Related Stories

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).


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.


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.


TPHC Statement: Contact Tracing is Effective Scientific Tool to Combat COVID-19 - 06/05/2020

Statement by Texas Public Health Coalition Chair Jason V. Terk, MD, in response to recent questions about the State of Texas’ COVID-19 contact tracing program.


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.  


The Power of Data: UTHealth Publishes Claims Statistics - 04/30/2020

After three years of work, the Center for Healthcare Data at McGovern Medical School at UTHealth is sharing part of its growing trove of numbers for data-driven discussions on many aspects of health care in Texas. The center doesn’t have all the answers. But its work under a federal certification from the Centers for Medicare & Medicaid Services (CMS) has resulted in valuable state and regional statistics that the center leaders believe provide food not only for thought, but also for policy.


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.  


Seeking a Measure of Reason: TMA Joins Collaborative to Standardize Quality Metrics - 03/31/2020

TMA joins collaborative seeking to identify and standardize quality metrics.


Going Nowhere: APM Committee Resignations Cast Doubt on Payment Models' Future - 03/31/2020

Resignations from HHS advisory committee cast doubt on future of physician-created alternative payment models.


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.


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.


Supporting Fair APM Payments: AMA Backs Accounting for Social Determinants of Health - 01/02/2020

Alternative payment models (APMs) are considered a key part of the future of value-based care. But for them to be successful, the American Medical Association says, APMs need to be fair, which means adjusting for the circumstances that make physicians’ cost and care challenges unique.