Related Stories

Blue Cross Says MOC Not Needed for BlueCompare - 02/28/2024

Physicians across the state reacted strongly to a March 5 letter from Blue Cross and Blue Shield of Texas (BCSTX) that implied the state’s largest insurance company is now using maintenance of certification (MOC) to rate physicians. That was not the intent, the company’s president says.


Help Patients Make Wise Choices About Treatment Options - 07/20/2023

Tools are emerging to help physicians overcome the time constraints that can preempt discussions with patients.


Quality Improvement: Practice Awards and Free Webinars - 07/20/2023

TMA, the Texas Osteopathic Medical Association (TOMA), and the TMF Health Quality Institute are collaborating again to provide the Physician Practice Quality Improvement Award program. The award formally recognizes physician practices for their dedication and commitment to providing high-quality patient care and improving outcomes.


Driving the Quality Train: TMA Physicians Lead the Way, From Measures to Standardization - 07/10/2023

In a proactive effort to resolve physician complaints, TMA and its members are deeply involved in quality issues, from participating in the development of new measures to pushing payers for standardized quality programs and supporting physicians who are curious about value-based care.


Texas Physicians Push to Improve Health Care for LGBTQ Patients - 06/28/2023

Lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) patients face unique barriers that put them at greater risk for mental and physical health problems. Often, their health disparities result from a lack of family support, public prejudice, and fear of the health care system. Texas physicians have launched a new workgroup and are adapting their practices to treat this underserved population.


TMF Offers Resources to Navigate CMS Requirements - 05/16/2023

TMF has launched three physician-focused networks designed to save time, improve patient care, and reduce costs associated with meeting these requirements. These programs, focused on immunizations, behavioral health and value-based improvements, are designed to help physicians benefit from—and not be penalized by—these mandates.


Blues to Expand HMO Network in January; Check Your Status - 10/21/2022

Blue Cross and Blue Shield of Texas (BCBSTX) will expand its MyBlue Health HMO network to six Texas counties starting in January.


Biden Administration to Launch Specialty Payment Model - 07/27/2022

A new, voluntary Medicare payment model option focused on cancer care opens the value-based care door wider for specialists at a time when such models have been limited.


The Customer Is Always Right? Patient-Reported Outcome Measures Have Fans and Detractors - 01/26/2021

For too long, some doctors say measures of a physician’s quality of care have been about process: the average length of a patient stay, for example, or a patient’s readmission rate. The bottom line is results, and that’s why a shift to patient-reported outcome (PRO) measures is necessary. However, even proponents of PRO measures note that collecting the information from patients for those metrics places burdens on physicians, and some remain skeptical of bonuses and penalties tied to a measure that derives from a subjective factor: what patients think.


Troubling Trend: Texas’ 2018 QPP Data Contains More Bad Signs - 01/05/2021

As the Centers for Medicare & Medicaid Services continues to churn out glowing data annually on its Quality Payment Program (QPP), a full picture of the program’s impact eludes the agency’s reporting. According to the Texas Medical Association’s analysis of state-level data in the 2018 QPP Experience Report, it’s clear that small practices continue to feel most of the program’s punitive pressures.


Blue Cross Bundles Payment for Some Diagnostic Services - 11/16/2020

Effective July 1, Blue Cross and Blue Shield of Texas will cut payments for certain diagnostic procedures. The cut will apply to diagnostic cardiovascular and ophthalmology procedures that are billed for the same patient on the same day.


Blue Cross HMO Emergency Payment Review Policy Begins - 11/16/2020

Beginning today, Blue Cross Blue and Shield of Texas will require some members to pay 100 percent of their medical bills if they go to an out-of-network emergency room for certain non-life-threatening conditions, company officials have confirmed.


See Blue Cross Referral Chart, Colonoscopy Coding Tips - 10/14/2020

As a result of “feedback from the provider community,” Blue Cross and Blue Shield of Texas has removed 111 procedure codes from its preauthorization requirements related to additional care categories of codes.


Blue Cross Prior Authorization Manager Changing - 09/30/2020

Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.


Charging Concierge Fees to BCBSTX Patients - 09/23/2020

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.


TMA Calls Governor’s Plan “Prudent and Careful” - 04/27/2020

Statement by Texas Medical Association (TMA) President David C. Fleeger, MD, in response to Texas Gov. Greg Abbott’s announcement that Texas hospitals now need to reserve only 15% of their capacity for COVID-19 patients.


TDI Fines Blue Cross $10 Million for Delays, Errors - 03/11/2020

Blue Cross and Blue Shield of Texas will pay a $10 million fine for providing consumers incorrect information, delays in out-of-network claims processing, and errors in marketing materials, the Texas Department of Insurance has announced.


Quality Care Pilot Takes Flight - 09/03/2019

How one children's clinic uses a targeted program to dramatically improve care, lower costs.


Faulty Guidelines - 06/03/2019

Former Texas Medical Association President Josie Williams, MD, was tenacious in advocating that organized medicine pay zealous attention to two topics: data and guidelines. In this, she was both sage and prescient. We have done well in following her recommendations on data, but we continue to fall far short of where we need to be on guidelines.


Dos and Don’ts of Using Modifier 22 - 04/25/2019

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.


Expect HEDIS Records Requests From Third Parties - 02/28/2019

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas or UnitedHealthcare, it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.


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.


Blue Cross to Put Off HMO Emergency Coverage Policy Until August - 06/27/2018

Blue Cross and Blue Shield of Texas will delay for 60 days a new HMO emergency care policy it had originally planned to begin on Monday, June 4.


Submitting Med Records, and More Tips From Blue Cross - 06/26/2018

Here’s some news you can use from Blue Cross and Blue Shield of Texas.


TMA Seeks TDI Review of Blue Cross HMO Emergency Policy - 05/10/2018

The Texas Medical Association and 18 other Texas medical societies are asking the Texas Department of Insurance to review a new Blue Cross Blue Shield of Texas policy that could require some HMO members to pay 100 percent of their out-of-network emergency medical bills.