An integral part of running a medical practice is billing for health care services that are provided. Below are many helpful guides, tools and information to assist you in navigating various billing requirements by payors.
Appeals and Denials Best Practices - PowerPoint presentation on mitigating the denial and appeals process.
Audits - AMA resources on payor audit trends, how to respond to an audit, etc. (in Regulatory and legal considerations section)
Bilateral Billing Guide - A guide on the bilateral billing requirements of the major Houston market health plans.
Clean Claim Edits - A guide to assist with avoiding claims rejections and denials using front-end claim editing.
Coordination of Benefits-Commercial Plans, Coordination of Benefits-Medicare - Information on determining primary or secondary payor status when a patient has multiple coverage.
Critical Care Billing and Coding - Two part videos and CMS resource outlining how to bill for these services
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 and the CMS1997 Documentation Guidelines.
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. Use our Documentation Score Sheet to assist with code selection.
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 Non-physician Practitioners along with billing tools, resources, and related links
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.
Prompt Payment Discounts - Prompt payment discounts for patients.
Prompt Pay Penalties - Resources to determine prompt pay penalties and regulations by payor type: Prompt Pay Penalties Fact Sheet, Prompt Pay Penalty Guide, and Underpayment Penalty Calculator.
Recoupments - Rules and information regarding recoupments.
Surprise Billing - Federal - An HCMS resource providing information and guidance on the federal No Surprises Act.
Surprise Billing - Texas - 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.
Telemedicine/Telehealth - Rules, legislation, and resources on providing telemedicine services.
Texas Preauthorization Gold Card Rules - A guide to the TDI Preauthorization Exemptions rules to assist with understanding and implementing its provisions. This resource requires your member log in.
Where To File Complaints - Information on where to file complaints against various payors.