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Direct Payment Model Available to All Texas Physicians Under New State Law - 11/10/2025

House Bill 541, now in effect, replaces the “direct primary care” nomenclature from a TMA-backed 2015 law with the more inclusive “direct patient care.” In a typical direct care model, patients pay a monthly fee, and in return, receive services like office visits and in-office procedures without involving insurance.

Value-Based Care Extended to Texas PPO, EPO Health Plans for Primary Care Physicians - 10/20/2025

The new state law authorizes primary care physicians to enter into value-based care (VBC) payment arrangements with state-regulated PPOs and EPOs, if they choose to. The new law includes several guardrails TMA advocated for that seek to promote fair dealing in VBC negotiations.

Cigna Clarifies Terms, Conditions of Its High-Level E/M Downcoding Policy - 09/30/2025

In communication with TMA, Cigna confirmed its policy will not apply to all physicians and those subject to it can request to be removed from the review process under certain circumstances. Nevertheless, the limited scope of the “exemption” could still represent a significant operational and financial challenge for some practices.

Federal Changes Allow Payment for Direct Primary Care Via Health Savings Accounts - 09/29/2025

The new law permits patients to use health savings account funds for direct primary care membership fees, provided the arrangement meets certain federal requirements.

Physicians Brace for Expiration of ACA Tax Credits, Uninsured Fallout - 09/25/2025

An estimated 1.3 million Texans could lose coverage due to the combined effects of Affordable Care Act marketplace changes under OBBBA and the expiration of the enhanced premium tax credits at the end of this year. “Physicians are definitely going to feel the effects.”

2025 Legislative Wrap-Up: Amid Bad Insurance Bills Defeated, Gold Card Law Refinements Close Gaps - 09/12/2025

House Bill 3812 addresses some of the shortfalls and inconsistencies among payers in the intended implementation of Texas’ landmark prior authorization exemption law. The law took effect Sept. 1 but additional rulemaking by the Texas Department of Insurance is likely.    

Cigna Downcoding Policy Threatens Payment; TMA Urges Repeal - 08/18/2025

The payer announced a new plan under which it may adjust certain higher-level evaluation and management codes based on the encounter criteria in a submitted claim.

Alison Days, MD: “We Can’t Go Back” to COVID’s Worst Days - 08/05/2025

Even as much of the crippling fear from the early days of the COVID-19 pandemic has faded, its impact persists on El Paso pediatrician Alison Days, MD, her city, her county, and her day-to-day. After the pandemic kicked into gear during early 2020, Dr. Days and her staff at Healthy Days Pediatrics started eating lunch apart from each other. With the virus now less of a terrifying mystery, her staff have gone back to keeping each other company at lunchtime. She still hasn’t.

FDA Proposes Transition Plan for Medical Devices Granted COVID Emergency Approval - 08/04/2025

The COVID-19 public health emergency is expected to be extended a ninth time, through at least mid-July. But its eventual end raises questions about the medical devices and therapies used to diagnose and treat COVID that were issued emergency use authorizations on the basis of the federal emergency declaration.

Texas Physicians Reflect on Two Years of Battling COVID-19 - 08/04/2025

Two years ago this week, normal life in Texas stopped. Uncertainty, fear, and anxiety loomed as the new coronavirus, SARS CoV-2, arrived in Texas. Looking back, physicians reflect on the ongoing impact of March 13, 2020, when Gov. Greg Abbott declared a state of emergency due to COVID-19, the disease the virus causes.

Cardiologist Experiences COVID – and Its Ripple Effects - 07/23/2025

Dallas cardiologist Rick Snyder, MD, had already witnessed firsthand many of the big-picture impacts of COVID-19: cases of long COVID, elements of the “Great Resignation,” and of course, the chaos the pandemic brought to just about every medical practice starting two years ago.

TMA Delegates OK Policy on Certain Health Care Disparities, LGBTQ Health Section - 07/17/2025

At an unprecedented live virtual meeting Saturday, the Texas Medical Association House of Delegates took action on a variety of initiatives important to the health of all Texans.

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.

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.

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.   

Panel Makes Big Change in Draft Federal Surprise Billing Law - 03/18/2025

Thanks to incessant lobbying from physicians, hospitals, organized medicine, and the Physicians Advocacy Institute, a key congressional committee today made significant revisions in a bill to reduce the strain of surprise billing on patients. “This certainly sounds like an improvement,” said Texas Medical Association President David Fleeger, MD, “but the devil will be in the details.”

BCBSTX Reprocessing Flu Testing Claims Following Incorrect Denials - 03/03/2025

Blue Cross and Blue Shield of Texas (BCBSTX) is reprocessing certain claims filed between Jan. 1 and Feb. 13, the payer told TMA’s Physician Payment Resource Center. Physicians should continue to review claims to ensure they are correctly reprocessed.

TDI Eases Prior Authorization Request Process for Prescription Renewals - 02/28/2025

After a three-year effort, the Texas Medical Association recently secured a form change that allows physicians to bypass the most onerous part of prior authorization requests when renewing an existing prescription.

TMA Seeks Prior Authorization Reform This Legislative Session - 02/13/2025

The Texas Medical Association (TMA) seeks to cut health insurers’ burdensome delays and denials of patients’ care this legislative session.

Aetna Reverses NPP Payment Reduction Under Incident-To Billing - 02/12/2025

Aetna previously intended to pay nonphysician practitioners (NPPs) 85% of the allowable amount, regardless of whether they billed directly or “incident-to” a physician’s diagnosis and treatment. Meanwhile, the payer upholds a new credentialing requirement.

More Than One in Five Claims Denied in Texas by Non-Group Qualified Health Plans - 02/11/2025

A study of health plans available through HealthCare.gov in 2023 shows one in five claims nationwide were denied – with Texas ranking among the top five states for in-network denials.

Safely Incorporate Remote Patient Monitoring Into Your Practice - 02/07/2025

If you’re considering using telemedicine or remote patient monitoring, the Texas Medical Liability Trust’s (TMLT) Risk Management team has some recommendations to protect you and your practice.

Are You Ready for Telemedicine Prime Time? - 02/07/2025

Like a stage actor who comes across awkward on a television or movie screen, you might find it challenging to connect with your patients during video telehealth visits. Here are some tips to make for five-star video telehealth visit.

Let Your Patients Know You Use Telemedicine - 02/07/2025

To make telemedicine more available, many state and federal rules and regulations regarding telehealth have changed temporarily during the COVID-19 public health emergency, including payments for certain types of visits. That’s all good news if you or your practice is struggling financially because of decreased in-person patient visits. But it doesn’t mean much if your patients don’t know about it.