Jamie

While it may appear that there is a dearth of good news in the '27 Medicare Physician Fee Schedule (MPFS) final rule (see below)--w/ the conversion factor cut for most physicians increasing from -1.68% proposed in July to -2.31% in the final rule--there were some advocacy wins--and there is work to do. The only entity that can prevent the over 2% cut this year is Congress and they will be in session starting Monday 11/9/26 for ~20 days. There is HR 8163, The Provider Reimbursement Stability Act of 2026 – which has passed the House Ways & Means in May with 79 bi-partisan cosponsors. Our theme is further cuts to Medicare, in addition to health plans' myopic instance on federal rate setting for out of network physicians, threatens access to care and threatens to accelerate the decline of independent physician practices. zotecpartners.us.newsweaver.… @ZotecPartners

1/Even the vaulted @WSJ (who I have said for their reporting of @UHC Medicare Advantage criminal & civil investigations in ‘25 that they should receive a Pulitzer) can completely overly hype a headline and miss the real story. The Wall Street Journal share.google/RuczBDJTj2JOlUg…

This new study (7/27/26) of nearly 5M patients confirms with data what other studies have shown, e.g. RAND Corp. study of emergency physician reimbursements (April 2025), that persistent declines in Medicare reimbursement rates are having a negative impact on patient's access to care. From 2025 to 2023, adjusted for inflation (recall that physicians are alone in not receiving a CPI-U adjustment in the CMS fee schedule), the Medicare fee schedule has declined over 48%. With over 10K seniors entering Medicare each day, Congress must respond to continued access to care threats. Two Decades of Medicare Payment Declines Associated with Worsening Patient Access Gaps neimanhpi.org/press-releases… via @neimanhpi

Thanks Doc and not a mention in the NYT of the issue with the initial payments (QPA) being about ~300% below the true median allowed amounts required by law. No mention either of huge payment compliance issues with the health plans not paying for one cohort of ED physicians nearly 50% of IDRs in compliance w/ law & totaling about $245M for 2025, and that I have cited here more times than I can count.

@senthomtillis @SenTedBuddNC @virginiafoxx 🚨 Congress passed the #NSA. Insurers are ignoring it. Physicians are fed up w/ delayed payments & insurers defying binding rulings. H.R. 4710/S. 2420 is a simple fix: enforce the law. Lawmakers — cosponsor now. Patients & physicians can’t wait. @ZP_PAC

1/@BlueCrossNC meanwhile is issuing demand letters to hospital based groups claiming coding errors and demanding literally many millions of $s from these groups. NC Blue has given no explanation of how they are using extrapolation to reach their many $Ms in claimed overpayments. The federal gov’t has a well defined process for using extrapolation and “progressive corrective action” for groups identified with coding issues. The groups vehemently deny the degree and extent of coding errors. Oh and BlueCross NC is threatening to use “voucher deductions” on future claims if the $6.27M demanded from one ED group is not paid. Rumor is that another larger group has been hit w/ a +$10M demand. These groups have no choice but to “lawyer up” to respond to these existential threats. In 3+ decades in this state I have never seen this level of aggressive misconduct by a health plan—one whose CEO is an MD! Blue Cross regains North Carolina’s state health plan contract while Aetna loses out beckerspayer.com/contracting…

After commenting multiple times, 100s of hours of work and waiting nearly 2.5 years, our considerable advocacy as a community has paid off—here are the highlights from the CMS Final Rule on IDR Operations under the #NoSurprisesAct —my editorial comments in are in bold: 1. Plans and issuers must use CARCs and RARCs to communicate NSA-related information on remittance advice. Huge potential win for physicians and will reduce the ineligible claims significantly. 2. Open negotiation must move through the Federal IDR portal, with expanded notice content. The plans have been ignoring the open negotiation (ON) process—not sure that will be working so well for them now. 3. A new open negotiation response notice is required within the first 15 business days. See previous comments. 4. IDR initiation notices require more information, and the non-initiating party must respond within 3 business days. Potentially neutral. 5. Certified IDR entities get 5 business days after final selection to make eligibility determinations. Also potentially good when the CARCs and RARCs are mandated. 6. Plans and issuers must register in the Federal IDR portal. This could be huge but the devil will be in the details. 7. Batching rules are expanded and clarified. Could be a plus/minus 8. Cooling-off for batched disputes is reduced to 30 business days. Better, but we wanted 1 day cooling but way better than the current 90 days. 9. The administrative fee is reduced to $15 per party per dispute. Huge win here as the current CMS fee is $115 per party. 10. CMS declines to finalize certain proposed fee-collection changes and reduced-fee structures for low-dollar or ineligible disputes. The low dollar structure could have really helped radiology. For those who question the resources spent in time and money for advocacy by the physician and supporting community, this rule, subject to reviewing all 600+ pages, could be Exhibit A for why we do it. cms.gov/files/document/feder…