Vol. 100 No. 9
COVER STORY
Weapons of Mass Inoculations
Without question, immunizations have had a dramatic impact on disease, in some cases eradicating cripplers and killers that once terrified the public. Unfortunately, immunization rates in some states are still way too low, in some cases because of ignorance and unfounded fears. Texas is one of those states where immunization rates are low. TMA and the Texas Department of Health have plans to change that.
By Ken Ortolon
LAW
Choose or Lose
Physicians have a chance to recover a considerable amount of money in unpaid claims from CIGNA because of the settlement of CIGNA's portion of a federal antiracketeering lawsuit. But you have to choose between a relatively simple process that only pays a little and an incredibly complicated one that could bring a lot more. There are 10 steps you need to take to make sure you're following the correct procedures.
By Walt Borges
SCIENCE
Lighting Up a Controversy
The use of marijuana to relieve a patient's pain has generated controversy across the country. Patients have been prosecuted and physicians harassed even in states where it's legal. TMA's House of Delegates says physicians should be able to discuss all forms of treatment with their patients without fear of going to jail.
By Ken Ortolon
MEDICAL ECONOMICS
Cleaning Up Their Act
Unicare and PacifiCare used to be names that popped up constantly on TMA's Hassle Factor Log as physicians complained about their reimbursement practices. But TMA's health care financing staff say complaints have decreased because the companies are changing the way they do business. And, they're willing to talk about problems and how they can be fixed.
By Walt Borges
LEGISLATIVE AFFAIRS
A Political Facelift
Republicans are likely to win big in the November Texas congressional elections, thanks to the bloody redistricting battle in last year's session of the Texas Legislature. Don't expect much in the Texas Legislature elections, however. No big changes are anticipated.
By Ken Ortolon
MANAGING YOUR PRACTICE
Look Out for Nursing Home Residents
If you bill Medicare for taking care of a patient who's also under the care of a skilled nursing facility, usually a nursing home, you may have trouble. The nursing home is responsible for payment, and if you don't have a contract with the facility, payment is doubtful.
Human Drops WebMD/Envoy
Humana has ended its contract with WebMD/Envoy for electronic claims and/or encounters submissions. If your practice is connected to WebMD, this change may affect claims or encounters you submit through your practice management service or clearinghouse.
Lower Medicare Drug Costs
Up to 50,000 Medicare patients will save a lot of money on certain medicines under a new Medicare demonstration program. They can self-administer the drugs for serious diseases, including cancer, multiple sclerosis, and rheumatoid arthritis.
New Medicare Software
Do you use free (or low-cost) billing software from Medicare for submitting claims in HIPAA 837 format? If so, make sure you get a software upgrade from TrailBlazer Health Enterprises for filing claims in which Medicare is a secondary payer.
TMA ROUNDS
Legislation, Lawsuits, and Leadership to Highlight October's TMA Summit
Helmet Giveaways Promote Safety, Prevention
Physician Services Can Help Streamline Billing, Collections
TMA Knowledge Center
Offers Electronic Medical Reference Library
Foundation Benefit Raises Money for Health Programs
JOURNAL
Epidemiology of Snakebites Reported to Poison Centers in TexasFrom 1998 Through 2002 (abstract)
By Mathias B. Forrester, BS, and Sharilyn K. Stanley, MD
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Texas Medicine is available to TMA members and presents timely information on public health, medicolegal issues, medical economics, science, medical education, and legislative affairs affecting Texas physicians and their patients.
Last Published: 12/11/2008
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