NCMS Morning Rounds 12-23-20

Enjoy your last NCMS Morning Rounds of 2020!

Dec. 23, 2020

The NCMS staff thanks all of our members for their continued support this year and for the incredible work you do for your patients in the most challenging of times.

Best wishes for a happy, healthy 2021!

NCMS offices will be closed from Dec. 24 through Jan. 3. We will reopen for normal business hours on Jan. 4, 2021, from our home offices. Feel free to contact us at with any questions. Your NCMS Morning Rounds newsletter will resume publication on Tuesday, Jan. 5.

Some More Details on Surprise Billing Legislation

On Monday evening both chambers of Congress passed a $900 billion COVID-19 relief bill along with $1.4 trillion omnibus spending legislation that funds the federal government through September. Read this high level summary of the legislation as it pertains to health care from the Democratic staffs of the House Committees on Ways and Means, Energy and Commerce, and Education and Labor and the Senate Committees on Health, Education, Labor and Pensions (HELP) and Finance.

Contained within the 5,000+ page legislation is a provision called The No Surprises Act, which seeks to address surprise medical bills. Here is a brief summary of that provision.

Specifically, the legislation is designed to protect consumers in the following ways:
• Holds patients harmless from surprise medical bills. Patients are only required to pay the in-network cost-sharing (i.e., copayment, coinsurance, and deductibles) amount for out-of-network emergency care, for certain ancillary services provided by out-of-network providers at in-network facilities, and for out-of-network care provided at in-network facilities without the patient’s informed consent.
• Holds patients harmless from surprise air ambulance medical bills.
• Allows consumers to access an external review process to determine whether surprise billing protections are applicable when there is an adverse determination by a health plan.
• Requires health plans to provide an Advance Explanation of Benefits for scheduled services at least three days in advance to give patients transparency into which providers are expected to provide treatment, the expected cost and the network status of the providers.
• Allows patients with complex care needs to have up to a 90-day period of continued coverage at in-network cost-sharing to allow for a transition of care to an in-network provider.
• Improves the accuracy of provider directories by holding plans and providers accountable for inaccurate directories, ensuring patients have more up-to-date information and are responsible for only their in-network cost-sharing amount when they rely on an inaccurate provider directory.

As noted in yesterday’s NCMS Morning Rounds, the NCMS has long advocated for reforms to protect patients from surprise bills, and in November 2019, the NCMS Board of Directors adopted a policy framework to guide our advocacy on this issue. We have long sought a solution that addresses the issue proactively by shifting the focus from reacting to the surprise bill after the fact, to preventing it in the first place. This could be accomplished 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. Learn more about the NCMS’ proactive approach to this issue.

The NCMS will continue to analyze the new legislation, which has been sent to the White House to be signed into law, and what it might mean for your practice. Watch this newsletter for updates.

Congratulations to Our 2021 Future Clinician Leaders

The newest cohort of Future Clinician Leaders College scholars has been selected and is ready to begin the year-long course of study starting in February 2021. The program, a partnership between the NCMS Foundation’s Kanof Institute for Physician Leadership and NC AHEC, offers leadership development for emerging leaders in health care professional training in North Carolina with an emphasis on leading in an inter-professional health care environment and networking across institutions.

The 30 scholars are listed below with their institution and area of study. Congratulations to the following future leaders!

Caroline Coggins, Cabarrus College, OT
Kara Tarpey, Cabarrus College, OT
Brennen Guzik, Campbell University, Pharmacy
Heather Pol, Campbell University, DO
Briana Williams, Campbell University, Pharmacy
Hunnain Siddiqui, Campbell University, Pharmacy
Meredith Smith, Duke University, Doctorate – Physical Therapy
Lauren Alexander, Duke University, Doctorate – Physical Therapy
Julianne Peters, Duke University, Doctorate – Physical Therapy
Tichelle Porch, Duke University, MD
Diya Uthappa, Duke University, MD
Denisse Porras, Duke University, MD
Kira Pazner, Duke University, MD
Shashank Rajkumar, Duke University, MD
Mariah Leroux, Duke University, PA
Adaugo Iwuala, Duke University, PA
Michaela Kaltner, Duke University, PA
Erin Figgins, Duke University, PA
LeVon James, Duke University, PA-C
James Parker, East Carolina University, DMD
Cody Phen, East Carolina University, DMD
Amber Gautam, East Carolina University, MD
Laura Beth Lavette, Wake Forest University, MD
Carly Olszewski, Wake Forest University, MD
Sharon Thomas, Wake Forest University, MD
Logan Oyler, Wake Forest University, PA
Douglas Teasdall, Wake Forest University, PA
Kristen Dodenhoff, Wake Forest University, PA
Amy Gallagher, Western Carolina University, Doctorate – CRNA
Wesley Maughon, Western Carolina University, Doctorate – CRNA

Review the work of the previous class of Future Clinician Leaders in this compendium of their final white papers here.

Learn more about Future Clinician Leaders College here and about all the programs of the Kanof Institute for Physician Leadership here.

Being a Good Corporate Partner in Health

Centene Corporation, with whom the NCMS has a joint venture in Carolina Complete Health Network one of the state contracted Medicaid managed care plans, recently highlighted its role as a partner in helping medical practices and communities in North Carolina during the pandemic.

This opinion piece illustrating Centene’s contributions appeared in the Charlotte Business Journal earlier this month.

Learn more about Carolina Complete Health Network here.

In the News

What the Vaccine’s Side Effects Feel Like, The Atlantic, 12-18-20

Learning Opportunity

The first Duke-UNC Tobacco Treatment Specialist Training Course for 2021 will take place beginning in March. Early bird registration is open through Jan. 15. The primary aim of the program is to train health professionals to provide evidence-based treatment for tobacco use and dependence. The program provides an impactful education experience for a wide variety of professionals, including clinicians, nurses, pharmacists, social workers and public health policymakers. This work is integral to women’s and children’s health. Learn more and register here.

If you have policies you’d like your NCMS Board of Directors to consider, please complete the Board input form here. Thanks for reading!


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