Tools and Resources

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

Calculators
Resources and Tip Sheets
Health Information Technology
Payer Resources
Quality
Health Equity 

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) Calculator - HCMS 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

• Calendar - Physician and Practice Timeline maintained by the ACP that keeps a running tally of important dates related to a variety of regulatory, payment, and delivery system changes and requirements.
• Key Performance Indicators - A bench-marking tool to measure and manage revenue cycle management processes and productivity. Review the Revenue Cycle KPIs and Productivity KPIs presentations for a more in depth information about this tool.
• Letters and Templates - Consent forms, Business Associate Agreements, etc. for your use.
• Locum Tenens - Guidance on locum tenens rules and billing protocols.
• Maintenance of Certification (MOC) Comparison Chart - This chart lists MOC requirements for each of the 24 specialty boards under the American Board of Medical Specialties (ABMS) and what reciprocating credits are offered if you are certified in more than one specialty.
• Medically Unlikely Edits (MUE) - Provides billing instructions for billing units in excess of the edit.
• New Practice Checklist - Checklist to assist physicians starting their own practice.
• NDC Billing Guidelines - How to bill for physician administered drugs using National Drug Codes (NDC). Use the NDC calculator above to assist with converting units.
• Posters and Notices Fact Sheet - Workplace posters, patient notices, and other documents necessary to comply with State and Federal laws.
• Prompt Pay Penalty Guide, Prompt Pay Penalties Fact Sheet - Late payment penalty regulations by payer type (commercial, Medicare, Medicaid, etc.)
• TMA Educational Quick Tips page - A TMA resource with several practice management, billing guides, and other educational resources.
• Where To File Complaints - Information on where to file complaints against various payers.
• Year End Checklist - A checklist to help start the new year right.

Health Information Technology (HIT)

• Information Blocking  - resources on information blocking and how to comply.
• 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

• Balance Billing/Surprise Billing - Texas - The Texas Department of Insurance (TDI) provides instruction and resources on the arbitration process for certain billing disputes. For further explanation and resources on the surprise billing law and arbitration, refer to TMA information and summary of the bill.
• Balance Billing/Surprise Billing - Federal - Set to go into effect in 2022, this federal regulation restricts surprise billing for patients in job-based and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Refer to the AMA resource for additional information.
• 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 and Documentation 2021-2023- Information on the new guidelines and revisions to E/M Services  effective Jan. 1, 2021 and Jan. 1, 2023. The TMA also has more information on the coding changes. Use our Documentation Score Sheet to assist with code selection. 
• Hospital Services Billing Guide - A guide on the billing rules for observation and inpatient care services for Medicare and commercial payers. 
• Incident-to Billing Guide - This guide provides billing information for physician extenders according to major payers. See our Non-physician practitioner  web page for additional information.
• Recoupments - Rules and information regarding recoupments.
• Resources, contacts, payer policies, and other information for various payers: Commercial, Marketplace, Medicare, Medicare Advantage Plans, Medicaid Plans 
• Telemedicine - Information and links to the major market payers are provided.

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

• Cultural Awareness Checklist - A one-pager for practices to help assess and ensure delivery of culturally competent care.
• Cultural Awareness Healthcare Tip Sheet - provides culture-specific healthcare data for various populations.
• Cultural Awareness Webpage - HCMS has created this web page to assist members with caring for a diverse patient population.
• Social Determinants of Health Webpage - HCMS has dedicated a page to provide physicians with information and tools to understand and address social determinants, promoting the idea of "whole-person care" and ensuring patients receive the best care.
• Social Determinants of Health: 5 Categories and Types of Resources - Review to learn about how social determinants impact the health of patients and examples of resources that practices can provide patients.
• Social Determinant: Referring Patients to Food Resources - action steps to take for patients who are unable to afford or access nutritious food.
• CMS Office of Minority Health Resource Center