Interacting With Payers
Medicare enrollment/PECOS: FAQ
Right click, "Save as.." to download file.Medicare Provider-Supplier Enrollment webpage
External link will open in a new window.Medicare: Novitas Solutions
External link will open in a new window.Novitas Solutions serves as the Part A Medicare Administrative Contractor (MAC) for Jurisdiction H, which includes Colorado, Arkansas, Louisiana, Mississippi, New Mexico, Oklahoma and Texas.
OIG Compliance Program Guidance
Right click, "Save as.." to download file.Prescription for a healthier practice: Contract with confidence
External link will open in a new window.The AMA's managed care contracting webinar series will help you understand new provisions that managed care organizations are adding to physician contracts as those organizations implement new physician payment models. The series will empower your practice to conduct business in a way that preserves your rights and maximizes your ability to reach your short- and long-term goals.
Prescription for a healthier practice: Empower your practice with the National Managed Care Contract
External link will open in a new window.Take advantage of this comprehensive managed care contracting resource, which is based on the most physician-favorable managed care laws and regulations from all 50 states and the District of Columbia. This advocacy resource and its accompanying supplements address many of the issues that arise in the managed care contracting process and in the subsequent business relationship between physicians and managed care organizations. Developed by the AMA and state medical association attorneys with expertise in managed care contracting issues and regulations, the National Managed Care Contract includes more than 70 pages of model provisions based on state law and is supported by hundreds of legal citations.
Prescription for a healthier practice: Fight for accurate payment by decoding payer ERAs
External link will open in a new window.The AMA has developed a tool to help address the hassle of decoding electronic remittance advices (ERAs) to determine if a billed claim was properly paid. If your practice performs property and casualty (workers’ compensation and auto injury) e-billing and receives ERAs, the AMA’s Claims Workflow Assistant tool can help you understand and address payment adjustments from payers. You can look up the reason or remark codes that payers place on the ERA to find associated workflows that can assist you in addressing claim denials or non-payments. And, you can look up the reason and remark codes payers place on the remittance advice to explain how the claim was processed and determine what those codes mean. Then, you can follow the steps provided to ensure accurate payment. The Claims Workflow Assistant also provides template appeal letters that physicians can easily modify to use in their practices.
Prescription for a healthier practice: Hold health insurers accountable for out-of-network services
External link will open in a new window.For this month’s practice checkup, ensure that your practice receives payment for out-of-network services it provides. Start with, “Holding health insurers accountable for out-of-network services.”
Prescription for a healthier practice: Prepare for health insurer retrospective audits
External link will open in a new window.The AMA and the American Academy of Neurology present this AMA-members-only resource "How to prepare for a health insurer retrospective audit" to educate physicians and their staff about the recoupment efforts of health insurers through the retrospective audit process. They encourage physician practices to use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit's findings.
Prescription for a healthier practice: Simplify the claim audit and appeals process
External link will open in a new window.This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim. AMA members can access the National Managed Care Contract Database to look up state laws and regulations, which may need to be cited or quoted directly in an appeals letter. Also refer to the issue brief, "Overpayments and underpayments" for additional information.
Prescription for a healthier practice: Understand your contracts
External link will open in a new window.Don't let contracts with managed care organizations intimidate you; gain a better understanding of what they say. AMA encourages physicians to learn more about how a negotiated fee schedule can affect your practice's bottom line by reading "Obtaining, uploading and utilizing your contracted fee schedules," also available on the AMA's Defensible Fee Schedule Toolkit webpage. The step-by-step guide will help you easily and accurately load contracted fee schedules into your practice management system.