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Help Patients Make Wise Choices About Treatment Options - 07/20/2023

Tools are emerging to help physicians overcome the time constraints that can preempt discussions with patients.

Quality Improvement: Practice Awards and Free Webinars - 07/20/2023

TMA, the Texas Osteopathic Medical Association (TOMA), and the TMF Health Quality Institute are collaborating again to provide the Physician Practice Quality Improvement Award program. The award formally recognizes physician practices for their dedication and commitment to providing high-quality patient care and improving outcomes.

Driving the Quality Train: TMA Physicians Lead the Way, From Measures to Standardization - 07/10/2023

In a proactive effort to resolve physician complaints, TMA and its members are deeply involved in quality issues, from participating in the development of new measures to pushing payers for standardized quality programs and supporting physicians who are curious about value-based care.

Texas Physicians Push to Improve Health Care for LGBTQ Patients - 06/28/2023

Lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) patients face unique barriers that put them at greater risk for mental and physical health problems. Often, their health disparities result from a lack of family support, public prejudice, and fear of the health care system. Texas physicians have launched a new workgroup and are adapting their practices to treat this underserved population.

TMF Offers Resources to Navigate CMS Requirements - 05/16/2023

TMF has launched three physician-focused networks designed to save time, improve patient care, and reduce costs associated with meeting these requirements. These programs, focused on immunizations, behavioral health and value-based improvements, are designed to help physicians benefit from—and not be penalized by—these mandates.

Which Health Insurers Currently Rank Physicians? - 10/20/2022

Aetna, Blue Cross Blue Shield of Texas, Cigna, and UnitedHealth are among the plans currently ranking Texas physicians on cost and/or quality of care.

TMA Develops Toolkit to Help You Challenge Unfair Rankings - 10/18/2022

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.”

UnitedHealthcare Eliminates Copay Costs on Insulin, Other Life-Saving Medications - 08/05/2022

Some patients struggling with the cost of medications like insulin and epinephrine just got a small-but-important break from one of the nation’s largest health insurers.

Biden Administration to Launch Specialty Payment Model - 07/27/2022

A new, voluntary Medicare payment model option focused on cancer care opens the value-based care door wider for specialists at a time when such models have been limited.

United Walks Back Payment Cut on Nonphysician Billing - 08/05/2021

Following strong pushback from the Texas Medical Association, UnitedHealthcare (UHC) has effectively reversed its payment-cutting policy change on “incident-to” billing for services performed by nonphysician practitioners (NPPs). 

UnitedHealthcare Waives Cost Sharing, Extends Telemedicine for Certain Plans - 06/16/2021

UnitedHealthcare is waiving cost sharing for Medicare Advantage plan members for primary care services, and has extended access to in-network and out-of-network telemedicine visits, including COVID-19 testing and treatment, until Dec. 31 for most of its plans.

Did You Subscribe to UHC’s Premium Payment Program? Check By March 31 - 03/29/2021

TMA reminds practices that now is a good time to determine whether you are enrolled in UnitedHealthcare’s (UHC) Optum Pay Premium program, which charges a fee for access to certain electronic data. Physicians and practices who wish to opt out of the program should do so by March 31.

The Customer Is Always Right? Patient-Reported Outcome Measures Have Fans and Detractors - 01/26/2021

For too long, some doctors say measures of a physician’s quality of care have been about process: the average length of a patient stay, for example, or a patient’s readmission rate. The bottom line is results, and that’s why a shift to patient-reported outcome (PRO) measures is necessary. However, even proponents of PRO measures note that collecting the information from patients for those metrics places burdens on physicians, and some remain skeptical of bonuses and penalties tied to a measure that derives from a subjective factor: what patients think.

Troubling Trend: Texas’ 2018 QPP Data Contains More Bad Signs - 01/05/2021

As the Centers for Medicare & Medicaid Services continues to churn out glowing data annually on its Quality Payment Program (QPP), a full picture of the program’s impact eludes the agency’s reporting. According to the Texas Medical Association’s analysis of state-level data in the 2018 QPP Experience Report, it’s clear that small practices continue to feel most of the program’s punitive pressures.

UHC Postpones Higher Liability Coverage Requirements Plan - 12/11/2020

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.

Revised UnitedHealthcare E&M, Prior Auth Procedures to Take Effect Jan. 1 - 12/09/2020

The Texas Medical Association’s reimbursement specialists want to be sure you see the following items in the UnitedHealthcare (UHC) December bulletin.

Collecting Payment for Noncovered Services - 10/15/2020

Can you charge a patient for a service the patient’s health insurance plan doesn’t cover? Answer: It depends.

TMA Calls Governor’s Plan “Prudent and Careful” - 04/27/2020

Statement by Texas Medical Association (TMA) President David C. Fleeger, MD, in response to Texas Gov. Greg Abbott’s announcement that Texas hospitals now need to reserve only 15% of their capacity for COVID-19 patients.

UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent - 02/05/2020

If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a nonemergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.

United Healthcare Cuts Consults - 09/04/2019

United Healthcare is eliminating payment for consults in two phases – one that took effect June 1 for certain services, and their complete elimination starting in October. The change is an effort to align with the Centers for Medicare & Medicaid Services policy that eliminated payment for most consults in 2010, but it’s going to make it more difficult for many specialists to get compensated for the extra time and work those services require.

Quality Care Pilot Takes Flight - 09/03/2019

How one children's clinic uses a targeted program to dramatically improve care, lower costs.

Faulty Guidelines - 06/03/2019

Former Texas Medical Association President Josie Williams, MD, was tenacious in advocating that organized medicine pay zealous attention to two topics: data and guidelines. In this, she was both sage and prescient. We have done well in following her recommendations on data, but we continue to fall far short of where we need to be on guidelines.

New UnitedHealthcare Automated Services Can Save You Time - 11/13/2018

UnitedHealthcare says it has made it easier for you to submit records, have claims paid sooner, and access pharmacy benefit information.

United to Add Lab, Change Lab and Other Policies - 10/04/2018

Starting Jan. 1, 2019, UnitedHealthcare will use Quest Diagnostics, in addition to LabCorp, as in-network laboratories for all UHC members (excluding existing lab capitation agreements).

United Makes Changes to After-Hours Policies - 06/28/2018

Here's some news you can use from UnitedHealthcare.