Billing and Collections

Know State and Payer Rules for Clean Claims - 12/03/2021

Filing a clean claim gives you protections under Texas’ prompt pay law. For a claim to be “clean” you don’t have to fill out every field on the claim form, just the right ones.


Coding a Cancelled Procedure - 11/19/2021

How do we code a cancelled procedure, for example when a patient’s vital signs preclude continuing the procedure?


Instructions for Deleting Data Elements on NPI Applications - 11/19/2021

Step-by-step instructions to delete data elements on NPI applications


How to Calculate Underpaid Amount in Prompt Pay Rules - 11/17/2021

Even if the insurance company pays on time but underpays you - if it doesn't pay in full by the statutory deadline, it still must pay you a penalty based on the number of days the payment is late and the underpaid amount of the claim.


Late Fees Under Prompt Pay — How Much and When - 11/17/2021

Let’s say your contracted insurance carrier violates prompt pay laws and misses the deadline for paying or responding to your claim. When can you collect late fees and how much?


Preauthorization: What If the Diagnosis Changes? - 11/17/2021

Can the carrier deny payment for services performed to treat the final diagnosis? Can it refuse to pay for some of the inpatient days it initially authorized?


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

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


Correct Code for Billing a Routine Venipuncture - 11/17/2021

Learn the correct code for billing a routine venipuncture.


Filing a Compliant With the Texas Department of Insurance (TDI) - 11/17/2021

Filing a Compliant With the Texas Department of Insurance (TDI)


At-a-Glance Billing Guidelines - 11/17/2021

At-a-Glance Billing Guidelines


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.


Practice e-Tips on Practice Operations - 10/29/2021

Billing Consulting HIPAA Forms Marketing Office Staff OSHA Patient Service Policies & Procedures Resources Billing Billing Medicare for Locum Tenens Billing Tip


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.


Practice E-Tips on Billing and Collections - 10/12/2021

Practice E-Tips on Billing and Collections


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.


Starting a Practice - 09/07/2021

Setting Up or Closing a Practice


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.


Practice e-Tips on Claims - 09/01/2021

Appeals Appealing Claims Can Have Appealing Results   Claim Forms Multiple Place-of-Service Codes on a Single 1500 Claim Form   Fees New Laws Require Billing Di


Notice to Patients of Noncovered Services - 08/27/2021

Notice to Patients of Noncovered Services


What Triggers a Coding Audit? - 08/20/2021

What Triggers a Coding Audit?


The Finer Points of Professional Courtesy - 08/20/2021

The Finer Points of Professional Courtesy


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.


New Patient Visit Not “Incident-to” - 08/17/2021

If a new Medicare patient comes into the office and sees the physician assistant (PA) only, can we bill Medicare for the PA’s services as “incident to” the physician?


Situational Data Element - 08/17/2021

Situational data element