Ed Gaines Profile picture
Jul 26 7 tweets 9 min read
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.....
4/ multiple stakeholders; readers here will know that in addition to the @BCBSAssociation plans, @UHC has engaged in similar behavior; frankly this a bit uncharacteristic of @CIGNA based on my experience--here's their email:
[Client Name Deleted]
Thank you for your response.
..
5/ "Unfortunately that rate is no longer competitive due to the no surprise billing act. We are looking for rates similar to what you would be paid as OON via the new legislation and we’ve sent reductions to all of the ER groups using the same proposal that I sent you.......
6/ I’m willing to consider a counter but it would need to be much closer to my original proposal.
Thank you" (this director's original proposal was a cut of -40 to -50% vs. contracted rates); here's the term letter from CIGNA and NC Blue Nov. '21 letter below that:

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Ed Gaines

Ed Gaines Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @EdGainesIII

Jul 20
1/ Folks, @UHC must be called out w/ official complaints to the NSA CMS complaint portal as they have created an artificial, illegal & unnecessary process to try to "burn the clock" on physician's rights under the #NSA. To wit here's what they direct physicians to do, bare w/...
2/ me--from #UHC website: “How to submit an open negotiation request by email or mail section.”
Reminder: If you submit a negotiation request through that portal, you will not need to complete either the Open Negotiation Notice Form or the Supplemental Open Negotiation....
3/ Request Form." And here are the @UHC forms--they are creating an illegal "acceptance process" when CMS has promulgated exactly 1 form for the official 30-day Open Negotiation Period notice; and unlike other CMS forms, it's not suggested--they want...
uhcprovider.com/content/dam/pr…
Read 9 tweets
Jul 15
1/Let’s be very clear about @UHC —for nearly 10 yrs I have chaired @ACEPNow Reimbursement Committee Work Group 2 charged w/ monitoring & addressing “bad payor” issues; for the,past +5 yrs nearly every month #UHC final diag. lists that down-pay/down-code….beckerspayer.com/payer/team-hea…
2/ blatant violations of federal & state prudent lay person laws w/ their Medicaid plans, non-compliant coding policies vs. AMA CPT stds. (Standards mandated by HIPAA regs.) & now policies set for 8/1/22 requiring FAXED medical records for E&M service w/ the -25 modifier…..
3/So these @UHC policies do not differentiate in ownership models, e.g. small, medium & large groups—the policies impact all EM docs while as just noted #UHC posts yr after yr record profits & revenue >; robust debate about group structures—sure but let’s not turn that into a ….
Read 5 tweets
Jun 6
1/ Important #NSA update as @CMSGov has posted "a checklist of reqs. for group health plans" after rec'g @ACEPNow @EDPMA letters & examples detailing numerous instances of #healthplan non-compliance w/ regs; 2/ The agency details several of most impactful non-compliance issues...
2/ health plans requiring that physicians/hospitals proceed through hosted website by the carrier to initiate the req. 30 day open negotiation period + lack of QPA info. + lack of health plan name, address AND email for sending the open negotiation notice 3/CMS states clearly....
3/ that the initial payment should be an amount the health plan "reasonably intends to be payment in full) (p. 2); 4/ CMS makes clear that the "clock" for the 30 day open negotiation period notice begins to run upon sending the notice, not per an "acceptance process or website".
Read 7 tweets
Apr 1
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
Feb 28
1/ Great potential news on the #NSA @texmed & @AdamCorley lawsuit response from @CMSGov --quoting--"The Departments are reviewing the court’s decision and considering next steps. This announcement serves as a notification to health care providers, emergency facilities....
2/ "providers of air ambulance services, group health plans, health insurance issuers, Federal Employees Health Benefits (FEHB) Carriers (“Disputing Parties”), and certified IDR entities of steps the Departments are taking to conform to the court’s order. Specifically, the ....
3/ Departments will:
1.Effective immediately, withdraw guidance documents that are based on, or that refer to, the portions of the Rule that the court invalidated. Once these documents have been updated to conform with the court’s order, we will promptly repost the updated....
Read 11 tweets
Nov 22, 2021
@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

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(