TMA Practice Resources Educate Physicians on Practice Challenges
By Alisa Pierce Texas Medicine May 2025

Spring family physician David Michalak, MD, and his wife, Michelle, run a tight practice. While Dr. Michalak takes care of patients, Ms. Michalak handles billing and payment tasks as their office’s sole practice manager.  

Although the couple love being in private practice, Ms. Michalak said dealing with insurers to receive correct payment has been a “pretty painful” experience for their small business. 

“It can be really frustrating to see claims denied or payment delayed for no reason,” she said. “We’re an independent practice. We don’t have [the] resources to face these challenges alone.” 

After a health plan declined coverage of a patient’s continuous positive airway pressure machine last year, the Michalaks reached out to the Texas Medical Association’s free Physician Payment Resource Center (PPRC) in the hopes TMA specialists could resolve the denial. 

Originally named the Hassle Factor Log, PPRC service began in 1989 in response to efforts by then-Medicare contractor Blue Cross and Blue Shield to recoup overpayments made to Texas physicians. 

In response, TMA’s Council on Socioeconomics formalized TMA’s program the next year, setting four objectives: 

• Identify physician time and effort wasted by insurance hassles; 

• Specify bureaucratic abuses that occur in the claims systems; 

• Find ways to eliminate administrative burdens on physicians; and 

• Provide a factual basis for advocacy efforts designed to achieve those ends. 

Since then, PPRC staff have gone to bat for members by helping their practices resolve issues related to insurance payments – including payer network status, prompt pay, and other payment and claims issues – and by regularly meeting with payers to discuss physician concerns. In 2024, TMA recovered more than $3.1 million for Texas practices. 

Dr. Michalak says within days of connecting with TMA payment specialist and certified professional coder Mary Fox, the payer reversed its decision. Soon after, the Michalaks’ practice was paid accordingly for the device. 

“Mary was a great liaison between our practice and the health plan,” Dr. Michalak said. “The PPRC got a claim paid we were certain we’d have to write off ourselves.”  

TMA provides its members and their practice staff exclusive access to high-quality practice management resources. Whether reaching out to payment specialists via TMA’s PPRC or Knowledge Center, browsing the association’s online benefits within its Practice Services webpage, or seeking payer updates and education from TMA’s Health Plan News page and Education Center, Texas physicians are “lucky to have [these assets],” Dr. Michalak said.

TMA’s Vice President of Medical Economics Robert Bennett says the education hub especially shines through in-depth features on large-scale topics like the 2025 Medicare Physician Fee Schedule or artificial intelligence.  

For members looking for educational quick tips rather than CME, TMA provides its members with education sheets, pocket guides, and case studies. These assets expound on topics like basics of Medicare participation, coding concepts, credentialing, and telehealth. 

Mr. Bennett says TMA’s educational sheets are particularly helpful in preparing members for coding changes, such as updates to chronic care management and transitional care management codes. 

“There’s always a slow uptick in new codes, but awareness and education help,” he said. 

On the health plan front, TMA provides notable and timely updates on payers’ billing, coding, and policy changes. Via the association’s Health Plan News webpage, members can stay informed about news from the major insurers like Blue Cross and Blue Shield of Texas, Aetna, and UnitedHealthcare. 

Chair of TMA’s Council on Socioeconomics Gary J. Sheppard, MD, frequently recommends the webpage and other association educational offerings to colleagues. 

“TMA works on our behalf,” the Houston internist said. “One of the best benefits of being a TMA member is the education provided to us free of cost.” 

Knowledge at physicians’ fingertips 

Dallas psychiatrist Lacy Edmundson, MD, reached out to the Knowledge Center – the association’s comprehensive resource hub for general information and resources responsive to physicians’ questions about practicing medicine in Texas – for such information on how to offer telemedicine services from her practice’s new location, including how to institute HIPAA-compliant platforms and switch to a new electronic health record system. 

The Knowledge Center was updated last year with systemwide improvements, including a new phone line enhanced with an interactive voice response functionality, an improved help center FAQ article database, an email tracking and response platform, and a digital chat bot.

Launched by TMA in October 2003, the Knowledge Center fields anywhere from 100 to 215 questions per week from physicians like Dr. Edmundson, their practice managers, and even some patients. 

Three Knowledge Center staffers provide responses to each member’s individual queries – including those requiring written email responses and supplemental website links. 

Ms. Bettridge notes 93% of member inquiries are completely resolved in an initial call. For some topics, the Knowledge Center directs inquiries to other TMA staff members with relevant knowledge. 

“I love taking care of patients, but I don’t love being totally inundated with the business components of medicine,” Dr. Edmundson said. “I turned to TMA because I knew I’d get the information I needed.”