Billing and Collections

E/M Revisions in 2023 CPT Code Set Aim to Simplify Documentation - 11/02/2022

In an effort to continue to tamp down physicians’ administrative burden, the American Medical Association has revised the codes and guidelines for most evaluation and management services in its 2023 Current Procedural Terminology code set.


No Penalties for Now in Medicare’s Appropriate Use Criteria Program - 10/25/2022

The Centers for Medicare & Medicaid Services (CMS) has said it would postpone indefinitely the payment penalty phase of its appropriate use criteria (AUC) program, which was expected to begin as soon as Jan. 1, 2023.


Practice Operations Services - 09/16/2022

With the many challenges that face today's medical practices, business operations remain at the core of a practice's ability to be successful and profitable. Work with a TMA practice management consultant to identify and assess key or problematic areas of your practice.


Financial Management Services - 09/15/2022

Having sound financial policies and processes can help your practice attain a steady cash flow, maintain healthy collection ratios, increase staff efficiencies, and boost your overall bottom line.


Pass-Through Billing Generally Not Permitted - 09/14/2022

Pass-through billing occurs when an ordering physician requests a service and bills insurance for it but does not perform the service. Insurance companies generally forbid this practice.


Don’t Forfeit Your APM Incentive Payment; Act Now - 08/23/2022

Wondering where your 5% payment incentive is for participating in an advanced alternative payment model (APM) in the 2020 Quality Payment Program?


Nickel and Dimed: Physicians Can Avoid Electronic Credit Cards and Their Fees - 07/29/2022

Some small medical insurance companies are trying to force physicians to receive payment via electronic credit cards, but medical practices can avoid this costly problem.


CMS Continues Webinar Series on No Surprises Act - 07/07/2022

Two upcoming webinars from the Centers for Medicare & Medicaid Services (CMS) – including one scheduled for next week – will educate physicians on the federal No Surprises Act (NSA) as part of a collaboration between CMS and the American Medical Association.


About Nurses as Assistants at Surgery - 06/22/2022

Learn what a first assistant nurse is, and how to bill when they assist during surgery.


Texas Medicare Contractor Answers Critical Care Coding Questions - 05/25/2022

Confused about how to quantify critical care services or delegate such services to nonphysician practitioners? You’re in luck.


Federal Surprise Billing Law in Effect: Get Educated - 04/05/2022

Despite ongoing litigation over certain aspects of the federal surprise billing law, the patient protection components of the No Surprises Act still took effect at the beginning of the year. With them come a number of changes that could significantly impact physician practices now that balance billing is largely prohibited.


Health Plans Not All Recognizing New Telehealth Code - 04/05/2022

A new telehealth code and a series of coding modifier descriptors have already taken effect in 2022 or will take effect soon. But not all health plans are recognizing the new coding elements, according to Texas Medical Association staff monitoring their status.


Here’s Your Billing and Collections Checklist for 2022 - 02/14/2022

TMA’s Reimbursement Services staff work year round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2022 to keep your billing and collections on track throughout the year.


Four Bill-Collecting Tips for New (or Any) Practices - 02/01/2022

Starting a practice can be daunting, and one challenge often overlooked is making sure you get paid. Although only a small number of patients will not pay you, or will pay slowly, they can hurt your bottom line. Writing off thousands of dollars in charges should not be an option.


Sample Letter: Enlisting Patients Assistance for Claims Payment - 11/17/2021

This is a sample letter regarding a patient's outstanding health insurance payment.


New Pocket Guides Added to TMA Quick Tips Page - 11/12/2021

Confused about billing for bilateral procedures or transitional care management? The wealth of resources on the Texas Medical Association’s Educational Quick Tips webpage recently grew with the addition of pocket guides for these services.


How to Avoid Coding Mistakes in Texas Medicaid - 10/15/2021

Ensuring Texas Medicaid dollars are spent for their intended purpose requires the Texas Health and Human Services (HHS) Office of Inspector General (OIG) to work with health care professionals to prevent waste. Accurate medical coding is part of that work. Incorrect codes result in overpayments – which impact taxpayers – and underpayments, which can impact your practice.


When Should We Write Off Large Patient Balances? - 09/23/2021

Is there a formula to calculate the net present value for the balance of a patient’s account compared with a small monthly payoff?


COVID-19: Billing and Coding - 09/16/2021

View COVID-19 resources related to billing and coding.


Billing for Telemedicine During COVID-19 - 09/06/2021

COVID-19 prompted an increased need for telemedicine services to connect physicians with their patients. To quickly meet that need, Texas Medicaid adopted waivers and changed policies to ease technology restrictions and expand the number of Medicaid services available virtually. Reimbursement for telemedicine and telehealth averaged less than $800,000 per month in 2019. By April 2020, Medicaid payment for virtual services jumped to $43 million, and averaged more than $37 million monthly throughout 2020.


New CPT Codes for Third Moderna, Pfizer COVID-19 Shots - 08/18/2021

AMA has expedited a new administration code for a potential third dose of Moderna’s COVID-19 vaccine, following release of the CPT code for a third dose of the Pfizer vaccine.


United Walks Back Payment Cut on Nonphysician Billing - 08/05/2021

Following strong pushback from the Texas Medical Association, UnitedHealthcare (UHC) has effectively reversed its payment-cutting policy change on “incident-to” billing for services performed by nonphysician practitioners (NPPs). 


Arbitration Requests Up, Consumer Complaints Down Under State Surprise Billing Law - 07/29/2021

Texas’ law to prevent patients from getting unanticipated bills for out-of-network care is resulting in more requests for arbitration between practitioners and insurers this year, while consumer complaints are on the decline since the law’s implementation, according to a Texas Department of Insurance report on the impact of the law six months into 2021.


Incident-To Billing Got You Confused? TMA Can Help - 07/12/2021

“Incident-to” billing – when services delivered by a nonphysician practitioner are billed under a supervising physician’s credentials – can be confusing, and Texas Medical Association staff are routinely fielding questions about those unique arrangements.


TMA Case Study: Coding and Documentation - 06/29/2021

TMA’s certified professional coders and auditors can help protect your revenue by performing an in-depth review of how your practice documents medical records and codes claims. The review helps streamline coding and documentation processes, and decrease the risk of external audits.