Medicare

Learn Medicare Payment Updates, Earn CME in Live TMA Webinar - 10/31/2025

TMA’s first live Medicare webinar in six years will also address changes to quality and alternative payment programs, as well as a new pilot testing AI in prior authorization. Register now and submit questions in advance.

Medicare to Test Enhanced Technology Utilization Review in Texas - 10/30/2025

The Wasteful and Inappropriate Service Reduction (WISeR) Model is set to debut in Texas and five other states in January 2026. It would require certain Medicare services to undergo “enhanced technology” review.

Government Shutdown: Medicare Continues to Pay Claims for Unexpired Services - 10/27/2025

As of Oct. 15, “no payments have been delayed,” the Centers for Medicare & Medicaid Services said, clarifying a previous notice suggesting a claims hold. Expired provisions continue to include telehealth services.

Medicare as Secondary Payer - 10/24/2025

Medicare as secondary payer: Submit the primary EOB with paper claims but not with electronic claims.

The X{EPSU} Modifiers Further Define Modifier 59 - 10/24/2025

Modifier 59, the distinct procedural service modifier associated with Medicare National Correct Coding Initiative edits, is one you might find confusing (many practices do). Follow these guidelines

CMS Details New Federal Prior Auth Program in AMA Webinar - 10/15/2025

Join leaders from the Centers for Medicare and Medicaid Services’ (CMS’) Center for Medicare & Medicaid Innovation (CMMI) and the American Medical Association on Oct. 22 at 7 pm CT in discussing the Wasteful and Inappropriate Service Reduction (WISeR) pilot, which will test new prior authorization processes for select services in the Medicare fee-for-service program in Texas and five other states.

TMA Monitors Government Shutdown: What You Need to Know - 10/03/2025

TMA is in regular communication with federal colleagues at the American Medical Association on the impact to physician practices, as AMA remains in touch with senior officials at the Centers for Medicare & Medicaid Services.

New Medicare Payment Complicated by Other Provisions in Proposed Rule - 09/25/2025

Despite a one-time pay increase, newly proposed adjustments in the 2026 Medicare physician fee schedule could offset the reprieve. This tops many issues TMA remarked upon in a lengthy comment letter to federal officials encompassing worrisome changes to certain quality payment programs and telemedicine flexibilities.

Timing for Annual Medicare Mammograms - 09/18/2025

Medicare counts 11 full months after the month in which the patient received her screening

Novitas Clarifies Payment Available for ‘Buildup Phase’ of Allergy Treatments - 09/12/2025

The Medicare administrative contractor confirmed their payment policy at a meeting with TMA. Members should contact the association’s Physician Payment Resource Center if claims denials occur.

Texas Organization Leads Medicare Quality Improvement Program - 08/20/2025

Chronic disease management, behavioral health, and patient safety are among the priorities of a renewed Medicare program led by TMF Health Quality Institute. Prospective participants chosen can receive access to consulting services and resources.

Flood-Impacted Texas Physicians Granted New MIPS EUC Exception - 08/14/2025

In response to severe storms and flooding affecting Texas in July, physicians in impacted counties will receive automatic adjustments to their Merit-Based Incentive Payment System scores. Some physicians will still have the option to report data and receive a corresponding payment adjustment.

Texas Leads National Charge for Medicare Physician Payment Reform - 08/08/2025

The Texas Delegation to the American Medical Association led the charge for more concrete action to achieve comprehensive Medicare physician payment reform , resulting in new AMA policy calling for less “talk” and more “action” to ensure access to care for patients.

CMS Delivers Temporary Bump to Medicare Pay in 2026, Among Sweeping Changes in Proposed Fee Schedule - 07/16/2025

A temporary, one-year 2.5% Medicare payment update across the board reflects requirements Congress approved in its final budget. The proposal also includes, for the first time, two separate conversion factors with slight, albeit permanent, updates aimed at promoting value-based care.

Now is the Time: Texas Delegates to AMA Make a Strong Push for Fixing What Ails Medicare - 06/23/2025

Texas Medical Association members made their voices heard at the American Medical Association’s three-day National Advocacy Conference (NAC), Feb. 10-12, 2025, calling for a long-term Medicare payment fix.

Multiple Choice: How Two APMs Are Contributing to Cost-Conscious Health Care - 06/17/2025

The Medicare Shared Savings Program and ACO REACH program provide physicians with two viable payment models incentivizing better patient care outcomes.

TMA Vigilant of New Medicare Advantage Audits - 06/17/2025

The Centers for Medicare and Medicaid Services has begun what the agency itself calls an “aggressive” new strategy to audit all Medicare Advantage plans annually to review whether insurers and their networks are inflating patients’ illnesses, leading to overpayments – and the additional compliance burdens and possible repayments could fall on physicians.  

Who Can Do the Face-to-Face Encounter for Home Health? - 06/12/2025

Medicare won’t pay home health agencies to care for Medicare patients without a physician’s certification, which must include a face-to-face encounter with the patient. Here’s who can perform that encounter.

MedPAC Calls for Tying Medicare Payment to Inflation with a Permanent Update - 04/22/2025

The agency advising Congress on Medicare issues calls for a physician payment structure tied to the Medical Economic Index, in line with TMA advocacy. The recommendation calls for a permanent payment update in 2026 and beyond.

Medicine Backs New Legislation Halting Latest Medicare Payment Cut - 04/14/2025

Led by physician lawmakers, the proposed legislation would cancel the most recent physician pay cut and provide some extenuating relief for the remainder of the year. TMA recently joined the American Medical Association’s national advocacy conference to take their efforts to lawmakers’ doorsteps in D.C.

CMS Issues New MIPS Hardship, Extension Tied to IV Fluid Shortage - 03/28/2025

The 15-day window opens today, March 31, and comes in response to medicine’s advocacy. TMA encourages affected physicians to document those shortages and the impact on their practices.

UPDATE: Submit 2024 MIPS Data by April 14 to Avoid 9% Pay Cut - 03/28/2025

The data submission period for Medicare’s 2024 Merit-Based Incentive Payment System (MIPS) performance year is underway and closes on April 14 at 7 pm CT. At stake is a pay cut of up to 9% in the 2026 payment year.

Congress Extends Medicare Telehealth Flexibilities for Another Six Months - 03/24/2025

Several pandemic-era Medicare telehealth and payment flexibilities will now last through Sept. 30 following recent action by Congress, including those that waive geographic site restrictions for mental health telemedicine services provided without an in-person visit.

Advancing Primary Care: Medicare Rolls Out New Payment Codes for Treating Chronic Conditions - 03/04/2025

Though the Centers for Medicare & Medicaid Services (CMS) has introduced another acronym into the Medicare mix, some physicians express optimism this particular one could help practices stay viable.   For Greg Fuller,

Without Congressional Action, Medicare Telehealth Waivers Will End March 31 - 02/26/2025

Medicare telehealth waivers previously extended by Congress will expire March 31, meaning Medicare patients will no longer be able to have telemedicine visits while in their home and physicians will again be required to meet with patients in-person before a telemedicine mental health consultation.