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Buying Time: Medicine’s Warnings Prompt CMS to Delay Dramatic Coding and Payment Changes - 06/23/2020

Medicine’s warnings prompt CMS to delay dramatic coding and payment changes.


Invoice No Longer Required for Some Medicare Claims - 06/03/2020

For certain biologicals and medications reported in Medicare Part B claims, Novitas Solutions now will allow you to enter invoice information on the claim, rather than provide the actual invoice for the services.


Use “Time, MDM” for Medicare Telehealth Coding - 06/02/2020

When coding for Medicare telehealth visits, you can use either medical decisionmaking (MDM) or time as the basis for your selection of office/outpatient evaluation and management (E&M) levels of service, the Centers for Medicare & Medicaid Services has clarified.


Running Out of Reasons: Low Payments, Hassles Leave Physicians Wondering: Why stay in Medicare? - 06/01/2020

Texas physicians who deal with Medicare’s substandard payments and world-class administrative hassles are feeling underappreciated. The latest report from the committee that advises Congress on Medicare payment policy may exacerbate that feeling. In March, the Medicare Payment Advisory Committee (MedPAC) released its annual report assessing payments to physicians, among other sectors. MedPAC recommended no changes to the 2021 Medicare physician fee schedule, meaning no increase in physician payments.  


Appropriate Use of Time? Medicare Rules for Advanced Imaging Orders Pose Prior-Auth Burdens - 04/09/2020

An effective way to cut down on overuse of potentially harmful imaging, or a prior authorization-esque burden on physicians who order needed tests? Texas physicians see Medicare’s “appropriate use” system for advanced imaging both ways. As of Jan. 1, physicians ordering advanced imaging tests for Medicare patients must consult an electronic portal, which evaluates whether the test meets Medicare’s own “appropriate use criteria” for whether a test should be ordered. Then when the claim is filed, physicians must document that they checked the system and its determination.  


CMS Postpones 2019 MIPS Reporting Deadline to April 30 - 03/23/2020

With a key deadline for clinicians in the Merit-Based Incentive Payment System approaching fast amid the COVID-19 pandemic, the Centers for Medicare & Medicaid Services is giving those clinicians a month of extra time to submit their data.


Submit 2019 QPP Data by March 31 to Avoid a 7% Medicare Payment Cut - 03/02/2020

The data submission period for Medicare’s 2019 Quality Payment Program (QPP) is under way and closes on March 31. If you haven’t started the process, now is the time to ensure your data for the Merit-Based Incentive Payment System (MIPS) is in order and submit it in time to make corrections by the deadline, if needed.


TPHC Praises Bill to Make State College Campuses and Offices Tobacco-Free - 02/20/2020

Statement by Eduardo Sanchez, MD, chair of the Texas Public Health Coalition and former Texas commissioner of health, in support of legislation filed to make Texas state college campuses and state agencies tobacco-free.


TMA Opposes Attempts to Expand Audiologists’ Scope - 02/14/2020

Proposed federal laws that would give audiologists unlimited access to Medicare patients without a physician referral could lead to lasting, and expensive, harm to patients, medicine once again told U.S. Senate and House leadership this week.


TMA to Trump: Do Not Expand NPPs’ Scope of Practice - 02/12/2020

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 - 02/03/2020

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.


Physicians Must Lead Care Teams, Medicine Tells Feds - 01/24/2020

The Texas Medical Association, and 99 other medical societies, are making it clear to Medicare that physicians are the nation’s most highly trained health care professionals – and the government shouldn’t weaken or eliminate their supervision of nonphysicians.


TMA Says “No” to Federal Scope Expansion Under President’s Medicare Executive Order - 01/23/2020

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.


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.


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.