Related Stories

How Health Plans Are Covering COVID-19 Testing and Treatment - 03/31/2020

Many health insurers in Texas are waiving patient costs associated with COVID-19. Last week in a news release, Gov. Greg Abbott and the Texas Department of Insurance asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention guidance, and telemedicine visits.


Seeking a Measure of Reason: TMA Joins Collaborative to Standardize Quality Metrics - 03/31/2020

TMA joins collaborative seeking to identify and standardize quality metrics.


Going Nowhere: APM Committee Resignations Cast Doubt on Payment Models' Future - 03/31/2020

Resignations from HHS advisory committee cast doubt on future of physician-created alternative payment models.


CMS Postpones 2019 MIPS Reporting Deadline to April 30 - 03/23/2020

With a key deadline for clinicians in the Merit-Based Incentive Payment System approaching fast amid the COVID-19 pandemic, the Centers for Medicare & Medicaid Services is giving those clinicians a month of extra time to submit their data.


TDI Fines Blue Cross $10 Million for Delays, Errors - 03/11/2020

Blue Cross and Blue Shield of Texas will pay a $10 million fine for providing consumers incorrect information, delays in out-of-network claims processing, and errors in marketing materials, the Texas Department of Insurance has announced.


Submit 2019 QPP Data by March 31 to Avoid a 7% Medicare Payment Cut - 03/02/2020

The data submission period for Medicare’s 2019 Quality Payment Program (QPP) is under way and closes on March 31. If you haven’t started the process, now is the time to ensure your data for the Merit-Based Incentive Payment System (MIPS) is in order and submit it in time to make corrections by the deadline, if needed.


TPHC Praises Bill to Make State College Campuses and Offices Tobacco-Free - 02/20/2020

Statement by Eduardo Sanchez, MD, chair of the Texas Public Health Coalition and former Texas commissioner of health, in support of legislation filed to make Texas state college campuses and state agencies tobacco-free.


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.


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.


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.


Supporting Fair APM Payments: AMA Backs Accounting for Social Determinants of Health - 01/02/2020

Alternative payment models (APMs) are considered a key part of the future of value-based care. But for them to be successful, the American Medical Association says, APMs need to be fair, which means adjusting for the circumstances that make physicians’ cost and care challenges unique.


An Unfair Game: Quality Payment Program Rules Still Stacked Against Physicians - 01/02/2020

What the Quality Payment Program (QPP) lacks in simplicity, it makes up for in deck-stacking. After three years of physician participation, Medicare’s quality program to drive value-based care continues to generate confusion, frustration, and worry that it’s only going to swallow up more physicians in its complex and financially punitive gameplay.


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.


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.


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.


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.