If you're a hospital based group, the No Surprises Act will be a significant factor. You need to understand the interplay between federal law and any applicable state law. If federal law will generally prevail (or no state law in place), then a key question is what is the QPA, which is what you would normally be paid out of network. Remember that the QPA is the January 2019 median contracted rates for the same code in the same geographic area, adjusted for inflation by the CPI-U (+9% last time I checked). Also remember that the inflation adjustment occurs annually each year into the future.
If the payor asserts a QPA well below what you see as common in the market in January 2019 + inflation, then I would ask for supporting data....the payor should be able to show that half of the contracts in the market were below the QPA in the base period.
I also think the No Surprises Act provides a strong argument for all future contract to contain annual escalators tied to CPI-U, since that will drive changes in the QPA going forward.
Obviously, the impact of the No Surprises Act may be negative for the minority of groups with rates well above the median, but it should be positive for the majority, especially as inflation continues.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
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Original Message:
Sent: 12-01-2021 10:20
From: Mindy Smith
Subject: Payor Contract Proposals
We notice that requested renegotiations almost always end up in reductions.
Unless you have proof that other markets in your same modality and setting are getting more, you don't have much of a leg to stand on.
Original Message:
Sent: 12/1/2021 9:48:00 AM
From: Joanne Chichizola
Subject: RE: Payor Contract Proposals
Marlo,
United HC came in and lowered our rates. They claim they were re-adjusting the market. After months of negotiations we agreed to the lesser of the evils.
Good luck!
Joanne Chichizola
Billing Manager
image002.png@01D4F5C8.AEAC51A0">
777 Passaic Ave, Clifton, NJ 07012
Phone: (973) 284-0020 X 1304
Fax: (973) 284-6310
Original Message:
Sent: 12/1/2021 9:42:00 AM
From: Marlo Bakst
Subject: Payor Contract Proposals
Good Morning,
We are in touch with a few consultants regarding renegotiating Aetna and United.
Neither have been done in awhile.
What should the expected uplift be and is it usually done over a period of time(3 yrs)?
Thank you
Marlo Bakst
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Marlo Bakst
Manager, RCM
New Rochelle Radiology Assoc., PC
New Rochelle NY
914-633-7700
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