Related Stories

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.

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.

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.”

Medicine to Feds: Back Off Prior Authorization Requirements - 08/09/2024

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.

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.

Aetna Scraps Required Prior Auth for Cataract Surgery - 05/15/2024

Organized medicine’s efforts across the nation to torpedo or curb prior authorization recently got a small but encouraging boost when Aetna rescinded its year-old preauthorization requirement for cataract surgeries.

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.

CMS to Test Prior Auth Requirements for Certain ASC Procedures - 04/10/2024

Texas physicians soon may encounter new Medicare prior authorization requirements for certain services that double as cosmetic procedures when provided at an ambulatory surgical center.

Shielding the Gold Card Law: TMA Fights to Guarantee Gold Card is Implemented as Intended - 04/09/2024

Texans earned one of its most prolific victories with its prior auth exemption law but still fights to guarantee it's implemented as intended.

Medicare May Seek Payment Recoupment for 2023 Claims - 04/09/2024

A new report by the Government Accountability Office shows physicians may face possible recoupments – or additional payment – for claims filed in 2023 as a result of over and underpayments by Medicare, Medicaid, and other federal programs.

MedPAC Backs Medicare Physician Payment Increase – Again - 03/26/2024

Echoing advocacy by the Texas Medical Association and others in organized medicine, the Medicare Payment Advisory Commission recently reupped its recommendation that Congress increase Medicare physician payment by tying such payment to inflation, among other factors.

Congress Mitigates 2024 Medicare Physician Pay Cut - 03/21/2024

Congress recently passed legislation halving the 3.4% Medicare physician pay cut that took effect on Jan. 1, 2024, following a months-long, high-pressure advocacy campaign by the Texas Medical Association, the American Medical Association, and others in organized medicine. But TMA and its allies continue to push for additional reform given that any cut threatens physicians’ practice viability and vulnerable patients’ access to care.

Cyberattack Prompts CMS to Extend 2023 MIPS Flexibilities - 03/19/2024

The Centers for Medicare & Medicaid Services recently announced two flexibilities related to Medicare’s Merit-Based Incentive Payment System 2023 performance year, citing the recent cyberattack on Change Healthcare and heeding advocacy by organized medicine.

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’ Response to Cyberattack Aids Physicians, But Further Measures Needed - 03/14/2024

Eligible physician practices and others impacted by the recent cyberattack on Change Healthcare now may apply for accelerated and advanced payments for certain Medicare and Medicaid claims.

Medicare to Debut “Stay of Enrollment” Status for Physicians, Others - 03/13/2024

Medicare soon will introduce a “stay of enrollment” status for physicians and others enrolled in the federal program, despite pushback from the Texas Medical Association.

Physicians May Face Lower Payment as CMS Resumes Lab Data Collection - 03/11/2024

The Centers for Medicare & Medicaid Services will continue to collect data from physician-owned laboratories to inform private payer rates despite pushback from the Texas Medical Association.

Middle Ground: Medicare Offers Options Amid Shift to Value-Based Care - 03/05/2024

Physicians are divided on the issue of value-based care, but, with Medicare forging ahead, the Texas Medical Association is focused on monitoring the development of alternative payment models, educating members about their options, and advocating for physician protections.

Medicine’s MIPS Win: 2024 Medicare Physician Fee Schedule Stabilizes Program - 03/05/2024

The Centers for Medicare & Medicaid Services yielded to the Texas Medical Association’s concerns about its proposal and the impact of constant changes to MIPS on its participants.

Senate Moves Toward Medicare Pay Fix - 02/28/2024

After hundreds of physician leaders from across the country, including Texas, gathered in Washington, D.C., in mid-February, U.S. senators appear to be moving toward a Medicare pay fix alongside House efforts.

Medicare Cuts Forcing Doctors Out - 02/27/2024

A 3.37% cut in Medicare physician pay is scheduled to hit on Jan. 1, 2024 [Editor's note: The cut took effect]. That’s on top of the 2% cut that took effect earlier this year and other compounding cuts over the years. In total, inflation-adjusted physician Medicare pay has fallen 26% since 2001. Medicare physician pay cuts are forcing some physicians out of the program.

Prior Auth Processes to Streamline Under Medicare Advantage, Other Federal Programs - 01/23/2024

Physicians who care for patients enrolled in federal health plans can expect shorter prior authorization response times and other process improvements in coming years, thanks to longstanding advocacy by the Texas Medical Association and others in organized medicine.