A Quick Guide to Each Payer’s Coronavirus Changes and Waivers

Throughout the COVID-19 pandemic, commercial and government payers have issued waivers and policy changes to help physicians care for as many patients as possible. 

But each plan has different effective and expiration dates for telemedicine, testing, and treatment changes. And most commercial plans can opt in or out of government-program adjustments such as waiving cost-share for treatment. 

If you’re trying to keep track of each payer’s policies, the Texas Medical Association has created a chart that shows when each change began – and is scheduled to end – for government and commercial plans. 

The chart includes information on Medicaid and Medicare as well as Texas Department of Insurance (TDI)-regulated commercial plans and ERISA (federally regulated) policies. It is based on details posted on each plan’s website and will be updated frequently. TMA recommends you contact each patient’s plan directly. 

The chart is one of several tools TMA has published to help you navigate the constantly changing payer landscape during the pandemic. 

TMA’s Practice Viability Toolkit details multiple ways to keep your practice’s finances healthy. It includes a section on each payer’s policies. 

The webinar, Payer Updates in the Time of COVID-19, offers guidance in sorting through the inconsistent patchwork of varying COVID-19 billing and coding policies. It is accredited for 0.5 AMA PRA Category 1 Credits™. 

You can find the payer chart, toolkit, webinar, and other resources and information on the practice viability section of the TMA COVID-19 Resource Center.

POET Update 8/19/2020: BCBS Expands Telemedicine through 12/31/2020.

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Last Updated On

May 12, 2020

Payers Extend Prior Authorization Windows During COVID-19, follow this link.

Follow this link:

https://www.texmed.org/Coronavirus/

As the Texas Medical Association told you Monday, personal protective equipment (PPE) will begin to move more quickly from state-managed warehouses to Texas county medical societies and on to private practice, community care physicians. Now, TMA has opened a PPE Portal for practices to submit their PPE needs.

Please visit the TMA website (https://www.texmed.org/TexasMedicineDetail.aspx?id=52910) for details.

TMA has a great chart to help answer your telehealth questions. Here is the link…https://www.texmed.org/uploadedFiles/Current/2016_Practice_Help/Health_Information_Technology/Telemedicine/Telemedicine%20Quick%20Reference%20Chart%20for%20Payers.pdf

Texas Medical Board Press Release

FOR IMMEDIATE RELEASE

April 21, 2020

Media contact: Jarrett Schneider, 512-305-7018

Customer service: 512-305-7030 or 800-248-4062

TMB Adopts Emergency Rule to Enforce Gov. Abbott’s Executive Order GA-15

Following Governor Greg Abbott’s issuance of Executive Order GA-15, the Texas Medical Board’s Executive Committee today adopted rules on an emergency basis to enforce the Governor’s Executive Order which continues the postponement of certain surgeries and procedures as outlined in the order.

The adopted rule amends 22 TAC Chapter 190.8 Violation Guidelines, and adds to the definition of “Unprofessional and Dishonorable Conduct” under 22 TAC §190.8(2)(U). The adopted emergency rule goes into effect later today at 11:59 p.m. when GA-15 goes into effect.

The rule adds to the definition to include the following:

(U) a violation of Texas Executive Order GA-15, issued April 17, 2020, which states: “All licensed health care professionals and all licensed health care facilities shall postpone all surgeries and procedures that are not medically necessary to diagnose or correct a serious medical condition of, or to preserve the life of, a patient who without timely performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician; provided, however, that this prohibition shall not apply to either of the following:

(i) any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the personal protective equipment needed to cope with the COVID-19 disaster; or

(ii) any surgery or procedure performed in a licensed health care facility that has certified in writing to the Texas Health and Human Services Commission both:

(1) that it will reserve at least 25% of its hospital capacity for treatment of COVID-19 patients, accounting for the range of clinical severity of COVID-l9 patients; and

(2) that it will not request any personal protective equipment from any public source, whether federal, state, or local, for the duration of the COVID-19 disaster.”

The Executive Committee also withdrew emergency rules related to Executive Order GA-09 effective today at 11:59 p.m.

The Board has published updated FAQs on the TMB website at www.tmb.state.tx.us/page/coronavirus.

For the latest COVID-19 information for health providers and the public, visit the Department of State Health Services (DSHS) COVID-19 web page at dshs.texas.gov/coronavirus/.

APRIL 22,2020 UPDATE FROM TMA : Please see link for further clarification provided by TMA. https://www.texmed.org/uploadedFiles/Current/2016_Public_Health/Infectious_Diseases/Emergency%20rule%20guidance%20-%203.25%20Update.pdf

TMA offers help with Payer’s COVID-19 Policies.  This is open to all Texas physicians now. To View