Tools and Resources

Below are helpful tools and resources related to the business of medicine.

Payment and Practice Help

The HCMS Payment and Practice Help program has been providing payment and practice management assistance since 2000, and we have collected millions of dollars for our members since inception of the program. The program assists members with claims disputes, credentialing and contracting issues, regulatory guidance, etc. by working closely with our contacts at a multitude of agencies including Houston market payers, the Texas Medical Association, the Texas Department of Insurance, Texas Health and Human Services Commission, CMS, and others. The program helps address and resolve physician issues and concerns or answer questions and provide guidance on various topics free of charge for our members. For assistance, contact us at 713-524-4267 or at paymentadvocacy@hcms.org. Note: Make sure to email protected health information securely. You may also fax information using our secure HIPAA fax line at 713-528-0951.   

The TMA Knowledge Center is also a free resource for members and can assist with legal, legislative/advocacy, research services, and other topics. They can be reached at 1-800-880-7955.

Calculators

  • HCMS Charge Master Calculator (based on a percentage above break-even) - All 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 using Medicare's RVU data in conjunction with the practice's costs.
  • HCMS Work Relative Value Unit (RVU) CalculatorHCMS 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 practice management system reports. The calculator includes the top 50 codes for 40 specialties. If a particular code is not listed within the top 50 codes, additional codes can be entered. To learn more about our wRVU calculator, watch the short informational video below. 


  • Patient Responsibility Calculator - Calculates the amount the patient will pay for a given service or procedure.
  • National Drug Code (NDC) Unit Calculator - This spreadsheet calculates the NDC billing units to be populated on the NDC claim line. For more information on NDC billing requirements, see our NDC Billing Guidelines.
  • Underpayment Penalty Calculator - This spreadsheet calculates the penalties/interest owed on claims partially paid late per SB 418 Texas Prompt Pay Laws.

Resources and Tip Sheets

Health Information Technology (HIT)

  • Information Blocking  - Read this page to learn about what information blocking is, upcoming deadlines, and how physicians can comply with these requirements.
  • COVID-19 Telemedicine Technology Options - easy to use technologies to quickly implement telemedicine during COVID-19 (only during the PHE event allowing for non-HIPAA compliant technologies). 
  • Cybersecurity Risk Assessment Vendors - Listing of Cybersecurity Risk Assessment Vendors
  • Six Simple Ways to go Paperless - There are many solutions to improving your practice's workflow. One of those is going paperless. The Harris County Medical Society has put together some steps that could help you create a paperless work environment.
  • HIT Consultants Grid (IT Vendors)  - This grid lists IT vendors and consultants with physical offices in Houston and compares the various MIPS and IT services offered by each vendor. 
  • EHR Vendor Comparison Tools - HCMS/TMA members can access assessments of EHR products that have a solid Texas market base. These assessments include most used vendors in Texas, side-by-side summary comparisons, vendor pricing comparisons, and EHR vendor profiles.
  • Telemedicine Vendor Evaluation -  evaluation tool created by the TMA to help Texas physicians with some of the criteria to consider in the selection of telemedicine vendor products

Payer Resources

Quality

  • Quality Payment Program Final Rule Summaries - An overview of CMS's final policies for MIPS 2021/2022 performance years, MVPs, APM Performance Pathways (APP), and COVID-19 PHE considerations. Refer to AMA's QPP 2021 final rule summary for more details pages 15 - 20), and AMA's QPP 2022 Final Rule Summary (pages 10 - 14). Refer to the 2022 QPP Final Rule Summary for performance year 2023 information.
  • Chronic Care Management (Medicare) - Information on patient eligibility, billing chronic care management (CCM) codes and more.
  • MIPS Participation Lookup Tool - An interactive tool to determine if a physician is exempt from participating in the MIPS program.
  • MIPS Measure Changes - Review the charts to identify if any of your selected measures have been deleted or modified for the 2022 MIPS performance year so you may make the appropriate changes. Reminder that the Quality category requires a full years' worth of data.          
  • MIPS Quick Guide - The guide provides information on preparing for the 2022 performance year. 
  • MIPS Step-by-Step Guide - Comprehensive guide on how to calculate, collect, and report data for the 2022 MIPS performance year.     
  • MIPS Qualified Registries List - A qualified registry is a CMS-approved entity that acts as an intermediary to collect data from MIPS physicians (both individuals and groups), and submits it to CMS on their behalf for purposes of MIPS reporting. Each registry varies, some able to report data for all three performance categories and some just one or two. See QCDRs below for more specialized registries.
  • MIPS Qualified Clinical Data Registry (QCDR) Vendors- CMS approved QCDR is an entity that collects clinical data from MIPS physicians just like qualified registries described above, except the QCDR reporting is not limited to just measures within MIPS. The QCDR can develop and submit QCDR measures for CMS approval (specialty-specific measures, etc.).
  • Quality and Efficiency Programs by Managed Health Plans Grid - This grid provides a list of managed care quality bonus incentive or performance rating programs along with their requirements and contact information. 

Health Equity