• NSA I-Tact

  Meeting Summary for EDPMA Standing I-TACT Call – 03.18.24

  Posted by name on March 19, 2024 at 5:10 pm

  Sorry – I didn’t capture the first part of the meeting 🙁

  Quick recap

  The team discussed the impact of a cyberattack on negotiation, deciding not to start a 30-day negotiation period due to lack of information. They also discussed issues related to not receiving the mandated 835 from a transaction code set regulation, with concerns raised about potential downstream effects. The conversation ended with a discussion about the possibility of a class action lawsuit against United due to financial losses incurred by providers.

  Next steps

  Draft a formal request regarding the impact of the Change cyberattack on open negotiation deadlines.

  Jennifer to respond to the email from Bob regarding the nuance of the impact on their client.

  Hart Health to start drafting the letter regarding the Change cyber attack impact.

  Consider exploring a class action lawsuit against United for financial losses caused by their payment processing issues.

  Focus on changing the narrative to emphasize timely payment and the inefficiency of the IDR process.

  Review and provide feedback on the write-up sent out by Tom.

  Summary

  Cyber Attack Impact on Negotiation Process

  Ed led a discussion on the impact of a cyberattack on the negotiation process. The team decided not to start a 30-day negotiation period due to lack of information. Jennifer expressed concern about missing an opportunity to grab a cohort of claims towards the end of February. Andrea emphasized the need for a simple statement that the negotiation clock wouldn’t start until both the payment and the ERA were received. The team discussed the impact of the outage on their claims processing system. Patrick expressed concerns about regulators not fully understanding the severity of the outage. Ed proposed reaching out to Bob to form a task force to address the issue and draft a letter to CMS. The team agreed to wait until after a scheduled webinar to gather more information before taking further action.

  Regulation and Compliance Issues Discussed

  The team discussed issues related to not receiving the mandated 835 from a transaction code set regulation. They agreed that the responsibility of providing this information lies with the other party and should not be required to gather extraneous information. Tom suggested penalizing or extending deadlines if they do not comply. Concerns were raised about potential downstream effects, but no evidence of payers holding claims due to this issue was found. Patrick expressed concerns about a lack of understanding regarding the functional aspects of their work process and the proposed solution being costly and unfeasible. The conversation ended with a discussion about the possibility of a class action lawsuit against United due to financial losses incurred by providers.

  PR Strategy and Claims Process Issues

  The team discussed potential issues with the operations rule by CMS,wh ich Ed feared could lead to missed benefits. The team decided to shift their approach to the PR war with CMS, focusing on narratives about the inefficiency of the claims process and the non-payment of claims after the IDR decision. They planned to seek advice from PR professionals and lobbyists on this new tactic. The team also discussed the problems of timely payment and the lengthy claims process, with Greg mentioning that 17% of claims were not paid correctly within 30 days and the average resolution time was 211 days. Tom suggested that imposing penalties for non-payment might encourage more people to file claims. Jennifer emphasized the importance of enforcement for the new proposed rule to be effective. The team agreed to review and provide feedback on a write-up by Tom and considered having potential meetings in April.

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