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.
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 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 Extend Telemedicine Changes Through June
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
Payer Policies for Telemedicine Services
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 June 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.
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.
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.
Fix Surprise Billing and You’ll Fix the Need to Report CollectionsJason Terk, MD on Senate Bill 1037April 23, 2019
Medical Debt and Credit ReportsDavid Bryant, MD on House Bill 2732April 16, 2019
Transparency in Prior Auth and Physician ReferralsJohn Flores, MD on House Bill 3828April 16, 2019
Eliminate Prior Auth for In-Network PhysiciansJohn Flores, MD on House Bill 3232April 16, 2019
Require Network Directory AccuracyJohn Carlo, MD,on Senate Bill 1742 April 9, 2019
Require Timely Updates to Network DirectoriesJohn Scott, DO, on House Bill 1880 April 9, 2019
Protecting Patients From Balance BillsRay Callas, MD, In SUPPORT of CSHB 2967 by Oliverson and CSHB 3933 by Martinez Fischer April 2, 2019
Enforce Network AdequacyRay Callas, MD In SUPPORT of HB 3911 April 2, 2019
Prohibit PA on Mandated BenefitsDr. Debra Patt, MD on House Bill 2408March 26, 2019
Take Patients Out of the Middle of Balance Billing – The Right WayDr. Ray Callas on House Bill 3933March 26, 2019
Bring Transparency to Prior AuthorizationDr. Doug Curran on House Bill 2327March 26, 2019
Utilization Reviews Should Be Done by Texas-Licensed PhysiciansDr. Doug Curran on House Bill 2387March 26, 2019
Plans Should Inform Patients of Network Status When Requiring PADr. Debra Patt on House Bill 2520March 26, 2019
Plan Directories Should Cross-Reference Physician Network StatusDr. Rick Snyder, MD on House Bill 2630March 26, 2019
Prevent Non-Medical Switching by PlansWritten Testimony on House Bill 2099March 26, 2019
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.
More OnSurprise Bills
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