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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.


Use New Medicare IDs in 2020 to Avoid Rejected Claims - 11/12/2019

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.


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.


File Your MIPS Targeted Review Request by Sept. 30 - 09/18/2019

Physicians have two weeks to file a targeted review request to appeal errors in their 2018 Merit-Based Incentive Payment System (MIPS) performance feedback and 2020 Medicare payment adjustment under the Quality Payment Program (QPP).


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).


Put Patients Over Paperwork, TMA Tells CMS - 08/19/2019

Allow physicians to use electronic health records how they see fit, eliminate prior authorization requirements, lift the ban on physician-owned hospitals, and allow a real out-of-network option. Those are among the 15 recommendations the Texas Medical Association presented to the Centers for Medicare & Medicaid Services, which is seeking to reduce administrative burdens and red tape in the Medicare program.


Yes, You Do Have to Comply With a MIPS Audit Request - 08/14/2019

TMA finally received clarification from CMS: If you receive an Merit-based Incentive Payment System (MIPS) audit request for the 2017 and/or 2018 performance years, compliance is indeed mandatory, and there are possible punishments for noncompliance.


Medicare Muzzle? New Rules May Make Physicians Reluctant to Speak Up - 08/02/2019

New Medicare rules on local coverage determinations may make physicians reluctant to speak their minds.


False Impression: Medicine Says Medicare Report Inflates Success of Quality Program - 08/02/2019

High participation, “significant strides,” overwhelming success. That was the picture the Centers for Medicare & Medicaid Services painted in a March report on the first year of the Quality Payment Program. But a closer look by the Texas Medical Association raises serious doubts about CMS’ numbers, transparency, and cheerleading – so much so that TMA and seven other state medical associations are asking the agency to rescind the report.


Get Paid for End-of-Life Care Discussions With Patients - 07/18/2019

Since 2016, the Centers for Medicare & Medicaid Services has used two Current Procedural Terminology (CPT) payment codes for conversations about end-of-life treatment.


Will You Get a Medicare Bonus or Pay Cut Next Year? - 07/11/2019

 If you participated in the 2018 Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP), it’s now possible to check whether you’ll receive a Medicare payment bonus or cut next year.  Physicians should check their 2018 MIPS performance feedback and 2020 payment adjustment as soon as possible in case the Centers for Medicare & Medicaid Services (CMS) made mistakes when calculating your data, which happened last year. 


Problem With Medicare’s PECOS Being Resolved, Officials Say - 07/11/2019

A software update to Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS) implemented last month has created problems associated with existing and new group reassignments. Because of this, data from PECOS to the Multi-Carrier System for these changes have been delayed for all Medicare Administrative Contractors.


AMA House Punts on Texas Plan to Fix QPP - 06/26/2019

A decision on whether the American Medical Association (AMA) will join the Texas Medical Association’s call for major changes to Medicare’s Quality Payment Program (QPP) will have to wait a few more months, the AMA House of Delegates decided at its annual meeting in Chicago last week. The QPP overhaul was just one of 11 resolutions the Texas delegation to the AMA took to the five-day meeting. Most of the other 10 received a very warm welcome.


TMA to Congress: Undo Payment Freeze, Help Physicians With MACRA - 06/25/2019

Physicians participating in the Quality Payment Program’s Merit-Based Incentive Payment System and alternative payment models need help from Congress to succeed, and lawmakers need to undo an upcoming freeze on Medicare payments. That’s what the American Medical Association, the Texas Medical Association, and dozens of other medical societies told House of Representatives and Senate leaders in both parties in a letter sent last week.


Be On the Lookout for MIPS Audit Request - 06/25/2019

The Centers for Medicare & Medicaid Services has contracted with Guidehouse, a nationwide consulting firm, to audit physicians who participate in the Merit-Based Incentive Program, which is under the Quality Payment Program. If you submitted MIPS data for 2017 and/or 2018, you could receive a request for information via email or certified letter from Guidehouse.