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Some Payers Resume Prior Authorization Requirements - 04/14/2021

Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.

Did You Subscribe to UHC’s Premium Payment Program? Check By March 31 - 03/29/2021

TMA reminds practices that now is a good time to determine whether you are enrolled in UnitedHealthcare’s (UHC) Optum Pay Premium program, which charges a fee for access to certain electronic data. Physicians and practices who wish to opt out of the program should do so by March 31.

Review Your Physician Compare Data Now - 03/23/2021

The Centers for Medicare & Medicaid Services (CMS) will close the Doctors and Clinicians Preview Period at 7 pm (CT) March 25. The preview allows you to check out your 2019 QPP performance data before its reported on Medicare Care Compare and in the Provider Data Catalog (PDC).

UnitedHealthcare Nonphysician Billing Policy Cuts Payments, TMA Says - 03/11/2021

TMA has expressed concerns about recent UnitedHealthcare (UHC) policy changes that will not only cut payments by 15% to physicians who employ nonphysician providers (NPPs), but also cause needless confusion in the billing process.

Medicine to Insurers: Pay Practices for Extra COVID-19 Supplies, Testing - 03/09/2021

The Texas Medical Association has urged Texas’ major private health plans to compensate practices for the additional supplies and staff required to provide safe patient care during the COVID-19 pandemic and to reimburse practices for rapid COVID-19 tests.

Provide Meaningful Health Care Coverage for Uninsured Texans - 03/08/2021

Texas can no longer ignore the human, social, and economic impact of having more than 20% of our people uninsured. Health care coverage matters, resulting in healthier Texans and more economically prosperous communities.

Send TMA Your Prior Authorization Nightmare Stories - 01/27/2021

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.

Proposed CMS Payer Requirements Shouldn’t Burden Physicians, TMA Says - 01/08/2021

A federal proposal that would require more transparency in insurers’ prior authorization denials in Medicaid and more sharing of such information with physicians could improve care delivery, but  also could result in more responsibilities on already overburdened physicians, TMA told the Centers for Medicare & Medicaid Services.

Help TMA Standardize Quality Measures in Value-Based Care - 12/18/2020

Would you like a say in what measures should be a standard part of insurance quality programs across the nation – and which ones shouldn’t? The Texas Medical Association now has input in that discussion and could use your help.

UHC Postpones Higher Liability Coverage Requirements Plan - 12/11/2020

UnitedHealthCare (UHC) postponed a plan that would require Texas physicians to substantially increase their professional liability insurance coverage in order to participate in its networks. The move comes after the Harris County Medical Society and Texas Medical Association expressed serious concerns about the new policy.

Comprehensive Prior Authorization Reforms Needed, Medicine Tells Feds - 12/02/2020

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.

Federal Agencies Adopt Rule Mandating Health Plan Price Transparency - 11/24/2020

A number of health plans will be required to be more transparent about coverage pricing starting in early 2021 after the recent adoption of a rule by three federal agencies.

Deadline Extended: Didn’t Get Your 5% APM Incentive Payment? Take Action by Dec. 13 - 11/19/2020

If you participated in an advanced alternative payment model (APM) under the 2018 Quality Payment Program (QPP), the Texas Medical Association encourages you to take action now to verify that you have received your 5% APM incentive payment for 2020.

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.

Cigna Extends COVID-19 Waivers - 11/10/2020

With the COVID-19 public health emergency now set to end Jan. 20, Cigna has extended some of its waivers and other COVID-19 exceptions, and introduced some payment changes.

Survey: Many Texans Skipping Care During Pandemic, Considering a Vaccine - 10/28/2020

More than a third of Texans say they or someone in their household have skipped or postponed some type of medical care because of COVID-19, according to an October Episcopal Health Foundation survey that explored attitudes about COVID-19.

Texas Leads Nation in Rise in Uninsured Children, Study Shows - 10/15/2020

The number of uninsured children nationwide climbed dramatically in recent years, with the biggest gains by far coming from the Lone Star State, according to a study released last week.

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.

Ambetter: New Required Field on CMS-1500 Claim Form - 09/23/2020

Ambetter from Superior HealthPlan, a plan available on the Affordable Care Act health insurance exchange, has changed the status of box 18 on the CMS-1500 claim form from a conditional/optional field to a required one, effective July 1.

Turn to TMA to Resolve Prompt-Pay Issues - 09/23/2020

If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Reimbursement Review and Resolution Service. The Texas Department of Insurance last week released a bulletin reminding plans that a portion of prompt-pay penalties must be paid to the state.

Are You Eligible for “Expedited Credentialing?” - 09/23/2020

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?

TMA to IRS: Direct Primary Care, Health Care-Sharing Ministries Aren’t Insurance - 08/19/2020

The Texas Medical Association is urging the IRS to reconsider a proposed rule that would classify direct primary care (DPC) arrangements and health care-sharing ministries (HSMs) as insurance.

UnitedHealthcare Phasing Out Paper Checks - 08/03/2020

If you receive claims payments from UnitedHealthcare (UHC) in paper checks, now is the time to enroll in direct deposit. UHC says it will phase out sending paper checks for payments throughout the remainder of 2020