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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.


Payers Axe Consultation Codes - 08/07/2019

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.


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.


United Healthcare Cuts Consults - 08/02/2019

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.


Medicaid: Reforms, But No Raise - 08/02/2019

Medicine didn’t get everything it needed from lawmakers for Medicaid, including TMA’s biggest and boldest ask of the 2019 session. Still, progress TMA achieved on managed care reform and other facets of Medicaid will advance physicians’ efforts to care for the most vulnerable Texans.


Get Dates of Service Right on Medicare Claims - 05/30/2019

When you a perform a Medicare service that is global, has both a professional and a technical component, or spans days or months, you need to know what date Medicare considers to be the official date of service when you file your claim. Here is some guidance from the Centers for Medicare & Medicaid Services (CMS) about coding and billing dates of service on professional claims.


Use Modifiers to Override Correct Coding Initiative Edits - 05/28/2019

Correct Coding Initiative Edits Now Free on Internet


Medicare X{EPSU} Modifiers Further Define Modifier 59 - 05/24/2019

The Centers for Medicare & Medicaid Services has established four new modifiers to define subsets of the commonly — but often mistakenly — used modifier 59.


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.


Code Carefully for Bilateral Procedures - 05/02/2019

Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.


Starting a Practice - 04/16/2019

Setting Up or Closing a Practice


Include Physicians on Long-Term Care Facilities Council - 04/09/2019

TMA strongly supports SB 1519 as it will address Texas’ growing need for best practices in dispute resolution and Medicaid quality-based payment systems in long-term care. However, we urge the chair and this committee to consider two additions to the long-term care council that will strengthen its ability to address medical and infectious disease concerns


Strengthen Medicaid MCO Oversight and Improve Access to Care - 04/02/2019

Over the past six months, leaders from TMA, the Texas Hospital Association, Texas Association of Health Plans, and Texas Association of Community Health Plans have met monthly to identify opportunities to reform Medicaid. While we do not always sing Kumbaya, we have developed a better understanding of the root causes of many of problems facing the program. And many problems are much more complex than we first realized, such as simplifying Medicaid prior authorizations.


Beyond the Slogan “Medicare for All” - 03/11/2019

Medicare For All is becoming popular among Democratic lawmakers and the public. But, as popular as the concept is, the details are lost in the simple slogan of “Medicare for All.”


Children Eligible for Medicaid Need Continuous Coverage - 03/11/2019

Texas is a state that values fairness. In 2007, lawmakers adopted 12 months’ continuous coverage as a best practice for children in CHIP. It is time to provide working parents of children enrolled in Medicaid the same treatment.


Urgent: Action Needed Today To Secure $500 Million For Medicaid - 03/08/2019

On Monday, the House Appropriations Committee will consider amendments, known as “riders,” to its draft state budget for 2020-21. Your state representative serves on the Appropriations Committee. Please contact your representative today and ask him or her to vote to adopt “the Sheffield rider in Article 11” to increase Medicaid rates.


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


Use New G Codes for Medicare Therapy Claims - 03/04/2019

Starting with services dated Jan. 1, 2013, physicians have to report new, nonpayable G codes and related modifiers on Medicare claims for outpatient physical, speech, and occupational therapy.


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.


Coding Changes Affect UnitedHealthcare Prior Authorization Lists - 02/22/2019

UnitedHealthcare (UHC) has replaced and added procedure codes on its notification and prior authorization (PA) lists.


TMA Pushes Back Against Planned Vaccine Payment Cuts - 02/12/2019

As the influenza virus continues to spread statewide, the Texas Medical Association and other specialty societies have taken a stand against a plan to cut by almost 36 percent payments to physicians who administer a flu vaccine in their offices.


Revenue Cycle Assessment - 02/11/2019

A TMA consultant will conduct a review of your business office operations that focuses on front desk procedures, billing, collections and revenue cycle improvement. We will identify opportunities for improvement of billing processes and procedures.


Physicians Tell Feds: Rework Network Adequacy Plan - 02/08/2019

The Texas Medical Association and the Texas Pediatric Society are urging the Centers for Medicare & Medicaid Services to reconsider several parts of its proposal to redefine adequate networks for Medicaid.


Improve Access to Care for Working Texans - 02/07/2019

Healthy Texans underpin Texas’ economic health. To ensure Texas can sustain its economic momentum over the long haul, it must invest in its greatest asset – its people. Our organizations call upon lawmakers to adopt a patient-centered legislative agenda to boldly address Texas’ access to health care challenges.