Related Stories

TMA Spotlights Access Threats Posed by No Surprises Act to House Committee - 04/17/2024

Following a recent congressional field hearing on emergency care in rural and underserved communities, the Texas Medical Association emphasized in written comments how federal regulators’ flawed implementation of the No Surprises Act has exacerbated access challenges.

Seeking Balance: TMA Opposes Feds' Implementation of the No Surprises Act - 04/09/2024

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.

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 Capitulate to Some of TMA’s NSA Regulatory Challenges Amid Appeal - 03/06/2024

Although federal regulators are appealing a recent court ruling in one of the Texas Medical Association’s four lawsuits regarding their implementation of the No Surprises Act, TMA already can declare a partial victory – via footnote.

New Federal IDR Data Highlight Importance of Ongoing TMA Advocacy - 03/05/2024

Health professionals and facilities are prevailing in most out-of-network payment disputes resolved under the federal No Surprises Act, but the implementation of the law remains flawed, as indicated by a significant backlog of unresolved disputes and other issues.

Extensions to End for Dispute Resolution Process Under No Surprises Act - 03/01/2024

After courtroom advocacy by the Texas Medical Association, physicians seeking to resolve out-of-network billing disputes under the No Surprises Act (NSA) received extensions of certain deadlines within the federal independent dispute resolution process. However, all currently applicable extensions will end March 14.

Revenue Cycle Assessment - 01/22/2024

A TMA consultant will conduct a review of your business office operations that focuses on front desk procedures, billing, collections and revenue cycle improvement. We will identify opportunities for improvement of billing processes and procedures.

Practice Operations Services - 01/22/2024

With the many challenges that face today's medical practices, business operations remain at the core of a practice's ability to be successful and profitable. Work with a TMA practice management consultant to identify and assess key or problematic areas of your practice.

Financial Management Services - 01/22/2024

Having sound financial policies and processes can help your practice attain a steady cash flow, maintain healthy collection ratios, increase staff efficiencies, and boost your overall bottom line.

Feds Propose Dispute Resolution Changes Under No Surprises Act - 01/22/2024

Heeding physician concerns about logistics and fairness, federal regulators recently proposed a series of changes to the independent dispute resolution process through which clinicians can dispute health plans’ initial payment for certain out-of-network care under the No Surprises Act.

Your Billing and Collections Checklist for 2024 - 12/19/2023

TMA’s Reimbursement Services staff work year-round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2024 to keep your billing and collections on track throughout the year.

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.

Bipartisan Legislation Would Prohibit Electronic Funds Transfer Fees - 12/08/2023

Recently introduced federal legislation could spare physicians from electronic funds transfer (EFT) fees, which payers routinely charge as a condition of electronic payment.

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.

CMS Strengthens Price Transparency for Hospitals - 11/29/2023

A new Centers for Medicare & Medicaid Services final rule aims to strengthen hospital price transparency regulations for 2024, a move physicians hope will address weaknesses in prior policy that hindered them and patients from making informed health care decisions.

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 Pushes for Elimination of Excessive Electronic Funds Transfer Fees - 09/22/2023

Payers routinely charge physicians the fees as a condition of electronic payment, often without consent. Alongside declining physician payment, the fees add to the threat to practice viability, and ultimately patients’ access to care. Read more.

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.

Here’s What Medicare Pays for Flu Shots This Season - 08/23/2023

The Centers for Medicare & Medicaid Services recently published 2019-20 payment rates for personal flu vaccines and their administration. The effective dates for these rates are Aug. 1, 2019, to July 31, 2020.

Is Medicare’s Chronic Care Management Program for You? - 08/21/2023

Interested in the possibility of getting paid as much as $75,000, or even more, for something you already more or less do? Medicare now pays separately for chronic care management services. To help you decide if this new opportunity is right for your practice, TMA created a new online resource center.

Don’t Forfeit Your APM Incentive Payment; Act Now - 08/14/2023

If you participated in an advanced alternative payment model in the 2021 Quality Payment Program and haven’t yet received your 2023 incentive payment, you have until Sept. 1 to update your billing information – or forfeit the payment.

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.