FIND A PHYSICIAN
Courses and Publications
Here’s How You’ll Get Paid for Dual-Eligible Patients
Help Patients Get Preexisting Condition Coverage
Your Payer Contracts: Money Makers or Money Drains?
A 2014 TMA survey of Texas physicians revealed that Texas doctors have a median of six preferred provider organization contracts and one HMO contract, and a majority are contracted with at least one of the five major payers. The question is: Is each of your contracts profitable for your practice?
Are you taking advantage of these resources?
Deadlines for Doctors
about upcoming state and federal compliance timelines and key health policy issues that impact Texas physicians.
TMA’s Hassle Factor Log (HFL)
Has a payer upheld a claim denial, even after an appeal? The TMA
is here to help.
30-Minute Billing Cure
TMA staff experts provide
free half-hour consultations
to member physicians and their employees at the county society headquarters. Contact your CMS to see when mini-consults will be in your area.
Attend a TMA seminar/webinar
CME accredited seminars and webinars
to educate you and your staff.
REMINDER: Novitas Solutions has all new street and post office mailing addresses in Mechanicsburg, Pa. The post office will forward mail addressed to the old Camp Hill, Pa., address, but that may delay delivery. Be sure to send your Medicare-related correspondence to the appropriate post office box and ZIP code. For mailings that can’t go to a PO box, use the new street address: 2020 Technology Pkwy., Ste. 100 Mechanicsburg, PA, 17050.
What are the Payers up to?
Don’t Miss New and Revised LCDs From Novitas
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, so be sure to stay abreast of all LCDS — as well as national coverage determinations (NCDs) from Centers for Medicare & Medicaid Services — that affect your practice.
Medicare Do’s and Don’ts
The do’s and don’ts in this list may apply to you, depending on your specialty and/or circumstances. Note that some are timely!
SGR Is Gone. Now What? Preparing for Medicare's New Payment Paradigm
Sooner than later, physicians will have to prepare for participation in one of the new quality-focused payment pathways set to replace Medicare's Sustainable Growth Rate (SGR) formula, which Congress eliminated in April via the Medicare and CHIP Reauthorization Act (MACRA).
Payer Roundup, January 2016
In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. If you have questions about billing and coding or payer policies, contact the specialists at
for help, or call TMA Knowledge Center at (800) 880-7955.
Mandatory Medicaid Reenrollment Is Underway
There's no point in procrastinating: If you enrolled in Texas Medicaid before Jan. 1, 2013, you need to complete a reenrollment by Sept. 25, 2016, to stay in the program.
United's New Reports Target Physician Outliers
If UnitedHealthcare (UHC) identifies you as an outlier among its physicians, you may receive a new type of report from UHC that details tests, procedures, referrals, and/or billing patterns in your practice that may be inconsistent with certain evidence-based medicine criteria.
HHSC Launches Policy Feedback Webpage
The Texas Health and Human Services Commission (HHSC) has a new webpage that features a list of proposed Medicaid policy changes.
Payer Roundup, January 2016
TMA’s reimbursement specialists give you a heads up and suggestions regarding some insurance hassles; also, find out about preauthorization changes, and new Medicare drug testing codes.
Medicare Now Pays Separately for Advance Care Planning
That difficult conversation you have with patients about their end-of-life care is now one you can get paid for. Medicare now pays for voluntary advance care planning, or end-of-life care planning, for Medicare patients.
Medicare Changes Payment for Incomplete Colonoscopies
As of Jan. 1, 2016, the Medicare Physician Fee Schedule has specific values for colonoscopy codes billed with modifier 53, that is, incomplete colonoscopies.
Take Part in New CMS Clinical Care, Social Services Model
The new Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities model bridges clinical care and social services to help address Medicare and Medicaid beneficiaries' health-related social needs. Physician practices are among the list of eligible applicants who can take part in this new CMS model.
PQRS: Last Day for Electronic Health Record (EHR) Reporting.
Last Day for Electronic Health Record (EHR) Reporting.
Texas Medical Association Payment Advocacy Department
Visit the TMA Blog
Meet the TMA Staff
County Medical Societies
Just for ...
Residents and Fellows
New to Texas
401 West 15th Street, Austin TX 78701 Phone (800) 880-1300 (512) 370-1300
Copyright © 1999-2015 Texas Medical Association. All Rights Reserved.