Insurance Advocacy

TMA's advocacy team works on behalf of members to address systemic insurance issues and help physicians navigate the increasingly complex and cumbersome necessity of doing business with health plans. From network contracting to reimbursement to insurance-related rules and regulations, TMA constantly monitors the payer landscape and works to ensure fair business practices for Tennessee’s doctors and their patients. It's not just about getting claims paid; it's about holding insurance companies accountable, and facilitating relationships between physicians and carriers. 

Member Services

TMA is an advocate for physicians on a number of insurance-related issues:

• Reimbursement disputes or claims issues 

• Alleviating administrative hassles 

• Solving health plan network contracting issues 

• Developing influential and effective contacts with health plans

Insurance Resources & Guides

• Insurance & Healthcare Law Guide: Find TMA Guides on Cancer Insurance, Credentialing of Physicians for Commercial Insurance Plans, Tiering by Insurance Plans and more in the TMA Law Guide Directory. (Member Login Required)

• Coding and Billing Guidelines during COVID-19: This PDF and slideshow created by TMA and LBMC outlines coding and billing guidelines that may have changed due to the pandemic.  

• Annual Wellness Visit Resources: These physician and patient-specific guides explain how third parties are interfering with Medicare Annual Wellness Visits and next steps if this happens to your patients.

• Guide to BCBS Professional Agreement: The TMA legal department has developed a summary guide to the BlueCross BlueShield of Tennessee, Inc. Professional Agreement (or Contract). The resource gives members an executive summary of the provisions of the Agreement, an analysis of some terms, and discussion of potential pitfalls in this or any managed care contract.

• Tennessee Health Care Innovation Initiative (Payment Reform): TMA has advocated since 2012 to improve the design and implementation of the state's move from fee-for-service to a payment model based on episodes of care.

Insurance Toolkits

• ERISA Physician Toolkit: TMA’s new Employment Retirement Income Security Act Toolkit is full of samples for filing appeals, claims and complaints.

• Medical Audit Toolkit: This toolkit provides practical information and tips to guide physicians in anticipating medical audits, responding to auditor's requests for medical records, and appealing erroneous audit findings. 

The TMA staff are liaisons between me and insurance companies, helping form meaningful relationships and secure contracts so I can manage my patients in network. I believe in the resources TMA has to offer because its support lead to a successful outcome for me, my practice and my patients.

 

Cynthia Niendorff, MD - Knoxville Pain Management Specialist