Transparency

Insurance Companies Have Denied My Doctor’s Orders, 25% of Texas Voters Say in New Poll - 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.

Plans Should Inform Patients of Network Status When Requiring PA - 03/25/2019

When a patient is preauthorized to receive a health care service scheduled at a facility, the health plan should use the information submitted on the standardized prior authorization form to inform the patient of the network status of any physicians or health care providers who may be involved in the preauthorized health care. It also should be used to educate the patient on what level of coverage the health plan will provide and what the patient’s financial responsibility will be to all physicians and providers.

Bring Transparency to Prior Authorization - 03/25/2019

Insurance companies need to stop creating hurdles to maintaining the patient-physician relationship. Unquestionably, prior authorization is a significant hurdle. HB 2327 would not eliminate this hurdle altogether for all physicians and patients, but it would make the prior authorization process easier to navigate and make health plans more accountable for the processes they put in place.

Understanding Limitations on Price Transparency - 05/09/2018

Information and education for patients on the health care coverage they are purchasing is critical to proper decisionmaking when seeking health care. For physicians, providing price transparency is complicated by individual patients’ health needs, avoiding delays in care or treatment, and overly burdensome administrative procedures that take time away from our ability to treat our patients. 

Law Sheds Light on Industry Payments to Physicians - 04/17/2018

Later this year under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services will make public physician payments reported by manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs.

CMS to Enforce Payment Transparency Law - 04/17/2018

The Centers for Medicare & Medicaid Services (CMS) will explain the provisions of the National Physician Payment Transparency Act, also known as the Open Payments Act or Sunshine Act, in a teleconference at 1:30 pm CDT on Wednesday, May 22. The act is part of the Patient Protection and Affordable Care Act and requires manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs to annually report payments and items of value they give physicians and teaching hospitals.

Reform Medicaid Vendor Drug Program - 03/30/2017

Increasing physician participation in Medicaid is a high priority for our organizations. Medicaid is critically important to 4 million low-income Texans, who rely on it to obtain preventive, primary, specialty and behavioral health care.Medicaid administrative simplification must be a high priority. Of particular concern is reforming the Medicaid Vendor Drug Program, which vexes physicians, patients and pharmacists with its bureaucracy and complexity. Physicians do not understand it. Patients do not understand it. The complexity creates red tape and administrative costs for physicians, but more importantly, frequently delays patients from getting the prescription drugs they need.

TMA Testimony: SB 1731 Implementation and Price Transparency - 12/20/2016

TMA knows there is interest in the business community for “transparency” and there is increasing patient interest in regard to charges as more of the financial cost through high premiums and narrow networks is placed upon them by benefit plan design.  As you can tell from the survey we conducted, physicians attempt to meet patients’ information needs – and the market demands for transparency - in a variety of ways.  However, as there have been proposals for a law mandating disclosures, some of which had the possibility of staggering penalties, TMA began an effort to explore enhancing the current transparency framework established in SB 1731 without adding undue administrative burdens or stifling innovation in how services are delivered.

Out in the Open - 05/13/2016

In February, Medicare for the first time added quality data to Physician Compare with the goal of helping patients make informed health care choices. The addition comes at a time of heightened interest in transparency, and this year the website includes quality information for certain large group practices and accountable care organizations. The Centers for Medicare & Medicaid Services plans to phase in more measures and make quality data public for all Medicare physicians in the coming years.

Lifting the Veil - 05/13/2016

As governments and employers look for ways to curb growing health care costs, and as patients bear a higher share of their medical bills, policymakers in Texas and beyond increasingly target physicians in their efforts to unveil health care prices. They couch such "price transparency" as a way to help patients make more informed health care decisions. But Texas Medical Association's Board of Trustees member Gary W. Floyd, MD, of Fort Worth, cautions that for a complex health care payment system, coupled with individual patients' complex needs, coming up with a so-called "sticker price" is not as simple as it seems.

Sunshine Act Physician Registration Process Has Begun - 05/12/2016

Later this year under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services will make public physician payments reported by manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs.

Sunshine Act Review and Dispute Period Now Open - 05/12/2016

CMS announced today that the Open Payments system is once again available for physicians and teaching hospitals to register, review and, as needed, dispute financial payment information received from health care manufacturers. The system was taken offline on August 3 to resolve a technical issue. To account for system down time, CMS is extending the time for physicians and teaching hospitals to review their records to September 8, 2014. The public website will be available on September 30, 2014.