TMA Develops Toolkit to Help You Challenge Unfair Rankings

Physician ranking (also known as physician tiering) has traditionally been a profiling methodology used by private insurance companies to steer patients toward lower-cost physicians. Many insurers are increasingly offering incentives for patients to chose physicians deemed as providing lower-cost, and some plans award bonuses to doctors who are deemed “low cost.” Similarly, the health care reform legislation promotes “value-based purchasing,” which would rely on some classification system to analyze physicians’ costs and determine who spends relatively less than their peers while delivering the same quality of care.

TMA staff has developed the following two page guide to appealing a health plan ranking or tiering based off HB 1888 which passed in the 2009 Texas Legislative Session. Physicians should use this information in developing their appeal to a health plan if they disagree with their ranking or tiering status.

Physician Ranking (Physician Tiering, Clinical Effectiveness) main page

Last Updated On

May 13, 2016

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