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Cigna to Request Records for Certain Office Visits, Unleashing Possible “Administrative Nightmare” - 05/26/2022

Cigna recently began alerting physicians to a new billing policy that could have far-reaching consequences for Texas physicians, practice staff, and patients.


Turn to TMA to Resolve Insurance Hassles - 05/19/2022

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.


Feds Finally Open Dispute Portal Under Surprise-Billing Law - 04/20/2022

Physicians needing to formally settle a dispute with insurers over certain out-of-network payments under the federal No Surprises Act finally can initiate that process online.


New Telehealth Code Sparingly Adopted - 04/20/2022

Despite the availability of a new Medicare code corresponding to telehealth provided to patients at home, Texas Medical Association payment staff say health plans are adopting it sparingly.


Health Plans Not All Recognizing New Telehealth Code - 04/05/2022

A new telehealth code and a series of coding modifier descriptors have already taken effect in 2022 or will take effect soon. But not all health plans are recognizing the new coding elements, according to Texas Medical Association staff monitoring their status.


Surprise Billing Rules Garner More Legal Action - 04/05/2022

Pressure is mounting on federal authorities with several legal actions now aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.


Court Hearing Approaches in TMA Surprise Billing Lawsuit - 04/05/2022

With a Feb. 4 court hearing on the horizon, the Texas Medical Association recently reiterated its strong opposition to a part of a federal rule that medicine says unfairly favors health insurers when directing arbiters to resolve payment disputes between insurers and physicians under the federal surprise billing law.


Power Data: Texas' Claims Database Will Help Clarify Care Costs - 03/31/2022

Texas is building an all-payer claims database, which will provide a clearer view of opaque health care costs.


Communication Amid Complexity: An Interview With TDI Commissioner Cassie Brown - 03/31/2022

With a number of new and fluctuating state and federal laws and regulations, Texas Department of Insurance (TDI) Commissioner Cassie Brown has her plate full when it comes to health plan regulation.


A Looming Deadline: What the Public Health Emergency's End Means for Coverage - 03/31/2022

The end of the public health emergency could mean big changes to Medicaid, telemedicine, and private insurance coverage.


AMA: High Concentration in Insurance Markets - 03/31/2022

Most U.S. commercial health insurance markets are “highly concentrated” among the top insurers in those markets, and evidence strongly suggests insurers are “causing competitive harm to consumers and providers of care.” Those were the findings of the American Medical Association’s 2021 update to its annual study, Competition in Health Insurance.


Navigating a Broken System: Helping Patients Use Health Resources - 03/31/2022

Whether patients do or don’t have health insurance, they need physicians’ help to make the most of their health care resources.


Medicaid to Fix Physician Enrollment Problems With TMA's Help - 03/31/2022

A rocky start for the state’s new Medicaid Provider Enrollment and Management System frustrated a number of practices around the state – and caused some worries that care they provided might go unpaid.


CMS Debuts Coding Changes for Telehealth - 03/10/2022

The Centers for Medicare & Medicaid Services (CMS) will implement a new place of service (POS) code related to telehealth and update an existing one on April 4. POS codes refer to where medical services are provided. These changes will affect Texas physicians caring for Medicare patients.


Out-of-Network and What It Means - 03/03/2022

A physician is out-of-network when a contract has not been established with a health plan. Get tips on what to do when providing services to out-of-network patients.


TMA Sues Feds Over Arbitration Rule for Surprise Billing Law - 03/02/2022

The Texas Medical Association has sued federal authorities over rulemaking for the federal surprise billing law, saying it failed to follow clear direction from Congress about how to implement the dispute resolution process meant to determine fair payments for out-of-network care.


TMA Welcomes U.S. District Court Decision to Grant Its Summary Judgment Motion - 02/25/2022

Statement by Diana L. Fite, MD, Texas Medical Association (TMA) immediate past president, in response to the U.S. District Court for the Eastern District of Texas’ ruling on TMA’s motion for summary judgment in its lawsuit opposing federal regulatory agencies’ dispute resolution approach under the No Surprises Act.


TMA Moves for Victory in Challenge to Unfair Arbitration Rule - 01/14/2022

The Texas Medical Association today announced it has filed a motion for summary judgment in its lawsuit in the U.S. District Court for the Eastern District of Texas. The motion asks the court to decide, without a trial, that the U.S. departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management failed to follow clear direction from Congress about how to implement the physician-insurance company dispute resolution process set forth in the No Surprises Act, legislation passed in 2020 to address surprise medical bills.


The X{EPSU} Modifiers Further Define Modifier 59 - 12/27/2021

Modifier 59, the distinct procedural service modifier associated with Medicare National Correct Coding Initiative edits, is one you might find confusing (many practices do). Follow these guidelines


New Patient Visit: Three Years Is a Key - 12/03/2021

Centers for Medicare & Medicaid Services auditors have identified claims coded for “new patient” evaluation and management services that don’t fit the definition for new patient services. Be sure to avoid this coding error.


Practice e-Tips on Coding - 12/03/2021

Get practice tips on all things coding. Learn about coding methods, correct coding, resources, coding related to Workers' Comp and more.


TMA, Other Physician Groups Urge Reconsideration of Surprise Billing Rule - 11/24/2021

While the Texas Medical Association awaits action on its lawsuit over part of recent rulemaking for the federal surprise billing law, TMA recently teamed with the American Medical Association and others to engage the Biden administration outside court.


Tell Your Uninsured Patients About HealthCare.gov Marketplace Enrollment - 11/19/2021

Enrollment in the federal health insurance marketplace on HealthCare.gov is now open, so it’s a good idea to let your uninsured patients know the option is there. And if they sign up by Dec. 15, their coverage will begin at the start of 2022.


Correct Code for Billing a Routine Venipuncture - 11/17/2021

Learn the correct code for billing a routine venipuncture.


Aetna Launching Patient-Facing Physician Performance Designation - 11/15/2021

Aetna Health Insurance is instituting a physician comparison system for its self-insured members in 2022, in which primary care physicians, obstetrician-gynecologists, and orthopedic hip-and-knee specialists can earn a “designation” based on their performance in two categories.