Helpful Grids and Informational Tools
Helpful Grids, Tables, Template Letters, and Posters for your practice. HCMS has developed several grids and tables to assist physicians' offices with contacting health plans (for eligibility, benefits, pre-certifications, etc.), and in areas such as behavioral health, a comparison of efficiency & quality programs, a language search for physician, incentive bonus programs, a search for physicians by language, a chart of Web Portal systems, and more.
- HCMS Charge Master Calculator (based on a percentage above breakeven) - All physician and/or practices need to establish a charge master or price list for services. Charge masters can be developed in multiple ways. HCMS has created a calculator in Excel which utilizes one of the possible options based upon using Medicare's RVU data in conjunction with the physician or practice's cost. (Updated October 2016)
- HCMS Medicare Incentive Calculator - HCMS has created a new tool to help you evaluate penalties and incentive scenarios for the various incentive programs including PQRS, E-prescribing, and EHR Meaningful Use.
- HCMS Work Relative Value Unit (RVU) Calculator - HCMS has developed a work RVU calculator to help physicians determine their total work RVUs. This calculator can be used to track work productivity and to compare one's work productivity to one's compensation. It can also be used to compare work productivity to what is being reported by a practice management system. The calculator includes 40 different specialties based upon the top 50 codes for their particular specialty. Plus, if a particular code is not listed within the top 50 codes additional codes can be added to help determine work productivity based upon the work RVU. (Updated 2017)
Grids and Tip Sheets:
- Behavioral Health Contact Grid - Complete contact information for behavioral/mental health with the five major Houston health plans. (Updated December 2015)
- Commercial Health Plans Contact Grid (complete version) - Complete contact information with the five major Houston health plans including eligibility, benefits, physician portals, lab, provider representatives, inpatient certifications, disease and case management, imaging, DME, and much more. (Updated March 2016)
- Commercial Health Plans Contact Grid (shortened version) - A shorten version of the complete commercial health plans contact grid with some of the same great and useful information. (Updated March 2016)
- Contract Analysis Tip Sheet (Physician Employment)- This tip sheet provides a list of items that physician should evaluate and discuss prior to signing an employment agreement.
- HIT Consultants Grid (IT Vendors) - this grid lists IT vendors and consultants with physical offices in Houston and compares the various Meaningful Use and IT services offered by each vendor. (Updated July 2016)
- Incentive Bonus Program - a helpful grid that summarizes various incentive programs based on quality measures offered by various health plans and how to participate in those programs. (Updated June 2016)
- Language-Search for Physician- a table describing the on-line instructions for the five major health plans in the Houston area to assist with locating a physician who speaks another language. (Updated February 2017)
- Maintenance of Certification (MOC) Comparison Chart - This chart lists MOC requirements for each of the 24 specialty boards under the American Board of Medical Specialties (ABMS) and what reciprocating credits are offered if you are certified in more than one specialty. (Updated July 2016)
- Medicaid Health Plans Contact Grid - complete contact information with Houston area Medicaid health plans including eligibility, benefits, physician portals, lab, provider representatives, inpatient certifications, disease and case management, imaging, DME, and much more. (Updated May 2016)
- Medical Cultural Awareness - Houston is a city of many cultures. To assist our membership with caring for a diverse population of patients, HCMS has created a webpage of the cultural awareness tools mentioned below. You can find this information at www.hcms.org → Practice Resources → Quality → Cultural Awareness. (August 2016)
- New Practice Checklist - HCMS created a New Practice checklist. This checklist is designed to help aid physicians in starting their own practice. (Updated Jan 2017)
- Qualified Clinical Data Registry Grid (2016) -Physicians wishing to participate in a QCDR for PY 2016 should review the list of available qualified registries. Each of the 2016 QCDRs have provided detailed information including their contact information, the measures they support, the services they offer and the costs incurred by their clients. (August 2016)
- Reference Guide for Reimbursement for Nurse Practitioners (NPs) and Physician Assistants (PAs) for in-office services - (Currently being revised) -This guide provides helpful information regarding billing for physician extenders according to major payers. (Updated Nov 2016)
- Telehealth Grid - HCMS has created a telehealth grid highlighting reimbursement policies for the major payers in Harris County. This information includes reimbursable CPT codes as well as coverage rules. (Updated March 2016)
Letters, and Templates:
- Advanced Beneficiary Notice (ABN) - An ABN is a standardized notice provided to Medicare patients to inform them of medical necessary services that are not covered by Medicare.
- Authorization to Disclose Protected Health Information
- Consent Forms - The Texas Medical Disclosure Panel adopted the following form which shall be used to provide informed consent to a patient or person authorized to consent for the patient of the possible risks and hazards involved with the procedure.
- Financial Agreement Language - The AMA developed the attached financial language as a template for physicians. This agreement personally obligates patients to pay co-payments, co-insurance, deductibles, and non-covered services.
- HITECH Non-Disclosure
- Sample policy - Regarding Patient Right – Restrict Use or Disclosure of PHI
- Sample Form - Regarding Patient Right - Restrict Use or Disclosure of PHI
- Out of state care forms for emergent and non-emergent care - Texas Tort reform has been challenged in New Mexico. A patient treated in Texas who lives in New Mexico filed suit against a Texas physician in New Mexico. On March 3, 2016, New Mexico Governor, Susan Martinez signed House Bill 270, the out of state provider access bill. New Mexico law makers crafted this solution to protect access to medical care for residents of New Mexico who come to Texas for their healthcare. It is recommended that Texas Physicians have patients sign an agreement consenting to medical care provided in Texas be governed by Texas law. The Texas Medical Association (TMA) has developed choice language that physicians can use for non-emergency care and emergency room care. As a protective measure, physicians might find it advantageous to offer a consent whenever treating any out-of- state patient. TMA encourages physicians to consult with their respective counsel in deciding to implement the consent forms. Although HB 270 doesn’t take effect until July 1, that does not mean a court would not uphold such a contract.
Patient Claim Forms
- Below are links to patient claim forms for the major payers:
- Practice/Physician Demographic Changes - It is important for physicians to update their practice demographic information with the health plans to ensure payment and other vital notices are received. Below are the forms and methods to make these important changes through each major payer
- Complaint Notice Poster - Board Rules require the posting of a notice of complaint procedure in English and Spanish.
- Texas Medical Board - Section 154.051 of the Occupations Code and Board Rule §177.13, requires the posting of a notice of complaint procedure in English and Spanish at each site of health care delivery that is readily visible to patients or potential patients. The signs must be displayed prominently, supplied with all bills for services, and/or placed on all registration forms, applications or contracts.
- Workplace Posters - Federal
- Workplace Posters -Texas
- Texas Pay Day Poster - Poster
- The Law in Texas - Poster
- Child Labor Law - Poster
- Notice to Employees Concerning Workers' Compensation in the State of Texas - Poster
- Employees Notice of Ombudsman Program - Poster