Lynn Warthan, MD, says Payment Advo- cacy staff helped him resolve billing is- sues with Blue Cross and Blue Shield of Texas when he hired his daughter, Molly Warthan, MD, to work in his practice on a part-time basis. While other health plans and Medi-
care allowed him to bill for his daugh- ter’s services using his tax identification number, Blue Cross would not. TMA staff helped him figure out the best way to bill that carrier, he says. “They helped me wade through some
of the different answers we got from Blue Cross,” he said. “They were able to help guide me through the NPI [Nation- al Provider Identifier] regulations and figure out how to file claims where you have an employee but want to file claims under the employer’s NPI number.” But Payment Advocacy staff does
more than just resolve individual phy- sician claims or enrollment issues. Re- cently, TMA persuaded Blue Cross to suspend the Procedure Plus Evaluation and Management Service Reimburse- ment Methodology that was set to go into effect Sept. 1. This would have paid the evaluation and management service at 100 percent of the allowable amount, while any procedure performed at the same time would have been considered the secondary service and paid at 95 per- cent of the allowable amount. TMA officials say that the policy
would have impacted multiple special- ties and could have totaled several mil- lion dollars annually in lost payments for physicians.
Getting the hassle out Ms. Davis says many of the claims, en- rollment, and other problems come to TMA’s attention through its Hassle Factor Log program, emails to Payment Advoca- cy staff, or inquiries to the TMA Knowl- edge Center. Sometimes, she says, it’s just “physicians reaching out” to TMA. “Even if it’s just calling (512) 370-
1300 and saying ‘Please help me,’ they are able to be routed appropriately with- in TMA to find somebody to help them resolve their issues,” she said. More information on TMA’s Hassle
Factor Log program is online at www
.texmed.org/hasslefactorlog.
November 2011 TEXAS MEDICINE 21
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