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

Evaluation and Management Coding Tool - 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.

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

Interpretation Services for the Hearing Impaired

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

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. 


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

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.