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Alert: Scammers Demanding Bogus Fines For Drug Purchases - 04/01/2019

The Texas Medical Association and the Texas Medical Liability Trust (TMLT) are warning physicians about scammers posing as a U.S. Drug Enforcement Administration agent trying to defraud doctors into paying a nonexistent federal fine for allegedly intercepting illegal prescription drugs the doctor had sent through the mail.


Greenway Clients Entitled to Free EHR Upgrade After Fraud Settlement - 02/12/2019

Electronic Health Record vendor Greenway Health has been ordered to offer its clients free upgrades to its latest version of Prime Suite as part of a settlement in a multimillion-dollar fraud case.  


Section 3: Hold Health Insurers Accountable - 01/30/2019

Beaumont anesthesiologist Ray Callas, MD, is tired of beating his head against the wall trying to get “in-network” with health insurance companies. And he’s tired of the surprise bills his patients receive when he can’t get in.  


Marriage Material: Independent Practices Find Success in Commitment to Accountable Care Organizations - 01/02/2019

TMA PracticeEdge joins together independent physician practices in accountable care organizations. Their commitment to pool resources and to improve patient care is paying off in the Medicare Shared Savings Program and other value-based care contracts.


This Month in Texas Medicine - 12/03/2018

The December edition of Texas Medicine looks at accountable care organizations in Texas. Plus, see what's new in the TMA Education Center.


Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.


MACRA Penalties Reprieve Makes Accountable Care Program Essential - 09/26/2018

TMA has some good news for physicians feeling apprehensive about future success under the Medicare Access and CHIP Reauthorization Act (MACRA). The Centers for Medicare & Medicaid Services (CMS) basically halted penalties for 2019, which means you still have time. If you're looking to make an informed, methodical shift to value-based care but don't know where to start, the 2017 Accountable Care Leadership Program is your one-stop solution.


Celebrating MDs Ahead of the Curve: TMA's 2016 Accountable Care Leaders - 09/26/2018

Accountable care is making big strides this year, most recently last month with the release of the final Medicare Access and CHIP Reauthorization Act (MACRA) rule. A collective of TMA physicians are eagerly matching pace. This month, 27 will graduate from TMA's 2016 Accountable Care Leadership Program.


What To Do When Employees Steal: Medical Practices Are a Ripe Target for Embezzlement - 09/14/2018

Medical practices are a ripe target for embezzlement.


EHR Vendors Behaving Badly; What Can You Do? - 08/27/2018

Have you had a problem with your electronic health record vendor not following through on its contractual obligations? Many practices don’t know how or where to get help.


Commentary: Clear direction needed - 05/03/2018

The best course for providing health care lies between entitlements and options


The Edge of Success - 05/03/2018

Make it through the challenges of forming an accountable care organization (ACO) for just a couple of years, and the money your groups save can be spectacular — into the millions under the right circumstances.


TMA Supports Bill to Improve Balance-Bill Mediation - 04/27/2018

Balance or “Surprise bills” may occur when a person insured under a preferred provider organization (PPO) unexpectedly receives services out of network. The mediation process for out-of-network billing is working well in the state of Texas and has been a tremendous patient protection with the narrowing of insurance networks. We have seen growth in the utilization of the mediation process grow from 14 requests in 2010, to 1,677 requests in 2016. Therefore, TMA is supportive of its expansion to all out-of-network health care providers at an in-network facility along with emergency care.  Additionally, we are pleased to see that the legislation maintains the $500 threshold as well as personal responsibility of the patient.


TMA Offers Remedies to Ease Surprise Billing - 04/27/2018

Texas patients sometimes feel the pain from unexpected out-of-pocket costs not covered by their health insurance, known as “surprise billing” or “balance billing.” The Texas Medical Association (TMA) is taking aim at the problem, which occurs when a health insurance company pays less than what a doctor charges, leaving the patient to pay the balance of the bill.


Transparency in Out-of-Network Payments Needed - 04/27/2018

Since the health plan’s contract or agreement is with the enrollee, we hope health plans don’t use the same argument, saying, “It’s proprietary” to circumvent the spirit of this legislation when their own enrollees make the same inquiry about the out-of-network payment methodology.


Texas Physicians Offer Legislators Fix for Surprise Billing Problem - 04/27/2018

The Texas Medical Association (TMA) and its physician members recognize surprise medical billing is a problem, and are offering lawmakers solutions that address the root causes. Physicians point to a confusing health insurance system they say leaves policyholders/patients too-often unaware, subject to unexpected out-of-pocket costs, inadequate coverage, and physicians frustrated by limited access to patients and their health plan networks.


Balance-Billing Ban Back in 2015 Legislature - 04/27/2018

Renewed attention in the 2015 Texas Legislative over balance billing stems in part from interim charges that tasked the Senate State Affairs and House Insurance committees to look at whether existing laws dating back to 2007 are working to inform patients ahead of time when out-of-network physicians might balance-bill them for services their health plans don't fully cover. The issue is in the national spotlight, too, with the proliferation of high-deductible and narrow-network plans sold in the Accountable Care Act insurance marketplace. New federal rules take aim at ACA plans' inadequate networks and inaccurate physician and hospital directories. The Texas Medical Association is pushing for similar health plan accountability measures at the state level, with a careful eye on legislation that could restrict out-of-network physicians' ability to balance-bill for services they legitimately provide.


TMA's 2015 Legislative Victories Build on Past Successes - 04/26/2018

In a 2015 legislative session marked by new state leadership, new money, and big shifts in how Texas' major health care agencies oversee care delivery, the house of medicine remained as steady as ever in its mission to ensure physicians can give their patients the best care possible. That resolve paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.


Capitol Success - 04/26/2018

This legislative session, medicine resolved to ensure physicians can give their patients the best care possible. The hard work paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.


Kyle Janek: The Texas Medicine Interview - 04/24/2018

New Texas Health and Human Services Executive Commissioner Kyle Janek, MD, has concerns about Medicaid - about having enough physicians to care for patients, about how to improve the health insurer, and other thoughts he shares with Texas Medicine magazine. In this interview he covers that, fraud investigations, women's health and other key issues he and the state face.


ACOs, Texas-Style - 04/24/2018

Burdensome federal regulations and antitrust rules and hefty overhead costs are oft-cited stumbling blocks to physician involvement in accountable care organizations (ACOs). So perhaps it came as little surprise when the Texas Legislature, less than enamored with the federal health reform legislation that authorized the coordinated care models, came up with its own rendition. In 2011, state lawmakers passed Senate Bill 7, which created a Texas-style ACO, known as a health care collaborative, to encourage physicians, hospitals, and payers to collaborate on more coordinated, cost-effective health care delivery. Now that the Texas Department of Insurance has adopted rules laying out a path to licensure as a collaborative, Texas physicians have a more flexible option that overcomes many of the barriers preventing them from stepping into integrated care models.


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 Analyzes Potential Aetna-Humana, Anthem-Cigna Mergers - 04/17/2018

The combined impact of proposed mergers among four of the nation's largest health insurance companies would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within Texas and 16 other states, according to new special analyses of commercial health insurance markets issued by the American Medical Association.


Bill Would Address Inaccurate Insurance Directories - 04/17/2018

With modern technology, there should be no issue in business daily updates to a health plan’s online provider directory.


TMA Seeks New Standards for Health Insurance Sold Across State Lines - 04/17/2018

The Texas Medical Association (TMA) is pushing for national consensus on standards to protect consumers who purchase health insurance across state lines.