating payments for Medicare Part B coinsurance and deductibles to those eligible for both Medicaid and Medicare has created havoc for these patients and the physicians who care for them. Thanks to TMA advocacy, some of the cuts have been reversed. But not all. This remains a medical emergency.
    • Join CMS Open Payments Q&A Live Webinar April 19
      Set aside time next Tuesday, April 19, 11 am-noon (CT), to tune in to the Centers for Medicare & Medicaid Services’ informal Q&A webinar about its Open Payments program, whereby it publicly reports data on items of value given annually to physicians and teaching hospitals.