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THE WEEKLY DOSE |
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May 14, 2017 |
Vol. 6, No. 19 |
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In this Issue… |
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Support BCMS Circle of Friends Sponsors
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BCMS Delegation to TMA wraps up
House of Delegates business during TexMed 2017 by Mary E. Nava, MBA, BCMS Chief
Government Affairs Officer and Delegation Liaison TexMed
2017, TMA’s annual meeting, convened May 5-6 in Houston at the beautiful
Marriott Marquis Hotel. Leading up to the meeting, the BCMS Delegation
to the TMA prepared, reviewed and approved resolutions to be considered by
the TMA House of Delegates. In addition, the group put forth two
physicians who were on the election ballot for seats on the TMA Board of
Trustees and the Texas Delegation to the AMA -- John Holcomb, MD and Jennifer
Rushton, MD, respectively. Dr. Rushton won election as an
alternate delegate to Texas Delegation to the AMA, in which both David
Henkes MD and Jayesh Shah, MD were reelected to their delegate
posts, with Dr. Henkes continuing as Chair of the Delegation to
AMA. Also, immediately following the conclusion of the business of the
House of Delegates, the TMA Board of Trustees convened and Dr. Henkes
was named Chairman of the Board of Trustees. In
a special presentation during the Caucus meeting of the BCMS Delegation to
TMA, BCMS President Leah Jacobson, MD and BCMS Delegation to TMA
Chair, Jayesh Shah, MD, presented Dr. Holcomb with the TMA Star
Award for his 15+ years of service as Chair of the TMA Select Committee on
Medicaid, CHIP and the Uninsured. Additionally, the BCMS Delegation to
TMA submitted a resolution honoring Dr. Holcomb for his years of
service on the Committee, which was recommended for adoption by the TMA
Reference Committee on Financial and Organizational Affairs and was
subsequently adopted by the full body of the House of Delegates. Many
thanks to the members of the BCMS Delegation to TMA who served as delegates
during the two-day business meetings, represented BCMS in reference committee
meetings and participated in the elections for office during the House of
Delegates proceedings: George Atiee, MD; Chelsea
Clinton, MD; Suresh Dutta, MD; John Edwards, MD; Harold Gaskill, MD; Alice
Gong, MD; Donald Gordon, MD, PhD; Sheldon Gross, MD; David Henkes, MD; John
Hinchey, MD; David Hnatow, MD; John Holcomb, MD; James Humphreys, MD; Leah
Jacobson, MD; Relief Jones, III, MD; Wendy Kang, MD, JD; Margaret Kelley, MD;
Alex Kenton, MD; Malathi Koli, MD; Vijay Koli, MD; Ashok Kumar, MD; John
Lacci, medical student; David Lam, MD; W. Cannon Lewis, MD; John Menchaca,
MD; Darlene Metter, MD; Jesse Moss, Jr., MD; John Nava, MD; Jennifer Nordhauser,
medical student; Rajam Ramamurthy, MD; Jennifer Rushton, MD; Navid Saigal,
MD; Jayesh Shah, MD; David Shulman, MD; J. Marvin Smith, III, MD; Bernard
Swift, Jr., DO; Lloyd Van Winkle, MD; and David Webster, MD. |
Stay
tuned to this column for updates on the final results of the 2017 business of
the TMA House of Delegates. For
more information on how you can become a member of the BCMS Delegation to
TMA, contact Mary Nava at mary.nava@bcms.org.
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s Be A part of History s Join the Founding Faculty Educating the inaugural class
of Osteopathic Physicians For more
information, contact: Carol
Browne, D.O., Associate Professor Department
of Clinical and Applied Science Education cbrowne@uiwtx.edu, (210)
841-6487 To Apply for
a Part-Time Clinical Position one day a week: Posting #
UN155PO Applicants
must have a D.O. degree from an accredited U.S. osteopathic medical school
with ability to obtain an unrestricted license to practice medicine in
Texas. Board certification or board eligible in Neuromusculoskeletal
Medicine/Osteopathic Manipulative Medicine and/or board certification or
board eligible in a field of primary care is preferred. |
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Alzheimer’s
Past & Future Thursday, May 18th, 2017 –
6-7:30 p.m. Join us for an educational talk
directed to primary care physicians. Presented by: Jason Miller, DO,
clinical investigator, Clinical Trials of Texas Inc. RSVP to Ginny Funk at gfunk@alz.org or call 210-822-6449 ext. 8102. |
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Preauthorization
Denial: What’s Your Recourse?
So a health plan has denied your
preauthorization request for a patient’s treatment. First
determine the patient’s type of coverage. Medicare
Advantage plans have specific appeal guidelines, which you can find on
the Centers
for Medicare & Medicaid Services website. Be
sure to check out the appeals flowchart. Commercial
health plans also post specific appeal guidelines on their websites,
typically as part of their provider manual. Before providing a service, you
should always check to see if the health plan has a notification and/or
precertification requirement. Finding out in advance about the coverage and
benefits available for a service is advantageous for both you and your
patients. Some services may require notification only, while for others,
health plans may require you to submit medical records for review before they
determine if the services meet plan guidelines for medical necessity. In
2013, as a result of hard work by TMA, the Texas Legislature passed bills to
develop and require health plans to accept a standardized prior authorization
form for both medical services and prescription drug benefits. Read details
about the forms in this Texas Medicine article. Both
forms are available for download on the Texas Department of Insurance (TDI)
website, along with links to the Texas Administrative Code (TAC) rules that
address the use of these forms. The
code also addresses preauthorization for
HMOs and preferred provider benefit plans. They must adhere to specific time
frames when responding to preauthorization requests from physicians and
providers. Finally, the code specifies written
procedures for appeal of adverse determinations when a request
for preauthorization is denied. (All these rules are in 28 TAC, Chapter 19.) In
1997, the Texas Legislature made Texas the first state to require a system of
independent review of insurer decisions by reviewers who do not work for the
insurance company or HMO. Use of the Independent Review Organization (IRO)
process usually is permitted only after patients have completed the insurer's
internal appeals process. If you
believe a health plan is not complying with any one of these requirements,
you may file a complaint with TDI. Patients may also file complaints
regarding their health plan and should be encouraged to do so. Step-by-step
guidance through the insurance complaint process is
on the TDI website. When
you have questions about billing or payer policies, contact TMA’s
reimbursement specialists for help at paymentadvocacy@texmed.org, or
call the TMA Knowledge Center at (800) 880-7955. TMA members can use
the TMA Hassle Factor Log to
help resolve insurance-related problems. Visit www.texmed.org/GetPaid for
more resources and information. |
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Circle of
Friends Silver Sponsor |
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Thank you to our BCMS Circle of Friends
sponsors! This information is sent on behalf of
our sponsors but it is not an endorsement. Donations from Circle of Friends
sponsors help keep down the cost of dues and allow BCMS to continue to provide quality
service to its members. The society continues its pledge to you
and only will involve itself in services and programs that benefit you,
the member, and your patients. |
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Bexar County Medical Society 4334 N Loop 1604 W., Suite
200 San Antonio, TX 78249 210-301-4391 |
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About The Weekly Dose The
Weekly Dose is a service of the Bexar County Medical Society. Some of
the suggestions conveyed may not be applicable to your practice today, but the
goal is to offer information over time that returns value in
excess of the cost of your membership. If you
would like to recommend future topics to share with your colleagues, please
submit them to the BCMS Executive Director at steve.fitzer@bcms.org. All
rights reserved. Unauthorized use prohibited. Copyright
© 2017 Bexar County Medical Society, San Antonio, Texas. All
rights reserved. |
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