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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.

Risk Management - 08/15/2024

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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.

TMA Wins Appeal Upholding Its Challenge to Skewed Federal Surprise Billing Rule - 08/05/2024

A federal appeals court handed a victory to medicine affirming the district court’s decision to strike down federal provisions that run counter to Congress' intent for implementing a key piece of the No Surprises Act: to operate an arbitration process that does not skew dispute resolutions and unfairly advantage health plans. Read more.

TMA Spotlights Access Threats Posed by No Surprises Act to House Committee - 07/31/2024

Following a recent congressional field hearing on emergency care in rural and underserved communities, the Texas Medical Association emphasized in written comments how federal regulators’ flawed implementation of the No Surprises Act has exacerbated access challenges.

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.

More Work Needed to Protect Texas Physicians - 06/28/2024

Following the Texas Medical Board’s newly adopted rules on abortion ban exceptions, the Texas Medical Association continues its advocacy for physicians performing abortions to treat a medical emergency under the state’s overlapping abortion laws.

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.

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.

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.  

TMB Proposed Rules on Abortion Ban Exceptions Invite TMA Opposition - 05/14/2024

The Texas Medical Board (TMB) recently released proposed rules intended to clarify exceptions to the state’s overlapping abortion laws. But TMA argues the proposal could exacerbate physician confusion, administrative burden on practices, and patient care delays. Read more.

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.

Seeking Balance: TMA Opposes Feds' Implementation of the No Surprises Act - 04/09/2024

The Texas Medical Association supported the patient protections in the federal No Surprises Act but also knew from the beginning that the law's payment arbitration provisions were flawed and could give insurers an advantage.

RICO Settlements: TMA's Leadership Against Payer Abuses Resulted in Relief, Reform - 04/09/2024

Back in 2001, the Texas Medical Association and the other plaintiffs alleged the nation’s major health plans had conspired to delay and reduce payments to clinicians and hospitals; the resulting lawsuits, brought under the federal Racketeer Influenced and Corrupt Organizations Act (RICO), represented a watershed moment in TMA history.

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.

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.

Feds Capitulate to Some of TMA’s NSA Regulatory Challenges Amid Appeal - 03/06/2024

Although federal regulators are appealing a recent court ruling in one of the Texas Medical Association’s four lawsuits regarding their implementation of the No Surprises Act, TMA already can declare a partial victory – via footnote.

Exceptional Circumstances: TMA Advocates “Legislative Clarity” Amid State Abortion Bans - 03/05/2024

TMA advocates “legislative clarity” amid state abortion bans.

New Federal IDR Data Highlight Importance of Ongoing TMA Advocacy - 03/05/2024

Health professionals and facilities are prevailing in most out-of-network payment disputes resolved under the federal No Surprises Act, but the implementation of the law remains flawed, as indicated by a significant backlog of unresolved disputes and other issues.