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Send TMA Your Prior Auth Nightmare Stories - 01/24/2020

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes. 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 to the TMA Payment Advocacy Department.


TDI Explains Arbitration Law Process - 01/15/2020

Before you’re involved in an out-of-network medical bill dispute that would be covered by the state’s new baseball-style arbitration law, it’s best to know what could be in store.  The Texas Department of Insurance has provided further details on how the law will be implemented, including how the arbitration process will work.


Insurance Commissioner to Health Plans: Be Proactive on New Surprise Billing Law - 01/09/2020

In a letter Tuesday addressed to “the health plans of Texas,” the Texas Department of Insurance (TDI) commissioner said TDI will monitor how health plans implement Senate Bill 1264, passed during last year’s session of the Texas Legislature and now in effect.


Medicare Sequestration Cuts, GPCI Floor Continue - 01/07/2020

As we begin 2020, it’s a good time to remember that several Medicare policies that affect physician payment remain in effect. Medicare sequestration, the federal government’s 2% across-the-board payment cut, will continue until further notice. In addition, Medicare’s 1.0 floor for the Geographic Practice Cost Indices (GPCI) has been extended temporarily, once again, to May 23.


Request UnitedHealthcare Peer-to-Peer Review Online - 01/02/2020

Seeking a peer-to-peer conversation after a preauthorization request was declined? Now you can request one through an online form available on UnitedHealthcare’s Prior Authorization and Notification webpage.


State Adopts Emergency Rule on Surprise Billing Law - 12/20/2019

The Texas Department of Insurance has adopted an emergency rule outlining the narrow circumstances when it will be legal for physicians to balance bill patients under the state’s new law that protects patients from surprise medical bills. And the Texas Medical Board is telling physicians to accept how TDI interprets the law in its emergency rule.


Texas' New Surprise Billing Law: Are You Ready? - 12/20/2019

Texas’ baseball-style arbitration law takes effect for certain out-of-network medical care beginning Jan. 1, 2020. It’s a big change from how disputes on out-of-network medical bills have been handled in the past – and you need to know how to navigate it. There are nuances to consider, and disciplinary action from the Texas Medical Board (TMB) may await you if you balance-bill in violation of the law. That’s why the Texas Medical Association has produced a digestible, seven-page summary of the surprise-billing law.


Review Cigna Patient Feedback Before It Goes Public - 12/13/2019

Now is the time to preview your patients’ reviews that will appear in myCigna.com provider directories starting in early 2020 – or you can opt out of having your patient reviews published in Cigna’s directories.


Tell Congress to Oppose Surprise Bill Compromise - 12/13/2019

If you see patients, if you take private insurance, you need to know that Congress is about to let Big Insurance set your fee schedule even lower than it is now... if they let you into their ever-narrowing networks. The Texas Medical Association strongly urges you to call or  email your U.S. representative immediately. Tell him or her you want to protect patients from out-of-network surprise medical bills, but you don’t want to give the health plans more power than they already have.


Congress Needs to Get This Right - 12/12/2019

The Texas Medical Association, with our nearly 53,000 physician and medical student members, was very pleased to see the Ways and Means Committee weigh in on the debate over surprise medical billing legislation. While the details are yet to come, the general outline of that proposal looks quite promising.


TMA Stands Firmly Against Surprise Medical Billing “Compromise” - 12/09/2019

“There is a right way and a wrong way to protect patients from surprise medical bills, and the so-called compromise federal legislation announced this weekend in Washington, D.C., is definitely the wrong way,” Texas Medical Association President David C. Fleeger, MD, said Monday.


CMS to Recoup Chronic Care Management Payments - 12/06/2019

Some Texas physicians and outpatient facilities might have to refund payments they received for chronic care management services performed during 2015 and 2016 under the Medicare Physician Fee Schedule, federal officials said.


TMA Makes Strong Push for Fair Surprise Billing Legislation - 12/04/2019

The Texas Medical Association is urging Texas lawmakers in Washington, D.C., to show their support for federal legislation on surprise medical bills that includes commercially reasonable upfront payments and independent arbitration.


High Deductible Plans? There’s CME for That - 11/25/2019

Texas is No. 2 in the nation in the number of people enrolled in high-deductible health plans – and payment responsibilities have increasingly shifted from insurers to consumers. For practices today, effectively communicating a patient’s financial responsibilities is becoming more vital. The Texas Medical Association’s free webinars can help prepare you and your practice for those conversations.


How Practice Owners Can Control Health Insurance Costs During Open Enrollment - 11/22/2019

If you’re a practice owner whose health insurance is up for renewal during Health Insurance Open Enrollment, Nov. 1 to Dec. 15, there are ways to control the cost of your health insurance. The health insurance advisors at TMA Insurance Trust know of a lesser-known option that you can use to keep group plan cost within budget.


Open Enrollment 2020: Be Prepared for Coverage Changes - 11/13/2019

You’re probably already aware that open enrollment for commercial health insurance plans, including those on the Affordable Care Act Exchanges, opened Nov. 1 and will run through Dec. 15. While some patients won’t make any changes to their coverage, others will make significant changes, including enrolling with a completely different health plan.


Texas’ Rise in Uninsured Kids Among Fastest in Nation, Report Says - 11/13/2019

The bad news keeps coming for Texas’ uninsured rate. Between 2016 and 2018, Texas tied for the second-highest jump in the rate of uninsured children among all 50 states, according to a study released Wednesday by Georgetown University's Center for Children and Families in Washington, D.C.


Get Details About Your 5% Medicare Bonus - 11/05/2019

If you participated in the advanced alternative payment model (APM) track during the 2017 Quality Payment Program (QPP) performance year, full details of your 5% APM incentive payment are finally available.


Take Steps To Improve Health Care Access Throughout Texas - 11/01/2019

If you’re looking for a way to let state lawmakers know why health care coverage matters to all Texans, join or start a block walk during #SickOfItTX’s Weekend of Action for Health Care on Nov. 9 and 10. Walks are currently scheduled in Austin, Dallas, Galveston, Houston, McAllen, and San Antonio; more sites may be added, or you can host your own.


Texas' High Rate of Uninsured Hurting the Economy, Study Says - 10/30/2019

Texas has the highest percentage and number of people without health insurance in the United States, which could cause long-term damage to the state’s economy, says a study released this week by the Texas Alliance for Health Care.


Medicine to Congress: Don’t Give Health Plans More Leverage - 10/24/2019

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.


Gender-Neutral Insurance Rates = Big Savings for Women Physicians - 10/17/2019

To help Texas Medical Association members get the income protection they need, the exclusive TMA Member Long Term Disability Plan, issued by The Prudential Insurance Company of America, uses group rates that are based on age, not gender. Female physicians will find these gender-neutral group rates significantly less expensive than most individual disability plans available in Texas. 


System Failure: Houston Practices Fight WellCare for Payment - 09/26/2019

Several Houston-area practices say a botched technology conversion by insurer WellCare after it acquired a Medicare Advantage plan led to prior authorization and network confusion, undue denials, and unpaid claims by the barrelful.


Comprehensive Prior Authorization Reforms Needed, Medicine Tells Feds - 09/25/2019

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.


An Insurance Company Auditor Tried to Destroy My Career - 09/16/2019

It didn’t matter that the charges against me were ludicrous. The potential consequences were only too real, and potentially catastrophic. Had the State Medical Board decided against me, I could have lost my license. I hired a lawyer, sinking more than $8,000 into legal fees. I was cleared by a unanimous committee vote. But other physicians facing similar situations may not be as lucky.