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United Launches National ‘Gold Card’ Program - 09/17/2024

UnitedHealthcare announced the launch of what it’s calling a national “gold card” program, which purports to allow physicians to bypass the prior authorization process and is set to begin Oct. 1.

BCBSTX to Require E/M Codes for Consultation Services - 09/03/2024

Starting Nov. 18, Blue Cross and Blue Shield of Texas will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology codes 99242 – 99245 and 99252 – 99255.

Ask “Dr. ChatGPT”: What Physicians Should Know About AI - 08/28/2024

Health care adviser Harvey Castro, MD, details what physicians should know about artificial intelligence.

Aetna to Correct G2211 Payment Disparities - 08/28/2024

Aetna will correct erroneously low payments made to physicians for G2211 claims following Texas Medical Association advocacy during a meeting with the payer Aug. 2.

TMA Presses Feds to Ensure Medical Database Is Peer-Reviewed, Evidence-Based - 08/08/2024

As the federal government tries to hone the future of its “actionable medical knowledge” database, the Texas Medical Association is urging officials to ensure the tool offers meaningful, evidence-based information to physicians, including with the evolution of artificial intelligence.

TMA Applauds Appeals Court’s Ruling in Physicians’, Patients’ Favor - 08/06/2024

Statement by G. Ray Callas, MD, TMA president, in response to the U.S Court of Appeals for the Fifth Circuit’s ruling Friday in TMA’s favor. The court affirmed the district court’s decision in an appeal filed by several federal government agencies to TMA’s earlier victory in a lawsuit challenging certain components of the federal agencies’ final rules governing independent dispute resolution for surprise medical bills under the No Surprises Act. TMA argued the case in December 2022 in the U.S. District Court for the Eastern District of Texas. The district court later ruled in TMA’s favor, prompting the federal government appeal.

HHS Establishes Information-Blocking Disincentives for Clinicians - 08/01/2024

The U.S. Department of Health and Human Services released a final rule that aims to hold health care professionals, including physicians, accountable for information blocking as determined by the HHS Office of Inspector General.

UHC Expands EZ Claim Pay Service to Certain Texas Medicare Patients - 07/26/2024

As of July 1, UnitedHealthcare has expanded its EZ Claim Pay service to Texas for Medicare Supplement Plan G patients, and for those patients who enroll, physicians won’t need to bill them directly for their Medicare Part B deductible.

Physicians Can Delegate Breach Notifications to Change Healthcare Following Cyberattack - 06/26/2024

The U.S. Department of Health and Human Services’ Office of Civil Rights announced  May 31 that covered entities – such as health plans, health care clearinghouses, and physicians – affected by privacy breaches stemming from the February cyberattack on Change Healthcare and its parent corporation UnitedHealth Group may delegate breach notifications to both companies.

G-Code Payment Frustration Persists With Inconsistent Implementation - 06/25/2024

Deepening ongoing physician concerns over Medicare’s add-on code for complex care, two major payers have either reduced payment for G2211 claims or announced plans to stop paying certain claims associated with the code altogether. Read more.

FTC Mandates Vendors Notify Patients of Breaches in Health Information - 06/24/2024

The Federal Trade Commission has amended its Health Breach Notification Rule to require vendors of personal health records and related entities not covered by HIPAA to notify individuals, the FTC, and, at times, the media, when a breach in protected health information occurs. The change will take effect July 29.

UHC Postpones Higher Liability Coverage Requirements Plan - 06/20/2024

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.

Wanted: AI Experts for TMA Committee - 06/05/2024

As augmented and artificial intelligence dominate headlines, the Texas Medical Association is looking to ensure physicians’ interests are represented and protected.

Virtual Vigilance: Robust Cybersecurity Can Safeguard Practices - 06/04/2024

System blackouts. Ransom notes. Lost revenue. Compromised patient care. Once straight from physicians’ nightmares, these threats are now reality for their practices as cyberattacks infiltrate health care. The more medical practices and health care organizations fall victim to ransomware cyberattacks, the more important it becomes to prevent them.

CMS Adds Cyberattack Option to MIPS Hardship Exemption - 05/30/2024

The option has been added to the Extreme and Uncontrollable Circumstances application. That portal is now open, and physicians have until Dec. 31 to file a hardship application and avoid a 2026 negative payment adjustment in the Merit-based Incentive Payment System. Read more.

TDI Debuts Network Adequacy Waiver Hearings - 05/24/2024

Physicians soon may hear from the Texas Department of Insurance (TDI) regarding public hearings for health plans seeking a network adequacy waiver. The hearings are required under a new state law championed by TMA to address inadequate networks and an overused waiver process. Read more.

New Medicare Advantage Rules Aim to Improve Access, Equity - 05/15/2024

 Medicare Advantage enrollees soon may benefit from expanded access to outpatient behavioral health care and more equitable prior authorization policies.  

ChatGPT Adviser Harvey Castro, MD, Shares AI Insights at TexMed - 05/09/2024

As a Dallas emergency physician, Harvey Castro, MD, began experimenting with ChatGPT – an artificial intelligence chatbot trained on data from the internet to generate human-like responses to text prompts – in November 2022 after asking himself what he’d “want from AI in a hospital setting.”

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 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.

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 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.

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.