Related Stories

Submit 2020 Data Now to Avoid Medicare Pay Cut - 02/12/2021

If you participated in Medicare’s Quality Payment Program (QPP) under the Merit-Based Incentive Payment System (MIPS), the deadline to submit all data through the Centers for Medicare & Medicaid Services (CMS) portal has been extended one day to April 1. The deadline had been March 31.


List Cost on Medicare Radiopharma Claims - 02/05/2021

When billing Medicare for radiopharmaceutical procedure codes, you must list the total acquisition cost on the claim.


CMS Open Payments Registration Under Way - 02/04/2021

Registration is now open for the Centers for Medicare & Medicaid Services’ (CMS) Open Payments Program, which requires CMS to publicly report data on items of value given annually to physicians and teaching hospitals.


Medicare Payments For January Withheld - 02/02/2021

Novitas Solutions, the Medicare administrative contractor for Texas, has held physician Medicare payments for services rendered in January 2021 to comply with changes to federal laws, the Texas Medical Association has confirmed.


Provide Meaningful Health Care Coverage for Uninsured Texans - 02/01/2021

Texas can no longer ignore the human, social, and economic impact of having more than 20% of our people uninsured. Health care coverage matters, resulting in healthier constituents and more economically prosperous communities.


Review Your Physician Compare Data Now - 01/29/2021

The Centers for Medicare & Medicaid Services (CMS) recently opened its Doctors and Clinicians Preview Period, which allows you to check out your 2019 QPP performance data before its reported on Medicare Care Compare and in the Provider Data Catalog (PDC). CMS will close the preview period at 7 pm (CT) March 25.


Send TMA Your Prior Authorization Nightmare Stories - 01/27/2021

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.


Medicare Freezes Thresholds for MIPS Exemption - 01/22/2021

If you’re in a Qualifying Alternative Payment Model (APM) in Medicare’s Quality Payment Program (QPP), or you’re considering making the jump, take note: The thresholds for participating this year are now the same as in 2020 thanks to recent federal law.


The COVID-19 Relief Bill: What It Means For Medicare Payments - 01/11/2021

When Congress passed the omnibus spending and COVID-19 relief bill at the tail end of 2020, it carried important implications for physicians operating under this year’s Medicare physician fee schedule, including some changes that will positively affect doctors’ bottom line.


Proposed CMS Payer Requirements Shouldn’t Burden Physicians, TMA Says - 01/08/2021

A federal proposal that would require more transparency in insurers’ prior authorization denials in Medicaid and more sharing of such information with physicians could improve care delivery, but  also could result in more responsibilities on already overburdened physicians, TMA told the Centers for Medicare & Medicaid Services.


Verify Which Health Plans Are Exempt From Prompt Pay Laws - 01/04/2021

Use this tool to affirm which health plans are self-funded and thus not subject to state prompt pay laws. ERISA or TDI?


Make Modifiers Work for You - 01/04/2021

Missing or incorrect coding modifiers are a common reason why claims are denied or physicians are paid incorrectly for their services. Follow these steps to make sure your practice uses modifiers correctly.


Medicare 2% Payment Cut Suspended Through March - 01/04/2021

Medicare sequestration, the federal government’s 2% across-the-board payment cut, will be suspended until March 31, because of the COVID-19 pandemic, officials said.


Help TMA Standardize Quality Measures in Value-Based Care - 12/18/2020

Would you like a say in what measures should be a standard part of insurance quality programs across the nation – and which ones shouldn’t? The Texas Medical Association now has input in that discussion and could use your help.


UHC Postpones Higher Liability Coverage Requirements Plan - 12/11/2020

UnitedHealthCare (UHC) postponed a plan that would require Texas physicians to substantially increase their professional liability insurance coverage in order to participate in its networks. The move comes after the Harris County Medical Society and Texas Medical Association expressed serious concerns about the new policy.


Take Action: Tell Federal Lawmakers to Stop Medicare Payment Cuts - 12/10/2020

TMA urges you to tell your federal lawmakers to support HR 8702, also known as the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act,” which would freeze Medicare Part B payments at 2020 rates for two years.


NPI Entity Type 1/Type 2 and Medicare Provider Numbers - 12/09/2020

If I am an incorporated physician, do I need two National Provider Identifiers (NPIs)?


CMS Finalizes Cut to Many Physician Payments, Adds Telehealth Codes in 2021 Fee Schedule - 12/04/2020

Medicare has finalized its 2021 physician fee schedule, resulting in payment cuts to many physicians due to the much-maligned budget neutrality requirements the Texas Medical Association has advocated against.


Deadline Extended: Apply for a MIPS Reporting Exemption - 12/02/2020

Did your practice face an unusual extreme hardship this year, such as financial or staffing difficulties related to COVID-19? If so, you could qualify for an exception to the Merit-Based Incentive Payment System (MIPS) reporting requirements for the 2020 performance year. The application deadline has been extended to Feb. 1, 2021. The previous deadline was Dec. 31, 2020.


Comprehensive Prior Authorization Reforms Needed, Medicine Tells Feds - 12/02/2020

As the Centers for Medicare & Medicaid Services (CMS) seeks ways to relieve the burdens of prior authorization on health care, it should not rely solely on automation of electronic health records. Instead, CMS should seek comprehensive reforms that include transparent PA requirements and protections of continuity of care as well as automation, the Texas Medical Association, American Medical Association, and a host of other medical societies wrote in a letter to CMS Administrator Seema Verma last week.


Federal Agencies Adopt Rule Mandating Health Plan Price Transparency - 11/24/2020

A number of health plans will be required to be more transparent about coverage pricing starting in early 2021 after the recent adoption of a rule by three federal agencies.


Timing for Annual Medicare Mammograms - 11/20/2020

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


CMS Relaxes Lookback Period for Medicare Overpayments - 11/20/2020

The Centers for Medicare & Medicaid Services (CMS) has spoken, finalizing a controversial rule and relaxing the lookback period physicians must adhere to when returning Medicare overpayments. In 2012, CMS proposed requiring physicians to return Medicare overpayments going back 10 years. The agency announced last week the required lookback period will be six years.


Deadline Extended: Didn’t Get Your 5% APM Incentive Payment? Take Action by Dec. 13 - 11/19/2020

If you participated in an advanced alternative payment model (APM) under the 2018 Quality Payment Program (QPP), the Texas Medical Association encourages you to take action now to verify that you have received your 5% APM incentive payment for 2020.


Blue Cross Bundles Payment for Some Diagnostic Services - 11/16/2020

Effective July 1, Blue Cross and Blue Shield of Texas will cut payments for certain diagnostic procedures. The cut will apply to diagnostic cardiovascular and ophthalmology procedures that are billed for the same patient on the same day.