Medicare

Congress’ Failure to Stop Medicare Payment Cut Frustrates, Threatens Texas Physicians, Patients - 01/21/2024

"Congress failed patients and the physicians who care for them" when it failed to stop a 3.37% Medicare physician payment cut in the measure that averted the latest government shutdown on Jan. 19. So says TMA President Rick Snyder, MD, in reaction to the "extremely disappointing" news. Physicians and patients across Texas already are feeling the sting, and TMA will not let up in its efforts to protect them.


Medicare Cuts Forcing Doctors Out - 01/19/2024

A 3.37% cut in Medicare physician pay is scheduled to hit on Jan. 1, 2024. That’s on top of the 2% cut that took effect earlier this year and other compounding cuts over the years. In total, inflation-adjusted physician Medicare pay has fallen 26% since 2001. Medicare physician pay cuts are forcing some physicians out of the program.


Medicare Toolkit Social Media Graphics - 01/12/2024

Once again, physicians face cuts to their Medicare payments in 2024, stinging practices trying to stay viable and care for the most vulnerable patients. The Texas Medical Association strongly urges Congress to find permanent, sensible solutions to the Medicare physician payment system.  


Submit 2023 MIPS Data by April 1 to Avoid Medicare Pay Cut - 01/09/2024

The data submission period for Medicare’s Merit-Based Incentive Payment System 2023 performance year is underway and closes April 1 at 7 pm CT. At stake is a pay cut of up to 9% in the 2025 payment year.


Medicare Payment Crisis Forces Rural Practice Closure - 01/04/2024

If Congress does not act by the end of the year to stop the impending Medicare physician payment cut, many practices will be forced to reduce available health care services, cut office hours, or even forgo treating Medicare patients altogether, organized medicine has warned over and over in its months-long advocacy campaign.


CMS Introduces Electronic Documentation Submission Tool - 01/02/2024

The Centers for Medicare & Medicaid Services (CMS) has developed a free service to help physician practices of varying sizes and documentation workloads upload and submit medical documents, including prior authorization requests, electronically.


Enroll As an Ordering or Referring Physician to Avoid Claims Denials - 12/15/2023

Physicians must enroll, at minimum, as an ordering or referring physician to provide Medicare patients with services or prescriptions. Failing to enroll may lead to denials on claims and services.


Add-On Payment Code for Complex Visits to Start in 2024 - 12/08/2023

Beginning in January, physicians will be able to receive more accurate payment for complex visits with Medicare add-on code G2211. But the Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.


How to File a Medicare Extended Repayment Plan - 12/06/2023

  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. 


Reminder: Apply for 2023 MIPS Hardship Exemption by Jan. 2 - 11/28/2023

Physicians eligible to participate in Medicare’s Merit-Based Incentive Payment System may be spared a steep financial penalty, continuing a trend seen throughout the COVID-19 pandemic.


CMS Releases 2024 Medicare Advantage and Part D Plan Ratings - 11/13/2023

Medicare patients and the physicians who care for them now have more information to guide their choice of plan in 2024.


Final 2024 Medicare Fee Schedule Solidifies Pay Cuts, Heightens Calls for Reform - 11/13/2023

Now that it’s been finalized, the 2024 Medicare physician fee schedule has solidified yet another pay cut, set for Jan. 1, 2024, underscoring calls for Medicare physician payment reform from physician advocates and lawmakers who’ve recently convened in federal hearings on the topic.


Medicare Premiums, Deductibles to Increase in 2024 - 10/27/2023

Medicare patients will be paying more for their coverage in 2024, which will impact how much co-pay practices collect.


CMS to Implement Street Medicine Code - 10/25/2023

Following advocacy from the Texas Medical Association and medical student members, the Centers for Medicare & Medicaid Services (CMS) created a place of service code for street medicine, making it possible for physicians to get paid for services provided to people who are currently unhoused effective Oct. 1.


Government Shutdown Could Delay Medicare Claims Payments, Reform - 10/18/2023

The looming federal government shutdown would have ramifications for physicians across the country as well as for desperately needed Medicare physician payment reform.


First-Ever MIPS Penalties Surface; Share Your Story With TMA - 10/16/2023

Given recent changes to Medicare’s Merit-Based Incentive Payment System (MIPS) and an ongoing push for Medicare physician payment reform, the Texas Medical Association encourages member physicians who participate in MIPS to closely review their final scores for the 2022 performance year.


Code Carefully for Bilateral Procedures - 10/04/2023

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.


Medicare Fee Schedule Proposal Remains “Highly Flawed,” Underscores Need for Reform - 09/28/2023

The proposed 2024 Medicare physician fee schedule came as no surprise, following earlier iterations that deepen physician pay cuts and increase complexities associated with the Merit-Based Incentive Payment System (MIPS) – prompting organized medicine to ramp up its call for reform that would break this cycle.


Reminder: Revalidate Your Medicare and Medicaid Enrollment - 09/25/2023

Starting Nov. 1, physicians must use a revised Medicare enrollment application. On the Medicaid front, physicians who were due to re-up their enrollment during the COVID-19 public health emergency get a grace period to complete this requirement, but all physicians must review and update their practice addresses. Read more.


Medicare Advantage Audits Expected to Rise in Face of Increased Federal Scrutiny - 09/20/2023

Based on a new rule and in response to heightened scrutiny, Medicare Advantage plans – and the physician practices that care for patients enrolled in them – should expect an increase in the number of audits related to such risk-sharing contracts.


Medicine, Congressional Leaders Strategize to Expedite Medicare Physician Pay Reform - 09/17/2023

TMA and other physician and congressional leaders from around the country convened an advocacy summit to build momentum for legislation to finally help Medicare payments keep pace with inflation. With nearly 40 co-sponsors signed on, and another pay cut on the way, medicine and lawmakers urged physicians to ramp up their advocacy now.


How to Identify Dual-Eligible Patients - 08/23/2023

The Centers for Medicare & Medicaid Services has been working to rein improper billing of Qualified Medicare Beneficiary program-enrolled patients, who have both Medicare and Medicaid coverage. You can verify patient status in several ways.  


TMA to Feds: Some Proposed QPP Changes “Costly and Wasteful” - 08/23/2023

TMA letter praises the Centers for Medicare & Medicaid Services for its commitment to deregulation and outlining TMA's concerns about the proposed changes and recommendations for how to improve the QPP.


Practice e-Tips on Medicare - 08/21/2023

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


Billing Errors to Avoid: Pulmonary, Mohs Procedures - 08/21/2023

Medicare audits have revealed recurring errors in billing for pulmonary procedures and Mohs surgery. Here are some guidelines for correct billing.