Dec 23, 2008

Medicare: Staying Out of Trouble -- Podcast TMA

There’s a debate out there somewhere over just how many pages of regulations the government has published to govern the Medicare program. Thousands? Tens of thousands? Hundreds of thousands? The answer depends on how you define the word “regulation.” But for physicians and office staff, the answer is pretty simple. Medicare has TOO MANY rules regulating how doctors must care for their patients and what they need to do to get paid. Don’t follow those regs and you don’t get paid … or you end up on the wrong end of a fraud investigation.

Download the show. Today’s conversation is based on the release of our fourth volume of “greatest hits” from TMA’s practice management e-tips. To download the greatest hits or read through our other tips on coding, please check out the TMA web site. Our guests today are two of Texas medical association’s expert staff members. Genevieve Davis and Erin Gregorcyk are both reimbursement specialists in TMA’s Division of Medical Economics. Erin and Genevieve spend their days sorting through all those Medicare publications and then answering questions from our physicians. This installment covers:

  • Where can physicians and office staff find answers to common Medicare questions?
  • How can physicians change their Medicare participation status?
  • What should physicians do if they want to waive copays and deductibles for Medicare patients who can’t afford to pay them?
  • The new Medicare Advance Beneficiary Notice that physicians must begin using on March 1, 2009.
  • What do physicians need to know about documenting Medicare patient consultations?
  • How can honest physicians best protect themselves from making mistakes that might trigger a fraud investigation?
  • How can TMA’s mini-consults and coding hotline help physicians with Medicare problems or concerns?

Resources


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More Healthy Benefits From Tort Reform

Two reports released in December continue to document the positive effects of TMA's 2003 medical liability reforms. They're working.

More Healthy Benefits From Tort Reform

12/21/2008 6:00 PM

Be a First Tuesdays Lobbyist!

Physicians at the Capitol, in person, played a key role in organized medicine's victories during the past three sessions of the Texas Legislature. The 2009 session offers a chance to do it again. TMA urges physicians, medical students, and TMA Alliance …

Be a First Tuesdays Lobbyist!

12/21/2008 6:00 PM

Tell Us How Plans 'Lowball' You

Physicians, patients, and regulators around the country are increasingly outraged over how health insurance companies set "usual, customary, and reasonable" (UCR) charges or maximum allowables to determine payments for out-of-network services. We need …

Tell Us How Plans 'Lowball' You

12/21/2008 6:00 PM

CMS Surveying Medicare Contractors

The Centers for Medicare & Medicaid Services (CMS) may soon ask you what you think of the job that TrailBlazer Health Enterprises, the Texas Medicare carrier, is doing.

CMS Surveying Medicare Contractors
12/18/2008 6:00 PM

Ike Relief Fund Deadline Extended

 

March 16 is the new deadline for physicians to apply for financial help to rebuild their practices damaged or destroyed by Hurricane Ike.

Ike Relief Fund Deadline Extended

12/18/2008 6:00 PM

Dec 15, 2008

TMA's Prescription for a Healthy Texas

As you will read in the January Texas Medicine, the Texas Medical Association plans to pursue an ambitious agenda when the legislature convenes next month. A tight budget, narrow partisan margins in the Texas House and Senate, and an anticipated all-out …

TMA's Prescription for a Healthy Texas 12/11/2008 6:00 PM

Doctor's Orders: Attend Winter Conference

 

Make sure you're prepared to participate in the legislative process next year by attending the TMA Winter Conference Jan 30-31 at the Hyatt Regency Hotel in Austin.

Doctor's Orders: Attend Winter Conference

12/11/2008 6:00 PM

Save These Dates for 2009 TMA Conferences

 

Join physician colleagues from across the state for TMA’s three annual opportunity-packed conferences that will equip you to be more successful in your medical practice, advance the profession of medicine, and better serve your patients.

Save These Dates for 2009 TMA Conferences

12/11/2008 6:00 PM

United to Help Boost e-Prescribing

 

UnitedHealthcare is expanding its support of e-prescribing from small pilots in three states to include Texas and several other states. The Texas phase will begin in the Austin, San Antonio, and Waco markets.

United to Help Boost e-Prescribing

12/11/2008 6:00 PM

TMA Offers Coding Tools

 

Physicians go to medical school so they can learn how to take care of sick and injured people. But medical coding — putting the right codes in the right boxes in an insurance billing claim — is the financial engine that drives a medical practice. Correct …

TMA Offers Coding Tools

12/11/2008 6:00 PM

Dr. Zeitler to Head TMB

 

Irvin E. Zeitler, Jr., DO, of San Angelo, is the new president of the Texas Medical Board (TMB). Gov. Rick Perry appointed him for a term to expire at the governor's pleasure.

Dr. Zeitler to Head TMB

12/11/2008 6:00 PM

It's Decision Time on Medicare Participation

 

You have until Dec. 31 to decide if you want to change your Medicare participation status from participating to non-participating or vice versa for 2009.

It's Decision Time on Medicare Participation

12/11/2008 6:00 PM

Medco Changes Drug Policy

 

Medco is notifying Texas Health Insurance Risk Pool patients that as of Jan. 1, certain specialty medications previously obtained directly from a specialty pharmacy, a home infusion company, or their doctor’s office will be covered only if they order …

Medco Changes Drug Policy

12/11/2008 6:00 PM

MMWR Warns of Oseltamivir-Resistant Flu

 

Preliminary Centers for Disease Control and Prevention data show that 45 of the 46 influenza A (H1N1) viruses tested recently were resistant to oseltamivir; all H1N1 viruses were sensitive to zanamivir, according to the Dec. 12 Morbidity and Mortality …

MMWR Warns of Oseltamivir-Resistant Flu

12/11/2008 6:00 PM

Dec 2, 2008

Ike Relief Fund Deadline Approaching

 

Physicians needing help rebuilding their medical practices shattered by Hurricane Ike have only a month left to apply for assistance from the Hurricane Ike Disaster Relief Fund. The Physicians Benevolent Fund of TMA is accepting applications for …

Ike Relief Fund Deadline Approaching

11/25/2008 6:00 PM

TMA Introduces TMA Weekly Headlines

 

With new procedures, new technologies, and new regulations, physicians’ practices are constantly evolving. To that end, TMA has partnered with MultiBriefs to create TMA Weekly Headlines, an opt-out e-mail resource providing comprehensive news briefings of …

TMA Introduces TMA Weekly Headlines

11/25/2008 6:00 PM

Workers' Comp Conversion Factors Adjusted

 

The Texas Department of Insurance (TDI) Division of Workers’ Compensation announced in late November the annual changes to conversion factors for workers’ compensation medical fee guidelines for professional services, charges, and payments using the …

Workers' Comp Conversion Factors Adjusted

11/25/2008 6:00 PM

Survey Reveals Physician Frustration

 

Results of a nationwide Physicians Foundation survey show primary care physicians are frustrated and concerned about the state of medicine today, so much so that many of the of the 12,000 physicians surveyed say they would not recommend a career in …

Survey Reveals Physician Frustration
11/25/2008 6:00 PM

Receive Your PQRI Incentive Using DocSite

 

You are still eligible to earn the 1.5-percent incentive on your Medicare billing for 2008 by submitting Physician Quality Reporting Initiative (PQRI) measures through a patient registry

Receive Your PQRI Incentive Using DocSite

11/25/2008 6:00 PM

Blue Cross Billing Dispute Help Available

 

As part of the settlement in physicians’ national class action lawsuit against numerous Blue Cross and Blue Shield plans, physicians may submit billing disputes to a new external review board.

Blue Cross Billing Dispute Help Available
 
11/25/2008 6:00 PM

Your 2009 Goal: Stronger Practice Operations

 

Take a look back over the last 12 months. Was staff turnover high? Did your overhead increase?  Was cash flow down? Whatever your situation, resolve now to make 2009 better.

Your 2009 Goal: Stronger Practice Operations

11/25/2008 6:00 PM

TMA Offers Tools to Navigate the Coding Maze

 

Physicians go to medical school so they can learn how to take care of sick and injured people. But medical coding — putting the right codes in the right boxes in an insurance billing claim — is the financial engine that drives a medical practice.

TMA Offers Tools to Navigate the Coding Maze

11/25/2008 6:00 PM

AMA Hosts PQRI Webinar

 

The American Medical Association will host a webinar on the Centers for Medicare and Medicaid Services (CMS) 2009 Physician Quality Reporting Initiative (PQRI) from noon to 1:30 pm CST on Wednesday, Dec. 17.

AMA Hosts PQRI Webinar

11/25/2008 6:00 PM

TMA Winter Conference Coming in January

 

The Texas Legislature will be in full swing come January, and you won’t want to miss any of the action at TMA’s 2009 Winter Conference in Austin Jan. 30-31.

TMA Winter Conference Coming in January

11/25/2008 6:00 PM

Advertise for as Little as $25

 

TMA’s Web site experiences nearly 320,000 visitor sessions each month. With this kind of activity, can you afford not to advertise in TMA’s online classifieds?

Advertise for as Little as $25

11/25/2008 6:00 PM

Aetna Teaches Cross-Cultural Communication

 

Aetna is offering free online cross-cultural communication training for physicians, nurses, and health care professionals who care for Aetna members.

Aetna Teaches Cross-Cultural Communication

11/25/2008 6:00 PM

United Changes SPECT MPI Policy

 

UnitedHealthcare implemented a new medical policy for Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI) on Dec. 1.

United Changes SPECT MPI Policy
11/25/2008 6:00 PM