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CMS Announces Latest Scores for Quality Payment Program - 06/23/2025

The Medicare Quality Payment Program will award a slightly higher percentage of positive payment adjustments in 2025 compared to 2024. However, the maximum will be considerably lower than last year’s.

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.

Preview Your Medicare Clinician Profile Through June 25 - 05/29/2025

Physicians participating in the Quality Payment Program will see their 2023 performance scores showcased on two publicly accessible websites. One of those will also feature star ratings in up to 17 categories including preventive health and patient safety.

CMS Suspends Eight MIPS Improvement Activities, Announces 2025 Exception Applications Process - 05/23/2025

The Centers for Medicare & Medicaid Services leaves 96 of the 104 traditional improvement activities available to physicians using the Merit-Based Incentive Payment System. It also indicated that physicians who have completed or are in the midst of completing any of the eight suspended activities can still use them this year.

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.   

UPDATE: Submit 2024 MIPS Data by April 14 to Avoid 9% Pay Cut - 03/28/2025

The data submission period for Medicare’s 2024 Merit-Based Incentive Payment System (MIPS) performance year is underway and closes on April 14 at 7 pm CT. At stake is a pay cut of up to 9% in the 2026 payment year.

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.”

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.

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 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.

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.

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.

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.