• NSA I-Tact

  12.11.23 I-Tact Meeting Notes

  Posted by name on December 11, 2023 at 6:34 pm

  EDPMA’s NSA IDR Tactical Work Group (“The I-Tact”)

  December 11, 2023

  4pm EDT/3pm CDT

  AI meeting summary:

  • Ed Gaines opens the call and wishes everyone happy holidays. The main topic of discussion is the comment letter to be filed on the IDR operations rule, following up on a previous letter filed on the fee issue.

  • Dr. Pilgrim talks about a 20-day grace period letter that is almost final and explains that it requests an extension of 40 -days instead of just making it 60- days due to technicalities. The group agrees that this needs to be a joint ask and plans to involve other organizations in advocating for the extension. Stephanie asks about how long it will take to receive a response, and Randy suggests having direct communication with Bob Jasak from CMS.

  • L Anthony Cirillo suggests involving champions in Congress as well. Ed comments on the complexity of these issues and jokingly suggests including NASA in their letter. Tom Sugarman adds humor by mentioning Speaker Johnson’s reluctance to do budget work during Christmas. Finally, Randy discusses the schedule for submitting the joint comment letter on IDR operations.

  • Randy Pilgrim mentions that letters on the proposed rule have been framed and filled out by Bob Jasak and Jeff Davis. The content from all work groups has been reviewed, and a final draft of the letter will be shared with ACEP and EDPMA leadership. The goal is to send the letter before the end of this week.

  • Once finalized, it will be shared with members for them to send similar letters on their own letterhead. Additionally, there are discussions about socializing the letter with friends in Congress and ensuring in-person translation of certain elements during meetings with the Department of Labor. Suggestions have been made to reduce manual data entry through APIs or drop-down menus and prioritize standardization for ease of data ingestion in web-based platforms. There is also a suggestion to include environmental concerns regarding paper charts in the final letter.

  • Ed Gaines received input from various people and discussed it in workgroups B and C. Jennifer Brown highlights some of the points, including objections to a 25-claim limit and proposed solutions to increase efficiency. They also discuss the possibility of eliminating or shortening the cooling off period for disputes, with Randy Pilgrim suggesting parallel requirements for health plans. Patrick Velliky raises concerns about endorsing shorter cooling off periods without statutory changes but suggests considering non-compliance with IDR awards as part of CMS’s considerations. The group discusses the rationale behind their requests and potential issues related to setting precedents.

  • Randy Pilgrim suggests not going back to the precedent issue and instead focusing on the difference in obligation. Jennifer Brown agrees that there is no parity in the process and questions the purpose of a cooling off period if parties are not negotiating. Ed Gaines supports including Randy’s rationale and suggests making an edit on the fly. Tom Sugarman expresses less concern about setting a precedent with a time limit, as they have been winning most claims. Patrick Velliky argues against including a precedent issue due to difficulties in implementation and lack of regulatory authority but supports emphasizing the lopsided process favoring payers.

  • L Anthony Cirillo agrees with Patrick’s points and does not believe asking for precedents will be successful or practical. Ed Gaines suggests eliminating code N 830 for better identification of state versus federal issues, but Tom Sugarman raises concerns about potential misinterpretation regarding patient protections. The group discusses rewording their request rather than prohibiting code N 830 altogether.

  • Ed Gaines presents work on RAC (Recovery Audit Contractor) and CARC (Claims Adjustment Reason Code) codes based on a previous letter sent to Javier Becerra. They propose populating the remittance advice field with in or out-of-network information to improve clarity, mandating this requirement, specifying which rock codes should be used (871 for state and 859 for federal), mentioning states’ specific laws as further justification for using rock codes, suggesting automatic penalties if health plans fail to comply with RAC or 835 requirements, and stating that non-compliance would result in default judgment during IDR (Independent Dispute Resolution).

  • There is discussion about requesting X12 committee elimination of code N 830 due to its lack of specificity regarding state or federal surprise billing laws. Concerns are raised about potentially misconstruing opposition to patient protections by removing code N 830 entirely. It is agreed that rewording the request may be more appropriate.

  • The group also discusses moving the January call to the 10th and adjusting their usual meeting schedule accordingly.

  • Ed Gaines announces an upcoming RCM workshop in Nevada, featuring Jen Brown, Stephanie Caruso, Bob Jasak, and Jim Bobic. Cathey B Wise also mentions a virtual workshop on moving to RCM practice. Patrick Velliky discusses concerns about a CMS enforcement report that contains inaccurate information and suggests taking action to address the flaws. Ed Gaines expresses his suspicion towards HHS and suggests seeking clarification from the agencies involved. L Anthony Cirillo proposes gathering data from members to challenge the validity of the report. The group discusses potential strategies for addressing the issue and agrees on assembling a response team within ITAC or federal policy.

  Action items:

  • 1. Ed Gaines:

  • – Move the January call to the 10th.

  • – Coordinate with the group to assemble a response to the CMS enforcement report.

  • 2. Patrick Velliky:

  • – Review the CMS enforcement report and identify flaws and concerns.

  • – Write up a document highlighting the issues with the report.

  • – Seek avenues to undermine the report’s credibility.

  • – Gather data from members regarding the number of complaints they filed.

  • 3. Randy Pilgrim:

  • – Remove the request to CMS to ask the x twelve committee to eliminate the N 830 code from the joint comment letter.

  • – Discuss the suggested change to the use of Rock Codes (859 and 871) in the joint comment letter with Bob Jasak.

  • – Coordinate with Bob Jasak and Judith on the response to the CMS enforcement report.

  • – Prepare a data request to the Right Thing regarding the number of complaints lodged during a specific period of time.

  • 4. Cathey B Wise:

  • – Share the CMS enforcement report with Bob and Judith to gather their input.

  • 5. L Anthony Cirillo:

  • – Review the CMS enforcement report and suggest strategies for responding to it.

  • – Propose a data request to the Right Thing regarding the number of complaints filed.

  • These action items are subject to discussion and agreement within the group.

  • Ed Gaines and the team will discuss the bullet points and information developed for the comment letter to be filed on the IDR operations rule.

  • Randy Pilgrim briefly mentions a 20-day grace period letter that will be submitted.

  • The letter is about two and a half pages long and will be finalized by Laura.

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