in claims it shouldn’t have paid, she says, until it finally could part ways with practitioners who didn’t play by the rules. “But that’s the past,” she said. “I have met the new director and deputy direc-
tor, and they’ve met with TMA; they’ve met with our committee on Medicaid and the uninsured. I think they’re willing to listen. They appreciate their role, I think, not just as an enforcer but as an educator. And where there’s the oppor- tunity to help physicians and other providers be compliant when it’s really not fraud, I think they’re willing to do that. That’s a big change and a breath of fresh air compared with what we had in the past.” For his part, Mr. Bowen says he’s looking forward to continued engagement with TMA. “As a regulator, my team and I cannot do our jobs properly without the sup- port and trust of the medical community,” he said. n
Joey Berlin is a reporter for Texas Medicine. You can reach himby phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email at
joey.berlin@
texmed.org.
BILLING AND CODING HELP FROM TMA
Are you apprehensive about receiving a billing audit letter from the Ofice of Inspector General? TMA Practice Consulting offers evaluation and management (E&M) coding and documentation help that includes a review of coding and medical record documentation to determine whether a prac- tice follows coding guidelines for appropriate billing. An abbreviated checkup and a full review are available. TMA Practice Consulting reviews a practice’s documentation for:
• Accurate CPT coding, appropriate application of CPT coding guidelines, E&M coding guidelines, and the correct use of modifiers;
• Accurate ICD-10 coding, appropriate application of ICD-10 coding guidelines, and documentation of medical necessity; and
• Encounter forms and corresponding explanations of benefits to ensure accurate billing and reim- bursement levels.
TMA also offers an E&M coding and documentation training program for practices. The two-hour
session covers a review of 1995 and 1997 E&M documentation guidelines, time-based coding, modi- fiers, audit triggers, prolonged services, preventive medicine, and E&M utilization patterns, among other topics. Services are available for a fee based on a practice’s needs. For more information, call TMA Practice Consulting at (800) 523-8776, email
practice.consulting@
texmed.org, or visit the TMA website,
www.texmed.org/PracticeHelp, to access all of TMA’s billing and coding resources.
November 2015 TEXAS MEDICINE 33
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