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Practice E-Tips on Billing and Collections - 10/20/2020

Practice E-Tips on Billing and Collections


Preauthorization Denial: What’s Your Recourse? - 10/16/2020

So a health plan has denied your preauthorization request for a patient’s treatment. What options do you have?


See Blue Cross Referral Chart, Colonoscopy Coding Tips - 10/14/2020

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.


Blue Cross Prior Authorization Manager Changing - 09/30/2020

Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.


Practice e-Tips on Claims - 09/24/2020

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


More Resources to Get Paid - 09/24/2020

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


Practice e-Tips on Reimbursement - 09/24/2020

Billing & Fees Claims Coding & Documentation Collections Copayments & Deductibles Medicaid & Medicare Workers' Comp Billing & Fees Are You Missing Out on Your Money?    Billi


Charging Concierge Fees to BCBSTX Patients - 09/23/2020

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.


Reimbursement Review and Resolution (RRR) Services User Guide - 09/09/2020

Please observe the following Reimbursement Review and Resolution (RRR) form guidelines to help us expedite processing while maintaining the integrity and credibility of RRR Services (previously known as the Hassle Factor Log Program).


CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15 - 08/12/2020

CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15


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.  


TMA Calls Governor’s Plan “Prudent and Careful” - 04/27/2020

Statement by Texas Medical Association (TMA) President David C. Fleeger, MD, in response to Texas Gov. Greg Abbott’s announcement that Texas hospitals now need to reserve only 15% of their capacity for COVID-19 patients.


TDI Fines Blue Cross $10 Million for Delays, Errors - 03/11/2020

Blue Cross and Blue Shield of Texas will pay a $10 million fine for providing consumers incorrect information, delays in out-of-network claims processing, and errors in marketing materials, the Texas Department of Insurance has announced.


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.


Don't Miss Out! Medicare Pays for Chronic Care Management - 11/22/2019

Do you manage patient referrals and care transitions between and among physicians and health care settings? Do you spend time reconciling medication lists and managing prescription refills for your patients? Do you take calls during and after office hours to address patient care needs? If the answer is yes and you're not billing for these types of services, you're missing out on a new CPT code and practice revenue opportunity from Medicare.


Be Careful With Covenants Not to Compete - 09/09/2019

Almost every contract has an escape hatch — but you might have to escape to a place you don't want to be.


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.


Texas Physicians Push to Improve Health Care for LGBTQ Patients - 09/03/2019

Lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) patients face unique barriers that put them at greater risk for mental and physical health problems. Often, their health disparities result from a lack of family support, public prejudice, and fear of the health care system. Texas physicians have launched a new workgroup and are adapting their practices to treat this underserved population.


Quality Care Pilot Takes Flight - 09/03/2019

How one children's clinic uses a targeted program to dramatically improve care, lower costs.


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.


Physician, Hospital Groups Distribute Urgent Measles Advisory - 08/06/2019

Texas doctors and hospitals have a new tool to fight the ever-increasing measles threat, as the number of people sickened by the infectious yet preventable disease climbs. The Texas Medical Association (TMA) and Texas Hospital Association (THA) have created a new resource to help physicians, hospitals, and other health care professionals combat the highly contagious, yet entirely preventable, respiratory illness.


7 Things You Must Know Before Signing an Employment Contract - 07/02/2019

A good contract by definition is one that is fair and reasonable and is a win-win situation for everyone involved. But how do physicians ensure they are getting a good contract before agreeing to work for a hospital or group practice?


Faulty Guidelines - 06/03/2019

Former Texas Medical Association President Josie Williams, MD, was tenacious in advocating that organized medicine pay zealous attention to two topics: data and guidelines. In this, she was both sage and prescient. We have done well in following her recommendations on data, but we continue to fall far short of where we need to be on guidelines.


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.


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.