BCBSTX Fee Schedule Update
Look for your “Opt-in/out” packet from POET next week. POET has been receiving bits and pieces of the fee schedule this week.
The update is effective March 1, 2020.
Beware Phishing Attempts in 2020
Rachel V. Rose, JD, MBA
January 13, 2020
Health IT, Pearls, Practice Management
According to the National Institute for Standards and Technology (“NIST”), phishing is defined as “[a] technique for attempting to acquire sensitive data, such as bank account numbers, through a fraudulent solicitation in email or on a web site, in which the perpetrator masquerades as a legitimate business or reputable person.” Often times, phishing attacks, especially those executed through email and unsecure websites, lead to the deployment of ransomware.
To view the entire article check out “Security” under the “Compliance” File.
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Mandated Use of the Texas Prescription Monitoring Program.
Effective March 1, 2020
Prescribers and pharmacists or their delegates will be required by Texas State Law to use the Texas Prescription Monitoring Program (PMP) to review a patient’s prescription history BEFORE prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol.
Provider Directory Updated 1/31/2020
To view the current Provider Directory please follow this link.
Provider Roster Updated 1/31/20
To view the lasted updated Roster click here.
UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent
By Ellen Terry, An Article by TMA
If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a non-emergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.
To review the entire article follow this link.
ALERT – Scam Targeting DEA Registrants & Other Health Professionals
From Texas Medical Board – February 5, 2020
The U.S. Drug Enforcement Administration (DEA) reports that health professionals have been targeted by criminals posing as DEA agents.
In some instances callers may claim to be employees with the Texas Medical Board, DEA, FBI or other law enforcement entity and may even attempt to spoof agency phone numbers or send documents on official-looking letterhead demanding money.
Please know the TMB would never call and make such requests for sensitive information over the phone or send demand letters for money to reinstate licenses or threaten the arrest of licensees. The TMB does not suspend licenses at the direction of the DEA, FBI or other federal entity. Additionally, the TMB has no authority to issue, cancel, or influence arrest warrants, as some scams have indicated.
Medicare Learning Network (MLN) Learning Management System (LMS) FAQs 8/2019
The Medicare Learning Network® (MLN) offers free educational materials for health care professionals on Centers for Medicare & Medicaid Services (CMS) programs, policies, and initiatives. Find a complete list of MLN educational offerings in the MLN Catalog at http://go.cms.gov/mln-catalog.
For a complete “HOW TO” guide on the MLN and LMS System, including how to set up an account: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/LMPOS-FAQs-Booklet-ICN909182.pdf
BCBSTX March 1, 2020
BCBSTX notified POET of a new fee schedule effective March 1, 2020 a few months back. POET will provide you with the new schedule when BCBSTX provides it to us.
yep…still waiting…..
Texas’ New Surprise Billing Law
ARE YOU READY?
By Joey Berlin (TMA)
Taken from the TMA Website.
It’s almost first-pitch time for the state’s new ballgame on out-of-network bill disputes.
Texas’ baseball-style arbitration law takes effect for certain out-of-network medical care beginning Jan. 1, 2020. It’s a big change from how disputes on out-of-network medical bills have been handled in the past – and you need to know how to navigate it. There are nuances to consider, and disciplinary action from the Texas Medical Board (TMB) may await you if you balance-bill in violation of the law.
That’s why the Texas Medical Association has produced a digestible, seven-page summary of the surprise-billing law, passed during this year’s session of the Texas Legislature as Senate Bill 1264. TMA’s overview explains topics such as when the law applies, and how the arbitration process works.
More details are available in the summary, but essentially, under SB 1264, certain out-of-network physicians can request arbitration if the physician isn’t satisfied with the health plan’s initial payment. The arbitrator – selected either by mutual agreement of each side or by the Texas Department of Insurance (TDI) – will determine which of two amounts is the closest to the reasonable amount for the services: the billed charge, or the payment made by the health plan, “as those amounts were last modified during the health plan’s internal appeals process, if the physician chooses to participate, or the informal settlement teleconference” that’s required prior to arbitration.
As in an offseason baseball arbitration proceeding between a team and one of its players, the arbitrator makes a binary choice: Either the physician’s billed charge or the health plan’s payment is the closest to the reasonable amount, and thus becomes the ordered payment. A claim that goes through the full arbitration process must be decided by the arbitrator within 51 days after the initial request.
As a result of the new system, balance billing will be prohibited for practitioners providing the out-of-network services to patients in the plans SB 1264 covers – with an exception, as explained in TMA’s overview. The law gives TMB latitude to take disciplinary action against a physician who violates the law by billing patients more than their applicable copayment, coinsurance, and deductible.
The summary also details which state-regulated health plans are covered by the arbitration process, as well as which out-of-network services and supplies fall under the new law. It also explains the required steps following an arbitration request and which factors arbitrators will consider in making their decision.
TDI is planning an information session on SB 1264 at 1 pm Dec. 30 in Austin. More details on the information session and SB 1264 in general can be found on the TDI’s website.
Last Updated On
January 29, 2020
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