Surprise Billing

Feds Extend Dispute Resolution Timelines Under No Surprises Act - 12/08/2023

As a byproduct of ongoing advocacy by the Texas Medical Association, physicians seeking to resolve out-of-network billing disputes under the flawed No Surprises Act may receive certain extensions through mid-January.

Seeking Balance: TMA Opposes Feds' Implementation of the No Surprises Act - 12/04/2023

The Texas Medical Association supported the patient protections in the federal No Surprises Act but also knew from the beginning that the law's payment arbitration provisions were flawed and could give insurers an advantage.

Misdirected: Health Plan Directories See Damaging Gaps Awaiting Final Rules - 12/04/2023

Health plan directories see damaging gaps while awaiting No Surprises Act final directory rules – and accountability.

No Surprises Act Arbitrations Resume for Some Claims - 10/11/2023

The Centers for Medicare & Medicaid Services has reopened the independent dispute resolution portal for new single and bundled – but not batched – claims, following decisions in TMA’s third and fourth lawsuits. The agency also announced certain deadline and enforcement extensions.

U.S. House Committee Spotlights TMA Leadership on Surprise-Billing Rules - 10/11/2023

As members of the U.S. House Committee on Ways & Means delved into the flawed implementation of the federal No Surprises Act in a recent hearing, discussion – and commendation – turned several times to the Texas Medical Association’s leadership on the topic.

TMA Wins Two More Surprise Billing Lawsuits; CMS Suspends Arbitrations - 10/03/2023

Marking a fourth victory for the Texas Medical Association in as many lawsuits, a court on Aug. 24 struck down a large portion of the regulations setting forth a methodology insurers use to calculate the qualifying payment amount, or QPA, used in surprise-billing disputes – part of a series of federal rules TMA has long argued skew the arbitration process in insurers’ favor.

TMA Wins Fourth Lawsuit Challenging Payment Calculations in Surprise Billing Arbitration - 08/28/2023

Marking a fourth victory for the Texas Medical Association in as many lawsuits, a court struck down a large portion of the regulations setting forth a methodology insurers use to calculate the qualifying payment amount, or QPA, used in surprise-billing disputes – part of a series of federal rules TMA has long argued skew the arbitration process in insurers’ favor.

Court Delivers TMA Win Against Fee Hike, Batching in Surprise Billing Arbitration - 08/10/2023

The court struck down a 600% administrative fee increase and certain unfair rules that narrowed the law’s provisions on combining or “batching” surprise-billing arbitration claims. The decision is one of several victories TMA has won against federal regulators tasked with implementing the federal No Surprises Act.

TMA Opposes Congressional Proposal to Cap Office-Based Physician Pay - 08/07/2023

A recently filed federal bill would recycle a controversial formula that TMA has waged several lawsuits against in the federal surprise billing regulatory context to limit payments for health care services furnished in physician offices.

New TMA Lawsuit Challenges Big Fee Hike in “No Surprises Act” Arbitration - 08/04/2023

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.

TMA Offers Remedies to Ease Surprise Billing - 06/28/2023

Texas patients sometimes feel the pain from unexpected out-of-pocket costs not covered by their health insurance, known as “surprise billing” or “balance billing.” The Texas Medical Association (TMA) is taking aim at the problem, which occurs when a health insurance company pays less than what a doctor charges, leaving the patient to pay the balance of the bill.

Physician-Led Results: Network Adequacy and Protecting Texas’ Surprise-Billing Law - 06/22/2023

Physicians’ ongoing struggles with health plan contracting galvanized TMA to champion network adequacy reform at the Texas Capitol. The regular session wrapped up with the unanimous passage of House Bill 3359, which cements the state’s network adequacy rules and strengthens insurers’ accountability under them.

TMA Reups Opposition to “Broad, Sweeping” Scope Creep in Federal Legislation - 06/07/2023

Organized medicine raised concerns about the Improving Care and Access to Nurses, or “I CAN,” Act in a letter to U.S. House leaders. The federal legislation would expand nonphysician practitioners’ scope of practice in treating Medicare and Medicaid patients. Read more.

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.

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.

No Surprises Act Includes Directory Update Requirement - 02/10/2023

In addition to resolving payment disputes over out-of-network medical care, the federal No Surprises Act aims to make sure health plans’ practitioner directories stay up to date, and part of that aim puts an onus on physicians.

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.

Learn About Surprise-Billing Law’s “Good Faith Estimates” - 02/10/2023

Federal authorities have released a frequently asked questions (FAQ) document on providing “good faith estimates,” included as part of the federal No Surprises Act geared toward curbing surprise medical bills.

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.

Surprise Billing Rules Garner More Legal Action - 02/10/2023

Pressure is mounting on federal authorities with several legal actions now aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.