• NSA I-Tact

  10.18.23 Summary from Standing Meeting

  Posted by name on October 19, 2023 at 1:54 pm

  I-Tact Standing Meeting

  October18, 2023
  Summary

  AI meeting summary:

  • Ed mentions legislative language sent to Representative Murphy’s office and raises concerns about enforcement of the NSA. Randy Pilgrim talks about successful press releases addressing their concerns. Patrick Velliky explains proposed legislative specs for improvements to enforcement within the NSA. The proposals include meaningful penalties for payer non-payment of IDR awards, mirroring CMPs for providers on payers who fail to provide patient rights and requiring transparent oversight of the NSA by departments.

  • Patrick Velliky discussed the need for more frequent and complete updates on penalties from an enforcement perspective. He shared this with Congressman Murphy’s office and is working on determining next steps. Ed Gaines emphasized the importance of Representative Murphy’s commitment to address the impact of the law on medical groups. Patrick also provided feedback from CMS regarding claims eligibility during portal closure, and they expect the new batching rules to be less restrictive than before. The joint comment letter is being reviewed and revised, with input from various parties, including Aaron Goldfeld who suggested a tiered payment structure based on dispute amounts.

  • Randy Pilgrim raises a question about whether certain changes require notice and comment. There are varying opinions on this matter. Ed Gaines suggests asking for an audit of fees to ensure transparency. Patrick Velliky believes that Congress may request an accounting of funds allocated for CMS purposes. Work Group A will include these requests in their letter.

  • The discussion then moves on to the grace period and confusion around filing deadlines during this waiting period. The group agrees that clarity is needed from CMS regarding the submission timeline and education for stakeholders. They discuss specific scenarios and agree that some cases may not be eligible for the grace period extension. Further clarification is needed regarding cooling batches and evidence requirements within the 90-day period.

  • Stephanie received a call from Federal Hearings regarding the submission deadline. Ed suggests communicating with Bob Jasek to get clarification on certain scenarios. Randy agrees and suggests involving experts in the review process. They discuss the grace period for batched claims and express concerns about the 90-day cooling off period. Shanna proposes discussing these issues further during Friday’s Work Group B meeting. The group also emphasizes that no out-of-network claim should be denied access to IDR. They consider requesting a longer grace period due to confusion and complexity of batched claims. Various members share their thoughts on timing and logistics of filing batches, suggesting a reasonable period for submission.

  • Stephanie Caruso asks if they should submit claims now or wait for new batching information. Ed Gaines suggests that there is no prejudice in submitting batched claims and they don’t have to file individually. They discuss the closure of the portal for 63 days and suggest a grace period formula based on closure duration. Patrick Velliky mentions estimates of a million claims in the backlog. They plan to write questions for a letter filing on October 26. They consider holding an educational webinar but decide to wait until batching rules are released. Jen Brown suggests creating an EDPMA roadmap infographic and an FAQ once batching rules come out. They also mention having testimonials from organizations who rely on EDPMA’s guidance.

  Action items:

  Work Group A:

  • Develop potential legislative specifications for draft legislation related to the NSA (Patrick Velliky)

  • Review the joint comment letter and provide input (All members of Work Group A)

  Work Group B:

  • Discuss and determine the grace period for filing batched claims during the portal closure (Shanna and members of Work Group B)

  Randy Pilgrim:

  • Coordinate with Bob Jasek to discuss the list of questions for CMS (Randy Pilgrim)

  • Include consideration of an audit of how CMS has spent the $500 million allocated for NSA implementation in the joint comment letter (Randy Pilgrim)

  Membership Marketing:

  • Reach out to member organizations for testimonials about the value of EDPMA’s work (Membership Marketing)

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