Related Stories

Federal Surprise Billing Law in Effect: Get Educated - 01/21/2022

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 - 01/20/2022

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.


CMS Debuts Coding Changes for Telehealth - 01/19/2022

The Centers for Medicare & Medicaid Services (CMS) will implement a new place of service (POS) code related to telehealth and update an existing one on April 4. POS codes refer to where medical services are provided. These changes will affect Texas physicians caring for Medicare patients.


TMA: Thanks for Saving Medicare; More Work Ahead - 01/14/2022

Statement by Texas Medical Association (TMA) President E. Linda Villarreal, MD, in reaction to Congress passing legislation Thursday averting most of a 9.75% Medicare cut to physician payments, which was scheduled to take effect on Jan. 1, 2022.


AMA Updates Estimated Medicare Payment Impacts - 01/12/2022

Following medicine’s fervent advocacy in late 2021 that convinced Congress to stop almost all of a nearly 10% Medicare physician pay cut for 2022, the American Medical Association has released an updated analysis on Medicare payments by specialty for this year.


The X{EPSU} Modifiers Further Define Modifier 59 - 12/27/2021

Modifier 59, the distinct procedural service modifier associated with Medicare National Correct Coding Initiative edits, is one you might find confusing (many practices do). Follow these guidelines


Congress Scraps Most of Medicare Cuts, Heeding Medicine’s Warnings - 12/15/2021

The Texas Medical Association and many others in organized medicine bellowed through a collective bullhorn, urging Congress to pull Medicare physician payments back from the brink.


New Patient Visit: Three Years Is a Key - 12/03/2021

Centers for Medicare & Medicaid Services auditors have identified claims coded for “new patient” evaluation and management services that don’t fit the definition for new patient services. Be sure to avoid this coding error.


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

Get practice tips on all things Medicare. Learn what Medicare requires for enrollment, participation, billing, claims, coding, documentation, and more.


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

Get practice tips on all things coding. Learn about coding methods, correct coding, resources, coding related to Workers' Comp and more.


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.


TMA Ask the Expert: Medicare Physician Fee Schedule - 12/02/2021

The Centers for Medicare & Medicaid Services’ (CMS’) 2022 Medicare Physician Fee Schedule takes effect on Jan. 1 and raises several concerns for physicians treating Medicare patients, including a series of mandated pay cuts totaling nearly 10% and changes to the already complex Quality Payment Program (QPP).


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.


Congressional Members Support Halt to Medicare Cuts - 11/28/2021

Two physician members of Congress are echoing the Texas Medical Association’s call for lawmakers to stop pending Medicare physician pay cuts totaling nearly 10%, and their push has the support of hundreds of members of the House of Representatives.


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


Medicare Cuts An Insult to Patients And Physicians - 11/12/2021

Opinion column by TMA President E. Linda Villarreal, MD, about significant Medicare cuts planned for January, 2022 if Congress does not act to prevent them.


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.