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Ed Gaines

@EdGainesIII

Oct 20, 2022

1/Big congrats 2 the Physicians Advocacy Institute, American College of Emergency Physicians, American College of Radiology, American Society of Anesthesiologists, American Hospital Association, American Medical Association, and The Emergency Department Practice Management....

@EPDMA

2/ Association for filing w/in a very short timeline (@EPDMA found out last Friday that 10/19/22 was the deadline for amicus briefs--FUN weekend!) "friends of the court" (amicus curiae) briefs in support of @texmed @AdamCorley Motions for Summary Judgment to have the Aug. 2022...

@AmerMedicalAssn

3/ NSA final rule vacated, just as the court had previously ruled in Feb. 2022 with the Q4 2021 final rule--with @AmerMedicalAssn PAI coming in with over 30 state & federal medical societies joining to oppose yet another ill fated attempt by HHS to set the QPA as a benchmark....

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Ed Gaines

@EdGainesIII

Sep 14, 2022

1/ Here's a call to action for the bill to address the Medicare fee schedule cuts--Tell Congress: Fix Medicare Reimbursement!
Clinicians are working harder than ever to recover from the pandemic—but continually facing cut after cut, and inflation is on the rise......

2/Insurers, who posted record-breaking pandemic profits, continue to raise premiums and lower reimbursement rates to clinicians. Additionally, across-the-board, sequestration cuts of -2%, just hit our clinicians in the first half of 2022.
January 1, 2023, approximately.....

3/ -10% plus, in Medicare cuts will impact hospital-based clinicians. We need Congress to enact new legislation to STOP THE CUTS!
•-4.42% - Medicare conversion factor (CF) cuts were proposed by CMS’ 2023 Medicare Physician Fee Schedule (MPFS).
•-4% - Pay-As-You-Go (PAYGO) ...

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Ed Gaines

@EdGainesIII

Sep 14, 2022

1/ Good news on CMS fee schedule--Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) introduced legislation Tuesday (Sept. 13) to mitigate CMS’ proposed physician fee schedule cuts for 2023, which doctors have decried since the rule was released, by increasing the conversion .....

2/ factor 4.42%effectively putting the cuts on hold for a year. Congress has stepped in the past few years to help mitigate physician fee schedule cuts, and stakeholders have urged lawmakers to do so again prior to 2023. The lawmakers, who recently spearheaded .....

3/ a bipartisan request for feedback on how to revamp the flawed Medicare Access and CHIP Reauthorization Act, also include in their newly introduced Supporting Medicare Providers Act a sense of Congress that HHS, the House and Senate should administratively and legislatively ...

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Ed Gaines

@EdGainesIII

Aug 20, 2022

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...

@ACEPNow

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......

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Ed Gaines

@EdGainesIII

Jul 26, 2022

@CIGNA

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 &......

@CIGNA

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

Ed Gaines

@EdGainesIII

Jul 20, 2022

@UHC

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....

@UHC

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…

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