Appeals Process By Payer and Template Letters

  • This section contains information regarding appeal and dispute processes for the various major commercial payers, as well as template appeal letters.

Complaints 

  •  This section contains information on where complaints against payers can be filed.

Compliance Posters

  • This section contains links to free posters that should be posted in the office.   

 Employee Retirement Income Security Act  

  • This section contains information on how to dispute claims and or benefits that are denied by self insured plans.

Department of Public Safety (DPS)

  • Major changes to DPS effective September 1, 2016. To learn more, click here

EMS Patient Transportation Rules 

  • This document is designed to help physicians educate their patients about Houston's EMS Transportation rules.

 Free Office Forms and Posters 

  • This section contains links to free sample forms for the office. These forms include: Advance Beneficiary Notice (ABN), Business Associate Agreement (BAA), credit card authorization form, mobile device use agreement, model financial agreement, notice of privacy practices and sample patient dismissal letters.

Hearing Impaired Patients  

  • This section contains information regarding rules and guidance on interpreters and treating hearing impaired patients, as well as those with limited-English proficiency (LEP).

Informational Tools and Grids 

  • HCMS has developed several grids and tables to assist physicians' offices with contacting health plans (for eligibility, benefits, precertifications, ect.), 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, and a chart of Web Portal systems, and more.

Medical Records  

  • This section contains information on retention, release, and fees regarding medical records.

Mental Health Providers Reporting to NICS

  • This section contains information on the final rule to modify HIPAA to permit certain covered entities to disclose identities of patients who are subject to Federal mental health prohibitors that do not allow them to own or carry firearms.

Narrow Networks Complaints

  • TMA has drafted a TDI complaint letter which can be customized for your patients. Available in English and Spanish, this TMA resource makes it possible for patients to easily file a complaint with the Texas Department of Insurance (TDI) about a health plan's network.

Out of Network Disclosure Forms  

  • This section contains links to the major payers "Out-of-Network Disclosure" forms. Participating physicians are required to have these forms completed prior to referring the patient to an out-of-network facility or physician.

Physician Extenders 

  • This section contains information regarding different billing practices for physician extenders. 
  • This section contains forms from the major payers that allow physicians to change/update data and other demographic information.

Practice and Payment Models

  • This section contains information on various Practice and Payment Models such as; ACO, Bundled Payment, Cash Practices, etc...  

Prohibiting Concealed or Open Carry Handguns on Private Property 

  • TMA published a white paper regarding Prohibiting Concealed or Open Carry Handguns on Private Property.

Protect yourself from out of state threats to Texas Tort Reform laws 

  • This section contains draft language from TMA to help protect Texas physicians.

Recoupments 

  • This section contains information regarding rules and regulations as to when health plans can recoup payments.

Reputation Management

  •  Info and resources on preventing and repairing negative online ratings and establishing a positive online presence.
 

Staff Educational Courses 

  • Information and links to Houston Metro area resources for various certificates and degrees related to physician office practices.

 Starting Your Own Practice

  • This section contains a New Practice Checklist that is designed to help physicians who are starting their own practice.

Selling or Closing Your Practice

  •  This section contains information regarding rules, guidance and resources when retiring, closing, selling a practice.    

Departing from a Group Practice  

  •  This section contains information regarding rules and guidance when leaving a group practice. 

 

Telehealth 

  • This section contains information and rules regarding telehealth, as well as a link to HCMS' Telehealth Grid with payer policies and reimbursement information.
 

Texas Medical Board (TMB) -FAQs             

  • The Texas Medical Board Office of the General Counsel assists licensees, the public, and other stakeholders with answers to frequently asked questions (FAQs) about TMB laws and rules.
  • Click here for information about supervision and delegation requirements, corporate practice of medicine, pain management clinic registration, and telemedicine. 
  • For additional information, including licensure, the TMB complaint process and more, please see the HCMS webpage on Texas Medical Board Info under the Practice Resources/Ethics section. 

501(a) Health Care Organizations 

  • This section contains information regarding 501(a) organization definitions, certifications, local organizations, and how to file a complaint.