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Use “Time, MDM” for Medicare Telehealth Coding - 05/20/2020

When coding for Medicare telehealth visits, you can use either medical decisionmaking (MDM) or time as the basis for your selection of office/outpatient evaluation and management (E&M) levels of service, the Centers for Medicare & Medicaid Services has clarified.


Medicine Pushes Texas Medicaid to Help Save Primary Care - 05/08/2020

Leaders of the Texas Medical Association and four large primary care specialty societies on Wednesday painted for senior Medicaid officials the bleak fiscal picture of many physician practices, and requested immediate financial assistance.


Appropriate Use of Time? Medicare Rules for Advanced Imaging Orders Pose Prior-Auth Burdens - 04/09/2020

An effective way to cut down on overuse of potentially harmful imaging, or a prior authorization-esque burden on physicians who order needed tests? Texas physicians see Medicare’s “appropriate use” system for advanced imaging both ways. As of Jan. 1, physicians ordering advanced imaging tests for Medicare patients must consult an electronic portal, which evaluates whether the test meets Medicare’s own “appropriate use criteria” for whether a test should be ordered. Then when the claim is filed, physicians must document that they checked the system and its determination.  


Feds Approve Texas’ Request for COVID-19 Medicaid Waiver - 03/31/2020

The Centers for Medicare & Medicaid Services (CMS) on March 30 approved Texas’ request to waive certain Medicaid regulatory requirements to help physicians and other health care professionals more effectively respond to the COVID-19 pandemic.


Census Undercount Could Stifle Texas’ Health Services, Doctors Say - 03/11/2020

Texas physicians are urging patients to answer the upcoming U.S. Census to ensure the state won’t lose billions of dollars’ worth of health and human services funding – a loss that could harm the patients themselves.


Physicians Needed for Medicaid Managed Care Advisory Panel - 03/03/2020

March 13 is the new deadline to get your application to the Texas Health and Human Services Commission if you want to serve on its State Medicaid Managed Care Advisory Committee. The panel advises the commission on Medicaid managed care operations statewide.


Submit 2019 QPP Data by March 31 to Avoid a 7% Medicare Payment Cut - 03/02/2020

The data submission period for Medicare’s 2019 Quality Payment Program (QPP) is under way and closes on March 31. If you haven’t started the process, now is the time to ensure your data for the Merit-Based Incentive Payment System (MIPS) is in order and submit it in time to make corrections by the deadline, if needed.


Which Presidential Candidate Stands for What Again? - 02/24/2020

A group of dedicated Harris County physicians has a cure for “too many candidates confusion disorder.” They compiled a simple table of the candidates’ positions on seven key health care policy issues based on the candidates’ official websites and The Washington Post’s “We’re Asking 2020 Democrats Where They Stand on Key Issues.”


TMA Opposes Attempts to Expand Audiologists’ Scope - 02/14/2020

Proposed federal laws that would give audiologists unlimited access to Medicare patients without a physician referral could lead to lasting, and expensive, harm to patients, medicine once again told U.S. Senate and House leadership this week.


TMA to Trump: Do Not Expand NPPs’ Scope of Practice - 02/12/2020

When President Donald Trump released an executive order earlier this month that would, in part, expand the scope of practice of nonphysician practitioners, the Texas Medical Association vowed to keep physicians at the head of the health care team. On Monday, TMA President David Fleeger, MD, took a major step to do that, urging President Trump and Health and Human Services (HHS) Secretary Alex Azar to remove that language entirely.


Medicaid Grant Could Pay for Your HIE Connection - 02/12/2020

Have you or your practice been considering connecting your electronic health record (EHR) to a health information exchange (HIE), but keep getting hung up by the cost? Well, here’s some good news. Three public HIEs recently were awarded contracts for a Medicaid grant that could pay for you to connect to their exchanges.


Proposed Medicaid Rule Would Severely Restrict Services, Medicine Argues - 02/03/2020

A proposed federal rule that would restrict how states fund their share of Medicaid would cause serious cuts in services, particularly for children, pregnant women, the elderly, and the disabled. That is the message the Texas Medical Association and multiple state and specialty medical societies have delivered to the Centers for Medicare & Medicaid Services.


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.


Arbitration Law Will be “Messy,” Bring Operational Concerns, Panelists Say - 01/31/2020

 The state’s new law allowing arbitration of payment disputes on certain out-of-network care carries concerns for physicians and uncertainty about what it will look like from an enforcement standpoint, a panel told the Texas Medical Association Winter Conference on Saturday morning.


Register to Vote by Monday - 01/29/2020

Elections, particularly the spring party primaries, determine the practice environment for Texas physicians and our patients. And election season is upon us. To help elect medicine-friendly candidates in the March primaries, you must be registered to vote by Monday, Feb. 3.


Federal Funding for Women’s Health Services in Texas Restored - 01/24/2020

Texas will again receive matching federal funds for women’s health services through a Medicaid 1115 waiver Gov. Greg Abbott announced Wednesday. Under the agreement, Texas will receive about $350 million from Washington over the next five years to cover the vast majority of costs for its Healthy Texas Women program.


Physicians Must Lead Care Teams, Medicine Tells Feds - 01/24/2020

The Texas Medical Association, and 99 other medical societies, are making it clear to Medicare that physicians are the nation’s most highly trained health care professionals – and the government shouldn’t weaken or eliminate their supervision of nonphysicians.


TMA Says “No” to Federal Scope Expansion Under President’s Medicare Executive Order - 01/23/2020

At least one piece of President Donald Trump’s recent executive order on Medicare will meet strong opposition from the Texas Medical Association. “Know this: TMA will stand up for our profession and our patients to prevent this totally unwarranted scope-of-practice expansion from becoming reality,” said TMA President David C. Fleeger, MD.


Deadline: Claim Your 5% Medicare Bonus by Feb. 28 - 01/21/2020

If you participated in an advanced alternative payment model (APM) during the 2017 Quality Payment Program (QPP) performance year but haven’t received your 5% APM incentive payment for 2019, the Centers for Medicare & Medicaid Services (CMS) wants to hear from you. The Texas Medical Association has learned that CMS has been unable to disburse the 2019 incentive payment to nearly 3,000 clinicians nationwide because the agency cannot verify their banking information.


The Math of Medicare for All - 01/09/2020

With two of the current top Democratic candidates – Sens. Bernie Sanders (I-Vermont) and Elizabeth Warren (D-Massachusetts) – espousing Medicare for All, supporters and detractors alike are asking more in-depth questions about the proposal, particularly how much it will cost.


Use New Medicare IDs to Avoid Rejected Claims - 01/07/2020

Your Medicare patients have ditched their old Medicare ID numbers. It’s high time you do, too, to avoid unpaid claims in the new year. Starting Jan. 1, Medicare beneficiary identifiers (MBIs) replace patients’ old Social Security number-based health insurance claim numbers (HICNs). Novitas Solutions, the Medicare payer for Texas, will reject any claim submitted with a patient’s HICN, with a few exceptions. You will have to refile the claim with the patient’s MBI to get paid.


Medicare Sequestration Cuts, GPCI Floor Continue - 01/07/2020

As we begin 2020, it’s a good time to remember that several Medicare policies that affect physician payment remain in effect. Medicare sequestration, the federal government’s 2% across-the-board payment cut, will continue until further notice. In addition, Medicare’s 1.0 floor for the Geographic Practice Cost Indices (GPCI) has been extended temporarily, once again, to May 23.


Apply by Dec. 31 for MIPS Reporting Exceptions - 12/17/2019

Did your practice face an unusual extreme hardship this year? Do you practice in a rural area with poor internet connectivity? If so, you could qualify for an exception to the Merit-Based Incentive Payment System (MIPS) reporting requirements for the 2019 performance year. The application deadline is Dec. 31.


New House Committee Takes on Health Care Costs - 12/16/2019

Two physician legislators will serve on a newly created House Select Committee on Statewide Health Care Costs during the Texas Legislature’s interim year in 2020. The committee will examine the “primary drivers of increased health care costs in Texas.  


Social Media A Vital Tool for Influencing Policy, Panel Says - 12/13/2019

Social media has become indispensable for politicians to reach voters, but it's also a crucial way for voters – like physicians – to influence decision-makers and public opinion, a panel of state representatives and social media consultants said at the Texas Medical Association's Advocacy Retreat on Saturday.