• NSA I-Tact

  01.22.24 Standing I-Tact AI Notes

  Posted by name on January 22, 2024 at 6:34 pm

  AI meeting summary:

  • Greg Hufstetler discusses the impact of a bill on health plans and providers. A survey was conducted to gather information about aggressive renewals, contract terminations, and pay cuts by health plans. The group suggests adding new questions to capture terminated contracts and significant cuts in renewal contracts. They also discuss the need for clarification in several existing questions and consider including other post-IDR determination changes in the survey.
  • Patrick Velliky discusses the challenges of receiving information on the 835. Ed Gaines suggests using concurrent payments and a separate portal for access. Randy Pilgrim recommends letting payers prove non-payment. They discuss the timing and format of a survey to collect data on claims filing and QPA tracking. Kathryn Beard mentions difficulty in tracking QPA, while Ed Gaines proposes giving three weeks for completion. Patrick Velliky suggests adding columns for late or unpaid awards pre- and post-April 2023. They consider including an open text field for additional remarks in the survey.
  • Ed Gaines suggests using comments to enhance the storytelling aspect of data analysis. They discuss adding a data point on the number of claims settled in open negotiation before and after changes were made. Kathryn Beard emphasizes the importance of finalizing this data point and questions the effectiveness of open negotiation if very few claims are settled. Patrick Velliky proposes measuring out-of-network claims that meet arbitration criteria but were not able to be arbitrated for various reasons. The group discusses potential survey questions and workgroup discussions, including participation in interviews about the impact of NSA by RAND. They also consider placing limits on health plans’ ability to question claim eligibility after it has been deemed eligible, with Randy Pilgrim suggesting filing a letter addressing this issue. Ed Gaines mentions an upcoming member newsletter with recommendation summaries based on EDPMA and ACEP letters sent previously.
  • Ed Gaines discusses the importance of complaining in order to initiate investigations and audits. He also reminds everyone about upcoming Lobby Days and the need to RSVP. Patrick Velliky informs the group about a closed-door briefing for Republican members regarding the NSA, as well as efforts to include a provider group in the discussion. Ed Gaines asks for updates on penalty provisions language and mentions potential fixes for fee schedule cuts. The conversation concludes with thanks and farewells.

  Ed Gaines:

  • Send out a communication to the membership about the upcoming survey, including the Fuchsia report and additional questions.
  • Work with Cathey and Greg to draft the communication and reminder about the survey.
  • Set a deadline for members to provide feedback on the survey questions to Greg.
  • Coordinate with Kathy to collect home and work addresses from members for the Lobby Day RSVP.
  • Prepare a member newsletter with a summary of the EDPMA and ACEP letter for members to personalize and send.
  • Keep a list of additional items to be added to the letter before the extended deadline.

  Greg Hufstetler:

  • Incorporate the feedback from the work group on the survey questions and finalize the survey document.
  • Send a draft of the survey questions to the work group members for review and comments.
  • Include a column for the total number of NSA eligible claims in 2023 as a denominator for the survey data.
  • Insert a new column for comments or other remarks in the survey.
  • Specify the date range for the claims filed in questions four, five, and six to avoid ambiguity.
  • Clarify the question about the presence of QPA in the claims payment advice (835) and consider adding a question about other forms of QPA reporting.
  • Consider adding questions about the number of claims settled in open negotiation and the reasons for not submitting eligible claims.

  Patrick Velliky:

  • Participate in the member-level briefing on the NSA by the House Committee on Education and the Workforce.
  • Follow up with Representative Murphy’s office regarding the language on penalty provisions.
  • Coordinate with Randy Harris’s office to lead a Doc caucus letter to House leadership about fixing the fee schedule cut.

  Randy Pilgrim:

  • File a brief letter in response to the extended deadline for comments on the IDR operations rule.
  • Prepare a synopsis of the EDPMA and ACEP letter on the NSA and share it with member organizations for personalized additions.

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