After a pandemic-induced hiatus, the Texas Medical Association recently resumed in-person meetings with Texas’ major payers to solve physicians’ payment policy problems, a practice that dates back more than 25 years.
Gary J. Sheppard, MD, in his capacity as chair of TMA’s Council on Socioeconomics, leads the meetings, which continued over phone and Zoom between 2019 and 2023. The Houston internist says TMA relies on member physicians’ reports of payment-related issues – through the association’s Reimbursement, Review and Resolution (RRR) Service, Practice Management and Consulting Services, internal governance, and legislative and regulatory advocacy processes – to inform its agenda.
“It gives you a really great view of what’s going on across the state,” he told Texas Medicine Today. “Sometimes, the payers don’t realize there’s a problem.”
In addition to Dr. Sheppard, TMA is represented by staff experts.
Robert Bennett, TMA’s vice president of medical economics, says the meetings play a critical role in the association’s ability to alleviate Texas physicians’ administrative burden and to improve Texas patients’ access to care. They also present an opportunity for payers to provide feedback to TMA and its member physicians.
“TMA strives to have strong relationships with all public and private payers,” he said. “Meeting with these five payers builds those relationships and allows us to communicate issues that are important to TMA members.”
For instance, TMA’s free RRR Service helps member physicians resolve payment problems, surfacing trends and repeat offenders. Last year, the service recovered more than $2.3 million in payment.
Carra Benson, TMA’s director of reimbursement services, has participated in these meetings for more than a decade. She says payers have similar issues for which they are eager to find solutions.
“It’s really [about]: How can we help each other?” she said. “How can we help them get their message out, and how can they help us help our members?”
Since April, TMA has met with three payers – Aetna, Humana, and United – and discussed a broad range of topics, including:
- Open and closed network status;
- Value-based care market share and attribution processes;
- Quality measurement standards;
- Post-pandemic telehealth payment policies;
- Incident-to billing policies; and
- Medical records requests and other administrative burdens.
Mr. Bennett says certain similarities have emerged, with each of the three payers:
- Recommending the code simulator Availity to reduce billing issues;
- Providing resources for physician practices; and
- Offering to work with TMA’s RRR Service.
The meetings also offer a chance for dialogue. During the meeting with Humana representatives, Dr. Sheppard suggested payers include covered urgent care facilities on members’ identification cards, like they do for preferred pharmacies, to cut down on surprise costs.
He says patient feedback spurred this suggestion and that he relishes the chance to be a voice for patients during such meetings, especially since patients often feel disempowered when dealing with payers.
“As physicians, we are the patients’ advocate,” he said. “It’s another way you take care of your patients.”
TMA plans to meet with Blue Cross and Blue Shield of Texas, Inc. and Cigna this fall and to continue in-person meetings with all five major payers moving forward.
TMA member physicians can report payment issues by submitting a Reimbursement Services Request for Information form.