Stories with related Professional Interests

Guide to Insurance Overpayments and Refund Requests - 04/29/2019

Use this guide to help you and your staff properly assess refund requests from health plans.


Physicians Foundation Checks Your Pulse - 04/20/2018

The Physicians Foundation is surveying you and your 650,000 physician colleagues across the country to determine how satisfied you are with the current state of medicine. The survey asks about the state of your practice, your morale, your career plans, and whether you can continue providing services in light of escalating regulatory and financial burdens.


AMA: Bad Claims Payment Increasing - 04/19/2018

It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card.


BCBS Posts BlueCompare Information - 03/08/2017

Blue Cross and Blue Shield of Texas (BCBS) has posted online the presentation from the Dec. 22 webinar about its BlueCompare program. It was the only webinar the company conducted on the program, which rates some 18,000 Texas physicians in 14 specialties.


Aetna Deselecting 130 Texas Physicians - 08/01/2016

Aetna has notified 130 Texas physicians it will terminate them from its networks on July 1, TMA's Payment Advocacy Department has learned. Aetna says it told the physicians a year ago it was concerned about their billing patterns. Evaluation and management (E&M) codes were the only ones Aetna examined, and its concern involves primarily levels 4 and 5 E&M codes.


ERS to Switch to United - 06/13/2016

More than 400,000 state employees, retirees, and their dependents will get a new health insurance company. The Employees Retirement System (ERS) is negotiating a new contract with UnitedHealthcare Services, replacing Blue Cross and Blue Shield of Texas as the party administrator for the self-funded HealthSelect of Texas health plan.


Aetna Aexcel Ranking Letters Coming - 06/13/2016

TMA's Payment Advocacy Department has learned Aetna will begin sending physicians letters informing them of their ranking in its Aexcel network in early June. The rankings take effect Jan. 1.


Adverse Impact on Quality of Care - 06/13/2016

A majority of physicians (71 percent) tell TMA in our latest survey that in the past year there was at least one instance in their practice when the quality of patient care was impacted adversely by the operating policies or utilization controls of a private health plan. The most frequently cited causes were limited networks (83 percent), formulary limitations (80 percent), coverage limitations or denials (73 percent), and treatment delays (57 percent).