Medicare

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.

Medicare Payment Cuts Drive Physician Shortage, TMA Tells AARP - 02/24/2025

After an AARP Bulletin article connected the current physician shortage to a wider health care crisis, TMA joined the Physicians Advocacy Institute to co-author a response focusing on the role that Medicare payment cuts play.

Medicine Backs New Legislation Halting Latest Medicare Payment Cut - 02/18/2025

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.

Check Eligibility for Medicare Bonus Following Annual HPSA Update - 01/28/2025

Physicians, including psychiatrists, can receive a 10% quarterly bonus from CMS for providing primary care or mental health services to Medicare patients in qualifying areas, with some important distinctions on services rendered.

Congress Extends Medicare Telehealth Waivers, Payment for Audio-Only Visits - 01/10/2025

With telehealth extensions granted under the American Relief Act, TMA has updated its telehealth waiver chart to reflect these temporary changes that allow physicians to provide telemedicine mental health services without conducting an in-person patient visit. The flexibilities were extended through March.

Congress Averts Shutdown, Still Cuts Medicare Payment for 2025 - 01/06/2025

The American Relief Act of 2025, signed into law by President Biden Saturday morning, will extend funding for the government until mid-March. Congress was unable to include several of the Texas Medical Association’s federal goals as the new piece of legislation will not avert the 2.8% cut in Medicare physician payments that will start on Jan. 1, 2025.

Medicare Premiums, Deductibles to Increase in 2025 - 11/12/2024

Medicare patients will be paying more for their coverage in 2025, which will impact how much co-pay practices collect. The rise in patient costs comes at a time when Medicare physician payments still decline and payments to hospitals and other Medicare entities increase.

Feds’ Response to Cyberattack Aids Physicians, But Further Measures Needed - 11/07/2024

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 Social Media Graphics - 11/06/2024

Once again, physicians’ Medicare payments are set to be cut, this time a 2.8% reduction in 2025. Please download the graphics and post them on your social media channels to raise awareness about the problem.

CMS Delays Dramatic Office-Visit Coding Changes Until 2021 - 11/04/2024

Following advocacy by the Texas Medical Association and much of organized medicine, the Centers for Medicare & Medicaid Services has delayed its proposal to dramatically overhaul evaluation and management coding for physician services, a proposal that TMA warned would make treating Medicare patients “even more challenging.”

Fix Medicare Now, TMA Tells Feds - 10/22/2024

Unless the federal government increases physicians’ Medicare payments and overhauls Medicare’s hassle-laden Quality Payment Program (QPP), access to health care for millions of American seniors and people with disabilities “is at risk,” the Texas Medical Association told Centers for Medicare & Medicaid Services Administrator Seema Verma.

Code Carefully for Bilateral Procedures - 10/02/2024

Coding for bilateral procedures can be confusing. See how payers differ in how they apply CPT modifier 50 to their coding and payment policies.

CMS Reopens 2023 MIPS Hardship Exception for Cyberattack - 09/26/2024

Thanks to medicine’s advocacy, the Centers for Medicare & Medicaid Services has reopened a hardship exception for the 2023 Merit-Based Incentive Payment System (MIPS) performance period to account for February’s Change Healthcare cyberattack.

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.

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.”

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.

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.

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.

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.