Reimbursement

Reimbursement Review and Resolution (RRR) Services User Guide - 09/09/2020

Please observe the following Reimbursement Review and Resolution (RRR) form guidelines to help us expedite processing while maintaining the integrity and credibility of RRR Services (previously known as the Hassle Factor Log Program).

Practice E-Tips on Billing and Collections - 08/13/2020

Practice E-Tips on Billing and Collections

CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15 - 08/12/2020

CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15

Running Out of Reasons: Low Payments, Hassles Leave Physicians Wondering: Why stay in Medicare? - 06/01/2020

Texas physicians who deal with Medicare’s substandard payments and world-class administrative hassles are feeling underappreciated. The latest report from the committee that advises Congress on Medicare payment policy may exacerbate that feeling. In March, the Medicare Payment Advisory Committee (MedPAC) released its annual report assessing payments to physicians, among other sectors. MedPAC recommended no changes to the 2021 Medicare physician fee schedule, meaning no increase in physician payments.  

CMS to Recoup Chronic Care Management Payments - 12/06/2019

Some Texas physicians and outpatient facilities might have to refund payments they received for chronic care management services performed during 2015 and 2016 under the Medicare Physician Fee Schedule, federal officials said.

Practice e-Tips on Claims - 10/30/2019

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

United Healthcare Cuts Consults - 09/04/2019

United Healthcare is eliminating payment for consults in two phases – one that took effect June 1 for certain services, and their complete elimination starting in October. The change is an effort to align with the Centers for Medicare & Medicaid Services policy that eliminated payment for most consults in 2010, but it’s going to make it more difficult for many specialists to get compensated for the extra time and work those services require.

Guide to Insurance Overpayments and Refund Requests - 08/14/2019

Use this guide to help you and your staff properly assess refund requests from health plans.

How to File a Medicare Extended Repayment Plan - 03/04/2019

  Extended repayment plans (ERPs) are an option for returning overpaid money to Medicare. Ideally, you should request an ERP immediately after receiving the initial demand letter. However, you can request an extended payment plan any time while the overpayment is outstanding. 

Texas Clinics Repay Medicare for Improper Claims - 03/04/2019

Several Texas dialysis clinics in El Paso and the Dallas-Fort Worth area have had to repay Medicare for treating people in the country illegally.

Cornered: Proposed Medicare Fee Overhaul Could Box In Doctors - 02/05/2019

Proposed overhaul to Medicare payments for complex patient care visits and same-day office-based procedures could box in Texas physicians.

SB 418: Prompt Pay Final Rules - 01/24/2019

SB 418: Prompt Pay Final Rules

Sharing is Caring? Health Care Sharing Ministries Cause Confusion - 12/07/2018

Confusion surrounding health care sharing ministries puts Texas Medical Association on alert.

New Laws Require Billing Disclosures by Physicians - 04/27/2018

A raft of new rules took effect Sept. 1 requiring, medical practices to reveal specific billing information to patients.

Billing for H1N1 Vaccine Administration - 04/27/2018

For some payers, you may need to bill a penny for the H1N1 vaccine to be paid for administration.

TMA Payment Advocacy Services - 04/26/2018

TMA Payment Advocacy Services

What Stimulus Means to Texas Health Care - 04/24/2018

State health officials have released preliminary information on major health and human services allocations for Texas in the $789 billion economic stimulus bill President Obama signed. The largest portion is $5.45 billion for Medicaid through the first quarter of 2011.

AMA: Bad Claims Payment Increasing - 04/19/2018

It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card.

5010 Deadline Extended; Dual Eligible Problem Not Fixed - 04/17/2018

Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.

Practice e-Tips on Reimbursement - 12/13/2017

Billing & Fees Claims Coding & Documentation Collections Copayments & Deductibles Medicaid & Medicare Workers' Comp Billing & Fees Are You Missing Out on Your Money?    Billi

Preauthorization Denial: What’s Your Recourse? - 05/10/2017

So a health plan has denied your preauthorization request for a patient’s treatment. What options do you have?

BCBS Posts BlueCompare Information - 03/08/2017

Blue Cross and Blue Shield of Texas (BCBS) has posted online the presentation from the Dec. 22 webinar about its BlueCompare program. It was the only webinar the company conducted on the program, which rates some 18,000 Texas physicians in 14 specialties.

How to Set a Standard Fee Schedule for Your Practice - 09/13/2016

You have complete authority and responsibility to set your own standard practice prices. When you set your fees, consider basic business principles, including profit, return on investment, competition, and marketing.

Aetna Deselecting 130 Texas Physicians - 08/01/2016

Aetna has notified 130 Texas physicians it will terminate them from its networks on July 1, TMA's Payment Advocacy Department has learned. Aetna says it told the physicians a year ago it was concerned about their billing patterns. Evaluation and management (E&M) codes were the only ones Aetna examined, and its concern involves primarily levels 4 and 5 E&M codes.

You've Got a Friend in Payment Advocacy - 06/27/2016

The TMA Payment Advocacy Department now has a direct link on Facebook.