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Don't Miss Out! Medicare Pays for Chronic Care Management - 11/22/2019

Do you manage patient referrals and care transitions between and among physicians and health care settings? Do you spend time reconciling medication lists and managing prescription refills for your patients? Do you take calls during and after office hours to address patient care needs? If the answer is yes and you're not billing for these types of services, you're missing out on a new CPT code and practice revenue opportunity from Medicare.


Texas Physicians Push to Improve Health Care for LGBTQ Patients - 09/03/2019

Lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) patients face unique barriers that put them at greater risk for mental and physical health problems. Often, their health disparities result from a lack of family support, public prejudice, and fear of the health care system. Texas physicians have launched a new workgroup and are adapting their practices to treat this underserved population.


Quality Care Pilot Takes Flight - 09/03/2019

How one children's clinic uses a targeted program to dramatically improve care, lower costs.


Physician, Hospital Groups Distribute Urgent Measles Advisory - 08/06/2019

Texas doctors and hospitals have a new tool to fight the ever-increasing measles threat, as the number of people sickened by the infectious yet preventable disease climbs. The Texas Medical Association (TMA) and Texas Hospital Association (THA) have created a new resource to help physicians, hospitals, and other health care professionals combat the highly contagious, yet entirely preventable, respiratory illness.


Faulty Guidelines - 06/03/2019

Former Texas Medical Association President Josie Williams, MD, was tenacious in advocating that organized medicine pay zealous attention to two topics: data and guidelines. In this, she was both sage and prescient. We have done well in following her recommendations on data, but we continue to fall far short of where we need to be on guidelines.


Dos and Don’ts of Using Modifier 22 - 04/25/2019

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.


Charging Concierge Fees to BCBSTX Patients - 04/23/2019

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.


Expect HEDIS Records Requests From Third Parties - 02/28/2019

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas or UnitedHealthcare, it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.


Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.


Learn From the Experts - 09/26/2018

The Texas Quality Summit, scheduled for November 18-19 and hosted by the Texas Medical Association and the American College of Medical Quality, will give physicians the tools they need to prosper in a value-based care environment.


Blue Cross HMO Emergency Payment Review Policy Begins - 08/10/2018

Beginning today, Blue Cross Blue and Shield of Texas will require some members to pay 100 percent of their medical bills if they go to an out-of-network emergency room for certain non-life-threatening conditions, company officials have confirmed.


From Blue Cross: What to Fax, Where to Find Answers - 08/07/2018

Here is a heads up on a couple of changes in Blue Cross and Blue Shield of Texas’ preauthorization and predetermination processes.


Blue Cross to Put Off HMO Emergency Coverage Policy Until August - 06/27/2018

Blue Cross and Blue Shield of Texas will delay for 60 days a new HMO emergency care policy it had originally planned to begin on Monday, June 4.


Submitting Med Records, and More Tips From Blue Cross - 06/26/2018

Here’s some news you can use from Blue Cross and Blue Shield of Texas.


Blue Cross Payment Cut on Tap for Some Diagnostic Services - 06/19/2018

Effective July 1, Blue Cross and Blue Shield of Texas will cut payments for certain diagnostic procedures. The cut will apply to diagnostic cardiovascular and ophthalmology procedures that are billed for the same patient on the same day.


Blue Cross Says MOC Not Needed for BlueCompare - 05/30/2018

Physicians across the state reacted strongly to a March 5 letter from Blue Cross and Blue Shield of Texas (BCSTX) that implied the state’s largest insurance company is now using maintenance of certification (MOC) to rate physicians. That was not the intent, the company’s president says.


TMA Seeks TDI Review of Blue Cross HMO Emergency Policy - 05/10/2018

The Texas Medical Association and 18 other Texas medical societies are asking the Texas Department of Insurance to review a new Blue Cross Blue Shield of Texas policy that could require some HMO members to pay 100 percent of their out-of-network emergency medical bills.


Some Blue Cross Members Could Pay 100 Percent of ER Bill - 05/01/2018

The Texas Medical Association has reached out to Blue Cross and Blue Shield of Texas to obtain more details on a new HMO emergency care policy at BCBSTX unveiled this week.


Private Payer Roundup, January 2015 - 04/27/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about drug formulary changes, coding tips, a prior authorization change, and more.


Private Payer Round-Up, May 2014 - 04/26/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Texas Measles Alert! - 04/26/2018

State health officials warned in mid-April that a child in Houston and two adults in Fort Worth were diagnosed with the measles in the previous two weeks.


Vaccine News and Notes - 04/26/2018

Medicare pricing, some guides, and a payer policy clarification: Stay up to date.


Private Payer Roundup, November 2016 - 04/26/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out what policy and other changes payers are rolling out for 2017.


Flu Scarce in Texas - 04/25/2018

So far, there are few cases of influenza in Texas. Surveillance by the Texas Department of State Health Services reports flu activity so far this season as "sporadic." No pediatric deaths have been reported so far during the 2011-12 season.


Register Now for the Texas Quality Summit - 04/24/2018

This fall, TMA is hosting a unique event to help you improve performance, increase efficiency, and continue to deliver high-quality care. Join your colleagues for the Texas Quality Summit Nov. 18–19, and get the latest resources and hands-on training to take your practice to the next level. Register now, as seating is limited.