Related Stories

VA Seeking Refunds from Physicians for Past CHAMPVA Claims - 06/26/2025

Physicians may soon hear from the U.S. Department of Veterans Affairs (VA) seeking refunds for payments it says were made in error. TMA has provided information on what steps physicians may take.

CMS Announces Latest Scores for Quality Payment Program - 06/23/2025

The Medicare Quality Payment Program will award a slightly higher percentage of positive payment adjustments in 2025 compared to 2024. However, the maximum will be considerably lower than last year’s.

Now is the Time: Texas Delegates to AMA Make a Strong Push for Fixing What Ails Medicare - 06/23/2025

Texas Medical Association members made their voices heard at the American Medical Association’s three-day National Advocacy Conference (NAC), Feb. 10-12, 2025, calling for a long-term Medicare payment fix.

Service Provider: TMA Practice Resources Educate Physicians on Practice Challenges - 06/23/2025

TMA’s robust practice resources help educate physicians on common billing issues, payer updates, and practice challenges.

Multiple Choice: How Two APMs Are Contributing to Cost-Conscious Health Care - 06/17/2025

The Medicare Shared Savings Program and ACO REACH program provide physicians with two viable payment models incentivizing better patient care outcomes.

TMA Vigilant of New Medicare Advantage Audits - 06/17/2025

The Centers for Medicare and Medicaid Services has begun what the agency itself calls an “aggressive” new strategy to audit all Medicare Advantage plans annually to review whether insurers and their networks are inflating patients’ illnesses, leading to overpayments – and the additional compliance burdens and possible repayments could fall on physicians.  

How to Set a Standard Fee Schedule for Your Practice - 06/16/2025

 You have complete authority and responsibility to set your own standard practice prices. When you set your fees, consider basic business principles, including profit, return on investment, competition, and marketing.  

Who Can Do the Face-to-Face Encounter for Home Health? - 06/12/2025

Medicare won’t pay home health agencies to care for Medicare patients without a physician’s certification, which must include a face-to-face encounter with the patient. Here’s who can perform that encounter.

HHSC Extends Medicaid Revalidation Another Six Months - 06/12/2025

The state is providing physicians with additional time to take a key step in caring for Medicaid patients. It’s also providing a reentry pathway for physicians disenrolled last year.

TMA Cheers Appellate Court Ruling in Third NSA Lawsuit - 06/03/2025

Statement by Texas Medical Association (TMA) President Jayesh "Jay" Shah, MD, in response to Friday's order by the U.S. Court of Appeals for the 5th Circuit granting TMA’s petition for rehearing en banc in TMA’s third No Surprises Act (NSA) lawsuit, which vacates the circuit panel’s Oct. 30, 2024 opinion and will result in a hearing by the full panel of judges at a later date.

Practice e-Tips on Claims - 05/29/2025

Appeals Appealing Claims Can Have Appealing Results   Claim Forms Multiple Place-of-Service Codes on a Single 1500 Claim Form   Fees New Laws Require Billing Di

Preview Your Medicare Clinician Profile Through June 25 - 05/29/2025

Physicians participating in the Quality Payment Program will see their 2023 performance scores showcased on two publicly accessible websites. One of those will also feature star ratings in up to 17 categories including preventive health and patient safety.

Texas Medicaid Delays Online Enrolling and Credentialing Integration - 05/22/2025

In April, the Texas Medicaid & Health Partnership had announced physicians could enroll and get credentialed in a one-stop, two-step process. The pause means the status quo remains for now.

TMA Forges New Policies on Same-Day Services, Patient Attribution in Value-Based Care - 05/16/2025

The house adopted several other payment-related policies as well, all emerging from ongoing physician frustration with payer practices that hinder patient care.

Insurance Bill Undermining Patient, Physician Protections Heads to House - 05/13/2025

A top target for TMA, House Bill 139 would create a new “employer choice of benefit” health plan exempt from decades’ worth of insurance laws that promise a minimum set of coverage, prompt pay, prior authorization restraints, and other guardrails. Other bad bills with serious consequences for practices also top TMA’s opposition list.

MedPAC Calls for Tying Medicare Payment to Inflation with a Permanent Update - 04/22/2025

The agency advising Congress on Medicare issues calls for a physician payment structure tied to the Medical Economic Index, in line with TMA advocacy. The recommendation calls for a permanent payment update in 2026 and beyond.

Medicaid Funding Streams Crucial in State, Federal Advocacy Discussions - 04/17/2025

In the chance the federal government moves forward with proposed cuts that could negatively impact Medicaid, TMA is here to help Texas physicians understand and navigate Medicaid’s funding complexities. Read more.

TMA’s Top Legislative Priorities: Enhance Medicaid Payments and Coverage - 04/17/2025

TMA will work to enhance Medicaid payments and coverage this legislative session

TMA Signs Letter Calling for Congress to Protect Medicaid Funding - 04/17/2025

As the U.S. House of Representatives considers $880 billion in cuts from the committee overseeing Medicaid, TMA and all 50 state medical societies detailed the impacts such a cut would make to patient care and practice viability.

Medicine Backs New Legislation Halting Latest Medicare Payment Cut - 04/14/2025

Led by physician lawmakers, the proposed legislation would cancel the most recent physician pay cut and provide some extenuating relief for the remainder of the year. TMA recently joined the American Medical Association’s national advocacy conference to take their efforts to lawmakers’ doorsteps in D.C.

Physician Legislators File Federal Prior Auth Reform Bill - 04/07/2025

The measure applies to Medicare, Medicare Advantage, and Part D prescription drug plans. Its reintroduction follows medicine’s federal advocacy in Washington, D.C., and AMA’s latest survey showing prior authorization continues to negatively impact physicians and patients.

Prior Authorization Fuels Physician Burnout, Decreases Access to Care, AMA Survey Finds - 04/03/2025

Prior authorization continues to intensify physician burnout, increase health care costs, and limit patients’ access to care, per AMA. Meanwhile, TMA advocates against health plans’ use of artificial intelligence in the prior auth process and aims to reduce its burden on physicians.   

CMS Issues New MIPS Hardship, Extension Tied to IV Fluid Shortage - 03/28/2025

The 15-day window opens today, March 31, and comes in response to medicine’s advocacy. TMA encourages affected physicians to document those shortages and the impact on their practices.

UPDATE: Submit 2024 MIPS Data by April 14 to Avoid 9% Pay Cut - 03/28/2025

The data submission period for Medicare’s 2024 Merit-Based Incentive Payment System (MIPS) performance year is underway and closes on April 14 at 7 pm CT. At stake is a pay cut of up to 9% in the 2026 payment year.

Congress Extends Medicare Telehealth Flexibilities for Another Six Months - 03/24/2025

Several pandemic-era Medicare telehealth and payment flexibilities will now last through Sept. 30 following recent action by Congress, including those that waive geographic site restrictions for mental health telemedicine services provided without an in-person visit.