Reimbursement

Practice e-Tips on Reimbursement - 12/03/2021

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

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.

Changing Your Medicare Participation Status for 2022 - 11/30/2021

The Texas Medical Association is still working to convince Congress to stop several cuts for 2022 payments for Medicare physician services that would total nearly 10%. But with those cuts still going into effect as of now, you may wish to modify their Medicare participation status.

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?

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.

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?

The Service Is Verified; Do I Need to Send a Clean Claim? - 11/17/2021

The Service Is Verified; Do I Need to Send a Clean Claim?

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

Insurers’ Unfair Electronic Fees Persist; AMA, TMA Take Action - 10/27/2021

Organized medicine, including the Texas Medical Association, is engaging the Biden administration on health plans’ unfair business practices physicians sometimes encounter when receiving electronic payments.

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

Practice E-Tips on Billing and Collections

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

ESRD Calculator - 08/27/2021

ESRD Calculator

Situational Data Element - 08/17/2021

Situational data element

Are You Losing Revenue by Undercoding? - 08/17/2021

Becuase of a fear of overcoding, undercoding is prevalent in many practices. This means lost revenue that is rightfully due to the practice. Correct coding can be a significant opportunity for revenue enhancement without additional resource consumption.

TMA Reimbursement Services - 08/13/2021

TMA Payment Advocacy Services

COVID-19: Payers / Insurance - 06/22/2021

Get COVID-19 resource related to payers / insurance.

COVID-19: Finances - 05/04/2021

View COVID-19 resources related to practice finances.

What's My Taxonomy Code? - 04/07/2021

What's My Line (Taxonomy Code)?

Verify Which Health Plans Are Exempt From Prompt Pay Laws - 01/04/2021

Use this tool to affirm which health plans are self-funded and thus not subject to state prompt pay laws. ERISA or TDI?

Make Modifiers Work for You - 01/04/2021

Missing or incorrect coding modifiers are a common reason why claims are denied or physicians are paid incorrectly for their services. Follow these steps to make sure your practice uses modifiers correctly.

NPI Entity Type 1/Type 2 and Medicare Provider Numbers - 12/09/2020

If I am an incorporated physician, do I need two National Provider Identifiers (NPIs)?

Preauthorization Denial: What’s Your Recourse? - 10/16/2020

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

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).

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