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New Disclosure Requirements for Physicians
Two bills that the Texas Legislature passed in 2007 affect disclosure requirements for physicians.
- SB 1731 put in place requirements with regard to out-of-network services.
- SB 1832 imposed disclosure specifically related to anatomical pathology services that are billed by a physician who does not actually perform the service, such as an FP who bills out for a PAP smear performed under contract with a pathologist or lab.
Both bills went into effect Sept 1, although rules have not yet been promulgated by the Texas Department of Insurance or the Texas Medical Board. Nevertheless, TMA has put together a flyer with more information. See it here.
Getting an NPI is free - not having one can be costly.
NPI: Get It. Share It. Use It.As the industry transitions to NPI compliance, remember that there is no charge to get an NPI. Providers can apply online for their NPI, free of charge, by visiting https://nppes.cms.hhs.gov or by calling 1-800-465-3203 to request a paper application. The CMS NPI page, located at www.cms.hhs.gov/NationalProvIdentStand/, is the only source for official CMS education and information on the NPI initiative; all products located on this site are free of charge.
CMS continues to urge providers to include legacy identifiers on their NPI applications, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. If providers have already applied for their NPI, CMS asks them to go back into the NPPES and update their information with their legacy identifiers. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI.
What the Medical Practice Relations Department Can do for You
The activities of the Medical Practice Relations Department focus on providing programs, advocacy, and activities relative to healthcare financing, quality management, economic impacts on physician practices, health system reform, managed care, and various forms of reimbursement.
In all of our activities, we strive to promote DCMS' relationships and assist DCMS members in their affiliations with private and public payors and the business community. Send questions or comments to Tracy Casto, director of public affairs or call (214)948-3622.
Do you need other information that you can't find here? Visit National Guideline Clearinghouse - a public resource for evidence-based clinical practice guidelines.
Texas Law Requires Physicians to Post the Required Notice to HMO Patients If your patients are not satisfied with the medical services of their HMO, they should write or call their HMO and complain. The Insurance Code, Article 20A.18A(i) requires the physician to post this information. The notice must include the Texas Department of Insurance's toll-free telephone number for filing complaints.
For additional information call:
Texas Department of Insurance
HMO Complaint Helpline
1-800-252-3439
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