Related Stories

Send TMA Your Prior Auth Nightmare Stories - 01/31/2020

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes. Your personal stories of patient harm due to prior authorization request delays or denials can give the Texas Medical Association the ammunition it needs to fight this problem. Please submit your stories via email to the TMA Payment Advocacy Department.


Insurance Companies Have Denied My Doctor’s Orders, 25% of Texas Voters Say - 01/29/2020

One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.


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.


CMS to Recoup Chronic Care Management Payments - 12/06/2019

Some Texas physicians and outpatient facilities might have to refund payments they received for chronic care management services performed during 2015 and 2016 under the Medicare Physician Fee Schedule, federal officials said.


Practice e-Tips on Claims - 10/30/2019

Appeals Appealing Claims Can Have Appealing Results   Claim Forms Multiple Place-of-Service Codes on a Single 1500 Claim Form   Fees New Laws Require Billing Di


More Resources to Get Paid - 10/23/2019

TMA helps physicians “Get Paid.” In 2016, our Hassle Factor Log helped members recover more than $1.8 million in insurance payments.


United Healthcare Cuts Consults - 09/04/2019

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.


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.


Turn to TMA to Resolve Prompt-Pay Issues - 07/22/2019

If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Hassle Factor Log program. The Texas Department of Insurance last week released a bulletin reminding plans that a portion of prompt-pay penalties must be paid to the state.


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.


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.


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.


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.


Practice E-Tips on Billing and Collections - 12/19/2017

Practice E-Tips on Billing and Collections


Practice e-Tips on Reimbursement - 12/13/2017

Billing & Fees Claims Coding & Documentation Collections Copayments & Deductibles Medicaid & Medicare Workers' Comp Billing & Fees Are You Missing Out on Your Money?    Billi


Focus on Member Services: Getting Paid - 10/13/2017

TMA's Hassle Factor Log recouped more than $1.8 million in unpaid insurance claims for physician members last year. If you have unresolved payment issues, know that your TMA membership gives you access to help to get you paid.


Preauthorization Denial: What’s Your Recourse? - 05/10/2017

So a health plan has denied your preauthorization request for a patient’s treatment. What options do you have?


BCBS Posts BlueCompare Information - 03/08/2017

Blue Cross and Blue Shield of Texas (BCBS) has posted online the presentation from the Dec. 22 webinar about its BlueCompare program. It was the only webinar the company conducted on the program, which rates some 18,000 Texas physicians in 14 specialties.