A pair of big wins capped a successful past week for medicine, as the Texas House of Representatives on Friday afternoon signed off on both curbing the impositions of prior authorization and updating the state’s immunization registry.
Category: Business
Provider Roster Update
Who’s On First?
Or should we say “Who’s in What”
This roster includes all the POET physicians and list what insurance plans they have opt’ed into.
It is a great tool to keep at your front desk or download for the person who makes the referrals in your office.
Oh, just google “Who’s on first” and watch the clip, for a little slap stick humor.
From CMS.Gov
Critical Care Evaluation & Management Services: Comparative Billing Report in May
In late May, CMS will issue a second letter in the Special Edition Comparative Billing Report (CBR) series on Part B claims for critical care evaluation & management services. Use the data-driven tables to compare your billing and payment patterns with peers in your state and across the nation.
The public can’t view CBRs. Look for an email from [email protected] to access your report. Update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on June 9 from 3-4 pm ET
Protecting Workers:
Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace
The Centers for Disease Control and Prevention (CDC) has issued new guidance relating to recommended precautions for people who are fully vaccinated, which is applicable to activities outside of healthcare and a few other environments. OSHA is reviewing the recent CDC guidance and will update our materials on this website accordingly. Until those updates are complete, please refer to the CDC guidance for information on measures appropriate to protect fully vaccinated workers.
Updated Plan Reps
The Health Plan Representative Contact List has been updated.
Need Expert Advice
The Texas Medical Association is launching a new “Ask the Expert” virtual series to bring members direct access to professional experts who can answer questions on legal, practice management, advocacy, and regulatory topics.
Join them each month as a TMA staff expert hosts a virtual meeting to discuss their area of expertise and answer questions from attendees
TMA "Ask the Expert"
BCBS UPDATE 5/12/2021
SA Modifier and Midlevel Provider Contracting Update.
On January 19, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) posted an article regarding contracting and credentialing midlevel providers and the upcoming implementation of the ClaimsXtenTM edit of the SA modifier for non-payable services resulting in the SA modifier being non-reimbursable. This edit has not been implemented and there are currently no plans for future implementation of this edit.
SA Modifier Reminder
The SA modifier should be used:
- By the supervising physician, when he/she is billing for services rendered by a Physician Assistant (PA), Advanced Practice Nurse (APN), Certified Registered Nurse First Assistant (CRNFA) or Licensed Surgical Assistant (LSA).
- On claims submissions by PA or APN’s when billing under their own NPI number for assisting with any other non-surgical procedures.
This information can be found in the Clinical Payment and Coding Policies – Modifier Reference Guideline located on the provider website. Information about the reimbursement amount for the SA modifier is available in the Reimbursement Schedules and Related Information (Secure Content) area of the General Reimbursement information page. You will need a password to access this information which can be obtained from your local Network Management Office location.
SA Modifier Update
House Passes Prior Auth, ImmTrac2 Improvement
Haters of preauthorization burdens – and if you’re reading this, chances are you’re among them – will celebrate the House’s passage of House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood). The bill attacks the plague of prior authorization requirements in two major ways.
First, for certain services, if a physician earns insurer approval on 80% of preauthorization requests for the service in one calendar year, the doctor will be exempt from preauthorization for that service in the next calendar year. HB 3459 would allow physicians to gain those exemptions on an every-other-year cycle
E&M Coding in 2021
Now is the time to take a few minutes to assess your coding.
- If you are coding close to your specialty’s bell curve and if your documentation supports your coding, take a deep breath. If you find you are an outlier, don’t panic. Time is on your side.
- Under-coders of the world, look to increase your coding. Your documentation likely supports a higher code. Over-coders, make sure your documentation supports your higher coding.
- You are at higher risk for an audit, and your best defense will be solid documentation
Are you curious to see how you are doing? Follow this link to “Physicians Practice” article:
E&M Coding in 2021: Four Questions, Four Answers
Physicians Practice
COVID-19 Coverage Assistance Fund (CAF)
MGMA Washington Connection May 6, 2021
This week, the HHS Health Resources and Services Administration (HRSA) announced the creation of the COVID-19 Coverage Assistance Fund (CAF). This new program will reimburse providers the cost of administering COVID-19 vaccines to patients specifically enrolled in certain short-term, limited duration and benefit health plans that either do not cover vaccinations or cover them with patient cost-sharing. Providers can request claims reimbursement electronically through the CAF Portal and will be reimbursed at the national Medicare rate for vaccine administration, and for patient charges related to COVID-19 vaccination, including co-payments, deductibles, and co-insurance for vaccine administration.
As a reminder to those practices that have received more than $10,000 from the Provider Relief Fund (PRF), registration is now open for the PRF Reporting Portal. According to HRSA, the portal is only open for registration. MGMA will update members once the portal is open for reporting.
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