Balance Billing

TMA Sues Feds – Again – Over Unfair Arbitration Process Under Federal Surprise Billing Rule - 09/25/2022

The Texas Medical Association is back in court – again – to hold federal regulators accountable for implementing a key piece of the No Surprises Act as Congress intended it: to operate an arbitration process that does not skew the dispute resolution process in favor of health plans.


CMS Continues Webinar Series on No Surprises Act - 07/07/2022

Two upcoming webinars from the Centers for Medicare & Medicaid Services (CMS) – including one scheduled for next week – will educate physicians on the federal No Surprises Act (NSA) as part of a collaboration between CMS and the American Medical Association.


Fed Advisors Want Physician Input on Federal Surprise Billing Provision - 05/18/2022

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.


TMA Win on Surprise-Billing Rule Also a Win for Access to Care - 05/01/2022

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.


Learn About Surprise-Billing Law’s “Good Faith Estimates” - 04/20/2022

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 Surprise Billing Law in Effect: Get Educated - 04/05/2022

Despite ongoing litigation over certain aspects of the federal surprise billing law, the patient protection components of the No Surprises Act still took effect at the beginning of the year. With them come a number of changes that could significantly impact physician practices now that balance billing is largely prohibited.


AMA Toolkit Dissects Federal Surprise Billing Law - 04/05/2022

Much of the federal government’s solution to resolve certain out-of-network billing disputes without balance billing or otherwise involving patients – known as the No Surprises Act – took effect at the start of 2022.


Surprise Billing Rules Garner More Legal Action - 04/05/2022

Pressure is mounting on federal authorities with several legal actions now aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.


Court Hearing Approaches in TMA Surprise Billing Lawsuit - 04/05/2022

With a Feb. 4 court hearing on the horizon, the Texas Medical Association recently reiterated its strong opposition to a part of a federal rule that medicine says unfairly favors health insurers when directing arbiters to resolve payment disputes between insurers and physicians under the federal surprise billing law.


Federal Memo Signals Compliance With TMA Court Win – For Now - 03/02/2022

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.


TMA Sues Feds Over Arbitration Rule for Surprise Billing Law - 03/02/2022

The Texas Medical Association has sued federal authorities over rulemaking for the federal surprise billing law, saying it failed to follow clear direction from Congress about how to implement the dispute resolution process meant to determine fair payments for out-of-network care.


TMA, Other Physician Groups Urge Reconsideration of Surprise Billing Rule - 11/24/2021

While the Texas Medical Association awaits action on its lawsuit over part of recent rulemaking for the federal surprise billing law, TMA recently teamed with the American Medical Association and others to engage the Biden administration outside court.


Payment Process Problematic Under Federal Surprise Billing Rules - 09/22/2021

The Texas Medical Association has weighed in on federal rulemaking to help curb surprise medical bills, telling federal authorities medicine supports many patient protections in the rules – but is deeply concerned with a key piece of the criteria to determine fair payments for out-of-network care.


Arbitration Requests Up, Consumer Complaints Down Under State Surprise Billing Law - 07/29/2021

Texas’ law to prevent patients from getting unanticipated bills for out-of-network care is resulting in more requests for arbitration between practitioners and insurers this year, while consumer complaints are on the decline since the law’s implementation, according to a Texas Department of Insurance report on the impact of the law six months into 2021.


Feds Release New Surprise Billing Rules - 07/16/2021

After passage of federal consumer protections against surprise and balance billing, the new law punted a lot of important details about enforcement to the federal rulemaking process.


Federal Fairness? Congressional Measure Addresses Out-of-Network Payments - 04/01/2021

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.


Federal Lawmakers Agree to Surprise Billing Restrictions, Physician Payment Protections - 12/23/2020

Federal lawmakers put new restrictions on surprise medical billing, reduced requirements that would’ve cut physician Medicare payments, and secured COVID-19-related relief for physicians as part of a massive omnibus legislation package approved this week.


AMA Opposes New Federal Surprise Billing Measure, Urges More Discussion - 12/17/2020

The American Medical Association is opposing the latest “No Surprises Act” and urging more vetting of the bill, which was agreed upon this week by key House and Senate committee leaders.TMA agrees with AMA’s assessment of the bill.


Arbitration Law Will be “Messy,” Bring Operational Concerns, Panelists Say - 12/02/2020

 The state’s new law allowing arbitration of payment disputes on certain out-of-network care carries concerns for physicians and uncertainty about what it will look like from an enforcement standpoint, a panel told the Texas Medical Association Winter Conference on Saturday morning.


TMA Weighs In On COVID-19 Surprise Billing, Insurance Premiums, and More - 09/09/2020

TMA submitted written testimony Tuesday to the House Committee on Insurance, providing details and recommendations on price gouging, surprise medical bills, health insurance premiums, and more caused by the COVID-19 pandemic.


The Updated Skinny on Texas’ Surprise Billing Law - 07/08/2020

The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.


Are You Ready For Arbitration On Out-Of-Network Billing Disputes? - 07/07/2020

Learn more about Texas' new balance billing law in a free, live webinar on the Texas arbitration process on Thursday, July 16, at 6 pm (CT).


Physicians Applaud State for Fining Health Plan - 03/09/2020

Statement by Texas Medical Association (TMA) President David C. Fleeger, MD, about the Texas Department of Insurance (TDI) sanction of Blue Cross Blue Shield of Texas (BCBSTX) for delaying payment of certain out-of-network emergency care claims. TDI also found the plans distributed incorrect information about how to resolve balance bills to many HMO members who received out-of-network emergency care.


TMA Keeps Pressing Congress on Surprise Billing - 03/09/2020

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 - 03/05/2020

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.