Billing and Payers

Resources for accurate billing to reduce claims denials and receive appropriate payment.

An integral part of running a medical practice is billing for health care services that are provided. 

Below you will find many helpful guides, tools and information to assist you in navigating various billing requirements by payers.

Balance Billing/Surprise Billing - The Texas Department of Insurance (TDI) provides instruction and resources on the arbitration process for certain billing disputes. For further explanation of and resources on the surprise billing law and arbitration, also refer to TMA information and summary of the bill.

Bilateral Billing Guide - A guide on the bilateral billing requirements of the major Houston market health plans.

Coordination of Benefits-Commercial PlansCoordination of Benefits-Medicare - Information on determining primary or secondary payer status when a patient has multiple coverage.





 

Evaluation and Management Coding Tool (prior to 2021) - Revamped from an AAFP Family Practice Management journal, a coding tool to assist physicians with proper E/M coding and auditing. For more information see Mastering E/M Coding.

Evaluation and Management Coding and Documentation - 2021 - Information on the new guidelines and revisions to the Office or Other Outpatient E/M Services CPT codes 99201-99215 effective Jan. 1, 2021. The TMA also has more information on the coding changes.

HCMS Payment and Practice Help
 - HCMS offers a payment assistance program at no charge to our members to assist them with payment issues.

Incident-to Billing Guide - Information on billing for physician extenders, along with billing tools, resources, and related links

Interpretation Services for the Hearing Impaired Hospital Services Billing Guide - A guide on the billing rules for observation and inpatient care services for Medicare and commercial payers. 


Locum Tenens
 - Guidance on locum tenens rules and billing protocols.

Modifier 25 Resources - Instructions and guides for the proper use of modifier 25.

Modifier 59 Resources - Instructions and guides for the proper use of modifier 59.

NDC Billing Guidelines- Guidance on billing for physician administered drugs using National Drug Codes (NDC). NDC Billing Units Calculator provides the HCPCS and NDC billing units. 

Payers


PHE CPT 99072
- New code for reporting additional practice expenses incurred during a public health emergency.

Prompt Payment Discounts - Prompt payment discounts for patients.

Prompt Pay Penalties - Resources to determine prompt pay penalties and regulations by payer type: Prompt Pay Penalties Fact SheetPrompt Pay Penalty Guide, and Underpayment Penalty Calculator.

Recoupments - Rules and information regarding recoupments.

Telemedicine/Telehealth - Rules, legislation, and resources.

Where To File Complaints - Information on where to file complaints against various payers.