“Even if it’s just calling (512) 370-1300 and saying ‘Please help me,’ they are able to be routed appropriately within TMA to find somebody to help them resolve their issues.”
Dr. Schmidt is among dozens of phy- sicians for whom TMA’s Payment Advo- cacy Department helped recover pay- ments from Medicare and private health plans this year. In fact, as of the end of August, the department had helped se- cure more than $1 million in payments delayed by incorrectly processed claims, Medicare enrollment issues, and other problems.
Plano family physician Christopher
Crow, MD, chair of TMA’s Council on Socioeconomic, says those results are a tremendous benefit of TMA membership.
TMA Payment Advocacy Staff
Persistence pays TMA’s Payment Advocacy Department has worked closely for years with the health plans, Medic- aid, and TrailBlazer to resolve problems physicians have getting their claims paid correctly. Dr. Crow says their per- sistence certainly paid off this year with more than $1 million recovered for TMA members. That money
Genevieve Davis Liz Jero 20 TEXAS MEDICINE November 2011 Connie Foxx comes from resolv-
“What a great, tangible member ben-
efit that so many physicians across the state obviously are making use of,” he said. You can contact TMA’s reimbursement specialists at paymentadvocacy@texmed .org for assistance. Visit the TMA web- site at
www.texmed.org/PracticeHelp for more information on how the asso- ciation can help you.
ing incorrectly processed claims, getting lost or delayed Medicare enrollment ap- plications processed, educating physi- cians’ office staff on how to resolve ongo- ing billing issues with health plans, and various other advocacy efforts. Genevieve Davis, director of the Pay- ment Advocacy Department, says the problems often are just “weird system glitches” at the health plans that cause a large number of claims to be denied. Also, many physicians have had prob- lems with Medicare enrollment applica- tions this year. Dr. Crow says the ongo- ing switch to the new Medicare Provider Enrollment, Chain, and Ownership Sys- tem could be responsible for that. “The transition to this new system went about how you would think it would go for any type of transition to new software for a government agency, which is extremely slow with a lot of hic- cups, a lot of unintended delays, with not really anybody on the other end of the line to tell you when and how it’s going to get fixed,” he said. Ms. Davis says there also were prob- lems with physicians continuing to sub- mit paper enrollment applications, hold- ing up payments for months. That was the case for Houston neu-
rologist William Gilmer, MD, who at- tempted to reenroll in Medicare after creating a professional association and relocating his office. “It was just a very long, drawn-out
ordeal,” said Kathy Huggins of Account Management Services, who does Dr. Gilmer’s billing. “The instructions are not real clear when enrolling in PECOS, and every time you call and speak with provider services, you get a different an- swer. So you’re filling out forms over and over, and they shut you down.” Ms. Huggins says Dr. Gilmer was waiting for more than $20,000 in Medi- care payments when he turned to the TMA Payment Advocacy Department for help. The department cleared up the problem in two days, and Dr. Gilmer re- ceived his payments. Payment Advocacy staff also helped a
four-physician Dallas oncology practice recover nearly $300,000 in claims that were tied up with enrollment issues. Nacogdoches dermatologist Travis
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