Related Stories

Medicaid: Reforms, But No Raise - 07/23/2019

Medicine didn’t get everything it needed from lawmakers for Medicaid, including TMA’s biggest and boldest ask of the 2019 session. Still, progress TMA achieved on managed care reform and other facets of Medicaid will advance physicians’ efforts to care for the most vulnerable Texans.


Get Paid for End-of-Life Care Discussions With Patients - 07/18/2019

Since 2016, the Centers for Medicare & Medicaid Services has used two Current Procedural Terminology (CPT) payment codes for conversations about end-of-life treatment.


Will You Get a Medicare Bonus or Pay Cut Next Year? - 07/11/2019

 If you participated in the 2018 Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP), it’s now possible to check whether you’ll receive a Medicare payment bonus or cut next year.  Physicians should check their 2018 MIPS performance feedback and 2020 payment adjustment as soon as possible in case the Centers for Medicare & Medicaid Services (CMS) made mistakes when calculating your data, which happened last year. 


Problem With Medicare’s PECOS Being Resolved, Officials Say - 07/11/2019

A software update to Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS) implemented last month has created problems associated with existing and new group reassignments. Because of this, data from PECOS to the Multi-Carrier System for these changes have been delayed for all Medicare Administrative Contractors.


False Impression: Medicine Says Medicare Report Inflates Success of Quality Program - 06/14/2019

High participation, “significant strides,” overwhelming success. That was the picture the Centers for Medicare & Medicaid Services painted in a March report on the first year of the Quality Payment Program. But a closer look by the Texas Medical Association raises serious doubts about CMS’ numbers, transparency, and cheerleading – so much so that TMA and seven other state medical associations are asking the agency to rescind the report.


Doctor’s Order A Must For Lab Tests - 05/29/2019

The Centers for Medicare & Medicaid Services is paying attention to claims for these lab services because it has found they were paid in error in 2018 by some $28 million. For routine venipuncture, medical necessity errors accounted for virtually all the improper payments. For urinalysis, it was insufficient documentation.


Medicare Muzzle? New Rules May Make Physicians Reluctant to Speak Up - 05/28/2019

New Medicare rules on local coverage determinations may make physicians reluctant to speak their minds.


Use Modifiers to Override Correct Coding Initiative Edits - 05/28/2019

Correct Coding Initiative Edits Now Free on Internet


Code Carefully for Bilateral Procedures - 05/02/2019

Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.


Make Sure These Medicare Missteps Didn’t Affect Your Claims - 04/16/2019

Because of all of the policies, edits, determinations, rules, and revisions, Medicare’s claims processing sometimes goes awry for certain codes, fees, or other specific claim elements. The Centers for Medicare & Medicaid Services (CMS) reports these errors and their fixes on a regular basis.


Include Physicians on Long-Term Care Facilities Council - 04/09/2019

TMA strongly supports SB 1519 as it will address Texas’ growing need for best practices in dispute resolution and Medicaid quality-based payment systems in long-term care. However, we urge the chair and this committee to consider two additions to the long-term care council that will strengthen its ability to address medical and infectious disease concerns


Strengthen Medicaid MCO Oversight and Improve Access to Care - 04/02/2019

Over the past six months, leaders from TMA, the Texas Hospital Association, Texas Association of Health Plans, and Texas Association of Community Health Plans have met monthly to identify opportunities to reform Medicaid. While we do not always sing Kumbaya, we have developed a better understanding of the root causes of many of problems facing the program. And many problems are much more complex than we first realized, such as simplifying Medicaid prior authorizations.


National Specialty Societies With MACRA Information - 03/27/2019

To help you get the best information possible, TMA has identified direct links to MACRA news, resource centers, education, and advocacy from national specialty societies. Visit your specialty society online for information specific to your specialty, setting, and practice.


Beyond the Slogan “Medicare for All” - 03/11/2019

Medicare For All is becoming popular among Democratic lawmakers and the public. But, as popular as the concept is, the details are lost in the simple slogan of “Medicare for All.”


Children Eligible for Medicaid Need Continuous Coverage - 03/11/2019

Texas is a state that values fairness. In 2007, lawmakers adopted 12 months’ continuous coverage as a best practice for children in CHIP. It is time to provide working parents of children enrolled in Medicaid the same treatment.


Urgent: Action Needed Today To Secure $500 Million For Medicaid - 03/08/2019

On Monday, the House Appropriations Committee will consider amendments, known as “riders,” to its draft state budget for 2020-21. Your state representative serves on the Appropriations Committee. Please contact your representative today and ask him or her to vote to adopt “the Sheffield rider in Article 11” to increase Medicaid rates.


Security Risk Analysis for HIPAA — and Medicare/Medicaid? - 03/08/2019

Do you need to conduct a security risk analysis or review of your practice in the next 72 days?


Medicare Enrollment Application Revised - 03/04/2019

A new Medicare enrollment application form for physicians and nonphysician practitioners will go into effect May 1.


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. 


Watch Those Extra Fees For Medicare Patients - 03/04/2019

Watch Those Extra Fees For Medicare Patients


Use New G Codes for Medicare Therapy Claims - 03/04/2019

Starting with services dated Jan. 1, 2013, physicians have to report new, nonpayable G codes and related modifiers on Medicare claims for outpatient physical, speech, and occupational therapy.


How's Novitas Doing? - 03/04/2019

Medicare wants to know what you think of the job Novitas Solutions is doing administering the Medicare program in Texas.


Where Do We Go From Here With Our Health Care System? - 03/04/2019

To say that Medicare works well, denies the fact that in many patients are no longer able to go to the doctor of their choice. In fact, even finding a doctor is difficult. Additionally, many doctors no longer participate in the Medicare program. This program is only one step away from a single payer health care system, which was once referred to as socialized medicine.


TMA Pushes Back Against Planned Vaccine Payment Cuts - 02/12/2019

As the influenza virus continues to spread statewide, the Texas Medical Association and other specialty societies have taken a stand against a plan to cut by almost 36 percent payments to physicians who administer a flu vaccine in their offices.


Physicians Tell Feds: Rework Network Adequacy Plan - 02/08/2019

The Texas Medical Association and the Texas Pediatric Society are urging the Centers for Medicare & Medicaid Services to reconsider several parts of its proposal to redefine adequate networks for Medicaid.