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Dos and Don’ts of Using Modifier 22 - 04/25/2019

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.


Charging Concierge Fees to BCBSTX Patients - 04/23/2019

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.


Closing a Loophole: Medicine Works to Clarify MOC Law - 04/17/2019

It was an important law that gave physicians new life, greatly restricting the discrimination they can face based on their maintenance of certification (MOC) status. And yet, opponents may have found a way to circumvent the 2017 legislature’s Senate Bill 1148.


Expect HEDIS Records Requests From Third Parties - 02/28/2019

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas or UnitedHealthcare, it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.


Section 1: Let Doctors Be Doctors - 02/01/2019

Stretched to the Limit: There came a moment when all the clicking on boxes, filling out forms, and waiting on hold was just too much for Houston internist Lisa Ehrlich, MD. The time and energy spent on all of these seemingly endless tasks meant she could not give nearly enough to her patients.


Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.


NEW! ABIM MOC Credit Offered at Fall Conference - 09/20/2018

If you’re looking for even more of an incentive to attend the Texas Medical Association’s Fall Conference at the end of the month, try this: You’ll be eligible to claim Maintenance of Certification credit in the American Board of Internal Medicine’s MOC program.


Blue Cross HMO Emergency Payment Review Policy Begins - 08/10/2018

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.


Can 34,616 Physicians Be Wrong About MOC? - 08/09/2018

The recently released findings of a national survey show that only 12 percent of the 34,616 physicians who answered the survey value the MOC program. Forty-six percent said they have mixed feelings, and 41 percent said they do not value it.


From Blue Cross: What to Fax, Where to Find Answers - 08/07/2018

Here is a heads up on a couple of changes in Blue Cross and Blue Shield of Texas’ preauthorization and predetermination processes.


Blue Cross to Put Off HMO Emergency Coverage Policy Until August - 06/27/2018

Blue Cross and Blue Shield of Texas will delay for 60 days a new HMO emergency care policy it had originally planned to begin on Monday, June 4.


Submitting Med Records, and More Tips From Blue Cross - 06/26/2018

Here’s some news you can use from Blue Cross and Blue Shield of Texas.


Blue Cross Payment Cut on Tap for Some Diagnostic Services - 06/19/2018

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 Says MOC Not Needed for BlueCompare - 05/30/2018

Physicians across the state reacted strongly to a March 5 letter from Blue Cross and Blue Shield of Texas (BCSTX) that implied the state’s largest insurance company is now using maintenance of certification (MOC) to rate physicians. That was not the intent, the company’s president says.


TMA Seeks TDI Review of Blue Cross HMO Emergency Policy - 05/10/2018

The Texas Medical Association and 18 other Texas medical societies are asking the Texas Department of Insurance to review a new Blue Cross Blue Shield of Texas policy that could require some HMO members to pay 100 percent of their out-of-network emergency medical bills.


Some Blue Cross Members Could Pay 100 Percent of ER Bill - 05/01/2018

The Texas Medical Association has reached out to Blue Cross and Blue Shield of Texas to obtain more details on a new HMO emergency care policy at BCBSTX unveiled this week.


Private Payer Roundup, January 2015 - 04/27/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about drug formulary changes, coding tips, a prior authorization change, and more.


Private Payer Round-Up, May 2014 - 04/26/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Vaccine News and Notes - 04/26/2018

Medicare pricing, some guides, and a payer policy clarification: Stay up to date.


Private Payer Roundup, November 2016 - 04/26/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out what policy and other changes payers are rolling out for 2017.


What Do You Really Think About MOC? - 04/24/2018

As Texas Medicine Today reported recently, leaders of the boards that run the Maintenance of Certification (MOC) programs have created a commission – the “Vision Initiative” – to develop “a set of recommendations about the future of continuing board certification.” They want to hear from you. And you have until April 30 to share your deepest thoughts.


Make a Child’s Holiday a Little Safer - 04/23/2018

Soon, there will be more little Texans riding bicycles because some not-for-profit organizations give bikes to underprivileged children as a holiday gift. Help ensure they have a safe experience when riding their new bike by giving the gift of health: a helmet.


BCBS Aids 2013 Hard Hats Program - 04/23/2018

Blue Cross and Blue Shield of Texas (BCBS) will continue its strong support of TMA's Hard Hats for Little Heads (HHLH) program in 2013. BCBS recently made a major gift earmarked for HHLH to the TMA Foundation. It is the seventh year BCBS has supported TMA's award-winning prevention program.


UHC Termination Date Correction, BCBSTX EFT Error - 04/20/2018

When checking eligibility for HealthSelect of Texas (Employees Retirement System) members, practices may see two lines of coverage.


Blue Cross Reverses Preauth Requirements — Payer Newsletter Excerpt - 04/19/2018

As a result of “feedback from the provider community,” Blue Cross and Blue Shield of Texas has removed 111 procedure codes from its preauthorization requirements related to additional care categories of codes.