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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.


United Healthcare Cuts Consults - 08/02/2019

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.


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. 


Texas Clinics Repay Medicare for Improper Claims - 03/04/2019

Several Texas dialysis clinics in El Paso and the Dallas-Fort Worth area have had to repay Medicare for treating people in the country illegally.


Humana Changes for 2019: Preauthorization, Notification, and Formularies - 02/27/2019

Humana has made changes for 2019 to its preauthorization and notification lists.


Cornered: Proposed Medicare Fee Overhaul Could Box In Doctors - 02/05/2019

Proposed overhaul to Medicare payments for complex patient care visits and same-day office-based procedures could box in Texas physicians.


SB 418: Prompt Pay Final Rules - 01/24/2019

SB 418: Prompt Pay Final Rules


Sharing is Caring? Health Care Sharing Ministries Cause Confusion - 12/07/2018

Confusion surrounding health care sharing ministries puts Texas Medical Association on alert.


Humana Revises Peer-to-Peer Review - 10/18/2018

Humana has tweaked its peer-to-peer review process for prior authorization requests, giving physicians contracted with its Medicare Advantage plans another opportunity for review before filing a claim.


TDI Fines Humana Over Inadequate Network - 10/12/2018

The Texas Department of Insurance has fined Humana $700,000 and ordered the insurer to take corrective steps for not having enough in-network anesthesiologists in Harris, Bexar, and Travis counties this year.


Humana Peer-to-Peer Review Changing for Medicare Advantage Plans - 10/05/2018

Effective Aug. 1, Humana Medicare Advantage health plans will no longer offer peer to peer reviews after a medical necessity denial. Instead, the company will offer to schedule a peer-to-peer review before Humana issues the denial


Humana Physician Portal to Retire in October - 08/27/2018

Humana will shutter its secure provider portal on Oct. 3. To continue or begin working with Humana online, prepare now by registering for the Availity Provider Portal if your practice doesn’t already have an account.


Payer Roundup, January 2017 - 04/27/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about new preauthorization and payment policies, an evaluation and management code review — and a letter you may get from Novitas Solutions.


New Laws Require Billing Disclosures by Physicians - 04/27/2018

A raft of new rules took effect Sept. 1 requiring, medical practices to reveal specific billing information to patients.


Billing for H1N1 Vaccine Administration - 04/27/2018

For some payers, you may need to bill a penny for the H1N1 vaccine to be paid for administration.


TMA Payment Advocacy Services - 04/26/2018

TMA Payment Advocacy Services


What Stimulus Means to Texas Health Care - 04/24/2018

State health officials have released preliminary information on major health and human services allocations for Texas in the $789 billion economic stimulus bill President Obama signed. The largest portion is $5.45 billion for Medicaid through the first quarter of 2011.


Private Payer Round-Up, January 2013 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Round-Up, September 2013 - 04/19/2018

Formulary, preauthorization, and precertification changes and more … TMA’s reimbursement specialists have rounded up these other coding, payment, and policy changes and tips from commercial payers.


Private Payer Round-Up, October 2013 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Roundup — April 2015 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about an automated phone system change, and more.


Private Payer Round-Up, December 2013 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Round-Up, January 2014 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


AMA: Bad Claims Payment Increasing - 04/19/2018

It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card.


5010 Deadline Extended; Dual Eligible Problem Not Fixed - 04/17/2018

Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.