What new TMA guidlines mean for you
Plus: Other headlines
Good morning and happy Friday. Welcome to the Friday Pulse Check from Fuclrum Strategies. The top story in the healthcare world this week is the introduction of new guidance from the Centers for Medicare and Medicaid Services (CMS) for the No Surprises Act. Unfortunately, CMS appears to have punted when it comes to calculating the Qualifying Payment Amount (QPA), allowing the payers to calculate it “in good faith.” More on that in a moment:
CMS issues new guidelines for the No Surprises Act
CMS issued new guidelines this week for the No Surprises Act after Judge Jeremey Kernodle threw out the previous guidance in the third Texas Medical Association lawsuit. In their new guidance, CMS told payers and insurers that they can act in “good faith” to produce QPA amounts and the method of calculation will not be enforced until March 2024.
CMS appears to have bowed to the payers on this one. The governmental entity said in its new guidance that insurers told them that it would take months or years to calculate new QPAs. What is buried in that statement is the admission that the QPAs (as suspected all along) were calculated incorrectly.
So what are providers to do? Keep holding the line. We are aware that UnitedHealthcare has sent some amendments to groups forcing their fee schedules down to Medicare rates; it is within your right to reject those amendments.
We know that other lawsuits are coming, likely against the payers or the payers and CMS. We’ll keep you updated about it here when that happens.
Read more reactions in Radiology Business.
Other articles of interest:
Medicare Part B premiums to increase slightly in 2024 - CMS.gov
Pediatricians having a difficult time getting RSV shots for babies - CBS News
US overdose deaths continue to rise - CNN
California Watch: MDs banned from using “excited delirium” diagnosis - KFF Health News
HIPAA Violation of the Week: Fines increase for inflation - HIPAA Journal
You probably noticed we didn’t have a new podcast this week. That is because my schedule and Ron’s didn’t jive, but we plan to have a new episode for you next week focusing on these changes for the No Surprises Act.
Have a good weekend,
Matthew