Stories written by Joey Berlin

Going Nowhere: APM Committee Resignations Cast Doubt on Payment Models' Future - 05/10/2023

Resignations from HHS advisory committee cast doubt on future of physician-created alternative payment models.

Hospital Ownership the Focus of New Medicare Report - 03/14/2023

In an effort to analyze the impact of consolidation within the health care system, Medicare for the first time has released data on mergers and acquisitions for enrolled hospitals and nursing homes between 2016 and 2022. The action follows up on the Biden Administration's Executive Order on Promoting Competition.

No Surprises Act Includes Directory Update Requirement - 02/10/2023

In addition to resolving payment disputes over out-of-network medical care, the federal No Surprises Act aims to make sure health plans’ practitioner directories stay up to date, and part of that aim puts an onus on physicians.

TMA Win on Surprise-Billing Rule Also a Win for Access to Care - 02/10/2023

When the Texas Medical Association scored a win over federal regulators in a Feb. 23 U.S. district court decision, it wasn’t just a victory for physicians. It was a victory for patients, too, cheers Houston emergency physician and TMA Immediate Past President Diana Fite, MD.

Feds Finally Open Dispute Portal Under Surprise-Billing Law - 02/10/2023

Physicians needing to formally settle a dispute with insurers over certain out-of-network payments under the federal No Surprises Act finally can initiate that process online.

Learn About Surprise-Billing Law’s “Good Faith Estimates” - 02/10/2023

Federal authorities have released a frequently asked questions (FAQ) document on providing “good faith estimates,” included as part of the federal No Surprises Act geared toward curbing surprise medical bills.

Federal Memo Signals Compliance With TMA Court Win – For Now - 02/10/2023

Within days of the Texas Medical Association’s Feb. 23 court victory over federal regulators, the U.S. Department of Health and Human Services (HHS) says it’s taking steps to comply with the court’s decision on rules for the No Surprises Act – even as HHS is “considering next steps” after TMA’s win.

Federal Fairness? Congressional Measure Addresses Out-of-Network Payments - 02/10/2023

Congress in December 2020 passed surprise-billing legislation as part of a wide-ranging coronavirus relief bill, tying a bow on federal lawmakers’ primary health care focus just prior to COVID-19. Texas already had set up its own system for state-regulated plans in 2019 with Senate Bill 1264, which took effect last year.

TMA Keeps Pressing Congress on Surprise Billing - 02/10/2023

As lawmakers continue their work on a federal solution to surprise medical bills, the Texas Medical Association is on guard to make sure patients will be protected – and physicians get a fair shot to get paid properly. TMA joined 18 other state medical and specialty societies on a letter last week to the chairs and ranking members of three U.S. House committees.  

Making Billing More Balanced: Congress Considers Surprise Billing Legislation - 02/10/2023

The widespread call to severely curb or end “surprise” medical bills prompted competing federal legislation during the summer and fall of 2019. The negotiations, maneuvering, and bill markups have continued into this year.   

TDI Explains Arbitration Law Process - 02/10/2023

Before you’re involved in an out-of-network medical bill dispute that would be covered by the state’s new baseball-style arbitration law, it’s best to know what could be in store.  The Texas Department of Insurance has provided further details on how the law will be implemented, including how the arbitration process will work.

Swinging For Fairness: Law Creates New Ballgame for Surprise Billing - 02/10/2023

When Senate Bill 1264 was first introduced in February, insurers had the bases loaded, threatening to score a lopsided surprise-billing victory on one swing. With some deft pitching in the Texas Legislature, medicine worked its way out of the jam. The “baseball-style arbitration” measure by Sen. Kelly Hancock (R-North Richland Hills) isn’t perfect, and like a hitter who’s getting busted inside, physicians will have adjustments to make. But the improved SB 1264 passed with a framework that’s fairer to everyone involved.   

Fed Advisors Want Physician Input on Federal Surprise Billing Provision - 02/10/2023

A workgroup that advises the federal government on health information technology matters is asking for physicians’ input on an important, but unrefined, provision of the federal No Surprises Act that isn’t yet being enforced. It’s a piece of the law that the Texas Medical Association fears might create more administrative burden for physicians.

Texas' New Surprise Billing Law: Are You Ready? - 02/10/2023

Texas’ baseball-style arbitration law takes effect for certain out-of-network medical care beginning Jan. 1, 2020. It’s a big change from how disputes on out-of-network medical bills have been handled in the past – and you need to know how to navigate it. There are nuances to consider, and disciplinary action from the Texas Medical Board (TMB) may await you if you balance-bill in violation of the law. That’s why the Texas Medical Association has produced a digestible, seven-page summary of the surprise-billing law.

Insurance Commissioner to Health Plans: Be Proactive on New Surprise Billing Law - 02/10/2023

In a letter Tuesday addressed to “the health plans of Texas,” the Texas Department of Insurance (TDI) commissioner said TDI will monitor how health plans implement Senate Bill 1264, passed during last year’s session of the Texas Legislature and now in effect.

State Adopts Emergency Rule on Surprise Billing Law - 02/10/2023

The Texas Department of Insurance has adopted an emergency rule outlining the narrow circumstances when it will be legal for physicians to balance bill patients under the state’s new law that protects patients from surprise medical bills. And the Texas Medical Board is telling physicians to accept how TDI interprets the law in its emergency rule.

TMB Pulls Proposed Rule on Surprise Bills - 02/09/2023

The Texas Medical Board has withdrawn its proposed rules to implement pieces of the state’s new law introducing baseball-style arbitration on many out-of-network medical bills. At its meeting Friday, the board pulled down its rule proposal, saying in a statement that it “would not cover all providers under the statute.”

Medicine to Congress: Don’t Give Health Plans More Leverage - 02/09/2023

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.

Have Your Say on Texas’ New Surprise Billing Law - 02/09/2023

The Texas Department of Insurance (TDI) is holding a public hearing next week on rulemaking for the state’s new “baseball-style arbitration” law to address surprise medical bills. If you wish to speak at the meeting, TDI requests you submit written comments or a summary of your testimony by noon Friday, Oct. 18 “to facilitate a meaningful discussion.”

Evening Out the Scale: TMA Gears Up for Another Legislative Battle Over Surprise Bills - 02/09/2023

TMA gears up for another legislative battle over surprise bills.

TMA Leery of Proposed Balance Billing Law - 02/09/2023

The Texas Medical Association is deeply skeptical of a state senator’s freshly filed effort to prevent physicians from balance billing patients for the services they provide. On Thursday, Sen. Kelly Hancock (R-North Richland Hills) filed Senate Bill 1264, a measure to address surprise out-of-network medical bills. The legislation emerged with no input from the House of Medicine

Closing the Gap - 02/08/2023

Balance billing was one of TMA's biggest legislative wins this year. Senate Bill 507 will expand mediation for out-of-network bills, but nasty financial surprises for patients won't end when it takes effect on Jan. 1.

Monkeypox Cases Resurface; CDC Urges Vigilance - 01/05/2023

With cases of monkeypox recently reported in several countries that don’t normally have that virus – including at least one confirmed case in the U.S. – federal health authorities are advising physicians to be on the lookout for the characteristic rash usually associated with monkeypox.

TMA: No Government Price Controls for Out-of-Network Billing Disputes - 10/13/2022

The government shouldn’t set the fees physicians are paid for out-of-network care. That’s the message the Texas Medical Association is sending to key members of the U.S. Senate as lawmakers consider a troubling federal bill.

TMA President: Rulemaking on Surprise Billing Must Be Fair to Docs - 10/08/2022

Now that the Texas Legislature has passed a measure to counteract surprise billing involving many state-regulated plans, it’s time for rulemaking. The Texas Medical Association is working to make sure the Texas Department of Insurance’s eventual rules borne out of Senate Bill 1264 will give physicians a fair shake.