Tmhp Fee Schedule: Everything You Need To Know In 2023
My Personal Experience
As a healthcare provider, I’ve learned the importance of understanding fee schedules. It can be frustrating to submit a claim only to find out that the reimbursement rate is much lower than expected. That’s why I made it a priority to learn about the Tmhp Fee Schedule and how it impacts my practice.
What is Tmhp Fee Schedule?
TMHP stands for Texas Medicaid & Healthcare Partnership. It’s a state agency that manages Medicaid claims and payments for Texas. The Tmhp Fee Schedule is a list of reimbursement rates for medical services provided to Medicaid patients. It’s used by healthcare providers to determine how much they will be paid for their services.
Why is Tmhp Fee Schedule Important?
The Tmhp Fee Schedule is important because it determines how much healthcare providers will be paid for their services. If the reimbursement rate is too low, providers may not be able to afford to offer certain services. This can lead to a shortage of healthcare providers in certain areas, making it difficult for Medicaid patients to access care.
List of Events and Competitions
- Annual Tmhp Fee Schedule Update
- Provider Education Days
- Medicaid Provider Enrollment
Detail Schedule Guide
The Tmhp Fee Schedule is updated annually. Providers should check the schedule each year to ensure they are billing correctly. The schedule is organized by procedure codes and includes the maximum allowable reimbursement rate for each code. Providers should also be aware of any modifiers that may impact the reimbursement rate.
Schedule Table
| Procedure Code | Description | Maximum Reimbursement Rate |
|---|---|---|
| 99213 | Office Visit, Established Patient | $50.00 |
| 81002 | Urinalysis, Non-Automated | $5.00 |
| 90834 | Psychotherapy, 45 Minutes | $90.00 |
Question and Answer
Q: Can I bill more than the maximum reimbursement rate?
A: No, you cannot bill more than the maximum reimbursement rate. If you do, your claim will be denied or adjusted down to the maximum allowable rate.
Q: What if I don’t agree with the reimbursement rate?
A: Providers can submit an appeal if they believe the reimbursement rate is incorrect. The appeal process is outlined on the TMHP website.
Q: Is the Tmhp Fee Schedule the same for all Medicaid patients?
A: No, the fee schedule may vary depending on the patient’s plan and the services provided.
FAQs
Q: How often is the Tmhp Fee Schedule updated?
A: The schedule is updated annually.
Q: Can I bill Medicaid patients for the difference between the maximum reimbursement rate and my usual fee?
A: No, providers are not allowed to bill Medicaid patients for the difference. This is considered balance billing and is against the law.
Q: Can I bill private insurance companies based on the Tmhp Fee Schedule?
A: No, the Tmhp Fee Schedule is only for Medicaid claims. Private insurance companies have their own fee schedules.
