Tag: Texas Medical Association (TMA)
Separate Services, Same Date of Service
With health plans increasingly adopting payment protocols that hinder physicians from providing multiple services on the same day – despite previously covering such services – delegates adopted policy calling on TMA to “advocate for legislation or regulation that would prevent Medicaid and commercial payers from denying payment for distinct, separate services provided on the same day.”
Delegates agreed with physicians’ concerns that these payer practices often force patients to forego care.
“This especially hurts patients who either have to travel long distances to see their physician or have transportation issues that prevent them from making multiple trips,” Odessa allergist and immunologist Vivek Rao, MD, wrote in online testimony on behalf of the Lone Star Caucus
Other measures adopted by the house to eliminate payment-related barriers to patient care direct TMA to pursue state-level legislation or regulation that:
- Prohibits insurers, plan sponsors, third party administrators, and other contracted identities from recouping previously paid claims due to retroactive termination of patient coverage;
- Imposes payer communication standards – with penalties – that provide patients, physicians, and others with timely access to a live representative; and
- Expedites prior authorization approvals for hospice care in emergency and acute care settings, eliminates deductibles for hospice care, and provides clear disclosures detailing hospice care benefits in policy documents as well as online.
Mandated CME Requirements Are Shifting
A recent reorganization of Texas Medical Board (TMB) rules has removed certain universal CME obligations. The removal of universal CME requirements could result in a lighter load for physicians but may make it more challenging to determine what is required and when.
Please click the button below to view the entire article from Texas Medical Assocation.
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.
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.
Aetna Reverses NPP Payment Reduction
By: Hannah Wisterman ~ 2/12/25
On January 31st, InK reported Aetna was changing it’s policy on billing for Non-Physician Providers (NPP). As of February 10th Aetna has changed their stand. Please Read!
Aetna’s Feb. 10 reversal preserves NPPs’ ability to fully bill under a supervising physician’s name and National Provider Identifier (NPI) for services “incidental to” the physician’s diagnosis and treatment of an injury or illness. Services billed incident-to must be conducted in the same office suite where the physician is present and available to intervene if needed.
HHSC Extends Medicaid PEMS Revalidation
~Phil West, TMA
Health and Human Services Commission (HHSC) has provided an extension for physicians due for revalidation between Dec. 13 and May 31 through Texas Medicaid & Health Partnership’s (TMHP’s) Provider Enrollment and Management System (PEMS).
While the extension grants an additional 180 days to physicians due for revalidation between those dates, TMA advises physicians who are due for revalidation over the next six months to file online with HHSC as soon as possible.
TMA Webinar Helps Equip Physicians for 2025
Medicare Fee Schedule
With the Centers for Medicare & Medicaid Services’ (CMS’) 2025 Medicare Physician Fee Schedule set to take effect Jan. 1, the Texas Medical Association is preparing physicians for changes in payment and coding, telemedicine, and quality and value-based care arrangements, among other areas.
Medicare Solidifies Pay Cut
In a final rule that solidifies a nearly 3% Medicare pay cut for physicians in 2025, the Centers for Medicare & Medicaid Services (CMS) also set the trajectory for physician practices over the next year with a mixed bag of changes related to telemedicine, coding and payment, and the Merit-Based Incentive Payment System (MIPS), among others. ~By Phil West
While TMA analyzes what it sees as some isolated, positive changes resulting from CMS’ finalization of the 2025 Medicare Physician Fee Schedule, it is also urging physicians to act now to show their support for House Resolution 10073
NOW YOU KNOW
Every business, especially a medical practice, needs to run like a well-oiled machine
Just as oil prevents an engine from drying out and freezing up, your medical practice must have a well-developed denial management program in place. This is the first proactive step.
CMS Increased Payment for Influenza Vaccines
On August 1, the Centers of Medicare and Medicaid Services (CMS) increased payments to physicians for influenza vaccines and updated which codes physicians should use when billing for the service during the 2024-25 flu season.
Texas Medical Association billing and coding staff caution that to receive payment, physicians also will need to use a national drug code (NDC) associated with the current period.
Follow this link for proper CPT codes and more vaccine information.
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations Policy
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