IF YOUR TREK TO COLLECT

is coming up with more dead-ends and reworks than you have ever had in your life!!!

There is a ray of hope!

Do you remember the old Texas Medical Association (TMA), Hassle Log?

It has a new name. 

“Reimbursement Review and Resolution (RRR) services” (because hassle log was too hard, lol).

If you are a TMA member, this is a great resource. 

Attached is the paperwork you will need to submit your issue. Just follow the links.

POET has recently reached out to TMA using this resource and so far it has been pretty simple. 

SOME GOOD HELP

PHE Current Information

Follow these links to find the most current 

health plan information.

PHE

Incident-To Billing Got You Confused?

Texas Medical Association (TMA) can help!

“Incident-to” billing – when services delivered by a nonphysician practitioner are billed under a supervising physician’s credentials – can be confusing, and Texas Medical Association staff are routinely fielding questions about those unique arrangements.

To help you avoid any billing blunders, TMA has released an education sheet on incident-to billing (login required), with a basic overview of guidelines and requirements.

The two-page guide addresses incident-to billing for Medicare, Medicaid, and commercial plans, along with helpful links to resources that can help answer your questions and resolve billing snags.

Download the incident-to education sheet – along with other resources on billing, collection, claims, and more – on TMA’s Educational Quick Tips page.

Incident-to

HealthSpring Insurance Card

You may have noticed the Cigna MA (HMO) insurance card  no longer sports the “HealthSpring” name.

Here is a tip.

There are only three customer benefit plans (HMO) for our service area.

  • 2021-TX-H4513-061-Preferred (HMO) – Medicare A, B, & D coverage
  • 2021-TX-H4513-060-TotalCare (HMO DSNP) – Medicare/Medicaid A, B, & D coverage
  • 2021-TX-H4513-009-Fundamental (HMO) – Medicare A & B coverage only (no part D); formerly known as the Advantage plan

Where you see “contract/PBP” with the orange circle around it, the card for our service area should have either H4513-061, H4513-060 or H4513-009. Any other number would suggest the patient is out of their service are. 

HMO

Automate Your Revenue Cycle and Avoiding EFT Fees

ARE YOU PAYING TO GET PAID?

OR

Would you like to lodge a complaint against a health plan?

Frontline Resource for helping low-income, Uninsured Texas Women

From Women’s Health

Reference Sheet Outlines Public Coverage Options for Uninsured Women

The Texas Collaborative for Healthy Mothers and Babies has developed a reference sheet for frontline health care workers to help low-income, uninsured women in Texas potentially find coverage through one of the state’s public health insurance programs.

The two-page reference sheet explains the eligibility requirements for Medicaid for Pregnant Women, the CHIP-Perinatal program, Healthy Texas Women, and the Family Planning Program, and includes a chart showing what services are covered under each. It’s intended “to help close knowledge gaps, encourage greater utilization of available resources, and increase access to health care,” the collaborative says. The sheet is available in English and Spanish.

Healthy Mothers and Babies

OSHA ETS

Original Message:
Sent: 06-14-2021 14:56
From: Drew Voytal
Subject: OSHA announces new COVID-19 temporary emergency standard for healthcare settings

Good afternoon MGMA members,

Last week, the Occupational Safety and Health Administration (OSHA) issued a COVID-19 emergency temporary standard (ETS) with implications for health care employers. The landing page for the ETS can be found here and the fact sheet can be found here. Once the rule is published in the Federal Register, the compliance deadline for most provisions is within 14 days and within 30 days for the rest.

Some of the requirements in the ETS include:

  • developing a “COVID-19 plan” that includes a workplace-specific hazard assessment
  • cleaning and disinfection guidelines
  • health screening and medical management protocols, and
  • physical distance and physical barrier guidelines.

For the full list of requirements under the ETS, see the rule. Certain requirements are waived if workers are vaccinated and are in well-defined areas where there is no reasonable expectation that a person with suspected or confirmed COVID-19 will be present. For more information, see the FAQ.

Thanks,

More on Emergency Temporary Standards

July 4th Closure

Emergency Temporary Standards

FINALLY! a flow chart that helps make since of some of this.