Billing and Collections

Medicare Sunsets Beleaguered Appropriate Use Criteria Program - 03/14/2024

After longstanding opposition from the Texas Medical Association and others, the Centers for Medicare & Medicaid Services finally nixed the appropriate use criteria program for advanced diagnostic services as part of the 2024 Medicare physician fee schedule.

Revenue Cycle Assessment - 01/22/2024

A TMA consultant will conduct a review of your business office operations that focuses on front desk procedures, billing, collections and revenue cycle improvement. We will identify opportunities for improvement of billing processes and procedures.

Practice Operations Services - 01/22/2024

With the many challenges that face today's medical practices, business operations remain at the core of a practice's ability to be successful and profitable. Work with a TMA practice management consultant to identify and assess key or problematic areas of your practice.

Financial Management Services - 01/22/2024

Having sound financial policies and processes can help your practice attain a steady cash flow, maintain healthy collection ratios, increase staff efficiencies, and boost your overall bottom line.

Your Billing and Collections Checklist for 2024 - 12/19/2023

TMA’s Reimbursement Services staff work year-round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2024 to keep your billing and collections on track throughout the year.

Bipartisan Legislation Would Prohibit Electronic Funds Transfer Fees - 12/08/2023

Recently introduced federal legislation could spare physicians from electronic funds transfer (EFT) fees, which payers routinely charge as a condition of electronic payment.

CMS Strengthens Price Transparency for Hospitals - 11/29/2023

A new Centers for Medicare & Medicaid Services final rule aims to strengthen hospital price transparency regulations for 2024, a move physicians hope will address weaknesses in prior policy that hindered them and patients from making informed health care decisions.

TMA Pushes for Elimination of Excessive Electronic Funds Transfer Fees - 09/22/2023

Payers routinely charge physicians the fees as a condition of electronic payment, often without consent. Alongside declining physician payment, the fees add to the threat to practice viability, and ultimately patients’ access to care. Read more.

Here’s What Medicare Pays for Flu Shots This Season - 08/23/2023

The Centers for Medicare & Medicaid Services recently published 2019-20 payment rates for personal flu vaccines and their administration. The effective dates for these rates are Aug. 1, 2019, to July 31, 2020.

Is Medicare’s Chronic Care Management Program for You? - 08/21/2023

Interested in the possibility of getting paid as much as $75,000, or even more, for something you already more or less do? Medicare now pays separately for chronic care management services. To help you decide if this new opportunity is right for your practice, TMA created a new online resource center.

Don’t Forfeit Your APM Incentive Payment; Act Now - 08/14/2023

If you participated in an advanced alternative payment model in the 2021 Quality Payment Program and haven’t yet received your 2023 incentive payment, you have until Sept. 1 to update your billing information – or forfeit the payment.

Preauthorization Denial: What’s Your Recourse? - 07/25/2023

So a health plan has denied your preauthorization request for a patient’s treatment. What options do you have?

5010 Deadline Extended; Dual Eligible Problem Not Fixed - 07/25/2023

Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.

TMA Offers Remedies to Ease Surprise Billing - 06/28/2023

Texas patients sometimes feel the pain from unexpected out-of-pocket costs not covered by their health insurance, known as “surprise billing” or “balance billing.” The Texas Medical Association (TMA) is taking aim at the problem, which occurs when a health insurance company pays less than what a doctor charges, leaving the patient to pay the balance of the bill.

Relief in Site: Physicians Say Setting Should Not Determine Medicare Payments - 06/07/2023

Physicians want to reform a Medicare policy that allows hospital-owned outpatient clinics to charge more than medical practices and ambulatory surgical centers for most medical procedures. This pay discrepancy pressures medical practices to merge in order to protect themselves from hospitals hot to acquire medical practices that, once bought, can collect much higher fees.

Cigna Delays Problematic Modifier 25 Policy - 05/31/2023

Cigna will delay its demanding requirement for physicians to submit additional documentation for routine, minor procedure claims after the Texas Medical Association, American Medical Association, and dozens of other medical organizations urged the payer to immediately rescind the policy in April.

Medicine Urges Cigna to Withdraw Far-Reaching Modifier 25 Policy - 05/03/2023

Demonstrating the far-reaching impact of a new Cigna policy, the Texas Medical Association joined organized medicine and other health professionals in collectively and vociferously calling on the payer to “immediately rescind” an onerous requirement for additional documentation for routine, minor procedure claims starting in June.

Update: New Cigna Policy Requires Additional Documentation for Same-Day Procedures - 04/03/2023

Despite medicine’s pushback, Cigna plans to move forward with burdensome billing policy requiring additional documentation for routine, minor procedure claims starting in June.

Prevent Improper Code Bundling With New Medicare Tool - 02/15/2023

Physicians can take advantage of a new Medicare tool to sort through the thousands upon thousands of service codes that can be bundled together for claims payment – and avoid improper billing.

No Surprises Act Includes Directory Update Requirement - 02/10/2023

In addition to resolving payment disputes over out-of-network medical care, the federal No Surprises Act aims to make sure health plans’ practitioner directories stay up to date, and part of that aim puts an onus on physicians.

Medicine to Congress: Don’t Give Health Plans More Leverage - 02/09/2023

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.

Here’s Your Billing and Collections Checklist for 2023 - 01/06/2023

TMA’s Reimbursement Services staff work year round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2023 to keep your billing and collections on track throughout the year.

OIG: Physicians Incorrectly Billing for End-of-Life Care Planning - 01/05/2023

Advance care planning (ACP) services were meant to give patients the opportunity to choose the care that is right for them at the end of their lives or during medical crises that could render them unable to make personal health decisions.

Check Claims Dates for Drug Administration as Coding Updates Loom - 12/02/2022

With annual updates to billing codes for medications set for Jan. 1, physicians are reminded to use the most current National Drug Code (NDC) and Healthcare Common Procedure Coding System (HCPCS) combinations when filing claims for drug administration.

E/M Revisions in 2023 CPT Code Set Aim to Simplify Documentation - 11/02/2022

In an effort to continue to tamp down physicians’ administrative burden, the American Medical Association has revised the codes and guidelines for most evaluation and management services in its 2023 Current Procedural Terminology code set.