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How Practice Owners Can Control Health Insurance Costs During Open Enrollment - 11/13/2019

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.


Open Enrollment 2020: Be Prepared for Coverage Changes - 11/13/2019

You’re probably already aware that open enrollment for commercial health insurance plans, including those on the Affordable Care Act Exchanges, opened Nov. 1 and will run through Dec. 15. While some patients won’t make any changes to their coverage, others will make significant changes, including enrolling with a completely different health plan.


The Uninsured in Texas Quick Links - 11/13/2019

The Uninsured in Texas Quick Links


Texas’ Rise in Uninsured Kids Among Fastest in Nation, Report Says - 11/13/2019

The bad news keeps coming for Texas’ uninsured rate. Between 2016 and 2018, Texas tied for the second-highest jump in the rate of uninsured children among all 50 states, according to a study released Wednesday by Georgetown University's Center for Children and Families in Washington, D.C.


Get Details About Your 5% Medicare Bonus - 11/05/2019

If you participated in the advanced alternative payment model (APM) track during the 2017 Quality Payment Program (QPP) performance year, full details of your 5% APM incentive payment are finally available.


Take Steps To Improve Health Care Access Throughout Texas - 11/01/2019

If you’re looking for a way to let state lawmakers know why health care coverage matters to all Texans, join or start a block walk during #SickOfItTX’s Weekend of Action for Health Care on Nov. 9 and 10. Walks are currently scheduled in Austin, Dallas, Galveston, Houston, McAllen, and San Antonio; more sites may be added, or you can host your own.


Texas' High Rate of Uninsured Hurting the Economy, Study Says - 10/30/2019

Texas has the highest percentage and number of people without health insurance in the United States, which could cause long-term damage to the state’s economy, says a study released this week by the Texas Alliance for Health Care.


Medicine to Congress: Don’t Give Health Plans More Leverage - 10/24/2019

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.


Gender-Neutral Insurance Rates = Big Savings for Women Physicians - 10/17/2019

To help Texas Medical Association members get the income protection they need, the exclusive TMA Member Long Term Disability Plan, issued by The Prudential Insurance Company of America, uses group rates that are based on age, not gender. Female physicians will find these gender-neutral group rates significantly less expensive than most individual disability plans available in Texas. 


Beyond the Slogan “Medicare for All” - 10/03/2019

Medicare For All is becoming popular among Democratic lawmakers and the public. But, as popular as the concept is, the details are lost in the simple slogan of “Medicare for All.”


System Failure: Houston Practices Fight WellCare for Payment - 09/26/2019

Several Houston-area practices say a botched technology conversion by insurer WellCare after it acquired a Medicare Advantage plan led to prior authorization and network confusion, undue denials, and unpaid claims by the barrelful.


Comprehensive Prior Authorization Reforms Needed, Medicine Tells Feds - 09/25/2019

As the Centers for Medicare & Medicaid Services (CMS) seeks ways to relieve the burdens of prior authorization on health care, it should not rely solely on automation of electronic health records. Instead, CMS should seek comprehensive reforms that include transparent PA requirements and protections of continuity of care as well as automation, the Texas Medical Association, American Medical Association, and a host of other medical societies wrote in a letter to CMS Administrator Seema Verma last week.


Send TMA Your Prior Auth Nightmare Stories - 09/18/2019

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.


An Insurance Company Auditor Tried to Destroy My Career - 09/16/2019

It didn’t matter that the charges against me were ludicrous. The potential consequences were only too real, and potentially catastrophic. Had the State Medical Board decided against me, I could have lost my license. I hired a lawyer, sinking more than $8,000 into legal fees. I was cleared by a unanimous committee vote. But other physicians facing similar situations may not be as lucky.


Are You Eligible for “Expedited Credentialing?” - 08/28/2019

If you’re completing health plan credentialing, “expedited credentialing” might apply to you. And if it applies, that could be good for you and your practice. But how do you know if it does?


Tell Congress: Protect Patients, Not Health Plans - 08/16/2019

Our U.S. senators and representatives are back home in Texas for the August recess, and Texas Medical Association President David Fleeger, MD, says their physician-constituents need to contact them to make sure they stop the surprise medical billing epidemic in a way that helps our patients – not big insurance companies.


Payers Axe Consultation Codes - 08/07/2019

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.


Out in the Cold: Health Plan Blamed For Major Prompt-Pay Mess - 08/02/2019

Molina Healthcare of Texas isn’t the only insurer to give physicians prompt-pay problems, and it won’t be the last. Some of the practices trying to recover payments blame not just the health plan, but also the extended response time from the state regulator overseeing insurance products and conduct: the Texas Department of Insurance, which says it’s hiring staff and making other changes to improve that response.


Insurance: Network Solutions - 08/02/2019

Charting Medicine’s Statehouse Progress TMA went into this session looking to attack insurer network inadequacy and health plans’ use of care impeding prior authorization demands. On both fronts, medicine scored solid legislative wins that will make it


TMA President: Rulemaking on Surprise Billing Must Be Fair to Docs - 07/31/2019

Now that the Texas Legislature has passed a measure to counteract surprise billing involving many state-regulated plans, it’s time for rulemaking. The Texas Medical Association is working to make sure the Texas Department of Insurance’s eventual rules borne out of Senate Bill 1264 will give physicians a fair shake.


Turn to TMA to Resolve Prompt-Pay Issues - 07/22/2019

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 Hassle Factor Log program. 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.


Panel Makes Big Change in Draft Federal Surprise Billing Law - 07/17/2019

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.”


TMA Pushes to End Surprise Bills – The Right Way - 07/10/2019

TMA’s chief lobbyist is working Capitol Hill this week to pass a bill that spares patients the pain of surprise bills but doesn’t give health insurance companies complete control over what it pays physicians who treat patients out of network.


Health Care is Difficult to Afford, More Than Half of Texans Say - 07/02/2019

Health care is the toughest living expense for most Texans to afford, and many skip or postpone tests, medications, and basic procedures because of the cost. And that very well could be bad for their health, especially for the millions who lack insurance. Those are the findings of a statewide poll on the affordability of and access to health care in Texas published last month by the Episcopal Health Foundation.


TMA: No Government Price Controls for Out-of-Network Billing Disputes - 06/25/2019

The government shouldn’t set the fees physicians are paid for out-of-network care. That’s the message the Texas Medical Association is sending to key members of the U.S. Senate as lawmakers consider a troubling federal bill.