Related Stories

TMA Cheers Appellate Court Ruling in Third NSA Lawsuit - 06/03/2025

Statement by Texas Medical Association (TMA) President Jayesh "Jay" Shah, MD, in response to Friday's order by the U.S. Court of Appeals for the 5th Circuit granting TMA’s petition for rehearing en banc in TMA’s third No Surprises Act (NSA) lawsuit, which vacates the circuit panel’s Oct. 30, 2024 opinion and will result in a hearing by the full panel of judges at a later date.

TMA Forges New Policies on Same-Day Services, Patient Attribution in Value-Based Care - 05/16/2025

The house adopted several other payment-related policies as well, all emerging from ongoing physician frustration with payer practices that hinder patient care.

Insurance Bill Undermining Patient, Physician Protections Heads to House - 05/13/2025

A top target for TMA, House Bill 139 would create a new “employer choice of benefit” health plan exempt from decades’ worth of insurance laws that promise a minimum set of coverage, prompt pay, prior authorization restraints, and other guardrails. Other bad bills with serious consequences for practices also top TMA’s opposition list.

Prior Authorization Fuels Physician Burnout, Decreases Access to Care, AMA Survey Finds - 04/03/2025

Prior authorization continues to intensify physician burnout, increase health care costs, and limit patients’ access to care, per AMA. Meanwhile, TMA advocates against health plans’ use of artificial intelligence in the prior auth process and aims to reduce its burden on physicians.   

Risk Management - 03/20/2025

Practice e-Tips on Risk Management

Panel Makes Big Change in Draft Federal Surprise Billing Law - 03/18/2025

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.”

Practice E-Tips on Legal Topics - 03/17/2025

TMA Practice E-Tips on Legal Topics

BCBSTX Reprocessing Flu Testing Claims Following Incorrect Denials - 03/03/2025

Blue Cross and Blue Shield of Texas (BCBSTX) is reprocessing certain claims filed between Jan. 1 and Feb. 13, the payer told TMA’s Physician Payment Resource Center. Physicians should continue to review claims to ensure they are correctly reprocessed.

TDI Eases Prior Authorization Request Process for Prescription Renewals - 02/28/2025

After a three-year effort, the Texas Medical Association recently secured a form change that allows physicians to bypass the most onerous part of prior authorization requests when renewing an existing prescription.

TMA Seeks Prior Authorization Reform This Legislative Session - 02/13/2025

The Texas Medical Association (TMA) seeks to cut health insurers’ burdensome delays and denials of patients’ care this legislative session.

Aetna Reverses NPP Payment Reduction Under Incident-To Billing - 02/12/2025

Aetna previously intended to pay nonphysician practitioners (NPPs) 85% of the allowable amount, regardless of whether they billed directly or “incident-to” a physician’s diagnosis and treatment. Meanwhile, the payer upholds a new credentialing requirement.

More Than One in Five Claims Denied in Texas by Non-Group Qualified Health Plans - 02/11/2025

A study of health plans available through HealthCare.gov in 2023 shows one in five claims nationwide were denied – with Texas ranking among the top five states for in-network denials.

Fees to Remain Unchanged for Federal Surprise Billing Dispute Resolution - 01/24/2025

The $115 amount, a nonrefundable fee each party in a dispute must pay, represents a significant reduction from what was once a proposed $350 fee that TMA successfully challenged in litigation.

Landmark Antitrust Settlement in BCBS Case Granted Preliminary Approval - 01/09/2025

Physicians can now file a claim in a $2.8 billion settlement fund given preliminary approval by a U.S. District Court involving Blue Cross Blue Shield. The final verdict is expected in July.

Putting the AI in Paid: Payer Use of Artificial Intelligence Sparks Physician Concerns - 12/20/2024

Physicians - worried about payers' increasing use of artificial intelligence to process prior authorization requests, enable value-based care models, and systematically deny coverage - are seeking transparency on behalf of their patients and practices.

Protect Patients From Inadequate, Narrow Networks - 11/18/2024

In an out-of-network surprise billing situation, the patient and the insurer have a contractual agreement. The physician and insurer do not. As a result, when we remove the patient from the claims settlement process, the insurer has little market accountability unless additional statutory protections are created.

TMA Leery of Proposed Balance Billing Law - 11/18/2024

The Texas Medical Association is deeply skeptical of a state senator’s freshly filed effort to prevent physicians from balance billing patients for the services they provide. On Thursday, Sen. Kelly Hancock (R-North Richland Hills) filed Senate Bill 1264, a measure to address surprise out-of-network medical bills. The legislation emerged with no input from the House of Medicine

Patient Care Protected: Prior Authorization Reforms - 11/18/2024

Carrying the torch from last session, the Texas Medical Association followed up on its 2021 gold-card success with a new prior authorization reform for vulnerable patients and other insurance-related policy wins this session.

“Gold Card” Cleanup, Network Adequacy Bills Head to House - 11/18/2024

Building on years of Texas Medical Association advocacy, two House committees cleared a pair of bills that would strengthen existing state laws and regulations by further easing health plans’ onerous prior authorization requirements and strengthening network adequacy protections.

TMA Considers Next Steps in Split Victory Over Payment Calculations in Surprise-Billing Arbitrations - 11/15/2024

After winning half the battle when the federal government dropped its appeal of two major components of the Texas Medical Association’s lawsuit early on, TMA is considering next steps after an appeals court upheld a portion of federal rules governing qualifying payment amount calculations in surprise-billing disputes that medicine says conflict with federal law and unfairly favor health plans.

TMA Joins New Statewide Insurance Reform Coalition - 11/08/2024

The newly created Texas Coalition for Patients calls for “common sense policy reforms” around health insurance, including greater transparency around prior authorizations. TMA leaders say the organization will augment medicine’s related advocacy.

High Court Decision Brings Favorable Wind for Physician Experts - 11/04/2024

The Texas Supreme Court has sided with the Texas Windstorm Insurance Association – and by extension, with medicine – in a case that impacts physicians who testify as expert witnesses in their own defense.

With FTC Rule in Limbo, Texas Legislature to Reconsider Noncompetes - 09/20/2024

Amid a pair of conflicting court rulings – one of which blocked a Federal Trade Commission (FTC) final rule banning most noncompete clauses – the Texas Senate is pondering related legislation for the upcoming session that could impact a significant number of physicians statewide.

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.