Stories written by Phil West

Medicare Modifier 25 Documentation Under Microscope Following Federal Report - 02/04/2026

A recent federal audit focused on Medicare payments for eye injections revealed overwhelmingly high improper payment rates for evaluation and management services billed with modifier 25 usage. TMA provides information on how to help physicians avoid denials.

TMB Adopts Rules for Two New Physician License Categories Amid Visa Impediments for IMGs - 02/02/2026

International medical graduates (IMGs) and unmatched physician graduates now have rules on how to apply for new license classes created via 2025 legislation aimed at expanding the state’s physician workforce. However, a state halt on certain work visas could also impede the law’s progress.

Federal, State Impediments to H-1B Visas Threaten Texas Physician Workforce - 02/02/2026

A 2025 presidential order requiring a new $100,000 fee for H-1B work visa applicants, followed by a Jan. 27 freeze on new petitions by Gov. Greg Abbott, could squeeze the pipeline of international medical graduates helping to meet the state's health care needs.

Questions About Your TMA Membership? TexMed Has a Member Services Booth for That - 02/02/2026

TexMed 2026 attendees have an on-site destination for information on all TMA membership has to offer, from the Knowledge Center and CME courses, to practice management support and resources for physicians in different practice settings and career phases.

Physicians Now Required to Provide Medicaid Enrollment Info to New Mothers - 01/28/2026

House Bill 3940 was one in a series of bills addressing Medicaid concerns and gives health care professionals tools to inform parents about covering their newborn children. The law also requires a key state agency to share that information with health care facilities.

Medicare Judicial Dispute Threshold Increases in 2026 - 01/28/2026

Physicians who take initial steps to dispute Medicare or Medicare Advantage decisions, upon receiving unfavorable reviews, can opt for two quasi-judicial pathways to resolve the case. However, the amount in controversy in the underlying dispute must meet a minimum amount, which has risen 11% over the past four years.

CME E-Tracking Mandate Begins Sept. 1 - 01/21/2026

Following state legislation, TMB has previewed an arrangement with vendor CE Broker for physicians to log CME. Experienced users suggest documentation tips and timely logging.

Rural Ambulance Grant Program Provides $84 Million for Texas Counties - 01/21/2026

More than 40 counties have applied for funding for rural-serving ambulances as of this writing. The funding, made possible by a 2025 bill, could assist the state’s largest county as it faces replacing a four-year EMS partner.

One Insurance Company Holds Majority Share of Texas Market, Per AMA Study - 01/14/2026

Increasing insurance consolidation negatively impacts both physicians and patients, according to the American Medical Association, making advocacy crucial.

Mixed Bag: Federal Changes May Narrow Certain Medicaid Eligibility Provisions, Boost Others - 01/12/2026

Changes on the horizon include a shortened timetable for giving new Medicaid applicants retroactive coverage, more frequent eligibility checks, and an expansion of the populations eligible for home and community-based services. Texas will also need to reconcile an issue concerning CHIP waiting periods and benefit caps.

Disrupting the Marketplace: How the ACA Expiring Tax Credits Could Impact Health Care Costs - 01/05/2026

With the Affordable Care Act (ACA) marketplace on the precipice of a massive change – expiration of the enhanced Advance Premium Tax Credits – physicians fear that might add additional confusion, higher costs, and even a loss of insurance for millions of Americans.

Direct Payment Model Available to All Texas Physicians Under New State Law - 12/30/2025

House Bill 541, now in effect, replaces the “direct primary care” nomenclature from a TMA-backed 2015 law with the more inclusive “direct patient care.” In a typical direct care model, patients pay a monthly fee, and in return, receive services like office visits and in-office procedures without involving insurance.

Medicare Physician Fee Schedule Retains Payment Increase and Concerning Cuts - 12/24/2025

A new practice efficiency cut impacting thousands of codes and a cut targeting hospital-based services could offset a one-time payment boost. TMA staff are poring over the 1,216-page final rule ahead of its Nov. 20 webinar, free for physicians.

Medicaid Revalidation Extended Again - 12/17/2025

Physicians who were disenrolled and have already submitted Medicaid revalidation applications now have until Jan. 31, 2026, to complete the process. Those with revalidation applications due by the end of May 2026 also received additional time to complete the process.

Medicine Supports Congressional Effort to Streamline Medicare Advantage Prior Auth - 12/15/2025

Prior authorization continues to cause delays in care and poorer patient health outcomes. A 2022 report shows that some Medicare Advantage claims that were denied would have been accepted under traditional Medicare guidelines.

WISeR’s Texas Administrators Coordinate with TMA to Ease Transition - 12/12/2025

Aiming to smooth the transition for physicians impacted by a new Medicare prior authorization pilot, the Texas Medical Association is coordinating with Cohere Health, the entity responsible for processing the program’s requests in Texas.

2025 Legislative Wrap-Up: TMA Defeats Concerning Vaccine Bills For Second Session in a Row - 12/08/2025

Two bills that did survive will took effect Sept. 1, one of which imposes a specific informed consent form on physicians.

Advocacy, Passion Motivates Medical Student Scholarship Winners - 12/04/2025

The Harris County Medical Alliance Scholarship has awarded close to half a million dollars in its history. This year, 16 medical students at three Houston schools are receiving scholarships.

Behavioral Health Infrastructure Gets Legislative Focus with TMA-Supported Bills - 12/02/2025

In addition to addressing youth social media use, the legislature also set out to create a pipeline for aspiring mental health professionals. Plus, TMA will help study how to balance psychiatric care burdens.

Medicare Fee Schedule Webinar Highlights Telemedicine, New Specialty Initiatives - 11/26/2025

In addition to uneven payment news, TMA shared the latest on telemedicine, coding changes, and new initiatives set to launch in 2026 and 2027.

Notify Medicare of Participation Changes by Dec. 31 - 11/25/2025

TMA reminds all physicians to check their Medicare participation information to make sure it is current. Those changing their status in 2026 will need to send notification via mail.

Legislators Can Request Health Insurance Mandate Analysis Via New State Law - 11/18/2025

Though the filed version of the bill would have heavily favored insurance companies, TMA successfully worked to add data transparency provisions to promote a comprehensive and unbiased analysis. Lawmakers also focused on price transparency bills affecting how facilities can bill patients for services.

Physicians Must Refund Medicare Overpayments Voluntarily, Program Administrator Cautions - 11/13/2025

Novitas, Texas’ Medicare administrator, reminds physicians they should promptly bring incorrect payments to its attention. TMA can assist physicians with payment issues through its Physician Payment Resource Center.

Touting Texas: David N. Henkes, MD, Championed the State’s Physicians in 25 Years on the AMA Delegation - 11/13/2025

David N. Henkes, MD, recalls his first American Medical Association meeting in San Francisco as a new member of the Texas Delegation to the AMA. The November 2001 conference was, in a word, “overwhelming.”

Now Is the Time: Texas Delegates to AMA Make a Strong Push for Fixing What Ails Medicare - 11/13/2025

Texas Medical Association members made their voices heard at the American Medical Association’s three-day National Advocacy Conference (NAC), Feb. 10-12, 2025, calling for a long-term Medicare payment fix.