Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

Sunday morning bathroom read (Deep Thoughts by Jack Handy “SNL” edition):

The race to the bottom is best described by the following:

A) QPA (less the threat to terminate the existing network arrangement)** The provider has 30 days to accurately identify AND dispute the underpayment in order to initiate the IDR process. Providers are ill equipped to do this. This will be a RBR tsunami;
B) Amounts Generally Billed (“AGB”) as a percentage of Medicare; (henceforth known as “Percentage of Walmart” or “FAP or bust” since half the US earns less than $35,612 or 275% of the FPL);
C) Medicare;
D) Medicaid;
E) Cash;
F)All of the above

“…The American College of Radiology (ACR) reports that CIGNA and BCBS have begun the process of threatening to terminate certain of its provider contracts unless the providers agree to a cut of 15% effective immediately, in at least one case. With no agreement in place, those providers would be out of network and would be forced to accept whatever payment is offered by the insurance company or initiate the Independent Dispute Resolution (IDR) process for each procedure code, which would quickly become costly and burdensome to the provider.”

Coming to a contract negotiation near you: the No Surprises Act