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Cigna to Deny Claims Without Z-Code Documentation - 04/24/2024

Starting July 14, Cigna Healthcare will deny certain claims that are billed with a Z code and without documentation, a move that could add to physicians’ administrative burden.

TMA Moment In Time: Pandemic Response - 04/09/2024

The strength of organized medicine carried TMA and Texas physicians through an unprecedented public health crisis and beyond.

Aetna Set to Pay Medicare Advantage G2211 Claims - 03/27/2024

The list of health plans providing payment for Medicare’s new add-on “G” code continues to grow with Aetna as the latest insurer to cover G2211 for Medicare Advantage claims Aetna confirmed with Texas Medical Association coding experts that its Medicare Advantage claims platform was updated in March to allow payment for the code, used to document the coordination of care for patients with complex or serious conditions. For now, the plan’s policy is only accessible through a physician’s Aetna portal.

Quality of Life: Pay-for-Quality Programs Increasingly Address Nonmedical Drivers of Health - 03/15/2024

Insurance payers seldom give physicians incentives to address nonmedical drivers of health, especially in traditional fee-for-service payer contracts. Those incentives remain rare even in pay-for-quality programs that emphasize value-based care, but they are gaining traction.

Medicare Sunsets Beleaguered Appropriate Use Criteria Program - 03/14/2024

After longstanding opposition from the Texas Medical Association and others, the Centers for Medicare & Medicaid Services finally nixed the appropriate use criteria program for advanced diagnostic services as part of the 2024 Medicare physician fee schedule.

Coding Changes in Fee Schedule Promote More Accurate Payment for Complex Visits - 03/05/2024

The 2024 Medicare physician fee schedule allows physicians to list G2211 in addition to codes used in office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians also can use it for telehealth visits.

New Law Prohibits Employer COVID-19 Vaccine Mandates, With Exceptions - 02/28/2024

Thanks to advocacy by the Texas Medical Association, guardrails for patient safety and practice viability are included in a new state law that prohibits employers, including physician offices and health care facilities, from mandating COVID-19 vaccines among employees.

New Poster Encourages Flu Vaccination Amid COVID-19 - 02/28/2024

“COVID-19 is here, but so is the flu.” That is the message of a new downloadable poster available from the Texas Medical Association’s Be Wise – Immunize program to help you stress the need for flu vaccination, this year more than ever.

Novitas Makes Mass Payment Adjustment for Telehealth Claims - 02/27/2024

Thanks to the vigilance of the Texas Medical Association’s payment specialists, Medicare administrative contractor Novitas Solutions updated its system to ensure all claims billed with place of service (POS) code 10 will be paid correctly.

Practice e-Tips on Coding - 02/20/2024

Get practice tips on all things coding. Learn about coding methods, correct coding, resources, coding related to Workers' Comp and more.

Revenue Cycle Assessment - 01/22/2024

A TMA consultant will conduct a review of your business office operations that focuses on front desk procedures, billing, collections and revenue cycle improvement. We will identify opportunities for improvement of billing processes and procedures.

Practice Operations Services - 01/22/2024

With the many challenges that face today's medical practices, business operations remain at the core of a practice's ability to be successful and profitable. Work with a TMA practice management consultant to identify and assess key or problematic areas of your practice.

Financial Management Services - 01/22/2024

Having sound financial policies and processes can help your practice attain a steady cash flow, maintain healthy collection ratios, increase staff efficiencies, and boost your overall bottom line.

Your Billing and Collections Checklist for 2024 - 12/19/2023

TMA’s Reimbursement Services staff work year-round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2024 to keep your billing and collections on track throughout the year.

Bipartisan Legislation Would Prohibit Electronic Funds Transfer Fees - 12/08/2023

Recently introduced federal legislation could spare physicians from electronic funds transfer (EFT) fees, which payers routinely charge as a condition of electronic payment.

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.

CMS Strengthens Price Transparency for Hospitals - 11/29/2023

A new Centers for Medicare & Medicaid Services final rule aims to strengthen hospital price transparency regulations for 2024, a move physicians hope will address weaknesses in prior policy that hindered them and patients from making informed health care decisions.

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.

FDA Approves New RSV Vaccine, COVID-19 Booster - 10/19/2023

Physicians will have a new vaccine in their arsenal to help protect against respiratory syncytial virus (RSV), a timely development as cold, flu, and COVID-19 illnesses tend to converge and ramp up this time of year and become difficult to differentiate.

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.

Leading in Crisis: Diana L. Fite, MD, Carried TMA During COVID-19 Pandemic - 10/03/2023

Diana L. Fite, MD, carried TMA during the height of the COVID-19 pandemic.

TMA Pushes for Elimination of Excessive Electronic Funds Transfer Fees - 09/22/2023

Payers routinely charge physicians the fees as a condition of electronic payment, often without consent. Alongside declining physician payment, the fees add to the threat to practice viability, and ultimately patients’ access to care. Read more.

Urge Texans to Get Flu Vaccine Early, Officials Say - 09/06/2023

With flu season on the horizon – and the COVID-19 pandemic expected to continue – Texas physicians should strongly encourage patients to receive a flu vaccination as early as possible.

Talk to Patients About: Breakthrough Infections for COVID-19 Vaccinations - 09/06/2023

 The new mRNA vaccines for COVID-19 are highly effective at giving people immunity against the disease. But as with all other vaccines, that immunity is not 100% for everyone who receives them.  

Tune in Saturday to Watch TMA’s 155th President Take Office - 08/31/2023

Although TexMed 2020 has been canceled, and the Texas Medical Association House of Delegates meeting has been suspended, Diana L. Fite, MD, still will take office as TMA’s 155th president Saturday. Visit TMA’s Facebook page at noon Saturday to watch a live broadcast of her installation and address.