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California Model Benefits Insurers, at Physicians’ and Patients’ Expense, Physicians Tell Congress - 02/11/2020

Texas Medical Association physician leaders, along with their colleagues from California and the rest of the country, are on Capitol Hill this week, lobbying Congress to toss out a California-inspired provision from a rapidly moving health insurance bill.


UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent - 02/05/2020

If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a nonemergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.


A Plan for the Uninsured in Texas - 02/05/2020

I call for our TMA to bring all of these groups together to directly address the issue of the uninsured in Texas, to plan a strategy, and to put it in motion.


Arbitration Law Will be “Messy,” Bring Operational Concerns, Panelists Say - 01/31/2020

 The state’s new law allowing arbitration of payment disputes on certain out-of-network care carries concerns for physicians and uncertainty about what it will look like from an enforcement standpoint, a panel told the Texas Medical Association Winter Conference on Saturday morning.


Send TMA Your Prior Auth Nightmare Stories - 01/31/2020

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.


Insurance Companies Have Denied My Doctor’s Orders, 25% of Texas Voters Say - 01/29/2020

One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.


Register to Vote by Monday - 01/29/2020

Elections, particularly the spring party primaries, determine the practice environment for Texas physicians and our patients. And election season is upon us. To help elect medicine-friendly candidates in the March primaries, you must be registered to vote by Monday, Feb. 3.


Texas' New Surprise Billing Law: Are You Ready? - 01/29/2020

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.


TDI Explains Arbitration Law Process - 01/28/2020

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 - 01/28/2020

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.


New House Committee Takes on Health Care Costs - 12/16/2019

Two physician legislators will serve on a newly created House Select Committee on Statewide Health Care Costs during the Texas Legislature’s interim year in 2020. The committee will examine the “primary drivers of increased health care costs in Texas.  


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.


Social Media A Vital Tool for Influencing Policy, Panel Says - 12/13/2019

Social media has become indispensable for politicians to reach voters, but it's also a crucial way for voters – like physicians – to influence decision-makers and public opinion, a panel of state representatives and social media consultants said at the Texas Medical Association's Advocacy Retreat on Saturday.


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.


Texas Medicine Issues First Endorsements for 2020 - 12/11/2019

Gearing up for the 2020 primary elections, the political action arm of the Texas Medical Association endorsed one candidate seeking an open seat in the Texas Senate and three running for open Texas House seats.


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.


House Will Study Behavioral Health, Early Childhood Intervention, and More - 12/02/2019

Among a number of health care-related topics, the Texas House of Representatives during the interim “off” year in 2020 will study the state’s behavioral health system, child trafficking prevention, and the effect of technology and “big data” on insurance. House Speaker Dennis Bonnen (R-Angleton) released the chamber’s interim charges last week.


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.