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How Health Plans Are Covering COVID-19 Testing and Treatment - 04/02/2020

Many health insurers in Texas are waiving patient costs associated with COVID-19. Last week in a news release, Gov. Greg Abbott and the Texas Department of Insurance asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention guidance, and telemedicine visits.

AMA Creates CPT Code for Coronavirus Test - 03/17/2020

The American Medical Association has created a Current Procedural Terminology (CPT) code, 87635, to report laboratory testing services that diagnose the presence of the novel coronavirus.

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.

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.

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

Timing for Annual Medicare Mammograms - 10/29/2019

Medicare counts 11 full months after the month in which the patient received her screening

Using Unlisted Codes for Workers' Comp Services - 10/29/2019

Using Unlisted Codes for Workers' Comp Services

Practice e-Tips on Coding - 10/24/2019

Get practice tips on all things coding. Learn about coding methods, correct coding, resources, coding related to Workers' Comp and more.

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.

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.

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.