Related Stories

Work to Expand Medicaid, Protect Telemedicine, Speakers at TMA Tele-Town Hall Say - 09/18/2020

Texas physicians need to lobby state and federal lawmakers as soon as possible to prevent cuts in important state services, to encourage the expansion of Medicaid, and to preserve gains made in telemedicine, a panel of speakers told participants in a telephone town hall sponsored Thursday by the Texas Medical Association’s Border Health Caucus.


Medicaid Kills Proposed Rule That Would Have Restricted Supplemental Funding, Services - 09/15/2020

The Centers for Medicare & Medicaid Services on Monday withdrew a proposed rule that would’ve restricted how states fund their share of Medicaid, causing serious cuts in services.


Medicaid Changing Prior Authorization Criteria for Certain Opioid Prescriptions - 08/28/2020

Beginning Sept. 1, Texas Medicaid will implement updated clinical prior authorization criteria for opioid prescriptions for certain Medicaid fee-for-service and managed care patients.


Don’t Delay. Medicaid and CHIP Relief Fund Process Can Be Lengthy - 08/17/2020

Although the deadline for physicians who treat Medicaid and Children’s Health Insurance Program (CHIP) patients to apply for federal Provider Relief Funds has been extended to Aug. 28, health officials recently emphasized that physicians apply as soon as possible because each practice's Taxpayer Identification Number (TIN) must be validated, if it hasn't already. The process can take up to 10 days. CMS also recently made important changes to the eligibility criteria.


The X{EPSU} Modifiers Further Define Modifier 59 - 08/13/2020

Modifier 59, the distinct procedural service modifier associated with Medicare National Correct Coding Initiative edits, is one you might find confusing (many practices do). Follow these guidelines


Don’t Miss New and Revised LCDs - 08/13/2020

Take a look at these new and revised Medicare local coverage determinations (LCDs) and article updates from Novitas Solutions. Remember, Novitas will reject claims that don’t adhere to LCDs.


CMS’ 2021 Fee Schedule Proposal Could Lower Physician Pay - 08/12/2020

Payments to some physicians who treat Medicare patients would fall from 2020 levels under the Centers for Medicare & Medicaid Services’ (CMS’) proposed physician fee schedule for 2021. CMS last week released the annual draft rule, which also recommends updates to the Quality Payment Program (QPP).


Medicaid Grant Could Pay for Your HIE Connection - 08/12/2020

Have you or your practice been considering connecting your electronic health record (EHR) to a health information exchange (HIE), but keep getting hung up by the cost? Well, here’s some good news. Three public HIEs recently were awarded contracts for a Medicaid grant that could pay for you to connect to their exchanges.


Can’t Say It Enough: Document, Document, Document - 08/11/2020

When Medicare delves into claims errors, one stands out: insufficient documentation.


Practice e-Tips on Medicare - 08/10/2020

Get practice tips on all things Medicare. Learn what Medicare requires for enrollment, participation, billing, claims, coding, documentation, and more.


Leadership by Fire: Stephanie Stephens New Texas Medicaid, CHIP Director - 08/03/2020

Stephanie Stephens received a not-so-welcome gift entering her new job running Medicaid operations for the nation’s second-largest state: A global pandemic. In that sense, the universe wasn’t easy on Ms. Stephens, the new director of Medicaid and CHIP for the Texas Health and Human Services Commission (HHSC).


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.


Portal to Apply for Medicaid and CHIP Relief Funds Open - 06/11/2020

The Department of Health and Human Services (HHS) has opened a portal for physicians who treat Medicaid and CHIP patients to apply for federal emergency assistance related to COVID-19.


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.  


Medicine Pushes Texas Medicaid to Help Save Primary Care - 05/08/2020

Leaders of the Texas Medical Association and four large primary care specialty societies on Wednesday painted for senior Medicaid officials the bleak fiscal picture of many physician practices, and requested immediate financial assistance.


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.  


Feds Approve Texas’ Request for COVID-19 Medicaid Waiver - 03/31/2020

The Centers for Medicare & Medicaid Services (CMS) on March 30 approved Texas’ request to waive certain Medicaid regulatory requirements to help physicians and other health care professionals more effectively respond to the COVID-19 pandemic.


Census Undercount Could Stifle Texas’ Health Services, Doctors Say - 03/11/2020

Texas physicians are urging patients to answer the upcoming U.S. Census to ensure the state won’t lose billions of dollars’ worth of health and human services funding – a loss that could harm the patients themselves.


Physicians Needed for Medicaid Managed Care Advisory Panel - 03/03/2020

March 13 is the new deadline to get your application to the Texas Health and Human Services Commission if you want to serve on its State Medicaid Managed Care Advisory Committee. The panel advises the commission on Medicaid managed care operations statewide.


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.


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.


Proposed Medicaid Rule Would Severely Restrict Services, Medicine Argues - 02/03/2020

A proposed federal rule that would restrict how states fund their share of Medicaid would cause serious cuts in services, particularly for children, pregnant women, the elderly, and the disabled. That is the message the Texas Medical Association and multiple state and specialty medical societies have delivered to the Centers for Medicare & Medicaid Services.