Discover and read the best of Twitter Threads about #NoSurprisesAct

Most recents (17)

1/ What’s the urgency re: #NoSurprisesAct dispute resolutions decisions (IDRs) returning immediately you ask? 1st, amicus briefs are important but they’re but 1 tool in the tool box. “We” need to do more, to wit: for EM docs the decline in post #NSA reimbursements is >32% so….
2/ IDR is the main remedy to the EM Docs who have (willingly) the #EMTALA & moral duty to provide care regardless of the in network status; 2. @EDPMA survey data on the +30% decline in pre vs post NSA reimbursements is 10s of 1000s of claims. 2 paraphrase the movie “Patton”, how
3/will we all answer the question “where were you & what do you do when independent physician groups’ independence suffered an accelerate decline?” To borrow a line from Netflix doc “Full Swing” (attributed to Tiger) “ Don’t get bitter, get better” @ACEPNow @ACRRAN @ASALifeline
Read 4 tweets
NEW: Many congratulations to @texmed, @AdamCorley, & @TxRadSociety on launching their *fourth* #NoSurprisesAct #lawsuit against @HHSGov, @CMSGov, @USTreasury, & @USDOL.

This filing challenges the government's decision to impose a 600% increase in administrative #IDR...

...fees and the requirement to batch by the same #CPT code.

⏰ Time is running out, and #regulators must be compelled to stand up and operate a fully-functioning, fair, accessible, & *timely* IDR process, just like the law prescribed.


#NSA #fixitnow #badreg #IDRE
Read 8 tweets
🧵⁦@AmerMedicalAssn⁩ & ⁦@ahahospitals⁩ support Texas suit challenging surprise billing rule provision.

👉 Read:…

2/ Press release states:

“Hospitals and doctors strongly believe that no patient should fear receiving a surprise medical bill and that patients should be kept out of the middle of any billing disputes between providers and commercial health insurance companies.”

continued 👇
3/“The AHA & AMA fully support the lawsuit just filed in the United States District Court for the Eastern District of Texas which challenges the government’s August 2022 final rule ( regarding the No Surprises Act’s independent dispute resolution process.”
Read 7 tweets
1/ Random musings on the #NoSurprisesAct final rule issued 8/19/22--sorry for the trade speak in advance but otherwise this string would be 50+--the "qualifying payment amount" serves 2 purposes--determine Pt cost sharing & as a factor in IDR; QPA by definition repeated in the...
2/ rule is the median allowed amount determined by health plans for same or similar svs. as of 1/1/19--adjusted for inflation; now my doc friend who used to be an actuary says the CPI on the QPA should be +20%--then how would over 90% of the claims surveyed by @ACEPNow & @EDPMA..
3/reflect that the QPA=the allowed amount in '22? Because the health plans are making up the QPA as they know their calculations are non-transparent to anyone--except if CMS audits & stakeholders have repeatedly requested same; but perhaps we are making progress; see the......
Read 10 tweets
Thanks @malonespeaking for having @uspirg on your show today to talk about medical bills & the latest Equifax mess.
Good news when we schedule a doctor's visit or procedure. The federal #NoSurprisesAct requires upfront estimates. @PatriciaKelmar… (THREAD)
@malonespeaking @uspirg @PatriciaKelmar Just like we can get a written estimate for a home improvement or car repair, we can start getting written, upfront estimates for medical care. It's in effect now for people without insurance or for uncovered procedures. It will take effect soon for people who have insurance. (2)
@malonespeaking @uspirg @PatriciaKelmar This protection is long overdue. It will help us not get shocked so bad by medical bills that it might cause a different health issue. And as @RobOn1100 noted, it might allow us to shop around for medical care and compare prices.… (3)
Read 8 tweets
1/PSA--this just in--@CIGNA is engaging in systemic, multi-state actions & demanding immediate physician group contract reductions in the range of -30 to -50% (I have seen the emails in that range, see below for redacted copy); actions have been confirmed in #NC, #FL #TN &......
2/ other states; @CIGNA is specifically referencing the #NoSurprisesAct as their justification for demanding immediate reductions or threatened unilateral termination, a 'la @BlueCrossNC (they tend to follow herd behavior) (as reported here but repeated again below)--redacted....
3/ client named email is below, received Mon. 7/25/22--I have seen or discussed w/ EM and anesthesia groups so far--likely more is coming & industry colleagues have shared term letters--also redacted and posted below--once again, time for a strong advocacy response from.....
Read 7 tweets
1/ Ironic that in the latest "shake-down" of #NC physicians @BlueCrossNC starts out by saying that they are a "non-profit" seeking to drive down "the costs of delivering healthcare." Let's look at their CEO comp. in '20--$3.14M + 8 of their execs. received at least $1.33M in.....
2/ compensation in '19; you may remember back in Nov. '21, citing to the #NoSurprisesAct, #NCBlue demanded that 54 hospital based groups immediately agree to contract rate reductions in the range of -5% to -30% or face contract termination--thought the letter was "fake news".....
3/ and it wasn't as an NC practice manager who knew the BCBSNC VP who signed the letter called him & said "is this for real?" Yes it was, said the VP; anyway the latest iteration of @BlueCrossNC w/ 60-70% of the commercial market using it's oligopoly power is cited below; for....
Read 6 tweets
⚖️ LEGAL LOOKOUT 1: We’ve read with interest the amicus brief below filed by 24 health policy experts in the @texmed v. @HHSGov lawsuit, as we filed one, too.

Without any further digging, though, we can see off the bat that a majority of the so-called experts who signed

(1/8) ImageImageImage
onto this brief are funded by the #insurance industry.

We respect and cherish the fact that everyone party to a significant #policy debate like this one over #regulatory implementation of the #NoSurprisesAct has a voice.

But, a question to @RonaldKlain, @SecBecerra, and

@BrooksLaSureCMS: How can you reconcile the fact that the administration’s #regulations rely on these bankrolled academics and experts while also claiming that these regulations help #patients and our #healthcare system? This is an alternative reality.

Read 19 tweets
If you'll indulge me, I'd like to do an end-of-year 🧵highlighting the incredible work by colleagues @KFF.
Here's a sample of the health policy & COVID analyses this year by @KrutikaAmin @matthew_t_rae @NirmitaPanchal @nishakurani @emmawage @gio_j_ramirez & @JaredOrtaliza (1/10)
2/ Looking at OECD data, @JaredOrtaliza @gio_j_ramirez @VenkSathees and @KrutikaAmin found the pandemic set back life expectancy far more in the U.S. than in similarly large/wealthy nations.
Life expectancy of Hispanic and Black Americans was set back most…
3/ Sadly @KrutikaAmin found that not only did the U.S. experience some of the worst excess death rates overall in 2020, we also saw many more young people die than did peer countries. Again, this is in part due to racial disparities, as more POC died young…
Read 10 tweets
@ZachJonesForTX @mass_marion 1/ Zach--where do I begin? 1. For those thinking that the #NoSurprisesAct is about out of network (OON)/balance billing (BB)--maybe 3-6% of a hospital based group--sorry--it's all about in network rates; the vaulted @USCBOcostest calculated that the Energy & Commerce bill in '19.
@ZachJonesForTX @mass_marion @USCBOcostest 2/ would "save" ~$20B over 10 yrs. BUT 80% of that savings would come from the declination in network rates; my opinion you say? Actually no--last week @BlueCrossNC wrote to over 50 physician groups in #NC citing the NSA and NC state law--groups in Rad., Anesthesia & EM--and....
@ZachJonesForTX @mass_marion @USCBOcostest @BlueCrossNC 3/ demanded (and we have letters to support the same) between -5% to -20% in current participation agreements (cuts rumored to be as high as -30%) else #BCBSNC would consider terminating the agreement b/c the #NSA & the #QPA as calculated would permit "interim reductions".....
Read 11 tweets
We issued the following statement this a.m. on the @UHC-@zackcooperYale-@Yale #surprisemedicalbill "research" scandal.

Read here ➡️

To ensure that forthcoming #NoSurprisesAct regs are implemented fairly and to protect #patients nationwide, we will...
...continue to shine a bright light on this trickery.

According to our President Christopher Sheeron, "We have long believed that this #Yale study, and several others that have shaped this debate over the past several years, was blatantly concocted out of the public eye by...
...insurers. Rose Adams' unveiling of this nasty truth is welcomed enthusiastically by #patients, #hospitals, #physicians, and many others who are sick of the #health #insurance industry's dirty tricks.

"As regulators at #HHS, #CMS, and other federal agencies continue...
Read 17 tweets
⚠️ GROSS COI REVEALED: In an extraordinary and fantastically written investigative report, @theintercept's @rose_n_adams unveils how @UHC co-opted @zackcooperYale's #surprisemedicalbill study, all while #Congress embraced it as "academic" and "unbiased" work to write #SMB law.
1⃣ This lays bare how #UnitedHealth has manipulated #surprisebill "research" to enrich itself at the expense of all #patients and the frontline #medical providers risking their lives over the past few years of #Covid.

2⃣ The study was foundational in the #SMB debate, and...
...Congress was duped. We believe that Congressional #investigations are now warranted by the #House and #Senate #Judiciary Committees. @HouseJudiciary @JudiciaryDems

3⃣ This work from Prof. #Cooper and his @Yale team was cited *10 TIMES* in the first #regulation issued by...
Read 19 tweets
🧵#OurAMA issues initial summary of “Interim Final Rule (Part 1) Implementing Certain Provisions of the #NoSurprisesAct.”

Several initial concerns:
•Way the QPA (median contracted rate) will be determined
•Provisions that ⬆️ admin burden for physicians without patient benefit Image
2/ July 1 @HHSGov @USDOL @USTreasury (Tri-Agencies), @USOPM released an IFR with comment period implementing many provisions of the #NoSurprisesAct signed into law as part of the Consolidated Appropriations Act, 2021 COVID-19 relief bill.
3/ Given statutory timeframes required under the NSA & the pending implementation of most provisions by January 1, 2022, the Departments made the decision to issue an IFR.

As a result, the requirements outlined in the IFR are final & will become effective on September 13, 2021.
Read 12 tweets
With new regulations on #SurpriseBills expected to drop momentarily, a reminder that about 1 in 5 emergency visits results in an out-of-network charge, putting patients at risk of surprise bills…
Even for childbirth -- something patients have months to prepare for, and it's common for new parents to even go on TOURS of hospitals in preparation for -- 1 in 10 in-network hospitalizations comes with an out-of-network charge…
Soon, most surprise billing practice should stop with implementation of the No Surprises Act.

But there are holes in these protections, particularly for ground ambulance rides (which are exactly the sort of situations patients feel powerless in).…
Read 12 tweets
MUST READ: *Terrific* letter to @SecBecerra, @SecYellen, and @SecMartyWalsh signed by 97 Members of Congress and spearheaded by @RepTomSuozzi and @RepBradWenstrup.

They urge @HHSGov, @USTreasury, and @USDOL to not only reflect congressional...

...intent in their rulemaking by ensuring a balanced process to settle payment disputes between #health plans and providers, but also ensure an #IDR process that captures the unique circumstances of each billing dispute and does not cause any single piece of information to be...
Read 11 tweets
@HouseCommerce (Chair Pallone/ Ranking Widen) released #NoSurprisesAct 7/9/19 & #healthplans could not happier: 1. Median contracted rates pegged to ‘19 initially as benchmark—watch out below for the low ball offers this yr; 2. Benchmark adjusted for CPI-U (thx? For what?) ....
(2) Pt cost sharing is this weird form of federalism—the lesser of what the Pt would pay under state law, e.g. CA (125% of CMS) or calculated on median K rates (did I say the health plans are still on a bender from last night over this bill?); 3. 1 of the broadest bans on #OON ..
(3) OON ban includes ED care + any facility care if faculty is In Network services + if there’s no par provider & if the service was the result of unforeseen medical needs + Pt consent & cost estimate for OON service must be 72 hours pre service; does not apply to ERISA plans ...
Read 5 tweets

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