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More Than $3.3 Million Recovered for TMA Practices in 2025 - 02/13/2026

The Physician Payment Resource Center works for physician members with Medicare, Medicaid, major private payers, and other health plans to help address issues that lead to lost revenue from claim payments.

Medicare Modifier 25 Documentation Under Microscope Following Federal Report - 02/04/2026

A recent federal audit focused on Medicare payments for eye injections revealed overwhelmingly high improper payment rates for evaluation and management services billed with modifier 25 usage. TMA provides information on how to help physicians avoid denials.

Medicare Judicial Dispute Threshold Increases in 2026 - 01/28/2026

Physicians who take initial steps to dispute Medicare or Medicare Advantage decisions, upon receiving unfavorable reviews, can opt for two quasi-judicial pathways to resolve the case. However, the amount in controversy in the underlying dispute must meet a minimum amount, which has risen 11% over the past four years.

Here’s Your 2026 Billing and Coding Checklist - 01/16/2026

TMA’s Physician Payment Resource Center works year-round with member physicians and health plans to resolve certain insurance payment issues. They suggest these practical actions you can take at the start of 2026 to keep your billing and collections on track throughout the year.

Starting a Practice - 01/14/2026

Setting Up or Closing a Practice

Practice e-Tips on Practice Operations - 01/13/2026

Billing Consulting HIPAA Forms Marketing Office Staff OSHA Patient Service Policies & Procedures Resources Billing Billing Medicare for Locum Tenens Billing Tip

Practice E-Tips on Billing and Collections - 01/13/2026

Practice E-Tips on Billing and Collections

Practice e-Tips on Claims - 01/13/2026

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

CMS Delivers Temporary Bump to Medicare Pay in 2026, Among Sweeping Changes in Proposed Fee Schedule - 12/30/2025

A temporary, one-year 2.5% Medicare payment update across the board reflects requirements Congress approved in its final budget. The proposal also includes, for the first time, two separate conversion factors with slight, albeit permanent, updates aimed at promoting value-based care.

Medicare Physician Fee Schedule Retains Payment Increase and Concerning Cuts - 12/24/2025

A new practice efficiency cut impacting thousands of codes and a cut targeting hospital-based services could offset a one-time payment boost. TMA staff are poring over the 1,216-page final rule ahead of its Nov. 20 webinar, free for physicians.

Medicine Supports Congressional Effort to Streamline Medicare Advantage Prior Auth - 12/15/2025

Prior authorization continues to cause delays in care and poorer patient health outcomes. A 2022 report shows that some Medicare Advantage claims that were denied would have been accepted under traditional Medicare guidelines.

WISeR’s Texas Administrators Coordinate with TMA to Ease Transition - 12/12/2025

Aiming to smooth the transition for physicians impacted by a new Medicare prior authorization pilot, the Texas Medical Association is coordinating with Cohere Health, the entity responsible for processing the program’s requests in Texas.

Medicare Fee Schedule Webinar Highlights Telemedicine, New Specialty Initiatives - 11/26/2025

In addition to uneven payment news, TMA shared the latest on telemedicine, coding changes, and new initiatives set to launch in 2026 and 2027.

Notify Medicare of Participation Changes by Dec. 31 - 11/25/2025

TMA reminds all physicians to check their Medicare participation information to make sure it is current. Those changing their status in 2026 will need to send notification via mail.

Medicare’s Quality Payment Program Won’t Support Internet Explorer 11 - 11/24/2025

Due to security concerns, Medicare’s Quality Payment Program (QPP) will no longer support the Internet Explorer (IE) 11 browser beginning on Oct. 13, the Centers for Medicare & Medicaid Services (CMS) has announced.

Filing a Compliant With the Texas Department of Insurance (TDI) - 11/13/2025

Filing a Compliant With the Texas Department of Insurance (TDI)

Medicare Proposal Offers More Flexibility for ACOs - 11/13/2025

A proposed regulation from the Centers for Medicare and Medicaid Services (CMS) would give certain accountable care organizations (ACOs) leeway to move at their own pace in graduating through the different levels of the Medicare Shared Savings Program, and the Texas Medical Association wants to ensure that flexibility sticks.

Stark Self-Referral Laws and Regulations - 11/13/2025

Stark generally prohibits a physician (or an immediate family member of such physician) who has a direct or indirect financial relationship with an entity that provides a designated health service from making a referral for that service for which Medicare or Medicaid would otherwise pay. This very broad prohibition is mitigated by a large number of exceptions. These exceptions must be met exactly. Failure to meet a Stark exception will result in a violation.

Physicians Must Refund Medicare Overpayments Voluntarily, Program Administrator Cautions - 11/13/2025

Novitas, Texas’ Medicare administrator, reminds physicians they should promptly bring incorrect payments to its attention. TMA can assist physicians with payment issues through its Physician Payment Resource Center.

Now Is the Time: Texas Delegates to AMA Make a Strong Push for Fixing What Ails Medicare - 11/13/2025

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.

When Should We Write Off Large Patient Balances? - 11/12/2025

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

Develop a No-Show Policy — and Use It - 11/12/2025

Develop a no-show policy — and use it

Collection Agency Submittal Do’s and Don’ts - 11/11/2025

Your collection agency has a better shot at success in collecting your past-due accounts if you follow tips for submitting accounts to the agency.

Verify Auditor Credentials - 11/11/2025

Be careful about who gets access to your medical records, and to which ones.

Learn Medicare Payment Updates, Earn CME in Live TMA Webinar - 10/31/2025

TMA’s first live Medicare webinar in six years will also address changes to quality and alternative payment programs, as well as a new pilot testing AI in prior authorization. Register now and submit questions in advance.