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TMA Moves for Victory in Challenge to Unfair Arbitration Rule - 01/14/2022

The Texas Medical Association today announced it has filed a motion for summary judgment in its lawsuit in the U.S. District Court for the Eastern District of Texas. The motion asks the court to decide, without a trial, that the U.S. departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management failed to follow clear direction from Congress about how to implement the physician-insurance company dispute resolution process set forth in the No Surprises Act, legislation passed in 2020 to address surprise medical bills.


TMA Sues Feds Over Unfair Rule for Surprise Billing Law - 01/14/2022

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.


Surprise Billing Rules Garner More Legal Action - 01/12/2022

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.


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.


Sample Letter: Enlisting Patients Assistance for Claims Payment - 11/17/2021

This is a sample letter regarding a patient's outstanding health insurance payment.


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.


New Pocket Guides Added to TMA Quick Tips Page - 11/12/2021

Confused about billing for bilateral procedures or transitional care management? The wealth of resources on the Texas Medical Association’s Educational Quick Tips webpage recently grew with the addition of pocket guides for these services.


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 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.


How to Avoid Coding Mistakes in Texas Medicaid - 10/15/2021

Ensuring Texas Medicaid dollars are spent for their intended purpose requires the Texas Health and Human Services (HHS) Office of Inspector General (OIG) to work with health care professionals to prevent waste. Accurate medical coding is part of that work. Incorrect codes result in overpayments – which impact taxpayers – and underpayments, which can impact your practice.


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.


When Should We Write Off Large Patient Balances? - 09/23/2021

Is there a formula to calculate the net present value for the balance of a patient’s account compared with a small monthly payoff?


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.


COVID-19: Billing and Coding - 09/16/2021

View COVID-19 resources related to billing and coding.


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.


Billing for Telemedicine During COVID-19 - 09/06/2021

COVID-19 prompted an increased need for telemedicine services to connect physicians with their patients. To quickly meet that need, Texas Medicaid adopted waivers and changed policies to ease technology restrictions and expand the number of Medicaid services available virtually. Reimbursement for telemedicine and telehealth averaged less than $800,000 per month in 2019. By April 2020, Medicaid payment for virtual services jumped to $43 million, and averaged more than $37 million monthly throughout 2020.


New CPT Codes for Third Moderna, Pfizer COVID-19 Shots - 08/18/2021

AMA has expedited a new administration code for a potential third dose of Moderna’s COVID-19 vaccine, following release of the CPT code for a third dose of the Pfizer vaccine.


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.


United Walks Back Payment Cut on Nonphysician Billing - 08/05/2021

Following strong pushback from the Texas Medical Association, UnitedHealthcare (UHC) has effectively reversed its payment-cutting policy change on “incident-to” billing for services performed by nonphysician practitioners (NPPs). 


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.


Remind Uninsured Patients: ACA Enrollment Ends Aug. 15 - 07/21/2021

The Texas Medical Association encourages physicians to remind uninsured patients to take advantage of the Affordable Care Act’s (ACA) Special Enrollment Period , which has been extended to Aug. 15 in response to the COVID-19 pandemic.


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.