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Talk to Patients About: Varicella - 09/19/2024

The varicella-zoster virus  does double-duty: It can cause chickenpox when you’re young and reactivate later in life as a painful, blistery rash called shingles. Well, there’s a vaccine for each disease.

Talk to Patients About: Rubella - 09/19/2024

The virus that causes rubella often appears deceptively mild — so mild in fact that one-quarter to half of people infected with it will have no symptoms at all, according to the Centers for Disease Control and Prevention (CDC). Vaccination is the best protection.

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.

Talk to Patients About: Breakthrough Infections for COVID-19 Vaccinations - 09/13/2024

 The new mRNA vaccines for COVID-19 are highly effective at giving people immunity against the disease. But as with all other vaccines, that immunity is not 100% for everyone who receives them.  

CMS Ups Seasonal Flu Vaccine Payment - 09/09/2024

On Aug. 1, the Centers for Medicare & Medicaid Services increased payments to physicians for influenza vaccines and updated which codes physicians should use when billing for the service during the 2024-25 flu season.

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.

Beryl-Affected Practices Automatically Eligible for MIPS Hardship Exemption - 08/19/2024

Due to the impact of Hurricane Beryl on Texas physician practices, the Centers for Medicare & Medicaid Services has automatically applied a hardship exemption within the 2024 Merit-Based Incentive Payment System performance period to eligible clinicians in “designated” areas.

2023 MIPS Scores, Feedback Now Available - 08/16/2024

With feedback and final scores for the 2023 performance year of Medicare’s Merit-Based Incentive Payment System now available online, Texas Medical Association experts urge physicians to check their scores soon as they will impact 2025 payment.

Medicine Urges 4 Steps to Reform Medicare Pay - 08/13/2024

In the face of an increasingly unsustainable Medicare physician payment system, hundreds of state and national medical associations collectively exhorted congressional leaders to adopt a four-point reform plan they say can “no longer be delayed without severe repercussions for patient access and quality of care.”

Science: Vaccines Do Not Cause Autism; Physicians Fight to Reassure, Immunize - 08/09/2024

Physicians repeat it over and over: Vaccines like the measles-mumps-rubella (MMR) vaccine do not cause autism; they are safe and effective. Yet the decades-old false claim that vaccines do cause autism has convinced millions of parents not to give their children potentially lifesaving shots and could lead more to opt out, according to Texas physicians.

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.

Long COVID Definition Created to Help Physicians, Patients - 08/01/2024

To better understand and manage “long COVID”, physicians must first be able to define the condition – so far impossible with no set parameters or qualifications. The National Academies of Sciences, Engineering, and Medicine recently moved to rectify that problem as a committee of experts created a consensus definition.

Medicare Proposes Yet Another Physician Pay Cut in 2025 - 07/31/2024

In yet another destabilizing move for physician practices, Medicare on July 10 proposed what amounts to another pay cut for the nation’s physicians in the face of increasing costs, positioning organized medicine for heightened advocacy.

Medicare Premiums, Deductibles to Increase in 2024 - 07/29/2024

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

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.

New Poster Encourages Flu Vaccination Amid COVID-19 - 07/22/2024

“COVID-19 is here, but so is the flu.” That is the message of a new downloadable poster available from the Texas Medical Association’s Be Wise – Immunize program to help you stress the need for flu vaccination, this year more than ever.

TMA Grants to Help Your Practice Improve Local Vaccination Rates - 07/16/2024

Apply for a grant. Vaccines Defend What Matters (formerly Be Wise – Immunize) is TMA’s integrated, multimedia public health education and advocacy effort to overcome vaccine hesitancy and increase vaccination rates in Texas. 

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.  

Innovation for Every Age: Texas Primary Care Physicians Improve Access for Older Patients - 05/06/2024

Texas' population is aging, highlighting the importance of access to high-quality, coordinated primary care that bridges complex systems, various clinicians, and concurrent chronic conditions.

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.