APPEALS AND DISPUTES:

Payer-specific appeal and dispute processes.

 

BILLING CHRONIC CARE MANAGEMENT SERVICES:

How to bill for the new Chronic Care Management code 99490.

 

BILLING FOR DUAL - ELIGIBLES (QMB):

Billing Qualified Medicare Beneficiaries (QMB), also known as dual eligible, is prohibited by CMS. Federal law protects QMBs from any cost-sharing liability and prohibits all original Medicare and Medicare Advantage providers - even those who do not accept Medicaid - from billing these patients their Medicare deductibles, coinsurance, or copayments. All Medicare and Medicaid payments that physicians receive for furnishing services to a QMB individual are considered payment in full. For additional information, see MLN Matters, Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program. 

 

BILLING FOR INTERPRETATION SERVICES FOR THE HEARING IMPAIRED:

Medicaid will pay for sign language services when specified criteria is met.

 

PAYERS: 

 

PAYMENT ASSISTANCE PROGRAM:

The Harris County Medical Society (HCMS) offers a payment assistance program to our members to assist them with payment issues.

 

PHYSICIAN EXTENDERS:

Information on billing for physician extenders.

 

PROMPT PAY DISCOUNTS

Information on offering prompt pay discounts to patients.

 

RECOUPMENTS

Rules and information regarding recoupments.

 

TEXAS PROMPT PAY- (Fully Insured Plans)

On June 17, 2003, Governor Perry signed into law SB 418 also known as Texas Prompt Pay to help physicians receive payment for services promptly.

 

WHERE TO FILE COMPLAINTS 

Information on filing complaints against Medicare, Medicaid, and other governmental payers.