NCMS Morning Rounds 11-12-19

Time to make your Tuesday

NCMS Morning Rounds.

Nov. 12, 2019

NCMS Board Establishes ‘Surprise Billing’ Policy Framework

At its regularly scheduled meeting on Saturday, Nov. 9, your NCMS Board of Directors had a robust discussion on the current debate underway around surprise billing. Three pieces of legislation currently are being weighed on Capitol Hill that address charges billed to patients for out-of-network services they may not even have been aware they were receiving.

For instance, a surgical patient may know they will receive a bill from the surgeon, but not know that the pathology report the surgeon routinely requests goes to an out-of-network pathologist. The patient may then receive a hefty ‘surprise’ bill for this service.

The current legislative proposals aim to resolve this surprise bill once the patient receives the bill. Congress currently is considering two such approaches – negotiating the amount owed through arbitration, which is the method used in New York, or benchmarking the figure to a reference point like Medicare. In both instances, bills would be reconciled on a case-by-case basis after services were already rendered.

NCMS Board members believe it is better for patients for these issues to be addressed more proactively by identifying the areas where surprise billing is most likely to occur and negotiating charges before they are billed perhaps by requiring them to be arbitrated in advance of services being rendered. This represents a shift in thinking from reacting to the surprise bill after the fact, to preventing it in the first place.

With this philosophy in mind, the Board agreed to the following policy framework statement: NCMS supports protecting patients from unanticipated bills due to non-network medical services through up-front, equitable financial arrangements.

Board members agreed this would help eliminate surprise bills and preserve the physician-patient relationship firmly in keeping with the NCMS’ values and mission.

NCMS Senior Vice President for Advocacy and Associate General Counsel Chip Baggett, JD, is in Washington, D.C. today meeting with the North Carolina delegation to discuss this proactive approach. Read the document he is distributing, which explains the issue and our position.

Watch your NCMS Morning Rounds for updates on this issue as Congress tries to resolve this issue before the holiday recess in December.

Wake Forest Inter-Professional Leaders in Medicine Program Kicks Off

Last weekend the 35 participants in this year’s Wake Forest Inter-Professional Leaders in Medicine gathered for their first session of the year-long program.

This Kanof Institute for Physician Leadership customized program, under the direction of Wake Forest’s Roy Strowd, MD, brings together physicians, physician assistants and certified registered nurse anesthetists to share perspectives and hone their leadership skills.

Learn more about the Kanof Institute and its various leadership development programs.

Flu Update: Slight Increase in Activity Reported

The Centers for Disease Control and Prevention’s (CDC) ‘FluView’ report shows that flu activity continues to increase in the U.S., but that it’s too early to predict when flu season will peak or which strains will be dominant. View the CDC’s report. The NC Department of Health and Human Services also tracks flu cases each week throughout the season. Access NCDHHS’ weekly report.

With credits to Becker’s Hospital Review, here are ‘Five Things to Know’ about the flu based on the CDC’s latest data:

  1. The percentage of outpatient visits for flu-like illness was 2.1 percent for the week ending Nov. 1, up from 1.9 percent a week prior. However, this figure remains below the national baseline of 2.4 percent.
    2. About 3.2 percent of respiratory specimens tested positive for flu in clinical laboratories nationwide for the week ending Nov. 1, marking a slight increase from the previous week. The agency has confirmed 1,978 positive specimens since Sep. 29.
    3. Louisiana experienced high flu-like illness activity for the week ending Nov. 1. Nine states experienced low activity, and the remaining states experienced minimal activity.
    4. No new pediatric flu deaths were reported to the CDC in the week ending Nov. 1. The pediatric death count remains at two for the 2019-20 flu season.
    5. Maryland and Louisiana reported widespread flu activity, and Alabama reported regional flu activity for the week ending Nov. 1. Fifteen states reported local flu activity, 31 states reported sporadic activity and Rhode Island reported no flu activity.

In the News

You Can Get a Master’s in Medical Cannabis in Maryland, NPR, 11-9-19

Learning Opportunity

NC Medicaid Provider Services is partnering with NC Area Health Education Centers (AHEC) to host Health Plan Meet and Greet sessions across the state. Meet and Greet sessions are structured as conversations between providers and Medicaid Managed Care Health Plan staff. NC Medicaid consultants will be on site to address your concerns and questions about the transition from Medicaid fee-for-service to Medicaid Managed Care. Presentations are not planned. Feel free to drop in at any time during the sessions.

Sessions will be held:
• Wednesday, Dec. 4 – Fayetteville
• Thursday, Dec. 5 – Raleigh
• Friday, Dec. 6 – Elizabeth City
• Monday, Dec. 9 – Rocky Mount
• Tuesday, Dec. 10 – Greenville
• Wednesday, Dec. 11 – Wilmington
• Friday, Dec. 13 – Burlington
• Monday, Dec. 16 – Asheville
• Tuesday, Dec. 17 – Winston-Salem
• Wednesday, Dec. 18 – Charlotte

Get the details and register.


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