Mo Azam, MD, MBA

#anesthesiologist, healthcare+business, Tweets my own & not advice, not employer's; RT/Follows not endorsement

[ASA Monitor @ASAMonitor]

In “Episode 192: Inside the Monitor - Practice Management: The Evolving Anesthesia Workforce,” you’ll hear from Drs. @moeed_azam and Jun Ma as they discuss ways to shape the next generation of #anesthesiology practice.

🎙️https://t.co/ot84TkGpB3
@EmoryMedicine @HopkinsMedicine

[ASA Monitor @ASAMonitor]

New podcast episode! Dr. Keya Locke speaks with Drs. Jun Ma and Mo Azam. Tune in to hear about:
🔸 Adaptive staffing models
🔸 NORA expansion
🔸 Workforce strategies

https://t.co/9cWWnlpUQ5
@EmoryMedicine @moeed_azam @HopkinsMedicine @zbdeutch

[Ed Gaines @EdGainesIII]

#KS AG sues ⁦@Aetna⁩ in part claiming that it used @Claritev f/k/a Multiplan to garner shared savings in violation of its state contract & False Claims Act. https://t.co/TFm23UMOq5

[Ed Gaines @EdGainesIII]

1/ After @AnthemBCBS (or @ElevanceHealth or whatever they are called this week; heads up that the corp. name changers may want to consider new names) reserved nearly $1B to re-pay CMS for numerous violations in #MedicareAdvantage (MA), Anthem paid CMS $342M amid Medicare Advantage sanctions threat.

How could the company refuse to re-pay MA overpayments? If physicians and hospitals fail to do so, they can face False Claims Act penalties for “reverse false claims.”

Potential CMS sanctions remain looming per CMS if the company does not come into compliance by the end of July.

Yet another sterling example of the urgent need to completely overhaul the MA system.

Oh, and @TheJusticeDept is separately suing Anthem for MA waste, fraud and abuse (link in this article) claiming that the company was garnering $100M+ in illegal payments.

https://t.co/fELj7araiW

[Mark Cuban @mcuban]

Is there a smart politician that would propose legislation that any healthcare company, fined, across all states or federal agencies, more than one time , is not eligible (including affiliated companies), to do business with the federal government for at least 5 years ?

[Mo Azam, MD, MBA @moeed_azam]

@brian_blase And tell me why we should have government in the business of regulating prices between FOR PROFIT insurance companies and free market medical practices? Insurance companies are blood sucking middlemen

[Christopher Cook, D.O., FASA @CRCook1978]

Today I testified before @TexasTDI on proposed Network Adequacy Rulemaking (Docket 2868).

Health plans often argue they cannot find physicians or facilities willing to contract. Yet our June 2026 review of nearly 50,000 network adequacy waivers requested across all 254 Texas counties revealed several important patterns.

Most striking: 36% of all waivers originated from just 10 of Texas’ most populated counties, not rural Texas.

If plans cannot build adequate networks in Harris, Dallas, Tarrant, Bexar, Collin, Denton, Travis, Montgomery, Williamson, and El Paso Counties areas with some of the highest concentrations of physicians, healthcare professionals, and facilities in Texas the answer is not weaker rules.

The answer is transparency, accountability, and enforcement of HB 3359.

Texans pay for PPO and EPO coverage expecting real access to in-network care.

@LoisKolkhorst @DrSchwertner @DrGregBonnen @RepJamesFrank

@TSAPhysicians @ASAGrassroots
#txlege #HB3359 #NetworkAdequacy #TexasHealthcare #HealthInsurance #PatientAccess #Transparency

[AZ Attorney General Kris Mayes @AZAGMayes]

By using a shared algorithm to set payments, these companies harmed doctors and patients alike—driving up patients’ risk of paying more out‑of‑pocket, depriving providers of fair payment, and making it harder for Arizonans to get the care they needed.

https://t.co/JJRmc6RR4j

[Mark Cuban @mcuban]

To all independent doctors. What percentage of your patients are in their deductible phase ? And what percent of those are getting care for less than their deductible?

Ins carriers know you take all the risk of payment. Time for that to stop

[Congressman Greg Murphy, M.D. @RepGregMurphy]

As a physician of 35 years, I have dedicated my life to serving others, primarily in rural and underserved communities.

Now, instead of spending time fighting disease, we spend more and more time fighting insurance companies’ ever-increasing obstruction.
https://t.co/ANVlWi9pEd

[Congressman Greg Murphy, M.D. @RepGregMurphy]

As a physician who has served patients for 35 years, I am sickened by the unconscionable practices of health insurance companies that continually place profits above patient care.

Prior authorization, in particular, is being abused to prop up profits and deny care to those who need it.

[Mark Cuban @mcuban]

@DrDiGiorgio All doctors are underpaid.

[Adam Bruggeman, MD @DrBruggeman]

It’s Fix It Friday. Let’s look at what went right and what still needs to be fixed for the NSA.

The final IDR Operations rule did a lot of things I have been asking for. The 87% reduction in the administrative fee is needed. For a small independent practice filing disputes to collect what an arbitrator already said they are owed, dropping from $115 to $15 per party is the difference between the process being accessible and it being prohibitive. The mandatory payer registry and CARC/RARC requirements attack the eligibility confusion problem that has generated enormous waste on every side of this process. Requiring a formal response during open negotiation means payers have to engage rather than simply wait out the clock. The batching cap going to 50 items reflects the Departments listening to practical feedback. The extenuating circumstances extensions give IDR entities flexibility they did not have before. And shortening the batched cooling-off period from 90 to 30 business days is genuine progress on an issue creating significant problems. The Departments deserve credit for all of it.

I think genuine consensus with insurers is possible on some issues, which was the point of the @RepAaronBean panel on May 18. The Elevance representative said directly that ineligible claims should not be getting into arbitration, that everyone must follow the law, and that driving in-network participation is a shared goal. I agree with all of that. The eligibility screening clearinghouse I described Thursday is a solution both sides should be able to support. No one benefits from ineligible claims consuming arbitration resources. Where we have agreement, we have to act on it.

Here is where I am focused on the remaining gaps.

Cooling Off
The Departments committed to clarifying how the cooling-off period applies. That guidance must define same parties at the level of the individual self-insured employer plan, not the third-party administrator. The Departments made exactly this determination in this same rule for batching identity. The employer plan is the responsible payment entity, not the TPA. That logic applied to the cooling-off definition contains the prospective stacking problem. If the guidance goes the other direction, the perpetual cooling the Departments acknowledged will continue and worsen regardless of the 30-day reduction. The ambiguity has now lead to a lawsuit between a payer and a billing company. We must resolve the issue.

Retroactive Ineligibility
The final rule removed the option to resubmit inappropriately batched disputes. In the context I described yesterday, that eliminates the only corrective pathway for a physician whose claim was fully adjudicated on the merits, resulted in a win, and was then declared ineligible after the fact by the party that owes the money. There is no resubmission right, no appeal, and no penalty on the insurer for doing this. Congress needs to restore the resubmission right and create the appeal mechanism that does not currently exist.

Enforcement parity
H.R. 4710 and S.2420, the No Surprises Enforcement Act sponsored by @RepGregMurphy and @RogerMarshallMD , creates automatic penalties for insurer non-payment after IDR awards and closes the penalty gap that Senator Marshall's own bill language acknowledges by calling explicitly for parity between parties who are not compliant with the law. In 2024, 59.6% of awards were not paid on time and 26.3% were paid in the wrong amount. That bill should be on the floor.

QPA transparency
The rule does not address how QPAs are calculated or what disclosure obligations insurers carry. An independent December 2025 analysis found the actual in-network rate exceeded the reported QPA in 60.6% of dispute cases, with the gap averaging 290.5%. A benchmark the insurer calculates, controls, and has every financial incentive to suppress should not function as a federal payment reference without disclosed methodology and independent audit. The Departments can address this through rulemaking. Congress should require it if they do not. This doesn’t even consider the mandated inflationary increase to qpa, which should be audited

Portal Infrastructure
The 24-month modernization window should produce a unified, real-time clearinghouse with pre-screening capability, payment compliance tracking, and genuine CMS oversight, not a rebuilt version of 15 separate email pipelines. The resources are in the fund. The design decisions are being made now.

The patient shield is working. The $567 in annual savings documented by the BMJ, with no premium increase, is the law doing exactly what Congress intended, even though this wasn’t created as a cost savings measure. I want to keep it working. That means finishing the job on the dispute machinery underneath it, through the guidance, through H.R. 4710, and through the portal.

[TheIntenseClinicalRecruiter @NealGrab]

@mmfnpcrna There is no staffing crisis....there is a surgeon convenience crisis

[Delaney Corcoran @del_corcoran]

Rural Arizona Paper Editorial about Kris Mayes' new health care cost lawsuit: "Insurers certainly have a duty to keep costs down, but they shouldn't shift the burden onto patients who already paid for protection. You voted: Yes 96.3% Yes 3.7% A major antitrust lawsuit by Arizona Attorney General Kris Mayes targets exactly that."

[Ed Gaines @EdGainesIII]

Thanks Adam; the EDPMA member survey of 2025 data (released in April ‘26) shows some improvement on payment compliance by the health plans but still systemically poor compliance at nearly 50%.

If you were to survey in the states covered by the US Court of Appeals for the 5th Circuit (TX, MS and LA), the non-compliance rate would be much higher than 50%, especially non-compliance by @BCBSTX.

TX Blue and their parent company, @HCSC, are hiding behind the 5th Circuit ruling in the past 12-18 months that holds that there is no private right of action to enforce IDRE determinations in federal court.

Witness the recent report in @RadiologyBiz on the overdue amounts due to Radiology Associates of North Texas (RANT) by TX BCBS, a substantial portion of which has been overdue for over 120 days.

[Adam Bruggeman, MD @DrBruggeman]

Today let’s discuss enforcement of the NSA and how the final rule only partially helped solve this problem.

A fair process for enforcement requires a front-end penalty for submitting ineligible claims and a back-end penalty for failing to pay after a successful IDR determination. The back-end penalty is straightforward. EDPMA's full-year 2024 data found 59.6% of IDR awards were not paid within the statutory 30-day window. Of awards that were paid, 26.3% were paid in the wrong amount. H.R. 4710, the No Surprises Enforcement Act sponsored by Rep. Greg Murphy and Sen. Roger Marshall, creates the penalty structure for non-payment that the NSA should have included from the beginning. It has bipartisan support in both chambers and it should move.

The front-end penalty is less straightforward.

In 2022, 45% of all IDR disputes were dismissed as ineligible. By 2023 that dropped to 22%, but at current volumes 22% still represents hundreds of thousands of cases consuming arbitrator time and administrative fees before being thrown out. A penalty for submitting ineligible claims seems like an obvious fix. The problem is that physicians frequently cannot determine eligibility at the time of submission.

The CARC and RARC codes the final rule mandates are a real improvement. That being said, many times a code is being used (N830) that tells the physician the claim is eligible but does not tell you whether a claim belongs in federal IDR or a state process. In the 33-plus states with bifurcated systems, where some plans go to state IDR and others go to federal, that distinction requires plan-level data the physician does not have. The insurer has it but chooses either not to provide the information or uses an ambiguous code

This is the irony at the center of the eligibility debate. The industry most loudly complaining about ineligible claims flooding the system is the only party with the data infrastructure to prevent it. Insurers know whether a given plan is self-insured ERISA, fully insured state-regulated, grandfathered, or non-grandfathered. They know what state law applies to each claim. Physicians are expected to make accurate eligibility determinations with none of that information.

A penalty that attaches to submitting ineligible claims cannot be fair if the data required to determine eligibility is held exclusively by the opposing party and not disclosed or incompletely disclosed.

Here is what a workable front-end enforcement structure looks like. Before a physician can submit a dispute to the federal IDR portal, they go through a standardized eligibility clearinghouse that takes the claim data and cross-references it against insurer-supplied plan data to make the state versus federal determination. If the claim clears that check, the clearinghouse issues a unique submission token. The federal portal only accepts disputes accompanied by a valid token. No token, no submission. The penalty attaches to submitting without a token, not to the outcome of an eligibility determination made without adequate data.

This approach changes the policy logic. If the penalty attaches to bypassing the eligibility check, then insurer participation in the clearinghouse is not optional. They either supply the plan-level data that makes accurate eligibility determinations possible, or they own the eligibility problem they have been complaining about. Physicians do not want to submit ineligible claims. They want the data to avoid it. The clearinghouse model gives them that, and it makes insurer data participation a structural requirement rather than a voluntary gesture.

Together we can solve these issues. Physicians don’t want to submit ineligible claims. Payers don’t want to have to fight every claim that is ineligible and/or pay out on claims that never should have been in the system in the first place. There is clear consensus here that the administration and Congress can move quickly on.

[Ed Gaines @EdGainesIII]

There is a plethora of good news in the newly issued CMS No Surprises Act (NSA) Independent Dispute Resolution (IDR) Operations final rule, but none better than CMS reducing its non-refundable administrative fee from $115 to $15 per party per dispute.

Mark and I discuss this highlight and more in our latest podcast.

CMS used its regulatory authority to announce yesterday June 2, 2026 that the new fee would be effective for disputes filed on June 11, 2026, instead of the standard 60 days after publication of the rule in the Federal Register.

Once again, the physician and supporting advocacy community should take another victory lap.

https://t.co/4Utrzpm2eX

[Adam Bruggeman, MD @DrBruggeman]

In every serious policy conversation about the NSA, insurers and insurer supported think tanks claim that IDR volume proves the process is being abused. That argument is built on a foundation of bad data.

The federal government projected 17,000 annual IDR disputes. The system is now processing over 2.6 million. That gap is routinely cited as evidence that physicians are gaming the system. I said at a Ways and Means Committee panel on May 18 that the 17,000 number is not a number we can anchor on, and @PatrickVelliky has done a great job explaining this in Health Affairs Forefront and his Substack.

The Departments based their estimate entirely on New York's IDR experience, scaling New York's roughly 1,000 annual disputes to the national insured population to arrive at 17,000. The problem is that New York's law structurally eliminated emergency medicine disputes by tying out-of-network emergency payments to usual and customary rates rather than sending them to arbitration. Emergency medicine accounts for more than half of all federal IDR disputes. Using New York as the baseline created the system around a model that excluded the largest category of claims from the beginning.

Texas was the right baseline and the data was publicly available. Texas had an analogous arbitration structure with no emergency medicine carve-out. In its first year, the Texas Department of Insurance received nearly 49,000 disputes from approximately 5.8 million Texans in state-regulated plans. Apply that rate to the 183 million nationally insured and you get roughly 1.55 million estimated annual federal disputes, not 17,000. The volume crisis was baked in before the law took effect and doesn’t reflect gaming.

Let’s look at what the volume actually represents. The October 2025 AHIP/BCBSA survey, the insurance industry's own data, found approximately 19.7 million commercial claims were NSA-eligible in 2025. Of those, only 1.23 million were submitted to IDR, a rate of 6.2%. After removing ineligible disputes and cases where the insurer prevailed, additional IDR payments were required in just 4.4% of NSA-eligible claims. The real insurer win rate across all NSA-eligible claims is over 95%. The insurance industry is telling Congress it is losing a process it wins 95% of the time.

The 85% provider win rate in IDR applies only to the 6% of claims that actually reach arbitration. These are cases providers specifically chose to dispute because they were confident the underpayment was real and documentable. Patrick provided a great example. A district attorney with a 50% conviction rate would be investigated for wrongful prosecution. A high win rate in a self-selected pool of documented underpayments is exactly what a functioning backstop looks like.

One more piece of context on the awards themselves. An independent December 2025 analysis of Q4 2024 CMS data across Aetna, BCBS, Cigna, and UHC found that in 60.6% of dispute cases, the actual median in-network contracted rate exceeded the reported QPA, and where it did, the actual in-network rate was 290.5% higher than the QPA. When providers win at what gets called three or four times QPA, they are frequently winning at or below what the same insurer pays its own contracted network physicians for the same service. The QPA is the benchmark, but the QPA is not the market rate.

The final rule does not address QPA methodology but does continue to ensure that eligible cases get through

@IndeMedAction

[Jerod MacDonald-Evoy @JerodMacEvoy]

Arizona sues MultiPlan, major insurers, alleging a ‘cartel’ that underpaid doctors and hospitals https://t.co/6V5VJAubHY