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Congress Needs to Get This Right - 12/12/2019

The Texas Medical Association, with our nearly 53,000 physician and medical student members, was very pleased to see the Ways and Means Committee weigh in on the debate over surprise medical billing legislation. While the details are yet to come, the general outline of that proposal looks quite promising.


Texas' New Surprise Billing Law: Are You Ready? - 12/11/2019

Texas’ baseball-style arbitration law takes effect for certain out-of-network medical care beginning Jan. 1, 2020. It’s a big change from how disputes on out-of-network medical bills have been handled in the past – and you need to know how to navigate it. There are nuances to consider, and disciplinary action from the Texas Medical Board (TMB) may await you if you balance-bill in violation of the law. That’s why the Texas Medical Association has produced a digestible, seven-page summary of the surprise-billing law.


TMA Stands Firmly Against Surprise Medical Billing “Compromise” - 12/09/2019

“There is a right way and a wrong way to protect patients from surprise medical bills, and the so-called compromise federal legislation announced this weekend in Washington, D.C., is definitely the wrong way,” Texas Medical Association President David C. Fleeger, MD, said Monday.


CMS to Recoup Chronic Care Management Payments - 12/06/2019

Some Texas physicians and outpatient facilities might have to refund payments they received for chronic care management services performed during 2015 and 2016 under the Medicare Physician Fee Schedule, federal officials said.


TMA Makes Strong Push for Fair Surprise Billing Legislation - 12/04/2019

The Texas Medical Association is urging Texas lawmakers in Washington, D.C., to show their support for federal legislation on surprise medical bills that includes commercially reasonable upfront payments and independent arbitration.


High Deductible Plans? There’s CME for That - 11/25/2019

Texas is No. 2 in the nation in the number of people enrolled in high-deductible health plans – and payment responsibilities have increasingly shifted from insurers to consumers. For practices today, effectively communicating a patient’s financial responsibilities is becoming more vital. The Texas Medical Association’s free webinars can help prepare you and your practice for those conversations.


How Practice Owners Can Control Health Insurance Costs During Open Enrollment - 11/22/2019

If you’re a practice owner whose health insurance is up for renewal during Health Insurance Open Enrollment, Nov. 1 to Dec. 15, there are ways to control the cost of your health insurance. The health insurance advisors at TMA Insurance Trust know of a lesser-known option that you can use to keep group plan cost within budget.


Open Enrollment 2020: Be Prepared for Coverage Changes - 11/13/2019

You’re probably already aware that open enrollment for commercial health insurance plans, including those on the Affordable Care Act Exchanges, opened Nov. 1 and will run through Dec. 15. While some patients won’t make any changes to their coverage, others will make significant changes, including enrolling with a completely different health plan.


Texas’ Rise in Uninsured Kids Among Fastest in Nation, Report Says - 11/13/2019

The bad news keeps coming for Texas’ uninsured rate. Between 2016 and 2018, Texas tied for the second-highest jump in the rate of uninsured children among all 50 states, according to a study released Wednesday by Georgetown University's Center for Children and Families in Washington, D.C.


Get Details About Your 5% Medicare Bonus - 11/05/2019

If you participated in the advanced alternative payment model (APM) track during the 2017 Quality Payment Program (QPP) performance year, full details of your 5% APM incentive payment are finally available.


Take Steps To Improve Health Care Access Throughout Texas - 11/01/2019

If you’re looking for a way to let state lawmakers know why health care coverage matters to all Texans, join or start a block walk during #SickOfItTX’s Weekend of Action for Health Care on Nov. 9 and 10. Walks are currently scheduled in Austin, Dallas, Galveston, Houston, McAllen, and San Antonio; more sites may be added, or you can host your own.


Texas' High Rate of Uninsured Hurting the Economy, Study Says - 10/30/2019

Texas has the highest percentage and number of people without health insurance in the United States, which could cause long-term damage to the state’s economy, says a study released this week by the Texas Alliance for Health Care.


Medicine to Congress: Don’t Give Health Plans More Leverage - 10/24/2019

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.


Gender-Neutral Insurance Rates = Big Savings for Women Physicians - 10/17/2019

To help Texas Medical Association members get the income protection they need, the exclusive TMA Member Long Term Disability Plan, issued by The Prudential Insurance Company of America, uses group rates that are based on age, not gender. Female physicians will find these gender-neutral group rates significantly less expensive than most individual disability plans available in Texas. 


System Failure: Houston Practices Fight WellCare for Payment - 09/26/2019

Several Houston-area practices say a botched technology conversion by insurer WellCare after it acquired a Medicare Advantage plan led to prior authorization and network confusion, undue denials, and unpaid claims by the barrelful.


Comprehensive Prior Authorization Reforms Needed, Medicine Tells Feds - 09/25/2019

As the Centers for Medicare & Medicaid Services (CMS) seeks ways to relieve the burdens of prior authorization on health care, it should not rely solely on automation of electronic health records. Instead, CMS should seek comprehensive reforms that include transparent PA requirements and protections of continuity of care as well as automation, the Texas Medical Association, American Medical Association, and a host of other medical societies wrote in a letter to CMS Administrator Seema Verma last week.


The ACA Marketplace - 09/19/2019

Physicians find themselves in a land of confusion months after the debut of the Affordable Care Act health insurance marketplace. Pervasive problems with the exchange rollout, including enrollment delays and questionable health plan networks, disrupt physicians' office operations and affect patients' access to care.


Send TMA Your Prior Auth Nightmare Stories - 09/18/2019

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes. Your personal stories of patient harm due to prior authorization request delays or denials can give the Texas Medical Association the ammunition it needs to fight this problem. Please submit your stories via email to the TMA Payment Advocacy Department.


An Insurance Company Auditor Tried to Destroy My Career - 09/16/2019

It didn’t matter that the charges against me were ludicrous. The potential consequences were only too real, and potentially catastrophic. Had the State Medical Board decided against me, I could have lost my license. I hired a lawyer, sinking more than $8,000 into legal fees. I was cleared by a unanimous committee vote. But other physicians facing similar situations may not be as lucky.


Are You Eligible for “Expedited Credentialing?” - 08/28/2019

If you’re completing health plan credentialing, “expedited credentialing” might apply to you. And if it applies, that could be good for you and your practice. But how do you know if it does?


Beware of Scam Email Sent to TMA Members - 08/21/2019

An unauthorized email that claimed to be from the Texas Medical Association recently was sent to some TMA members stating that the individual member’s dues statement and insurance policy update was included. If you received this email, please know that it did not originate from nor was it authorized by TMA or the TMA Insurance Trust, and you should discard it.


Tell Congress: Protect Patients, Not Health Plans - 08/16/2019

Our U.S. senators and representatives are back home in Texas for the August recess, and Texas Medical Association President David Fleeger, MD, says their physician-constituents need to contact them to make sure they stop the surprise medical billing epidemic in a way that helps our patients – not big insurance companies.


Payers Axe Consultation Codes - 08/07/2019

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.


Out in the Cold: Health Plan Blamed For Major Prompt-Pay Mess - 08/02/2019

Molina Healthcare of Texas isn’t the only insurer to give physicians prompt-pay problems, and it won’t be the last. Some of the practices trying to recover payments blame not just the health plan, but also the extended response time from the state regulator overseeing insurance products and conduct: the Texas Department of Insurance, which says it’s hiring staff and making other changes to improve that response.


Insurance: Network Solutions - 08/02/2019

Charting Medicine’s Statehouse Progress TMA went into this session looking to attack insurer network inadequacy and health plans’ use of care impeding prior authorization demands. On both fronts, medicine scored solid legislative wins that will make it