Medicare Preventive Services – Revised
The above link will lead you to MLN Educational Tool, where you can click a service and see the changes.
Bringing Joy to Your Staff
Medical practices run on people, not just physicians.
Support staff—front‑desk schedulers, billers, MAs, nurses—often shoulder the first wave of patient frustration and the last wave of administrative overload. When joy disappears, turnover follows and patient experience slips.
Here are 10 evidence‑based tactics (offered by “Physician Practice”) to put delight back into the workday and keep your best people.
1. Ask, listen and act on feedback
Move from “suggestion box” to true participative management. Before rolling out any workflow change, solicit frontline ideas in daily huddles, publish the top three suggestions on a whiteboard and close the loop within a week. Employees who see their input reflected in policy score higher on engagement surveys and are more likely to propose innovations that save time and money
2. Recognize great work in real time
Dollar‑free praise beats stale year‑end bonuses. Public shout‑outs at a morning huddle or via an oversized card signed by peers reinforce behaviors that improve patient flow and safety. Tie each kudo to a specific accomplishment so staff connect the dots between effort and outcome
3. Celebrate small wins and birthdays
Micro‑celebrations trump a lone holiday party. The classic “Cinco de Mayo taco bar” or an impromptu cupcake run after a spotless audit tells staff you notice the grind. Those light moments strengthen social bonds that translate into better teamwork when the waiting room is overflowing.
4. Offer genuine scheduling flexibility
Extra PTO, rotating early‑out Fridays or seasonal compressed shifts cost less than recruiting a replacement. Flexible scheduling keeps mid‑career parents in the workforce and can even delay retirements, preserving institutional knowledge while lifting morale.
5. Make the break room a refuge
Healthy snacks, natural light and a phone‑free policy turn 15 minutes of downtime into true recovery. Keeping the refrigerator stocked with fruit and yogurt is a low‑budget perk that employees consistently list among their favorite morale boosters.
6. Invest in professional growth
Stagnation is the enemy of joy. Map a modest CME budget to every role, fund at least one conference or certification per employee each year, and spotlight success stories at staff meetings. Practices that budget for training report higher morale and fewer costly coding errors.
7. Delegate with purpose, not desperation
Match assignments to strengths and clarify roles so no one feels set up to fail. Clear expectations create “psychological safety,” a proven driver of high‑performing medical teams and a buffer against burnout.
8. Lead with transparency and empathy
Trust grows when leadership shares key metrics, explains tough decisions and asks, “How can we help?” Thoughtful, two‑way communication is one of the quickest ways to boost engagement and cut gossip that erodes culture.
9. Give employees a voice in quality‑improvement projects
Invite schedulers, billers and medical assistants to co‑design process fixes—whether a new triage script or a quicker prior‑auth checklist. Staff who help craft solutions adopt them faster and police the workflow themselves, freeing managers to lead rather than chase compliance.
10. Inject fun into routine days
Ugly‑sweater contests, step‑count challenges or “puppy‑visit Fridays” (partner with a local shelter) deliver quick dopamine hits that last long after the prize. Practices that weave lighthearted events into the calendar report lower absenteeism and higher patient‑experience scores.
Check Your BCBS Flu Test Claims
BCBSTX explained in correspondence with TMA’s Physician Payment Resource Center (PPRC) – which reached out for clarification earlier this month on the payer’s new flu testing policy – that some claims for certain labs, including those offering flu testing, were unintentionally denied due to a vendor error.
TMA’s Director of Physician Payment Services Carra Benson says physicians do not need to take action to receive payment. However, she recommends physicians review flu testing claims filed between Jan. 1 and Feb. 13 to ensure correct reprocessing.
Aetna OfficeLink Updates May 2025
May 2025
This month’s reminders:
We regularly review and adjust our clinical, payment and coding policies. Review our policies and claim edits on our provider portal on Availity®.* Just go to Payer Space > Resources > Expanded Claim Edits. Or you may visit Aetna.com to see them.
Coding/billing update: To align with CMS, starting August 1, 2025 we’ll no longer cover 88305 (Level IV surgical pathology, gross and microscopic examination) when billed with 55700 and/or 55706 (prostate incision procedures) on the same date of service. We’ll also allow G0416 (surgical pathology, gross and microscopic examinations) once per date of service.
Note to Texas providers: Changes described in this article will be implemented for fully insured plans written in the state of Texas only if such changes are in accordance with applicable regulatory requirements. Changes for all other plans will be as outlined in this article
Billing Tips by “Physicians Practice”
- Correct Data Entry and Demographics at Check-in
Accurate data entry during patient check-in is critical. Gathering complete insurance and demographic information helps ensure proper billing and reduces potential claim denials. Make sure you always collect a photo of the patient’s insurance card, and most importantly, a photo of the back of the card. The back of the card is often more important for billing than the front.
2. Understand Your Insurance Payer Contracts.
Knowing exactly what your contract allows in terms of reimbursement rates, covered services, and billing guidelines helps prevent underpayment or denials.
3. Accurate Coding of Symptoms vs. Diagnoses.
Use the appropriate diagnosis codes for billing, avoiding the use of symptoms as primary codes. Insurance companies typically require specific diagnoses for proper reimbursement.
4. Frequent and Proactive Denials Management.
Actively follow up on denied claims and address the issues promptly. Letting accounts receivable (AR) build up can lead to financial complications and decreased revenue. Analyzing denial patterns, rectifying errors, and resubmitting claims correctly are essential steps. In particular, don’t leave denial follow ups to biweekly or monthly batched processes. The best practice is to build denials into your standard, weekly claims, and payment posting processes. In addition, the first time you receive a denial, your billing team should call the insurance payer to understand the reason behind the denial. This way, you can prevent the same error from occurring in future claims
5. Thorough Documentation.
Maintain detailed and accurate medical records for each patient. Poor documentation not only affects patient care but can also lead to audit risks and billing disputes. Proper documentation is not only required under your insurance payer contract but also required as a part of your state license as a health care practitioner.
6. Proper Secondary (2ndary) Insurance Filing.
Understand the proper procedures for filing claims with 2ndary insurance. Know the coordination of benefits (COB) and which insurance is the primary one. Often, the patient may not even be clear as to which is the primary. Have the patient contact their insurance payers and verify the primary and 2ndary insurance. Secondary payers often require physical documentation of the primary payer rejecting the claim first and this explanation of benefits (EOB) must sent along with the claim.
7. Medicare Billing Compliance.
Follow the guidelines set by Medicare’s Local Coverage Determinations (LCDs) when billing for services. Noncompliance could lead to denied claims and financial penalties.
8. Access to Insurance Portals.
Ensure you have access to the online portals of all insurance providers you work with. This will help you track claims, check eligibility, and communicate efficiently.
Superior: New Availity Claim Features and Webinars.
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Superior: Appeal Submissions
IMPORTANT: Post-Service Medical Necessity Appeal Submissions
Superior HealthPlan would like to remind providers that post-service Medical Necessity Appeals must be mailed or faxed using the submission information below. Submissions must include the reason for appeal and any additional clinical information for appeal review..
Centene Management Company
ATTN: Medical Management Appeals
5900 E. Ben White Blvd
Austin, Texas 78741
Fax number: 1-866-918-2266
Post-service appeals for reconsideration of a Medical Necessity Denial on behalf of a member should not be sent to the Claims Appeal address.
For questions about post-service Medical Necessity Appeals, providers can contact 1-877-398-9461.
Submit 2024 MIPS Data by April 14th
The data submission period for Medicare’s 2024 Merit-Based Incentive Payment System (MIPS) performance yeard has been extended to April 14th at 7 pm CT.
At Stake is a pay cut of up to 9% in the 2026 payment year.
Prior Auth for Certain Sleep Studies, No Longer Required by Superior as of April 1, 2025.
For all Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP and Ambetter from Superior HealthPlan members, Superior will no longer require prior authorization for the following Current Procedural Terminology (CPT) codes:
For Medicaid, CHIP and Ambetter members 17 years of age and younger, Superior will no longer require prior authorization for the following CPT codes:
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