Related Stories

Medicare Solidifies Pay Cut, Mixed Bag of Changes for Physicians in 2025 - 11/08/2024

In addition to finalizing a nearly 3% pay reduction for physicians, the Centers for Medicare & Medicaid Services also set the trajectory for practices over the next year with changes related to telemedicine, coding and payment, and the Merit-Based Incentive Payment System, among others.

Medicare Proposes Yet Another Physician Pay Cut in 2025 - 11/07/2024

In yet another destabilizing move for physician practices, Medicare on July 10 proposed what amounts to another pay cut for the nation’s physicians in the face of increasing costs, positioning organized medicine for heightened advocacy.

Feds’ Response to Cyberattack Aids Physicians, But Further Measures Needed - 11/07/2024

Eligible physician practices and others impacted by the recent cyberattack on Change Healthcare now may apply for accelerated and advanced payments for certain Medicare and Medicaid claims.

Congress Introduces Stopgap Bill to Halt Impending Medicare Pay Cut - 11/06/2024

While Congress considers a comprehensive Medicare payment fix, this new bill would halt the current proposed cut and provide a needed payment increase over the next year.

Medicare Social Media Graphics - 11/06/2024

Once again, physicians’ Medicare payments are set to be cut, this time a 2.8% reduction in 2025. Please download the graphics and post them on your social media channels to raise awareness about the problem.

Reform Can’t Wait: Medicine Prescribes Urgently-Needed Improvements to Flawed Medicare Payment System - 11/05/2024

When the Centers for Medicare & Medicaid Services (CMS) in July proposed a fifth consecutive round of cuts to physicians’ Medicare payments – contributing to a nearly 30% lag behind inflation growth since 2001 – medicine immediately mobilized.

CMS Delays Dramatic Office-Visit Coding Changes Until 2021 - 11/04/2024

Following advocacy by the Texas Medical Association and much of organized medicine, the Centers for Medicare & Medicaid Services has delayed its proposal to dramatically overhaul evaluation and management coding for physician services, a proposal that TMA warned would make treating Medicare patients “even more challenging.”

Fix Medicare Now, TMA Tells Feds - 10/22/2024

Unless the federal government increases physicians’ Medicare payments and overhauls Medicare’s hassle-laden Quality Payment Program (QPP), access to health care for millions of American seniors and people with disabilities “is at risk,” the Texas Medical Association told Centers for Medicare & Medicaid Services Administrator Seema Verma.

Majority of House Members Sign On to Appeal to Fix Medicare - 10/21/2024

Supporting medicine’s plea to halt the scheduled 2.8% cut in Medicare payment for physicians in 2025, a majority of U.S. House of Representatives members signed on to a letter urging House leadership to take action before the end of its current session Jan. 3.

AMA Board Chair Calls on Texas to Help Secure Medicare Fix, Restore Physician Autonomy - 10/15/2024

Attendees of Texas Medical Association’s second Business of Medicine Conference heard a host of economic hurdles to physicians, but underscoring them all is the decades-long trend of decreasing Medicare physician payment, according to the American Medical Association’s Board of Trustees Chair Michael Suk, MD.

TMA Critiques CMS’ Proposed Fee Schedule for Myriad Shortfalls - 10/04/2024

Noting that “private practices are breaking under the pressure of lack of adequate payment and increasing overhead,” the Texas Medical Association recommended numerous improvements to the 2025 proposed Medicare physician fee schedule. The schedule leads off with a 2.8% cut to physician payments and adds layers of complexity to its Quality Payment Program, among other administrative burdens.

Code Carefully for Bilateral Procedures - 10/02/2024

Coding for bilateral procedures can be confusing. See how payers differ in how they apply CPT modifier 50 to their coding and payment policies.

Practice E-Tips on Billing and Collections - 09/26/2024

Practice E-Tips on Billing and Collections

CMS Reopens 2023 MIPS Hardship Exception for Cyberattack - 09/26/2024

Thanks to medicine’s advocacy, the Centers for Medicare & Medicaid Services has reopened a hardship exception for the 2023 Merit-Based Incentive Payment System (MIPS) performance period to account for February’s Change Healthcare cyberattack.

CMS Ups Seasonal Flu Vaccine Payment - 09/09/2024

On Aug. 1, the Centers for Medicare & Medicaid Services increased payments to physicians for influenza vaccines and updated which codes physicians should use when billing for the service during the 2024-25 flu season.

BCBSTX to Require E/M Codes for Consultation Services - 09/03/2024

Starting Nov. 18, Blue Cross and Blue Shield of Texas will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology codes 99242 – 99245 and 99252 – 99255.

Coding with Care: Knowing Billing Codes for Complex Care Can Maximize Revenue, Access to Care - 08/28/2024

Knowing billing codes for complex care can maximize revenue and access to care.

Beryl-Affected Practices Automatically Eligible for MIPS Hardship Exemption - 08/19/2024

Due to the impact of Hurricane Beryl on Texas physician practices, the Centers for Medicare & Medicaid Services has automatically applied a hardship exemption within the 2024 Merit-Based Incentive Payment System performance period to eligible clinicians in “designated” areas.

Medicine Urges 4 Steps to Reform Medicare Pay - 08/13/2024

In the face of an increasingly unsustainable Medicare physician payment system, hundreds of state and national medical associations collectively exhorted congressional leaders to adopt a four-point reform plan they say can “no longer be delayed without severe repercussions for patient access and quality of care.”

Medicare Premiums, Deductibles to Increase in 2024 - 07/29/2024

Medicare patients will be paying more for their coverage in 2024, which will impact how much co-pay practices collect.

G-Code Payment Frustration Persists With Inconsistent Implementation - 06/25/2024

Deepening ongoing physician concerns over Medicare’s add-on code for complex care, two major payers have either reduced payment for G2211 claims or announced plans to stop paying certain claims associated with the code altogether. Read more.

Starting a Practice - 06/03/2024

Setting Up or Closing a Practice

Innovation for Every Age: Texas Primary Care Physicians Improve Access for Older Patients - 05/06/2024

Texas' population is aging, highlighting the importance of access to high-quality, coordinated primary care that bridges complex systems, various clinicians, and concurrent chronic conditions.

Cigna to Deny Claims Without Z-Code Documentation - 04/24/2024

Starting July 14, Cigna Healthcare will deny certain claims that are billed with a Z code and without documentation, a move that could add to physicians’ administrative burden.

Medicare May Seek Payment Recoupment for 2023 Claims - 04/09/2024

A new report by the Government Accountability Office shows physicians may face possible recoupments – or additional payment – for claims filed in 2023 as a result of over and underpayments by Medicare, Medicaid, and other federal programs.