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PBM Consolidation Concerns Medicine for Impacts on Drug Costs, Access - 03/03/2026

Low competition in the pharmacy benefit manager (PBM) market may drive higher costs with savings not fully passed to consumers. Medicine is vigilant as state and federal legislators have started addressing the entities’ evolving role.

Network Adequacy Enforcement Paused for State-Regulated PPOs and EPOs - 02/23/2026

A dispute between the Texas Department of Insurance and Texas Association of Health Plans has reopened rulemaking connected to a 2023 network adequacy law. TMA, which supported that law’s passage, will weigh in on the process.

More Than $3.3 Million Recovered for TMA Practices in 2025 - 02/13/2026

The Physician Payment Resource Center works for physician members with Medicare, Medicaid, major private payers, and other health plans to help address issues that lead to lost revenue from claim payments.

Patients Can Now Pay Some Direct Primary Care Expenses with Health Savings Account Funds - 02/05/2026

Patients who see physicians in direct primary care medical practices can now use their health savings account funds to pay their associated membership fees, because of new federal regulations that took effect in early 2026.

Here’s Your 2026 Billing and Coding Checklist - 01/16/2026

TMA’s Physician Payment Resource Center works year-round with member physicians and health plans to resolve certain insurance payment issues. They suggest these practical actions you can take at the start of 2026 to keep your billing and collections on track throughout the year.

One Insurance Company Holds Majority Share of Texas Market, Per AMA Study - 01/14/2026

Increasing insurance consolidation negatively impacts both physicians and patients, according to the American Medical Association, making advocacy crucial.

Direct Payment Model Available to All Texas Physicians Under New State Law - 12/30/2025

House Bill 541, now in effect, replaces the “direct primary care” nomenclature from a TMA-backed 2015 law with the more inclusive “direct patient care.” In a typical direct care model, patients pay a monthly fee, and in return, receive services like office visits and in-office procedures without involving insurance.

Cigna Clarifies Terms, Conditions of Its High-Level E/M Downcoding Policy - 12/30/2025

In communication with TMA, Cigna confirmed its policy will not apply to all physicians and those subject to it can request to be removed from the review process under certain circumstances. Nevertheless, the limited scope of the “exemption” could still represent a significant operational and financial challenge for some practices.

Texas Can’t Afford for Congress to Let ACA Tax Credits Expire - 12/08/2025

Lawmakers must realize what’s at stake by not firming up a deal that keeps the credits in place: higher health care costs, poorer health outcomes and further destabilization of our health system. This opinion-editorial first appeared in the Austin American-Statesman on Dec. 4, 2025.

2025 Legislative Wrap-Up: Amid Bad Insurance Bills Defeated, Gold Card Law Refinements Close Gaps - 12/08/2025

House Bill 3812 addresses some of the shortfalls and inconsistencies among payers in the intended implementation of Texas’ landmark prior authorization exemption law. The law took effect Sept. 1 but additional rulemaking by the Texas Department of Insurance is likely.    

Legislators Can Request Health Insurance Mandate Analysis Via New State Law - 11/18/2025

Though the filed version of the bill would have heavily favored insurance companies, TMA successfully worked to add data transparency provisions to promote a comprehensive and unbiased analysis. Lawmakers also focused on price transparency bills affecting how facilities can bill patients for services.

When Should We Write Off Large Patient Balances? - 11/12/2025

Is there a formula to calculate the net present value for the balance of a patient’s account compared with a small monthly payoff?

Collection Agency Submittal Do’s and Don’ts - 11/11/2025

Your collection agency has a better shot at success in collecting your past-due accounts if you follow tips for submitting accounts to the agency.

Value-Based Care Extended to Texas PPO, EPO Health Plans for Primary Care Physicians - 10/20/2025

The new state law authorizes primary care physicians to enter into value-based care (VBC) payment arrangements with state-regulated PPOs and EPOs, if they choose to. The new law includes several guardrails TMA advocated for that seek to promote fair dealing in VBC negotiations.

Should You Bill This Visit as “Incident to”? - 10/16/2025

A physician hires a nonphysician practitioner and establishes a standing delegation order for a specific course of treatment. … Read the rest of the scenario. Can you answer the billing question correctly?

Federal Changes Allow Payment for Direct Primary Care Via Health Savings Accounts - 09/29/2025

The new law permits patients to use health savings account funds for direct primary care membership fees, provided the arrangement meets certain federal requirements.

Physicians Brace for Expiration of ACA Tax Credits, Uninsured Fallout - 09/25/2025

An estimated 1.3 million Texans could lose coverage due to the combined effects of Affordable Care Act marketplace changes under OBBBA and the expiration of the enhanced premium tax credits at the end of this year. “Physicians are definitely going to feel the effects.”

Four Bill-Collecting Tips for New (or Any) Practices - 09/16/2025

Starting a practice can be daunting, and one challenge often overlooked is making sure you get paid. Although only a small number of patients will not pay you, or will pay slowly, they can hurt your bottom line. Writing off thousands of dollars in charges should not be an option.

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.

Cigna Downcoding Policy Threatens Payment; TMA Urges Repeal - 08/18/2025

The payer announced a new plan under which it may adjust certain higher-level evaluation and management codes based on the encounter criteria in a submitted claim.

How to Improve Patient Debt Collection Practices - 08/06/2025

TMA staff remind physicians that securing insurance information from patients before seeing them is a crucial first step in obtaining payment. They also offer advice on involving office staff and accountants in the process.

VA Seeking Refunds from Physicians for Past CHAMPVA Claims - 06/26/2025

Physicians may soon hear from the U.S. Department of Veterans Affairs (VA) seeking refunds for payments it says were made in error. TMA has provided information on what steps physicians may take.

TMA Cheers Appellate Court Ruling in Third NSA Lawsuit - 06/03/2025

Statement by Texas Medical Association (TMA) President Jayesh "Jay" Shah, MD, in response to Friday's order by the U.S. Court of Appeals for the 5th Circuit granting TMA’s petition for rehearing en banc in TMA’s third No Surprises Act (NSA) lawsuit, which vacates the circuit panel’s Oct. 30, 2024 opinion and will result in a hearing by the full panel of judges at a later date.

TMA Forges New Policies on Same-Day Services, Patient Attribution in Value-Based Care - 05/16/2025

The house adopted several other payment-related policies as well, all emerging from ongoing physician frustration with payer practices that hinder patient care.

Insurance Bill Undermining Patient, Physician Protections Heads to House - 05/13/2025

A top target for TMA, House Bill 139 would create a new “employer choice of benefit” health plan exempt from decades’ worth of insurance laws that promise a minimum set of coverage, prompt pay, prior authorization restraints, and other guardrails. Other bad bills with serious consequences for practices also top TMA’s opposition list.