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Feds Extend Marketplace Special Enrollment Amid Medicaid Unwinding - 04/19/2024

Texas patients who have been disenrolled from Medicaid in the wake of the COVID-19 public health emergency now have more time to find alternative coverage on the federal marketplace. The extension could mitigate a coverage cliff about which the Texas Medical Association has long raised concerns.

Medicare May Seek Payment Recoupment for 2023 Claims - 04/09/2024

A new report by the Government Accountability Office shows physicians may face possible recoupments – or additional payment – for claims filed in 2023 as a result of over and underpayments by Medicare, Medicaid, and other federal programs.

Postpartum Coverage Extension Brings Payment Complexities - 04/05/2024

As the 12-month postpartum coverage Texas legislature approved took effect March 1, physicians and their practice staff should take note of subsequent payment complexities, Texas Medical Association experts caution.

Physicians May Face Lower Payment as CMS Resumes Lab Data Collection - 03/11/2024

The Centers for Medicare & Medicaid Services will continue to collect data from physician-owned laboratories to inform private payer rates despite pushback from the Texas Medical Association.

Practice E-Tips on Billing and Collections - 02/20/2024

Practice E-Tips on Billing and Collections

Medicaid, CHIP Postpartum Coverage Extension Will Take Effect March 1 - 02/08/2024

After a multi-session advocacy effort by the Texas Medical Association, specialty societies, and women’s health advocates, Texans who are enrolled in Medicaid or the Children’s Health Insurance Program and who are pregnant or become pregnant will see their postpartum coverage automatically extended starting March 1.

Spending Growth Rate for Physician Services Slows - 01/09/2024

Although spending on physician and clinical services increased 2.7% year-over-year to $884.9 billion in 2022, the spending growth rate fell, due in part to a slowdown in the use of such services and in physician prices. In comparison, spending on physicians and clinical services grew 5.3% in 2021.

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. 

On the Mend: Maternal Care Wins Encourage Better Outcomes in Texas - 11/05/2023

Twelve months of postpartum coverage and other maternal wins encourage physicians for better outcomes.

First Steps: TMA Secures Medicaid Physician Rate Increases With Hopes for Momentum - 11/05/2023

TMA helped secure the first Medicaid physician rate increases in decades in hopes it will build momentum for future gains.

Report Aims to Catalyze Texas Medicaid’s Shift to Value-Based Care - 11/02/2023

A new report aims to accelerate Texas Medicaid’s transition from a fee-for-service payment model to a value-based one, a shift that has been underway for 25 years.

Coming Unwound: Mass Disenrollments Hurt Patients and Physicians Alike - 11/02/2023

The end of continuous Medicaid eligibility has led to mass disenrollments, hurting patients and physicians alike.

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.

TMA Pushes Back Against Planned Vaccine Payment Cuts - 09/06/2023

As the influenza virus continues to spread statewide, the Texas Medical Association and other specialty societies have taken a stand against a plan to cut by almost 36 percent payments to physicians who administer a flu vaccine in their offices.

Zika Reminder: Mosquito Repellent Covered Under Medicaid - 09/06/2023

To protect against Zika, mosquito repellent prescriptions are covered through Medicaid and other state programs, including the Children’s Health Insurance Program.

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.  

CMS to Recoup Chronic Care Management Payments - 08/21/2023

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.

Medicaid Drops Thousands of Texans; Many Still Qualify - 08/07/2023

Texas’ effort to “unwind” continuous Medicaid coverage – a pandemic-era benefit – has resulted in a steep coverage cliff. State officials and advocates urge physicians to help soften patients’ falls. Read more.

Preauthorization Denial: What’s Your Recourse? - 07/25/2023

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

5010 Deadline Extended; Dual Eligible Problem Not Fixed - 07/25/2023

Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.

What Stimulus Means to Texas Health Care - 07/25/2023

State health officials have released preliminary information on major health and human services allocations for Texas in the $789 billion economic stimulus bill President Obama signed. The largest portion is $5.45 billion for Medicaid through the first quarter of 2011.

Practice e-Tips on Claims - 07/20/2023

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 - 07/20/2023

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

You Can Get Paid for Medicaid Emergency Services - 07/20/2023

You Can Get Paid for Medicaid Emergency Services

Mastering Quality Reporting: Ease the Challenge of Quality Reporting - 07/10/2023

Understanding the maze of quality reporting pathways may help ease the challenge.