Tools and Resources

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

Payment Advocacy  

The HCMS Payment Advocacy 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) CalculatorHCMS 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.
  • 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

Health Information Technology (HIT)

  • Cybersecurity Risk Assessment Vendors - Listing of Cybersecurity Risk Assessment Vendors (Updated January 2019)
  • 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. (Updated October 2018)
  • 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.

Payer Resources

Quality

  • 2019 MIPS Step-by-Step Guides - Comprehensive guides on how to calculate, collect and report data for the 2019 MIPS performance year.
  • Alternative Payment Models (APM) Participation Guide - A guide on 2019 advanced alternative payment model participation. (Updated February 2019)
  • Chronic Care Management (Medicare) - Information on patient eligibility, billing chronic care management (CCM) codes and more.
  • Medical Cultural Awareness Tip Sheet - Houston is a city of many cultures. HCMS has created this web page to assist our membership with caring for a diverse population of patients.
  • MIPS Participation Lookup Tool - An interactive tool to determine if a physician is exempt from participating in the MIPS program.
  • MIPS Quick Guide - This two page guide provides information on preparing for 2019 MIPS data collection.
  • 2020 MIPS Measure Changes - Review chart to identify if any of your current selected measures have been deleted or modified so you may make the appropriate changes for 2020 data collection. Reminder that the Quality category requires a full years worth of data in 2020 so it is important to begin collecting data asap.
  • 2019 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 from being able to report data for all three of the performance categories (Quality, Advancing Care Information (ACI) and Improvement Activities) to just one or two. Check under the Performance Categories section of each grid for this information. See QCDRs below for more specialized registries.
  • 2019 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 option is different from a qualified registry because it is not limited to measures within MIPS. The QCDR can develop and submit QCDR measures for CMS approval (i.e. specialty specific measures, see Qualified Registries above for non-specific registries).
  • Quality and Efficiency Programs by Managed Care Health Plan - A grid that summarizes the different criteria including quality measures used by different health plans for physician rating.