Medicare

Medicare Sunsets Beleaguered Appropriate Use Criteria Program - 03/14/2024

After longstanding opposition from the Texas Medical Association and others, the Centers for Medicare & Medicaid Services finally nixed the appropriate use criteria program for advanced diagnostic services as part of the 2024 Medicare physician fee schedule.


Feds’ Response to Cyberattack Aids Physicians, But Further Measures Needed - 03/14/2024

Eligible physician practices and others impacted by the recent cyberattack on Change Healthcare now may apply for accelerated and advanced payments for certain Medicare and Medicaid claims.


Medicare to Debut “Stay of Enrollment” Status for Physicians, Others - 03/13/2024

Medicare soon will introduce a “stay of enrollment” status for physicians and others enrolled in the federal program, despite pushback from the Texas Medical Association.


Submit 2023 MIPS Data by April 15 to Avoid Medicare Pay Cut - 03/12/2024

The data submission period for Medicare’s Merit-Based Incentive Payment System 2023 performance year is underway and closes April 15 at 7 pm CT. At stake is a pay cut of up to 9% in the 2025 payment year.


Congress Mitigates 2024 Medicare Physician Pay Cut - 03/12/2024

Congress recently passed legislation halving the 3.4% Medicare physician pay cut that took effect on Jan. 1, 2024, following a months-long, high-pressure advocacy campaign by the Texas Medical Association, the American Medical Association, and others in organized medicine. But TMA and its allies continue to push for additional reform given that any cut threatens physicians’ practice viability and vulnerable patients’ access to care.


Physicians May Face Lower Payment as CMS Resumes Lab Data Collection - 03/11/2024

The Centers for Medicare & Medicaid Services will continue to collect data from physician-owned laboratories to inform private payer rates despite pushback from the Texas Medical Association.


Middle Ground: Medicare Offers Options Amid Shift to Value-Based Care - 03/05/2024

Physicians are divided on the issue of value-based care, but, with Medicare forging ahead, the Texas Medical Association is focused on monitoring the development of alternative payment models, educating members about their options, and advocating for physician protections.


Medicine’s MIPS Win: 2024 Medicare Physician Fee Schedule Stabilizes Program - 03/05/2024

The Centers for Medicare & Medicaid Services yielded to the Texas Medical Association’s concerns about its proposal and the impact of constant changes to MIPS on its participants.


Senate Moves Toward Medicare Pay Fix - 02/28/2024

After hundreds of physician leaders from across the country, including Texas, gathered in Washington, D.C., in mid-February, U.S. senators appear to be moving toward a Medicare pay fix alongside House efforts.


Congress’ Failure to Stop Medicare Payment Cut Frustrates, Threatens Texas Physicians, Patients - 02/27/2024

"Congress failed patients and the physicians who care for them" when it failed to stop a 3.37% Medicare physician payment cut in the measure that averted the latest government shutdown on Jan. 19. So says TMA President Rick Snyder, MD, in reaction to the "extremely disappointing" news. Physicians and patients across Texas already are feeling the sting, and TMA will not let up in its efforts to protect them.


Medicare Cuts Forcing Doctors Out - 02/27/2024

A 3.37% cut in Medicare physician pay is scheduled to hit on Jan. 1, 2024 [Editor's note: The cut took effect]. That’s on top of the 2% cut that took effect earlier this year and other compounding cuts over the years. In total, inflation-adjusted physician Medicare pay has fallen 26% since 2001. Medicare physician pay cuts are forcing some physicians out of the program.


Medicare Toolkit Social Media Graphics - 01/12/2024

Once again, physicians face cuts to their Medicare payments in 2024, stinging practices trying to stay viable and care for the most vulnerable patients. The Texas Medical Association strongly urges Congress to find permanent, sensible solutions to the Medicare physician payment system.  


Medicare Payment Crisis Forces Rural Practice Closure - 01/04/2024

If Congress does not act by the end of the year to stop the impending Medicare physician payment cut, many practices will be forced to reduce available health care services, cut office hours, or even forgo treating Medicare patients altogether, organized medicine has warned over and over in its months-long advocacy campaign.


CMS Introduces Electronic Documentation Submission Tool - 01/02/2024

The Centers for Medicare & Medicaid Services (CMS) has developed a free service to help physician practices of varying sizes and documentation workloads upload and submit medical documents, including prior authorization requests, electronically.


Enroll As an Ordering or Referring Physician to Avoid Claims Denials - 12/15/2023

Physicians must enroll, at minimum, as an ordering or referring physician to provide Medicare patients with services or prescriptions. Failing to enroll may lead to denials on claims and services.


Add-On Payment Code for Complex Visits to Start in 2024 - 12/08/2023

Beginning in January, physicians will be able to receive more accurate payment for complex visits with Medicare add-on code G2211. But the Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.


How to File a Medicare Extended Repayment Plan - 12/06/2023

  Extended repayment plans (ERPs) are an option for returning overpaid money to Medicare. Ideally, you should request an ERP immediately after receiving the initial demand letter. However, you can request an extended payment plan any time while the overpayment is outstanding. 


Reminder: Apply for 2023 MIPS Hardship Exemption by Jan. 2 - 11/28/2023

Physicians eligible to participate in Medicare’s Merit-Based Incentive Payment System may be spared a steep financial penalty, continuing a trend seen throughout the COVID-19 pandemic.


CMS Releases 2024 Medicare Advantage and Part D Plan Ratings - 11/13/2023

Medicare patients and the physicians who care for them now have more information to guide their choice of plan in 2024.


Final 2024 Medicare Fee Schedule Solidifies Pay Cuts, Heightens Calls for Reform - 11/13/2023

Now that it’s been finalized, the 2024 Medicare physician fee schedule has solidified yet another pay cut, set for Jan. 1, 2024, underscoring calls for Medicare physician payment reform from physician advocates and lawmakers who’ve recently convened in federal hearings on the topic.


Medicare Premiums, Deductibles to Increase in 2024 - 10/27/2023

Medicare patients will be paying more for their coverage in 2024, which will impact how much co-pay practices collect.


CMS to Implement Street Medicine Code - 10/25/2023

Following advocacy from the Texas Medical Association and medical student members, the Centers for Medicare & Medicaid Services (CMS) created a place of service code for street medicine, making it possible for physicians to get paid for services provided to people who are currently unhoused effective Oct. 1.


Government Shutdown Could Delay Medicare Claims Payments, Reform - 10/18/2023

The looming federal government shutdown would have ramifications for physicians across the country as well as for desperately needed Medicare physician payment reform.


First-Ever MIPS Penalties Surface; Share Your Story With TMA - 10/16/2023

Given recent changes to Medicare’s Merit-Based Incentive Payment System (MIPS) and an ongoing push for Medicare physician payment reform, the Texas Medical Association encourages member physicians who participate in MIPS to closely review their final scores for the 2022 performance year.


Code Carefully for Bilateral Procedures - 10/04/2023

Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.