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Running Out of Reasons: Low Payments, Hassles Leave Physicians Wondering: Why stay in Medicare? - 06/01/2020

Texas physicians who deal with Medicare’s substandard payments and world-class administrative hassles are feeling underappreciated. The latest report from the committee that advises Congress on Medicare payment policy may exacerbate that feeling. In March, the Medicare Payment Advisory Committee (MedPAC) released its annual report assessing payments to physicians, among other sectors. MedPAC recommended no changes to the 2021 Medicare physician fee schedule, meaning no increase in physician payments.  


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.


Send TMA Your Prior Auth Nightmare Stories - 01/31/2020

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes. Your personal stories of patient harm due to prior authorization request delays or denials can give the Texas Medical Association the ammunition it needs to fight this problem. Please submit your stories via email to the TMA Payment Advocacy Department.


Insurance Companies Have Denied My Doctor’s Orders, 25% of Texas Voters Say in New Poll - 01/29/2020

One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.


Insurance Companies Have Denied My Doctor’s Orders, 25% of Texas Voters Say - 01/29/2020

One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.


Deadline: Claim Your 5% Medicare Bonus by Feb. 28 - 01/21/2020

If you participated in an advanced alternative payment model (APM) during the 2017 Quality Payment Program (QPP) performance year but haven’t received your 5% APM incentive payment for 2019, the Centers for Medicare & Medicaid Services (CMS) wants to hear from you. The Texas Medical Association has learned that CMS has been unable to disburse the 2019 incentive payment to nearly 3,000 clinicians nationwide because the agency cannot verify their banking information.


FAQs for New Physicians: Starting Your Career - 01/21/2020

Starting a new medical practice with the right people, processes, and structure is key to the success of any new practice. This informative seminar helps residents make critical decisions about getting started. Starting Your Career is a one-hour seminar conducted at your facility by TMA's practice management consultants.


Develop a No-Show Policy — and Use It - 12/12/2019

Develop a no-show policy — and use it


CMS to Recoup Chronic Care Management Payments - 12/06/2019

Some Texas physicians and outpatient facilities might have to refund payments they received for chronic care management services performed during 2015 and 2016 under the Medicare Physician Fee Schedule, federal officials said.


Is Medicare’s Chronic Care Management Program for You? - 11/22/2019

Interested in the possibility of getting paid as much as $75,000, or even more, for something you already more or less do? Medicare now pays separately for chronic care management services. To help you decide if this new opportunity is right for your practice, TMA created a new online resource center.


Chronic Care Management: The Patient Agreement - 11/22/2019

Securing a patient’s informed and written consent is an important part of the Medicare Chronic Care Management Services program. Medicare requires it, and you’ll be sure your patients understand how it works.


Examine the Billing Cycle “Vitals” for Your Practice - 11/13/2019

The Texas Medical Association’s free webinar, What You Need to Know to Evaluate Your Billing Process, offers a step-by-step process and tools to assess your practice’s financial health and identify key areas for improvement. The webinar will show you how to use practice management reports to evaluate your staff’s productivity, your billing and collections processes, and even payer performance.


Practice e-Tips on Claims - 10/30/2019

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


Starting a Practice - 10/30/2019

Setting Up or Closing a Practice


More Resources to Get Paid - 10/23/2019

TMA helps physicians “Get Paid.” In 2016, our Hassle Factor Log helped members recover more than $1.8 million in insurance payments.


Medicare Lab Fee Includes Routine Venipuncture - 10/16/2019

If you perform the lab test in your office, you may not bill separately for the “collection of venous blood by venipuncture,” or CPT code 36415, according to the Medicare Claims Processing Manual. However, a significant number of physicians who collect blood and perform lab tests in their office are billing for CPT code 36415 along with the test code, the Center for Medicare & Medicaid Services says.


Here’s What Medicare Pays for Flu Shots This Season - 10/04/2019

The Centers for Medicare & Medicaid Services recently published 2019-20 payment rates for personal flu vaccines and their administration. The effective dates for these rates are Aug. 1, 2019, to July 31, 2020.


United Healthcare Cuts Consults - 09/04/2019

United Healthcare is eliminating payment for consults in two phases – one that took effect June 1 for certain services, and their complete elimination starting in October. The change is an effort to align with the Centers for Medicare & Medicaid Services policy that eliminated payment for most consults in 2010, but it’s going to make it more difficult for many specialists to get compensated for the extra time and work those services require.


Guide to Insurance Overpayments and Refund Requests - 08/14/2019

Use this guide to help you and your staff properly assess refund requests from health plans.


Most Valuable Team: Managing Nonphysician Staff Efficiently Can Boost Patient Care and Bottom Line - 08/02/2019

Because state laws and insurer billing requirements governing physician delegation and supervision can be tricky to navigate, practices must stay up to date to avoid potential penalties.


Turn to TMA to Resolve Prompt-Pay Issues - 07/22/2019

If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Hassle Factor Log program. The Texas Department of Insurance last week released a bulletin reminding plans that a portion of prompt-pay penalties must be paid to the state.


Medicare Critical Care and Initial Hospital Services E and M Slated for Review - 05/17/2019

If you’ve been “probed and educated” twice by Novitas Solutions Inc. for high rate of claims errors regarding certain evaluation and management (E&M) services, you may receive more such review and education this summer.


How to File a Medicare Extended Repayment Plan - 03/04/2019

  Extended repayment plans (ERPs) are an option for returning overpaid money to Medicare. Ideally, you should request an ERP immediately after receiving the initial demand letter. However, you can request an extended payment plan any time while the overpayment is outstanding. 


Watch Those Extra Fees For Medicare Patients - 03/04/2019

Watch Those Extra Fees For Medicare Patients


Texas Clinics Repay Medicare for Improper Claims - 03/04/2019

Several Texas dialysis clinics in El Paso and the Dallas-Fort Worth area have had to repay Medicare for treating people in the country illegally.