Archive for the ‘Health Insurance’ Category

Dear Medicare

February 27, 2014

Dear Medicare,

Do you know why providers don’t want to do business with you? What business has a one hour window that is the “best time” to call each morning? Are you saying you only work one hour of each day? When I call in this one hour window, I still don’t get help. Please help me understand why you would not staff customer service representatives to SERVE your clients all day long. Please help me understand why a minimum 90 minute wait to talk to you is acceptable. Please help me understand why you direct us to your website but the website doesn’t have any information to answer our questions. Please help me understand when the new intermediary took over for the old intermediary why you don’t have access to these files. Please help me understand with the advancement of technology and the ability to do so much online why you haven’t adapted to the year 2014. Please help me understand why we still do business with you…OH, I forgot, you don’t want to know.


A Healthcare Consultant that seriously feels she is losing her passion for what she does!!!!!


Verify Texas Medicaid Eligibility

February 7, 2013

Each person approved for Medicaid benefits gets a Your Texas Benefits Medicaid card. However, having
a card does not necessarily mean the patient has current Medicaid coverage. You must still verify
eligibility. There are several ways to do this:

• Swipe the patient’s Your Texas Benefits Medicaid card through a standard magnetic card reader,
if your office uses that technology.

• Search for the patient using, a secure website with a variety
of useful features for Medicaid providers.

• Use TexMedConnect on the TMHP website at

• Call the Your Texas Benefits provider helpline at 1-855-827-3747.

• Call Provider Services at the client’s medical or dental plan.

Important: Do not send patients who forgot or lost their cards to an HHSC benefits office for a paper
form. They can get a new card mailed to them by calling 1-855-827-3748. Medicaid members also can go
online to order new cards or print temporary cards. For instructions, visit
and click Learn more about the Your Texas Benefits Medicaid card.

Medicare Pay Cut Averted…again

January 3, 2013

Doctors can breathe a sigh of relief as a Medicare pay cut of nearly 30 percent is narrowly averted — at least temporarily.  On New Year’s Day, Congress approved a “fiscal cliff” bill that includes a one-year delay of the scheduled Medicare pay cut — to the tune of 26.5 percent — due to the flawed sustainable growth rate (SGR) formula.

The bill also includes a two-month delay of an additional 2 percent cut to Medicare pay due to across-the-board spending cuts scheduled as a result of Congress’ failure to reach a budget deficit deal in 2011, according to Medscape.

Medical organizations, consultants, and physicians expressed tempered enthusiasm regarding the SGR delay.

While the AMA praised Congress for avoiding the massive pay cut, it criticized its continued failure to identify a permanent SGR fix.

” … Congress’ work is not complete; it has simply delayed this massive, unsustainable cut for one year,” AMA president and psychiatrist Jeremy A. Lazarus said in a statement. “Over the next months, it must act to eliminate this ongoing problem once and for all.”

Lazarus went on to say that the “last-minute action” to delay the SGR cut is a “clear example of how the Medicare program is increasingly unreliable for physicians and patients.”

Texas Clean Claim Requirements

April 2, 2012

Each states has its own guidelines and regulations set forth in various forms of the Healthcare Industry.  The Texas Department of Insurance has guidelines on specific requirements that are needed on a HCFA1500 in order for it to be considered as a Clean Claim.  You can review those documents here on the Texas Secretary of State website.

Do you wonder if the Texas Clean Claim Requirements apply to you?  You can read and find that information here.

A clean claim must be submitted in order for the Prompt Pay Guidelines to apply.  We will review those with you soon!

CMS Important Update regarding 5010

February 20, 2012

With the implementation of Accredited Standards Committee (ASC) X12 Version 5010, several concerns have been identified that may impact certain activities surrounding the transition.  Medicare has published a Guidance and Clarification for Version 5010 Implementations here.

HSA Data for 2012

February 17, 2012

Do you have an HSA?  If you do, you will be interested in knowing the information on the update on your contributions for the calendar year of 2012…

For 2012, an individual can contribute up to $3,100 to their HSA, and a family can contribute up to $6,250. Minimum high deductible health plan deductible requirements remain the same, at $1,200 for an individual and $2,400 for a family. Maximum out-of-pocket for HSA plans in the 2012 calendar year is $6,050 for an individual and $12,100 for a family.

Do you have an HSA?  Do you utilize it as one?  If you don’t know if it is a good thing for you and your tax plan, consider talking to both your Insurance Agent and your CPA.  They will advise you in your circumstances on what would be best.