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| Payment Advocacy (Hassle Factor) |
| Both the Harris County Medical Society (HCMS) and the Texas Medical Association (TMA) have programs to assist our member physicians who have been unable to resolve claims issues and problems with payers. Learn more about these programs and our policies and requirements. |
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| Delivery and Payment Models |
| Information and resources on the public and private delivery and payment models and initiatives being developed, or already underway, that are designed to reign in healthcare cost growth while also improving the quality of patient care, including accountable care organizations |
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| HIPAA, ARRA, HITECH, NPI, and Red Flag Rules |
| Resources and information about Health Insurance Portability & Accountability Act (HIPAA) privacy and security, the American Reinvestment & Recovery Act (ARRA), the Health Information Technology for Economic & Clinical Health Act (HITECH), the National Provider Identifier (NPI), and the Red Flags Rule (for identify theft prevention and protection). |
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| Commerial Payors |
| Information and updates on commercial health plans, helpful grids and tables for your practice (health plan contacts, behaviorial health, efficiency and quality products by managed care companies, search for physician by languages spoken, Web portal systems, etc.), medical tourism guidelines, physician rating/ranking by health plans, prompt payment, silent PPOs and rental networks, Texas Department of Insurance links, Texas Medical Association resources and contract evaluation assistance, Tricare, links to Houston-area health plans, IPAs and PPO networks, and more. |
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| Medicaid and CHIP |
| Resources and information on the Texas Health & Human Services Commission (HHSC), the Texas Medicaid & Healthcare Partnership (TMHP), updates on Medicaid health plans and contact grid, dual-eligble patients (those with both Medicaid and Medicare), prescription drug pad requirements, links to Houston-area Medicaid and CHIP plans, and more. |
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| Medicare |
| Information and updates on Medicare Fee-For-Service, Medicare physician enrollment/options and the online enrollment system (PECOS), advanced beneficiary notice (ABN), Medicare Advantage, the Recovery Audit Contractor Program (RAC), resources and links to the Centers for Medicare & Medicaid Services (CMS) and TrailBlazer Health Enterprises, and more. |
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| Practice Management |
| Resources, information and updates on management tools for your practice, the Texas Medical Association, Texas Department of Insurance, billing, collections and discounts, CLIA, closing or selling a practice, coders and coding, credentialing, electronic death registration, EMTALA, health insurance for small employers, marketing your practice, notices for posting in your office, pre-existing conditions, prescribing data, prescriptions and pharmaceutical samples, and more. |
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| Workers' Compensation |
| Links to the Texas Department of Insurance Division of Workers' Compensation and the Texas Medical Association Compensation Advocacy resources. |
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| Houston Physicians Unveil Health Insurance Report Card |
| HCMS Physicians reveal results of the Harris County Medical Society Payor Survey, in which physicians rated the six largest health insurance companies in Harris County on patient care, payment and customer service. More |
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| NEWS AND UPDATES |
- Alert! Sequester guidelines for Medicare Advantage Plans
CMS has provided additional information regarding the Sequester guidelines for Medicare Advantage plans. For more information click here.
- Alert! PECOS (Medicare Enrollment)
CMS has temporarily delayed Phase 2 Ordering and Referring denial edits. Initially, CMS had announced that all physicians and non-physicians who order and/or refer in the Medicare Program be in the new Medicare enrollment system, PECOS, by May 1st, 2013. However, this edit has been postponed. For additional information please click here. For information about PECOS and physician enrollment, please see our PECOS and Medicare Physician Enrollment Web page.
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