Insurance

Texas Prepares to Implement “Gold Card” Prior Auth Bill - 11/30/2021

Soon, physicians who’ve had their fill of insurers’ burdensome prior authorizations will have the chance to earn their way out of them. The Texas Medical Association wants to make sure the  new law giving doctors that “golden” opportunity will be implemented as intended – and is pushing back against health plans’ attempts to reduce its impact.


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.


Tell Your Uninsured Patients About HealthCare.gov Marketplace Enrollment - 11/19/2021

Enrollment in the federal health insurance marketplace on HealthCare.gov is now open, so it’s a good idea to let your uninsured patients know the option is there. And if they sign up by Dec. 15, their coverage will begin at the start of 2022.


Aetna Launching Patient-Facing Physician Performance Designation - 11/15/2021

Aetna Health Insurance is instituting a physician comparison system for its self-insured members in 2022, in which primary care physicians, obstetrician-gynecologists, and orthopedic hip-and-knee specialists can earn a “designation” based on their performance in two categories.


Impending Medicare Pay Cuts Total Nearly 10% - 11/08/2021

Physicians in Medicare are about to get nickel-and-dimed – only it’s more like hundred-and-thousand-ed. And with a pandemic making this moment one of the worst times to financially hit physician practices still reeling from shutdowns last year, the Texas Medical Association, American Medical Association, and others are urging Congress to stop impending payment cuts that could devastate access to care for the nation’s elderly and disabled.


TMA Sues Feds Over Unfair Rule for Surprise Billing Law - 11/02/2021

The Texas Medical Association filed a lawsuit in federal district court in Tyler, Texas, after the Biden administration failed to follow clear direction from Congress about how to implement the dispute resolution process set forth in the No Surprises Act, legislation that was passed in 2020 to protect patients from surprise medical bills.


TMA Sues Feds Over Arbitration Rule for Surprise Billing Law - 10/29/2021

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.


AMA: High Concentration in Insurance Markets - 10/25/2021

Most U.S. commercial health insurance markets are “highly concentrated” among the top insurers in those markets, and evidence strongly suggests insurers are “causing competitive harm to consumers and providers of care.” Those were the findings of the American Medical Association’s 2021 update to its annual study, Competition in Health Insurance.


Afghan Evacuees Eligible for Health Insurance, CMS Says - 10/04/2021

Nearly 4,500 people in the first group of evacuees to the U.S. from Afghanistan will resettle in Texas. The Centers for Medicare & Medicaid Services (CMS) says most evacuees will be eligible for health insurance, and the agency has released guidance outlining their health coverage options.


Enrollment for Marketplace Plans Extended by One Month - 09/24/2021

The Biden-Harris administration has announced a 30-day extension of the upcoming open enrollment period for federal marketplace health plans available through HealthCare.gov, as well as a new monthly special enrollment period targeting people with low incomes.


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.


Report: Most Private Payers Have Stopped COVID Cost-Sharing Waivers - 09/08/2021

Private health insurance plans have largely stopped waiving patient cost-sharing for COVID-19 treatment, according to a recent report by the Peterson Center on Healthcare and Kaiser Family Foundation. The data represent an overwhelming shift from payer cost-sharing policies during 2020 as indicated by previous research.


TMA Urges UHC to Scrap Effective Ban on “Incident-to” Billing - 08/05/2021

After earning one delay from UnitedHealthcare (UHC) on a concerning policy change on “incident-to” billing, the Texas Medical Association is making a last-ditch effort to urge UHC to scrap the new policy entirely – and prevent an ill-timed 15% cut to payments.


Biden Executive Order Likely to Prompt Rulemaking on Noncompetes - 07/19/2021

Directly and indirectly, the Biden administration’s wide-ranging Executive Order on Promoting Competition in the American Economy features myriad implications for health care and physician practices. The executive order, issued earlier this month, takes aim at hospital and insurance market consolidation, noncompete agreements, lack of competition among drug manufacturers, and exorbitant costs of prescription drugs and hearing aids.


TMA Urges UHC to Scrap Retroactive Emergency Denial Policy - 06/30/2021

A recent policy change planned by UnitedHealthcare to allow retroactive coverage denials of emergency department care has drawn a swift and pointed response from TMA and other state and national medical societies and specialty organizations.


Health Coverage Extensions Will Help Mothers, Children - 06/28/2021

Women can access critical health care longer after delivering their babies, and more children will continue uninterrupted medical care, thanks to two new bills that will become Texas law. Gov. Greg Abbott recently signed Texas House Bill 133 and House Bill 2658, ensuring longer Medicaid health care coverage for these populations who are susceptible to health complications – even death – if that care is interrupted.


Physician-Led Results: Medicine Earns Its Gold Star on Insurance Bills - 06/22/2021

When it came to addressing prior authorization burdens this legislative session, the Texas Medical Association asked physicians directly what they needed, and those responses helped medicine attack the problem with a laser-like focus.


CMS Finalizes Lower-Than-Proposed Cost-Sharing for Marketplace Plans; Enrollment Closes Aug. 15 - 06/17/2021

The Centers for Medicare & Medicaid Services (CMS) has settled on a lower maximum for consumers’ out-of-pocket costs for federal health insurance marketplace plans in 2022 than what the agency proposed last November.


Deal or No Deal: Negotiating Contracts - 06/02/2021

Maximize your leverage when negotiating a health plan contract.


PEAQ Performance: Blues Program Shows Little Progress in Addressing Physicians’ Concerns - 05/31/2021

Blues performance recognition program shows little progress in addressing physicians’ concerns over such quality programs


UHC Expands Access to Digital Claims Portal, Optum Pay Basic - 05/20/2021

Starting this Saturday, May 22, UnitedHealthcare's Optum Pay basic claims portal will begin allowing unlimited users for each account. Practices can use the portal to manage claim payments and other digital administrative paperwork.


UHC to Cover Fertility Preservation - 05/18/2021

UnitedHealthcare (UHC) will begin offering coverage for fertility preservation treatments this summer, good news for oncologists and physicians involved in reproductive health care.


Some Payers Resume Prior Authorization Requirements - 04/14/2021

Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.


Did You Subscribe to UHC’s Premium Payment Program? Check By March 31 - 03/29/2021

TMA reminds practices that now is a good time to determine whether you are enrolled in UnitedHealthcare’s (UHC) Optum Pay Premium program, which charges a fee for access to certain electronic data. Physicians and practices who wish to opt out of the program should do so by March 31.


Review Your Physician Compare Data Now - 03/23/2021

The Centers for Medicare & Medicaid Services (CMS) will close the Doctors and Clinicians Preview Period at 7 pm (CT) March 25. The preview allows you to check out your 2019 QPP performance data before its reported on Medicare Care Compare and in the Provider Data Catalog (PDC).