Related Stories

AMA House Punts on Texas Plan to Fix QPP - 06/19/2019

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.


False Impression: Medicine Says Medicare Report Inflates Success of Quality Program - 06/14/2019

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.


TMA to Congress: Undo Payment Freeze, Help Physicians With MACRA - 06/10/2019

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.


Faulty Guidelines - 06/03/2019

Former Texas Medical Association President Josie Williams, MD, was tenacious in advocating that organized medicine pay zealous attention to two topics: data and guidelines. In this, she was both sage and prescient. We have done well in following her recommendations on data, but we continue to fall far short of where we need to be on guidelines.


Doctor’s Order A Must For Lab Tests - 05/29/2019

The Centers for Medicare & Medicaid Services is paying attention to claims for these lab services because it has found they were paid in error in 2018 by some $28 million. For routine venipuncture, medical necessity errors accounted for virtually all the improper payments. For urinalysis, it was insufficient documentation.


Medicare Muzzle? New Rules May Make Physicians Reluctant to Speak Up - 05/28/2019

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


Use Modifiers to Override Correct Coding Initiative Edits - 05/28/2019

Correct Coding Initiative Edits Now Free on Internet


Get Awarded For Your Quality Work in 2018 - 05/23/2019

Did you submit Merit-Based Incentive Payment System data for the 2018 Quality Payment Program and feel like you deserve some kind of recognition for your hard work all year long? Apply now for the 2018-19 Physician Practice Quality Improvement Award.


Code Carefully for Bilateral Procedures - 05/02/2019

Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.


Medicine to CMS: Medicare Report Inflates Success of Quality Program - 05/01/2019

If you read the recent Centers for Medicare & Medicaid Services (CMS) report on the first-year of the Quality Payment Program, you’d likely come away with the perception that the program’s launch was an overwhelming success. 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 take back the report.


Make Sure These Medicare Missteps Didn’t Affect Your Claims - 04/16/2019

Because of all of the policies, edits, determinations, rules, and revisions, Medicare’s claims processing sometimes goes awry for certain codes, fees, or other specific claim elements. The Centers for Medicare & Medicaid Services (CMS) reports these errors and their fixes on a regular basis.


Unfair Playing Field? QPP Scoring May Hurt Physicians Not Hospital-Affiliated - 03/28/2019

As 2019 rolls on and physicians operate under new portions of the Merit-Based Incentive Payment System (MIPS), many physicians may face an even bigger disadvantage — simply by virtue of not billing the vast majority of their services at a hospital.


Deadline to Submit 2018 MIPS Data is April 2 - 03/27/2019

If you plan to participate in the Merit-Based Incentive Payment System, submitting your data for 2018 on time is not something to fool around with. That’s why the Texas Medical Association reminds you that the deadline to submit data for the Centers for Medicare & Medicaid Services’2018 Quality Payment Program is April 2 – the day after April Fool’s Day.


National Specialty Societies With MACRA Information - 03/27/2019

To help you get the best information possible, TMA has identified direct links to MACRA news, resource centers, education, and advocacy from national specialty societies. Visit your specialty society online for information specific to your specialty, setting, and practice.


How to Avoid MIPS Penalty with Minimal Reporting by April 2 - 03/25/2019

For 2018 reporting, your 2020 Medicare payments will be cut even more – by 5 percent – if you are required to participate in MIPS but choose not to submit data. So if you’d rather get paid in full next year (or – even better – receive a payment bonus), there’s still time to submit 2018 data. But you should act fast. The deadline is April 2.


Free MIPS Help from TMF Health Quality Institute - 03/22/2019

The Texas Medical Association has heard from physicians who do not know if they are required to participate in Medicare’s Merit-Based Incentive Payment System (MIPS) as well as those who know they need to participate – and know they need help.


Security Risk Analysis for HIPAA — and Medicare/Medicaid? - 03/08/2019

Do you need to conduct a security risk analysis or review of your practice in the next 72 days?


CMS Working to Correct MIPS Payment Errors - 03/05/2019

The Centers for Medicare & Medicaid Services says it has become aware of an error in MIPS payment adjustments applied to Medicare Part B drugs, and is working to resolve the issue.


Medicare Enrollment Application Revised - 03/04/2019

A new Medicare enrollment application form for physicians and nonphysician practitioners will go into effect May 1.


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. 


Watch Those Extra Fees For Medicare Patients - 03/04/2019

Watch Those Extra Fees For Medicare Patients


Use New G Codes for Medicare Therapy Claims - 03/04/2019

Starting with services dated Jan. 1, 2013, physicians have to report new, nonpayable G codes and related modifiers on Medicare claims for outpatient physical, speech, and occupational therapy.


How's Novitas Doing? - 03/04/2019

Medicare wants to know what you think of the job Novitas Solutions is doing administering the Medicare program in Texas.


Where Do We Go From Here With Our Health Care System? - 03/04/2019

To say that Medicare works well, denies the fact that in many patients are no longer able to go to the doctor of their choice. In fact, even finding a doctor is difficult. Additionally, many doctors no longer participate in the Medicare program. This program is only one step away from a single payer health care system, which was once referred to as socialized medicine.


Use Transitional Care Management CPT Codes - 01/10/2019

Two new CPT codes for transitional care management services are in effect, and Medicare accepts them. But read the Medicare rules carefully because they vary from the CPT guide.