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United Launches National ‘Gold Card’ Program - 09/17/2024

UnitedHealthcare announced the launch of what it’s calling a national “gold card” program, which purports to allow physicians to bypass the prior authorization process and is set to begin Oct. 1.

CHIP COVID-19 Copays Set to Resume in October - 09/12/2024

Physicians can begin collecting copays from Children’s Health Insurance Program members for COVID-19 vaccines, testing, and treatment starting Oct. 1.

BCBSTX to Require E/M Codes for Consultation Services - 09/03/2024

Starting Nov. 18, Blue Cross and Blue Shield of Texas will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology codes 99242 – 99245 and 99252 – 99255.

Aetna to Correct G2211 Payment Disparities - 08/28/2024

Aetna will correct erroneously low payments made to physicians for G2211 claims following Texas Medical Association advocacy during a meeting with the payer Aug. 2.

TMA Applauds Appeals Court’s Ruling in Physicians’, Patients’ Favor - 08/06/2024

Statement by G. Ray Callas, MD, TMA president, in response to the U.S Court of Appeals for the Fifth Circuit’s ruling Friday in TMA’s favor. The court affirmed the district court’s decision in an appeal filed by several federal government agencies to TMA’s earlier victory in a lawsuit challenging certain components of the federal agencies’ final rules governing independent dispute resolution for surprise medical bills under the No Surprises Act. TMA argued the case in December 2022 in the U.S. District Court for the Eastern District of Texas. The district court later ruled in TMA’s favor, prompting the federal government appeal.

UHC Expands EZ Claim Pay Service to Certain Texas Medicare Patients - 07/26/2024

As of July 1, UnitedHealthcare has expanded its EZ Claim Pay service to Texas for Medicare Supplement Plan G patients, and for those patients who enroll, physicians won’t need to bill them directly for their Medicare Part B deductible.

G-Code Payment Frustration Persists With Inconsistent Implementation - 06/25/2024

Deepening ongoing physician concerns over Medicare’s add-on code for complex care, two major payers have either reduced payment for G2211 claims or announced plans to stop paying certain claims associated with the code altogether. Read more.

UHC Postpones Higher Liability Coverage Requirements Plan - 06/20/2024

UnitedHealthCare (UHC) postponed a plan that would require Texas physicians to substantially increase their professional liability insurance coverage in order to participate in its networks. The move comes after the Harris County Medical Society and Texas Medical Association expressed serious concerns about the new policy.

Physicians Must Validate Email to Avoid Medicaid Disenrollment, Payment Delays - 05/29/2024

Texas physicians who care for Medicaid patients should confirm their email address is valid in the Texas Medicaid and Healthcare Partnership’s Provider Enrollment Management System to ensure effective communication and timely payments from the state Medicaid administrator.

TDI Debuts Network Adequacy Waiver Hearings - 05/24/2024

Physicians soon may hear from the Texas Department of Insurance (TDI) regarding public hearings for health plans seeking a network adequacy waiver. The hearings are required under a new state law championed by TMA to address inadequate networks and an overused waiver process. Read more.

New Medicare Advantage Rules Aim to Improve Access, Equity - 05/15/2024

 Medicare Advantage enrollees soon may benefit from expanded access to outpatient behavioral health care and more equitable prior authorization policies.  

Feds Extend Marketplace Special Enrollment Amid Medicaid Unwinding - 04/19/2024

Texas patients who have been disenrolled from Medicaid in the wake of the COVID-19 public health emergency now have more time to find alternative coverage on the federal marketplace. The extension could mitigate a coverage cliff about which the Texas Medical Association has long raised concerns.

New Federal Rules Limit Short-Term Insurance Plans, Enhance Protections - 04/17/2024

Following advocacy by the Texas Medical Association, the U.S. departments of Health and Human Services, Labor, and the Treasury recently issued final rules that strengthen consumer protections related to short term, limited duration insurance.

TMA Pushes for Prior Authorization Limits, Clarity - 04/16/2024

After hearing story after story of delays and denials, the Texas Medical Association is pushing the Texas Legislature to sign off on measures that would significantly curb insurers’ ability to require prior authorization on needed care, as well as clarify for both physicians and patients what it means when prior authorization is required.

Cigna Launches Digital Newsroom for Payer Updates - 04/12/2024

Physicians and practice staff looking for updates from one of Texas’ major payers, Cigna Healthcare, can now refer to the company’s new digital newsroom.

TMA Moment in Time: Texas' First PPO Rules - 04/09/2024

TMA fought to ensure fair regulation of PPOs, which now dominate the health plan market.

Postpartum Coverage Extension Brings Payment Complexities - 04/05/2024

As the 12-month postpartum coverage Texas legislature approved took effect March 1, physicians and their practice staff should take note of subsequent payment complexities, Texas Medical Association experts caution.

TMA to IRS: Direct Primary Care, Health Care-Sharing Ministries Aren’t Insurance - 04/05/2024

The Texas Medical Association is urging the IRS to reconsider a proposed rule that would classify direct primary care (DPC) arrangements and health care-sharing ministries (HSMs) as insurance.

TMA Sues Feds Over Unfair Rule for Surprise Billing Law - 03/22/2024

The Texas Medical Association filed a lawsuit in federal district court in Tyler, Texas, after the Biden administration failed to follow clear direction from Congress about how to implement the dispute resolution process set forth in the No Surprises Act, legislation that was passed in 2020 to protect patients from surprise medical bills.

TDI Proposed Rules for State Network Adequacy Law Raise Strong Concerns - 03/20/2024

After securing network adequacy reform during the 2023 regular state legislative session, the Texas Medical Association has shifted its focus to ensuring the Texas Department of Insurance’s network adequacy rules conform to the plain language and intent of the law.

Power Data: Texas' Claims Database Will Help Clarify Care Costs - 03/15/2024

Texas is building an all-payer claims database, which will provide a clearer view of opaque health care costs.

Medicaid, CHIP Postpartum Coverage Extension Will Take Effect March 1 - 02/08/2024

After a multi-session advocacy effort by the Texas Medical Association, specialty societies, and women’s health advocates, Texans who are enrolled in Medicaid or the Children’s Health Insurance Program and who are pregnant or become pregnant will see their postpartum coverage automatically extended starting March 1.

Spending Growth Rate for Physician Services Slows - 01/09/2024

Although spending on physician and clinical services increased 2.7% year-over-year to $884.9 billion in 2022, the spending growth rate fell, due in part to a slowdown in the use of such services and in physician prices. In comparison, spending on physicians and clinical services grew 5.3% in 2021.

Comprehensive Prior Authorization Reforms Needed, Medicine Tells Feds - 11/30/2023

As the Centers for Medicare & Medicaid Services (CMS) seeks ways to relieve the burdens of prior authorization on health care, it should not rely solely on automation of electronic health records. Instead, CMS should seek comprehensive reforms that include transparent PA requirements and protections of continuity of care as well as automation, the Texas Medical Association, American Medical Association, and a host of other medical societies wrote in a letter to CMS Administrator Seema Verma last week.

On the Mend: Maternal Care Wins Encourage Better Outcomes in Texas - 11/05/2023

Twelve months of postpartum coverage and other maternal wins encourage physicians for better outcomes.