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Feds Extend Marketplace Special Enrollment Amid Medicaid Unwinding - 04/19/2024

Texas patients who have been disenrolled from Medicaid in the wake of the COVID-19 public health emergency now have more time to find alternative coverage on the federal marketplace. The extension could mitigate a coverage cliff about which the Texas Medical Association has long raised concerns.

New Federal Rules Limit Short-Term Insurance Plans, Enhance Protections - 04/17/2024

Following advocacy by the Texas Medical Association, the U.S. departments of Health and Human Services, Labor, and the Treasury recently issued final rules that strengthen consumer protections related to short term, limited duration insurance.

TMA Pushes for Prior Authorization Limits, Clarity - 04/16/2024

After hearing story after story of delays and denials, the Texas Medical Association is pushing the Texas Legislature to sign off on measures that would significantly curb insurers’ ability to require prior authorization on needed care, as well as clarify for both physicians and patients what it means when prior authorization is required.

Cigna Launches Digital Newsroom for Payer Updates - 04/12/2024

Physicians and practice staff looking for updates from one of Texas’ major payers, Cigna Healthcare, can now refer to the company’s new digital newsroom.

TMA Grants to Help Your Practice Improve Local Vaccination Rates - 04/11/2024

Apply for a grant. Vaccines Defend What Matters (formerly Be Wise – Immunize) is TMA’s integrated, multimedia public health education and advocacy effort to overcome vaccine hesitancy and increase vaccination rates in Texas. 

TMA Moment in Time: Texas' First PPO Rules - 04/09/2024

TMA fought to ensure fair regulation of PPOs, which now dominate the health plan market.

Medicare May Seek Payment Recoupment for 2023 Claims - 04/09/2024

A new report by the Government Accountability Office shows physicians may face possible recoupments – or additional payment – for claims filed in 2023 as a result of over and underpayments by Medicare, Medicaid, and other federal programs.

Postpartum Coverage Extension Brings Payment Complexities - 04/05/2024

As the 12-month postpartum coverage Texas legislature approved took effect March 1, physicians and their practice staff should take note of subsequent payment complexities, Texas Medical Association experts caution.

TMA to IRS: Direct Primary Care, Health Care-Sharing Ministries Aren’t Insurance - 04/05/2024

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.

TMA Vaccination Grants Connect Hard-to-Reach Patients; Apply by May 1 - 03/28/2024

Dozens of patients in the Lubbock area are up to date on their vaccinations thanks to a local impact grant from the Texas Medical Association, which has opened the latest 2024 application cycle for vaccine outreach programs until May 1.

Mumps: Virus Causes Puffy Cheeks and Sometimes, Serious Complications - 03/27/2024

The bottom line: Mumps is a viral contagious disease. People know mumps for patients’ swollen cheeks and jaw, but patients also suffer fever, headache, muscle aches, tiredness, and loss of appetite. Outbreaks occur every year in the United States and Texas. The MMR vaccine protects people against this disease.

MedPAC Backs Medicare Physician Payment Increase – Again - 03/26/2024

Echoing advocacy by the Texas Medical Association and others in organized medicine, the Medicare Payment Advisory Commission recently reupped its recommendation that Congress increase Medicare physician payment by tying such payment to inflation, among other factors.

TMA Scholarship Cultivates a Diverse Workforce; Apply by May 31 - 03/25/2024

Are you sharing in the excitement of someone who's just been accepted to medical school?

TMA Sues Feds Over Unfair Rule for Surprise Billing Law - 03/22/2024

The Texas Medical Association filed a lawsuit in federal district court in Tyler, Texas, after the Biden administration failed to follow clear direction from Congress about how to implement the dispute resolution process set forth in the No Surprises Act, legislation that was passed in 2020 to protect patients from surprise medical bills.

Congress Mitigates 2024 Medicare Physician Pay Cut - 03/21/2024

Congress recently passed legislation halving the 3.4% Medicare physician pay cut that took effect on Jan. 1, 2024, following a months-long, high-pressure advocacy campaign by the Texas Medical Association, the American Medical Association, and others in organized medicine. But TMA and its allies continue to push for additional reform given that any cut threatens physicians’ practice viability and vulnerable patients’ access to care.

TDI Proposed Rules for State Network Adequacy Law Raise Strong Concerns - 03/20/2024

After securing network adequacy reform during the 2023 regular state legislative session, the Texas Medical Association has shifted its focus to ensuring the Texas Department of Insurance’s network adequacy rules conform to the plain language and intent of the law.

Cyberattack Prompts CMS to Extend 2023 MIPS Flexibilities - 03/19/2024

The Centers for Medicare & Medicaid Services recently announced two flexibilities related to Medicare’s Merit-Based Incentive Payment System 2023 performance year, citing the recent cyberattack on Change Healthcare and heeding advocacy by organized medicine.

Power Data: Texas' Claims Database Will Help Clarify Care Costs - 03/15/2024

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

Medicare Sunsets Beleaguered Appropriate Use Criteria Program - 03/14/2024

After longstanding opposition from the Texas Medical Association and others, the Centers for Medicare & Medicaid Services finally nixed the appropriate use criteria program for advanced diagnostic services as part of the 2024 Medicare physician fee schedule.

Feds’ Response to Cyberattack Aids Physicians, But Further Measures Needed - 03/14/2024

Eligible physician practices and others impacted by the recent cyberattack on Change Healthcare now may apply for accelerated and advanced payments for certain Medicare and Medicaid claims.

Medicare to Debut “Stay of Enrollment” Status for Physicians, Others - 03/13/2024

Medicare soon will introduce a “stay of enrollment” status for physicians and others enrolled in the federal program, despite pushback from the Texas Medical Association.

Physicians May Face Lower Payment as CMS Resumes Lab Data Collection - 03/11/2024

The Centers for Medicare & Medicaid Services will continue to collect data from physician-owned laboratories to inform private payer rates despite pushback from the Texas Medical Association.

Middle Ground: Medicare Offers Options Amid Shift to Value-Based Care - 03/05/2024

Physicians are divided on the issue of value-based care, but, with Medicare forging ahead, the Texas Medical Association is focused on monitoring the development of alternative payment models, educating members about their options, and advocating for physician protections.

Medicine’s MIPS Win: 2024 Medicare Physician Fee Schedule Stabilizes Program - 03/05/2024

The Centers for Medicare & Medicaid Services yielded to the Texas Medical Association’s concerns about its proposal and the impact of constant changes to MIPS on its participants.

Senate Moves Toward Medicare Pay Fix - 02/28/2024

After hundreds of physician leaders from across the country, including Texas, gathered in Washington, D.C., in mid-February, U.S. senators appear to be moving toward a Medicare pay fix alongside House efforts.