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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.


TMA to Lawmakers: Stop Proposed Medicare Changes - 12/06/2019

Federal lawmakers must hold hearings immediately to stop proposed changes to Medicare that would cause lasting and serious damage to the program and to health care in the United States, Texas Medical Association President Douglas Curran, MD, told two key Texas congressmen today.


New Help to Get Paid for CCM Services - 12/02/2019

A new initiative aims to raise awareness of the benefits of chronic care management (CCM) services for Medicare patients with multiple chronic conditions and to support physicians in starting CCM programs.


Chronic Care Management’s Five Codes: Know Which to Use - 11/22/2019

Q. If I provide more than 20 minutes of chronic care management (CCM) services to my Medicare patient, can I bill more than one unit or more than one line item of CPT 99490 in the service period to account.


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.


Can We Contract Out Chronic Care Management Services? - 11/22/2019

Under the Medicare Chronic Care Management (CCM) Services program, can my practice subcontract CCM services to a case management company?


Is Medicare’s Chronic Care Management Program for You? - 11/22/2019

Interested in the possibility of getting paid as much as $75,000, or even more, for something you already more or less do? Medicare now pays separately for chronic care management services. To help you decide if this new opportunity is right for your practice, TMA created a new online resource center.


Chronic Care Management: The Patient Agreement - 11/22/2019

Securing a patient’s informed and written consent is an important part of the Medicare Chronic Care Management Services program. Medicare requires it, and you’ll be sure your patients understand how it works.


AMA House Rejects MIPS Plan - 11/20/2019

Led by the Texas delegation, the American Medical Association House of Delegates on Tuesday rejected as inadequate a plan to improve Medicare’s Quality Payment Program (QPP) and its highly-flawed Merit-Based Incentive Payment System (MIPS) track.


Learn The ABCs of the QPP With Free CME - 11/12/2019

The Texas Medical Association has heard from physicians who are just now tuning in to the 2019 Quality Payment Program (QPP) and don’t know where to begin to avoid the 7% Medicare payment penalty in 2021.


TMA PracticeEdge ACOs Tops for State, National Medicare Savings - 11/11/2019

Three accountable care organizations formed through TMA PracticeEdge were among state and national leaders in generating Medicare savings during the 2018 Medicare Shared Savings Program performance year.


Get Details About Your 5% Medicare Bonus - 11/05/2019

If you participated in the advanced alternative payment model (APM) track during the 2017 Quality Payment Program (QPP) performance year, full details of your 5% APM incentive payment are finally available.


CMS Finalizes Changes to QPP, Medicare Fee Schedule - 11/04/2019

Changes to Medicare’s Quality Payment Program (QPP) finalized Friday include both wins and losses for medicine, according to Texas Medical Association staff's initial analysis of the QPP final rule for 2020.


Timing for Annual Medicare Mammograms - 10/29/2019

Medicare counts 11 full months after the month in which the patient received her screening


TMA to Trump: Do Not Expand NPPs’ Scope of Practice - 10/29/2019

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.


You May Need to Refile Some Medicare Claims - 10/25/2019

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.


Medicare Lab Fee Includes Routine Venipuncture - 10/16/2019

If you perform the lab test in your office, you may not bill separately for the “collection of venous blood by venipuncture,” or CPT code 36415, according to the Medicare Claims Processing Manual. However, a significant number of physicians who collect blood and perform lab tests in their office are billing for CPT code 36415 along with the test code, the Center for Medicare & Medicaid Services says.


TMA Says “No” to Federal Scope Expansion Under President’s Medicare Executive Order - 10/09/2019

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.


Beyond the Slogan “Medicare for All” - 10/03/2019

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.”


Fix Medicare Now, TMA Tells Feds - 10/01/2019

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.


More Pain for Small Shops? 2020 Quality Program Rule Could Mean More Penalties - 10/01/2019

Small and solo practices already take the worst of the administrative and financial pounding the Quality Payment Program (QPP) dishes out each year. In the Texas Medical Association’s analysis, the government’s plans for the QPP in 2020 would make the situation even harder on those smaller shops. Since QPP’s birth in 2017, small practices have struggled with the demands and synapse-straining complexities of the program’s Merit-Based Incentive Payment System (MIPS). And TMA analysis shows the payment penalties those “have-not” practices incur fund the bonus payments earned by MIPS “haves” – often, larger practices with the resources to make the program work. Under the 2020 changes that the Centers for Medicare & Medicaid Services (CMS) has proposed, the maximum penalties for practices who don’t hit their MIPS targets will be larger than ever. But TMA’s review shows that MIPS – despite CMS’ claims to the contrary – isn’t getting any simpler.


Upgrade Your EHR Before It’s Too Late - 08/28/2019

If you participate in Medicaid and/or Medicare incentive payment programs, time is running out to upgrade to the 2015 certified electronic health record technology (CEHRT).