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Congress Extends Medicare Telehealth Waivers, Payment for Audio-Only Visits - 01/10/2025

With telehealth extensions granted under the American Relief Act, TMA has updated its telehealth waiver chart to reflect these temporary changes that allow physicians to provide telemedicine mental health services without conducting an in-person patient visit. The flexibilities were extended through March.

Your Billing and Collections Checklist for 2025 - 01/10/2025

TMA’s Reimbursement Services staff work year-round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2024 to keep your billing and collections on track throughout the year.

Congress Averts Shutdown, Still Cuts Medicare Payment for 2025 - 01/06/2025

The American Relief Act of 2025, signed into law by President Biden Saturday morning, will extend funding for the government until mid-March. Congress was unable to include several of the Texas Medical Association’s federal goals as the new piece of legislation will not avert the 2.8% cut in Medicare physician payments that will start on Jan. 1, 2025.

TMA to Represent Texas Physicians’ Coding, Payment Concerns on National Credentialing Organization - 12/17/2024

TMA’s Director of Physician Payment Services has been appointed to the former Academy of Professional Coders’ National Advisory Board, where she will elevate the voices of Texas physicians through collaboration on coding, billing, and compliance issues.

Medicare Premiums, Deductibles to Increase in 2025 - 11/12/2024

Medicare patients will be paying more for their coverage in 2025, which will impact how much co-pay practices collect. The rise in patient costs comes at a time when Medicare physician payments still decline and payments to hospitals and other Medicare entities increase.

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.

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.

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.

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.

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.

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.”

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.

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.

MedPAC Backs Medicare Physician Payment Increase – Again - 03/26/2024

Echoing advocacy by the Texas Medical Association and others in organized medicine, the Medicare Payment Advisory Commission recently reupped its recommendation that Congress increase Medicare physician payment by tying such payment to inflation, among other factors.

Cyberattack Prompts CMS to Extend 2023 MIPS Flexibilities - 03/19/2024

The Centers for Medicare & Medicaid Services recently announced two flexibilities related to Medicare’s Merit-Based Incentive Payment System 2023 performance year, citing the recent cyberattack on Change Healthcare and heeding advocacy by organized medicine.

Quality of Life: Pay-for-Quality Programs Increasingly Address Nonmedical Drivers of Health - 03/15/2024

Insurance payers seldom give physicians incentives to address nonmedical drivers of health, especially in traditional fee-for-service payer contracts. Those incentives remain rare even in pay-for-quality programs that emphasize value-based care, but they are gaining traction.

Medicare Sunsets Beleaguered Appropriate Use Criteria Program - 03/14/2024

After longstanding opposition from the Texas Medical Association and others, the Centers for Medicare & Medicaid Services finally nixed the appropriate use criteria program for advanced diagnostic services as part of the 2024 Medicare physician fee schedule.