Billing and Collections

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.


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.


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.


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.


United Walks Back Payment Cut on Nonphysician Billing - 08/05/2021

Following strong pushback from the Texas Medical Association, UnitedHealthcare (UHC) has effectively reversed its payment-cutting policy change on “incident-to” billing for services performed by nonphysician practitioners (NPPs). 


Arbitration Requests Up, Consumer Complaints Down Under State Surprise Billing Law - 07/29/2021

Texas’ law to prevent patients from getting unanticipated bills for out-of-network care is resulting in more requests for arbitration between practitioners and insurers this year, while consumer complaints are on the decline since the law’s implementation, according to a Texas Department of Insurance report on the impact of the law six months into 2021.


Incident-To Billing Got You Confused? TMA Can Help - 07/12/2021

“Incident-to” billing – when services delivered by a nonphysician practitioner are billed under a supervising physician’s credentials – can be confusing, and Texas Medical Association staff are routinely fielding questions about those unique arrangements.


TMA Case Study: Coding and Documentation - 06/29/2021

TMA’s certified professional coders and auditors can help protect your revenue by performing an in-depth review of how your practice documents medical records and codes claims. The review helps streamline coding and documentation processes, and decrease the risk of external audits.


First Across the Finish Line: Medical Billing Tax Eliminated - 06/07/2021

More than a year of work and collaboration came to fruition with House Bill 1445 by Rep. Tom Oliverson, MD (R-Cypress), which classifies outsourced medical billing as being outside the realm of insurance services. When Gov. Greg Abbott signed the bill on April 30, it nullified a medical billing tax scheduled to take effect Oct. 1.


UHC Expands Access to Digital Claims Portal, Optum Pay Basic - 05/20/2021

Starting this Saturday, May 22, UnitedHealthcare's Optum Pay basic claims portal will begin allowing unlimited users for each account. Practices can use the portal to manage claim payments and other digital administrative paperwork.


Five Ways to Improve Patient Collections - 05/14/2021

If your practice spends too much time chasing down patient overdue balances, maybe you should rethink some of your up-front practice policies related to collections.


Don’t Overlook Credit Card Processing Fees - 05/14/2021

In today’s world of coinsurance and high-deductible health plans, more of a practice’s revenue comes from the patient, and taking credit cards has become a must. But are you paying too much for credit card processing services?


Four Bill-Collecting Tips for New (or Any) Practices - 05/14/2021

Starting a practice can be daunting, and one challenge often overlooked is making sure you get paid. Although only a small number of patients will not pay you, or will pay slowly, they can hurt your bottom line. Writing off thousands of dollars in charges should not be an option.


ICD-10 Coding Advice for Hurricane Injuries - 04/08/2021

If you are treating patients for hurricane-related injuries or illnesses, here is some timely ICD-10 coding guidance from the Centers for Disease Control and Prevention.


Medicare Claim Errors: The Easy and the Common - 03/31/2021

Filing your Medicare claims correctly the right way every time saves time and money. Fortunately, correcting a simple mistake on a Medicare claim is easy. However you might need to invest in training if you commonly make more significant errors.


Need Billing and Coding Help? Visit TMA’s New Educational Quick Tips Website - 03/18/2021

The Texas Medical Association’s reimbursement specialists understand how quickly information changes, and are here to help you stay stay up to date with a new webpage that features educational quick tips on a variety of practice help topics.


Should You Bill This Visit as “Incident to”? - 03/04/2021

A physician hires a nonphysician practitioner and establishes a standing delegation order for a specific course of treatment. … Read the rest of the scenario. Can you answer the billing question correctly?


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?


TMA: Fair Telemedicine Payments will Ensure Patients’ Care Continues - 09/25/2020

Statement by Texas Medical Association (TMA) President Diana L. Fite, MD, regarding Gov. Greg Abbott’s announcement today that Texas’ state-regulated health plans will continue to pay physicians and health care providers the same rate for patients’ telemedicine care as for in-person care, through the end 2020.


Don’t Miss New and Revised LCDs - 08/13/2020

Take a look at these new and revised Medicare local coverage determinations (LCDs) and article updates from Novitas Solutions. Remember, Novitas will reject claims that don’t adhere to LCDs.


E&M Coding About to Change - 08/03/2020

First, the bad news: Physicians need to take some serious time between now and Jan 1, 2021, to study changes that are coming to Medicare outpatient evaluation and management (E&M) codes – changes most private insurers likely will follow. Now the good news: The changes should reduce the amount of documentation needed with each patient.


Take Our Billing and Coding Quiz - 07/17/2020

TMA Knowledge Center staff fields hundreds of questions about coding and billing from TMA members. Here are a few FAQs. Do you know the answers to these questions?


Invoice No Longer Required for Some Medicare Claims - 06/03/2020

For certain biologicals and medications reported in Medicare Part B claims, Novitas Solutions now will allow you to enter invoice information on the claim, rather than provide the actual invoice for the services.


You May Need to Refile Some Medicare Claims - 02/03/2020

Be on the lookout for Medicare claims you’ve filed since Oct. 1 in which procedure codes failed to process, causing a rejected claim. You will need to refile these claims.