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Coding a Cancelled Procedure - 11/19/2021

How do we code a cancelled procedure, for example when a patient’s vital signs preclude continuing the procedure?


How to Calculate Underpaid Amount in Prompt Pay Rules - 11/17/2021

Even if the insurance company pays on time but underpays you - if it doesn't pay in full by the statutory deadline, it still must pay you a penalty based on the number of days the payment is late and the underpaid amount of the claim.


Preauthorization: What If the Diagnosis Changes? - 11/17/2021

Can the carrier deny payment for services performed to treat the final diagnosis? Can it refuse to pay for some of the inpatient days it initially authorized?


The Service Is Verified; Do I Need to Send a Clean Claim? - 11/17/2021

The Service Is Verified; Do I Need to Send a Clean Claim?


Filing a Compliant With the Texas Department of Insurance (TDI) - 11/17/2021

Filing a Compliant With the Texas Department of Insurance (TDI)


At-a-Glance Billing Guidelines - 11/17/2021

At-a-Glance Billing Guidelines


Insurers’ Unfair Electronic Fees Persist; AMA, TMA Take Action - 10/27/2021

Organized medicine, including the Texas Medical Association, is engaging the Biden administration on health plans’ unfair business practices physicians sometimes encounter when receiving electronic payments.


Practice E-Tips on Billing and Collections - 10/12/2021

Practice E-Tips on Billing and Collections


Practice e-Tips on Claims - 09/01/2021

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


Practice e-Tips on Reimbursement - 08/28/2021

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


ESRD Calculator - 08/27/2021

ESRD Calculator


Situational Data Element - 08/17/2021

Situational data element


Are You Losing Revenue by Undercoding? - 08/17/2021

Becuase of a fear of overcoding, undercoding is prevalent in many practices. This means lost revenue that is rightfully due to the practice. Correct coding can be a significant opportunity for revenue enhancement without additional resource consumption.


TMA Reimbursement Services - 08/13/2021

TMA Payment Advocacy Services


COVID-19: Payers / Insurance - 06/22/2021

Get COVID-19 resource related to payers / insurance.


COVID-19: Finances - 05/04/2021

View COVID-19 resources related to practice finances.


What's My Taxonomy Code? - 04/07/2021

What's My Line (Taxonomy Code)?


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.


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)?


Preauthorization Denial: What’s Your Recourse? - 10/16/2020

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


Reimbursement Review and Resolution (RRR) Services User Guide - 09/09/2020

Please observe the following Reimbursement Review and Resolution (RRR) form guidelines to help us expedite processing while maintaining the integrity and credibility of RRR Services (previously known as the Hassle Factor Log Program).


CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15 - 08/12/2020

CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15


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.  


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.