Stories written by Joey Berlin

Feds Scrap TMA-Opposed SUNSET Regulation-Review Rule - 03/21/2025

The U.S. Department of Health and Human Services (HHS) has turned out the lights on a “sunset” rule requiring extensive federal review of thousands of regulations, which the Texas Medical Association and others in organized medicine believed would needlessly divert HHS’ attention from the COVID-19 pandemic.

Federal Memo Signals Compliance With TMA Court Win – For Now - 12/06/2024

Within days of the Texas Medical Association’s Feb. 23 court victory over federal regulators, the U.S. Department of Health and Human Services (HHS) says it’s taking steps to comply with the court’s decision on rules for the No Surprises Act – even as HHS is “considering next steps” after TMA’s win.

Hospital Asks for Expedited Trial in Fort Worth Life-Sustaining Treatment Case - 12/05/2024

Believing that court-mandated, life-sustaining treatment is causing harm to a child in its care, Cook Children’s Medical Center in Fort Worth is attempting to resolve a highly publicized court case as quickly as possible.

Evening Out the Scale: TMA Gears Up for Another Legislative Battle Over Surprise Bills - 11/18/2024

TMA gears up for another legislative battle over surprise bills.

TMA Leery of Proposed Balance Billing Law - 11/18/2024

The Texas Medical Association is deeply skeptical of a state senator’s freshly filed effort to prevent physicians from balance billing patients for the services they provide. On Thursday, Sen. Kelly Hancock (R-North Richland Hills) filed Senate Bill 1264, a measure to address surprise out-of-network medical bills. The legislation emerged with no input from the House of Medicine

TMA, Lawmakers Working to Tackle Telemedicine Parity, Prior Authorization - 11/18/2024

As one of the most unique eras of both living and lawmaking continues, attendees at TMA’s Winter Conference heard about medicine’s legislative agenda in both Austin and Washington, D.C., and how COVID-19 has helped shape this year’s legislative focus.

High Court Decision Brings Favorable Wind for Physician Experts - 11/04/2024

The Texas Supreme Court has sided with the Texas Windstorm Insurance Association – and by extension, with medicine – in a case that impacts physicians who testify as expert witnesses in their own defense.

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.”

“Overlooked” Pediatricians Fight for Survival During Pandemic - 09/20/2024

For Angela Moemeka, MD, COVID-19 was a rude welcome to a nascent solo practice. The Coppell pediatrician opened her one-doc shop, Mark9 Pediatrics, in November. Now, nearly six months and one sweeping pandemic later, she’s in the same boat as many of her fellow pediatricians: Patient volume is down, and the

Court Sides With Medical Examiner in Suit Over Autopsy - 08/09/2024

With the Texas Medical Association’s help, a Harris County medical examiner has won the latest battle in a lawsuit over an autopsy he performed following a woman’s 2007 shooting death.

Physicians Will Lead Legislature’s Controlled Substances Committee - 08/09/2024

When a special joint committee of the Texas Legislature tackles issues with controlled substances this year, physician-lawmakers will take the lead.

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.

High Court Decision in Nondisclosure Case A Win For Medicine - 07/31/2024

The Texas Supreme Court sided with the Texas Medical Association in a nondisclosure case that TMA warned would have significant, troubling implications had it gone the wrong way.

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.

TMA Pushes for Prior Authorization Limits, Clarity - 04/16/2024

After hearing story after story of delays and denials, the Texas Medical Association is pushing the Texas Legislature to sign off on measures that would significantly curb insurers’ ability to require prior authorization on needed care, as well as clarify for both physicians and patients what it means when prior authorization is required.

TMA to IRS: Direct Primary Care, Health Care-Sharing Ministries Aren’t Insurance - 04/05/2024

The Texas Medical Association is urging the IRS to reconsider a proposed rule that would classify direct primary care (DPC) arrangements and health care-sharing ministries (HSMs) as insurance.

You Write Scripts? You Better Sign Up With the PMP - 02/28/2024

If you don't yet have a user account set up with the state's prescription monitoring program (PMP), known as PMP Aware, now is a good time to get it done.

Report: Most Private Payers Have Stopped COVID Cost-Sharing Waivers - 08/21/2023

Private health insurance plans have largely stopped waiving patient cost-sharing for COVID-19 treatment, according to a recent report by the Peterson Center on Healthcare and Kaiser Family Foundation. The data represent an overwhelming shift from payer cost-sharing policies during 2020 as indicated by previous research.

Federal Prior Auth Bill Filed in Congress - 07/25/2023

U.S. Rep. Michael C. Burgess, MD (R-Lewisville), is following his fellow Texas physicians’ lead on curbing insurers’ hassle-laden prior authorization burdens, introducing a federal bill similar to the “gold-card” law the Texas Medical Association proposed and championed into law at the state level.

TMA Convinces CMS to Give Harvey-Affected Physicians a Break - 07/20/2023

At TMA's request, CMS announced in December that physicians in areas affected by Hurricane Harvey will not be required to participate in the Quality Payment Program's (QPP's) Merit-Based Incentive Payment System (MIPS) for 2017. Thus, those physicians won't incur a 4-percent Medicare payment cut in 2019.

HHS Doling Out About $9 Billion in Fourth Phase of PRF - 07/20/2023

Texas practitioners are receiving more than $642 million in Provider Relief Fund (PRF) Phase 4 payments totaling nearly $9 billion nationally, the federal Department of Health and Human Services (HHS) announced.

Where Does Immunity for Government-Employed Physicians End? - 07/17/2023

The Texas Medical Association is fighting to ensure the Texas Supreme Court does not disrupt liability protections for physicians who are employed by a state medical school or other government entity.

Fighting Back: Practice Wins Court Battle Over Defamatory Online Reviews - 06/20/2023

One practice’s recent legal battle epitomizes physicians’ worst nightmares when it comes to online reviews. Here’s an extreme but glaring real world example, straight from the documents in a lawsuit that Austin Eye first filed in October 2017 over

Going Nowhere: APM Committee Resignations Cast Doubt on Payment Models' Future - 05/10/2023

Resignations from HHS advisory committee cast doubt on future of physician-created alternative payment models.

No Surprises Act Includes Directory Update Requirement - 02/10/2023

In addition to resolving payment disputes over out-of-network medical care, the federal No Surprises Act aims to make sure health plans’ practitioner directories stay up to date, and part of that aim puts an onus on physicians.