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86th Texas Legislature Letters and Testimonies - 10/20/2020

During this legislative session, TMA councils and committees are locking down and promoting health care policies to ensure Texas’ patients have access to affordable and high quality health care. Here are TMA’s testimonies, comments, and letters to state lawmakers.


Texas Leads Nation in Rise in Uninsured Children, Study Shows - 10/15/2020

The number of uninsured children nationwide climbed dramatically in recent years, with the biggest gains by far coming from the Lone Star State, according to a study released last week.


Strengthen Texas' Public Health Capabilities - 10/09/2020

On behalf of TMA, please read comments relating to Interim Charge I. Implementation of new funding and full-time equivalent positions for the Department of State Health Services (DSHS) Vital 2 Statistics Unit; and implementation of DSHS Rider 29; evaluate the capacity of immunization programs to prevent, reduce, and eliminate vaccine preventable diseases in adults and children.


Champions of Medicine: TEXPAC-Endorsed Incumbents Head to November Elections - 10/01/2020

Each election, TEXPAC, the Texas Medical Association’s nonpartisan political arm, throws its support behind candidates who have demonstrated their support for a medicine-friendly agenda.


Blue Cross Prior Authorization Manager Changing - 09/30/2020

Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.


Go Paperless With UHC Document Vault - 09/25/2020

Looking for ways to reduce the amount of paper your practice uses? One way is to digitally receive claim and prior authorization letters for UnitedHealthcare commercial and Medicare patients through UHC’s Document Vault, rather than by mail.


Charging Concierge Fees to BCBSTX Patients - 09/23/2020

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.


Ambetter: New Required Field on CMS-1500 Claim Form - 09/23/2020

Ambetter from Superior HealthPlan, a plan available on the Affordable Care Act health insurance exchange, has changed the status of box 18 on the CMS-1500 claim form from a conditional/optional field to a required one, effective July 1.


Turn to TMA to Resolve Prompt-Pay Issues - 09/23/2020

If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Reimbursement Review and Resolution Service. The Texas Department of Insurance last week released a bulletin reminding plans that a portion of prompt-pay penalties must be paid to the state.


Are You Eligible for “Expedited Credentialing?” - 09/23/2020

If you’re completing health plan credentialing, “expedited credentialing” might apply to you. And if it applies, that could be good for you and your practice. But how do you know if it does?


Didn’t Get Your 5% APM Incentive Payment? Take Action by Nov. 13 - 09/23/2020

If you participated in an advanced alternative payment model (APM) under the 2018 Quality Payment Program (QPP), the Texas Medical Association encourages you to take action now to verify that you have received your 5% APM incentive payment for 2020.


TMA Weighs In On COVID-19 Surprise Billing, Insurance Premiums, and More - 09/09/2020

TMA submitted written testimony Tuesday to the House Committee on Insurance, providing details and recommendations on price gouging, surprise medical bills, health insurance premiums, and more caused by the COVID-19 pandemic.


TMA to IRS: Direct Primary Care, Health Care-Sharing Ministries Aren’t Insurance - 08/19/2020

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.


UnitedHealthcare Phasing Out Paper Checks - 08/03/2020

If you receive claims payments from UnitedHealthcare (UHC) in paper checks, now is the time to enroll in direct deposit. UHC says it will phase out sending paper checks for payments throughout the remainder of 2020


Medicine-Friendly Candidates Prevail in Tuesday’s Runoff Elections - 07/15/2020

Most of the Texas House and Senate candidates backed by TEXPAC won their races in Tuesday’s primary runoff elections and will move on to November’s general election.


Payers Extend Prior Authorization Windows During COVID-19 - 05/19/2020

Commercial payers have temporarily modified prior authorization timelines to help physicians care for patients during the COVID-19 emergency. Here is an overview of some payers’ COVID-19 prior authorization policies.


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.


Which Presidential Candidate Stands for What Again? - 02/24/2020

A group of dedicated Harris County physicians has a cure for “too many candidates confusion disorder.” They compiled a simple table of the candidates’ positions on seven key health care policy issues based on the candidates’ official websites and The Washington Post’s “We’re Asking 2020 Democrats Where They Stand on Key Issues.”


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.


Arbitration Law Will be “Messy,” Bring Operational Concerns, Panelists Say - 01/31/2020

 The state’s new law allowing arbitration of payment disputes on certain out-of-network care carries concerns for physicians and uncertainty about what it will look like from an enforcement standpoint, a panel told the Texas Medical Association Winter Conference on Saturday morning.


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.


Register to Vote by Monday - 01/29/2020

Elections, particularly the spring party primaries, determine the practice environment for Texas physicians and our patients. And election season is upon us. To help elect medicine-friendly candidates in the March primaries, you must be registered to vote by Monday, Feb. 3.