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Update: TMA Pushes for Compliance With Second Surprise-Billing Win Amid Backlog of Payment Disputes - 03/24/2023

Amid much wrangling with federal regulators, the Texas Medical Association is taking steps to hold them accountable for complying with TMA’s second legal victory nullifying certain rules governing out-of-network payment disputes under the No Surprises Act.

TDI Eases Prior Authorization Request Process for Prescription Renewals - 03/20/2023

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.

Medicine Backs Proposed Medicare Prior Authorization Reforms - 02/24/2023

Physicians caring for Medicare patients soon may find relief from onerous prior authorization requirements that frequently delay, discourage, or drive up the costs of care, thanks to proposed regulations governing Medicare Advantage (Part C) and prescription drug (Part D) plans.

New TMA Lawsuit Challenges Big Fee Hike in “No Surprises Act” Arbitration - 02/10/2023

The Texas Medical Association (TMA) is challenging a 600% hike in administrative fees for seeking federal dispute resolution in No Surprises Act (NSA) situations. TMA seeks relief by filing a fourth lawsuit in the U.S. District Court for the Eastern District of Texas.

UPDATE: TMA Sues Feds – Again – Over Unfair Arbitration Process Under Federal Surprise Billing Rule - 02/10/2023

The Texas Medical Association is back in court – again – to hold federal regulators accountable for implementing a key piece of the No Surprises Act as Congress intended it: to operate an arbitration process that does not skew the dispute resolution process in favor of health plans.

Legislative Priority #9: Network Adequacy, Surprise Billing - 02/10/2023

The Texas Medical Association wants to see enhanced enforcement of and accountability under state network adequacy laws and to protect Texas' surprising-billing law during the 2023 legislative session.

Feds Delay Portion of “Good Faith Estimate” Requirements Under Surprise Billing Law - 02/10/2023

Despite ongoing litigation over certain aspects of the federal surprise billing law, many of the patient protection components of the No Surprises Act still took effect in 2022. However, enforcement of a price transparency measure slated for Jan. 1, 2023, has been delayed indefinitely, giving physician practices more time to prepare.

TMA Seeks to Protect Patients’ Access to Care in New “No Surprises Act” Rules Lawsuit - 02/10/2023

Amid concerns about threats to patients’ access to physicians’ care, the Texas Medical Association has filed a new lawsuit in the U.S. District Court for the Eastern District of Texas, challenging certain portions of the July 2021 interim final rules implementing the federal No Surprises Act. This is the third lawsuit TMA has filed against federal agencies related to rulemaking under the law.

TMA Win on Surprise-Billing Rule Also a Win for Access to Care - 02/10/2023

When the Texas Medical Association scored a win over federal regulators in a Feb. 23 U.S. district court decision, it wasn’t just a victory for physicians. It was a victory for patients, too, cheers Houston emergency physician and TMA Immediate Past President Diana Fite, MD.

Feds Finally Open Dispute Portal Under Surprise-Billing Law - 02/10/2023

Physicians needing to formally settle a dispute with insurers over certain out-of-network payments under the federal No Surprises Act finally can initiate that process online.

Federal Memo Signals Compliance With TMA Court Win – For Now - 02/10/2023

Within days of the Texas Medical Association’s Feb. 23 court victory over federal regulators, the U.S. Department of Health and Human Services (HHS) says it’s taking steps to comply with the court’s decision on rules for the No Surprises Act – even as HHS is “considering next steps” after TMA’s win.

TMA Welcomes U.S. District Court Decision to Grant Its Summary Judgment Motion - 02/10/2023

Statement by Diana L. Fite, MD, Texas Medical Association (TMA) immediate past president, in response to the U.S. District Court for the Eastern District of Texas’ ruling on TMA’s motion for summary judgment in its lawsuit opposing federal regulatory agencies’ dispute resolution approach under the No Surprises Act.

California Model Benefits Insurers, at Physicians’ and Patients’ Expense, Physicians Tell Congress - 02/10/2023

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.

TDI Explains Arbitration Law Process - 02/10/2023

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.

Texas' New Surprise Billing Law: Are You Ready? - 02/10/2023

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.

TMB Pulls Proposed Rule on Surprise Bills - 02/09/2023

The Texas Medical Board has withdrawn its proposed rules to implement pieces of the state’s new law introducing baseball-style arbitration on many out-of-network medical bills. At its meeting Friday, the board pulled down its rule proposal, saying in a statement that it “would not cover all providers under the statute.”

TMA Stands Firmly Against Surprise Medical Billing “Compromise” - 02/09/2023

“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.

TMA Makes Strong Push for Fair Surprise Billing Legislation - 02/09/2023

The Texas Medical Association is urging Texas lawmakers in Washington, D.C., to show their support for federal legislation on surprise medical bills that includes commercially reasonable upfront payments and independent arbitration.

Virtual Meeting to Cover Surprise Billing Laws, TMA Member Benefits - 02/09/2023

But if you want to learn even more about Texas' new suprise billing law, or if you want to find out what’s new with the Lone Star Caucus – which represents your county in the Texas Medical Association’s House of Delegates – tune in to a 30-minute virtual meeting scheduled for noon on Tuesday, Nov. 12.

Have Your Say on Texas’ New Surprise Billing Law - 02/09/2023

The Texas Department of Insurance (TDI) is holding a public hearing next week on rulemaking for the state’s new “baseball-style arbitration” law to address surprise medical bills. If you wish to speak at the meeting, TDI requests you submit written comments or a summary of your testimony by noon Friday, Oct. 18 “to facilitate a meaningful discussion.”

Fix Surprise Billing and You’ll Fix the Need to Report Collections - 02/09/2023

Practicing medicine is our primary focus as we maintain our patient-physician relationships. Physicians do not want to report patients to credit agencies for unpaid accounts. Doing so harms our relationships with our patients. If we are successful in taking patients out of surprise billing scenarios, then credit reporting will no longer be an issue.

Require Network Directory Accuracy - 02/09/2023

The basic product of a health insurance company is a comprehensive facility and physician network for the covered members. Balance billing events most commonly occur when a patient is receiving care at an in-network facility by an out-of network physician. The problem for both patients and physicians is not being able to easily match up the in-network facilities with in-network specialists. While I can find for a given city what physicians are in network, and what facilities are in network, there is no easy or uniform way to cross-reference the in-network facilities with in-network, facility-based physicians who provide services there.

Protecting Patients From Balance Bills - 02/09/2023

The committee substitute will hold harmless patients for expenses beyond their copay, coinsurance. and deductible for all emergency care and situations where a patient may receive a surprise bill for physician services, facility fees or diagnostic testing or imaging, and for special medical services ordered by an in-network physician.

Protect Patients From Inadequate, Narrow Networks - 02/09/2023

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 - 02/09/2023

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