Federal Agencies Adopt Rule Mandating Health Plan Price Transparency - 11/24/2020
A number of health plans will be required to be more transparent about coverage pricing starting in early 2021 after the recent adoption of a rule by three federal agencies.
Timing for Annual Medicare Mammograms - 11/20/2020
Medicare counts 11 full months after the month in which the patient received her screening
CMS Relaxes Lookback Period for Medicare Overpayments - 11/20/2020
The Centers for Medicare & Medicaid Services (CMS) has spoken, finalizing a controversial rule and relaxing the lookback period physicians must adhere to when returning Medicare overpayments. In 2012, CMS proposed requiring physicians to return Medicare overpayments going back 10 years. The agency announced last week the required lookback period will be six years.
AMA Advocates for 24/7 Prior Authorization Processing - 11/19/2020
AMA delegates passed new policy on Tuesday that advocates for insurers and benefit managers who require prior authorization to have staff available to process those approvals 24 hours a day, year-round, “including holidays and weekends.”
Deadline Extended: Didn’t Get Your 5% APM Incentive Payment? Take Action by Dec. 13 - 11/19/2020
If you participated in an advanced alternative payment model (APM) under the 2018 Quality Payment Program (QPP), the Texas Medical Association encourages you to take action now to verify that you have received your 5% APM incentive payment for 2020.
Medicare Advantage Plans - 11/17/2020
More than ten million Medicare beneficiaries currently receive their Medicare coverage through Medicare Advantage (MA); a program in which Medicare contracts with and pays private health plans to provide coverage for Medicare benefits.
Blue Cross Bundles Payment for Some Diagnostic Services - 11/16/2020
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 HMO Emergency Payment Review Policy Begins - 11/16/2020
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.
Practice E-Tips on Billing and Collections - 11/16/2020
Practice E-Tips on Billing and Collections
A Case for More Coverage: Studies Suggest Medicaid Expansion Would Fiscally Benefit Texas - 11/12/2020
Two recent studies suggest expanding Medicaid will not only save Texas money, but add to the Lone Star State’s coffers.
TMA Questions QPP Data Showing Most Clinicians Will Receive Medicare Bonus in 2021 - 11/05/2020
The Centers for Medicare & Medicaid Services (CMS) has released preliminary data for the 2019 Medicare Quality Payment Program (QPP), which shows more than 95% of participating clinicians earned an incentive payment that they’ll see next year. However, Texas Medical Association experts are skeptical of the preliminary data.
Mixed Bag: Some Payers Capitalize on COVID Chaos; Others Help Make Care Easier - 10/30/2020
Physicians believe some payers are taking advantage of COVID chaos with their drug policies, but also see some plans taking steps to make care easier during the pandemic.
CMS Announces Plans to Cover COVID-19 Vaccine - 10/29/2020
The Centers for Medicare & Medicaid Services (CMS) has released a rule to make COVID-19 vaccines available at no cost to Medicare, Medicaid, and CHIP patients.
Survey: Many Texans Skipping Care During Pandemic, Considering a Vaccine - 10/28/2020
More than a third of Texans say they or someone in their household have skipped or postponed some type of medical care because of COVID-19, according to an October Episcopal Health Foundation survey that explored attitudes about COVID-19.
Support Medicare Payment Parity for Another Year, TMA Tells Lawmakers - 10/26/2020
TMA is calling for passage of a bill that would require at least a one-year waiver of budget neutrality adjustments, which were part of the Centers for Medicare & Medicaid Services’ (CMS) proposed 2021 Medicare physician fee schedule, released in August.
Expanded State Services for Some New Mothers Now Available - 10/22/2020
Certain new mothers in Texas are now eligible for expanded care through Healthy Texas Women (HTW) after the first 60 days of giving birth, including treatment for postpartum depression and substance use disorder.
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?
Texas Leads Nation in Rise in Uninsured Children, Study Shows - 10/15/2020
The number of uninsured children nationwide climbed dramatically in recent years, with the biggest gains by far coming from the Lone Star State, according to a study released last week.
TMA Balks at Proposed Medicare Payment Cut, More Changes to QPP During Pandemic - 10/12/2020
Physicians who renew their medical licenses after Sept. 1, 2020, are required to take one hour of CME that addresses human trafficking. TMA has now published its own CME course to educate physicians on how to identify, treat, and respond to people who are at risk or who have been trafficked.
Was Your Practice Affected by COVID-19? Apply for a MIPS Reporting Exemption - 10/09/2020
Did your practice face an unusual extreme hardship this year, such as financial or staffing difficulties related to COVID-19? If so, you could qualify for an exception to the Merit-Based Incentive Payment System (MIPS) reporting requirements for the 2020 performance year. The application deadline is Dec. 31.
Last Chance to Start Certain 2020 MIPS Reporting Tomorrow - 10/02/2020
If you participate in Medicare’s Quality Payment Program (QPP) under the Merit-Based Incentive Payment System (MIPS), you will have to report on the required measures – Promoting Interoperability and Improvement Activities – starting Saturday, Oct. 3.
Blue Cross Prior Authorization Manager Changing - 09/30/2020
Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.
TMA Opposes Bill Defining Clinical Psychologists as Physicians in Medicare - 09/28/2020
A broad swath of organized medicine, including the Texas Medical Association, is asking congressional leadership to oppose a bill that legally would consider clinical psychologists to be physicians within Medicare, saying it “inappropriately” expands psychologists’ scope of practice.
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.
Go Paperless With UHC Document Vault - 09/25/2020
Looking for ways to reduce the amount of paper your practice uses? One way is to digitally receive claim and prior authorization letters for UnitedHealthcare commercial and Medicare patients through UHC’s Document Vault, rather than by mail.