Author Archive for Adrienne Frederick

EDPMA Joins Coalition Urging CMS to Extend Telehealth Codes Through CY 2024

On Thursday, January 26, 2023, a coalition of over 45 organizations sent a letter to CMS urging the extension of telehealth codes through CY 2024 to align with Congress’ intent under the Consolidated Appropriations Act, 2023, which extends telehealth flexibilities through CY 2024. The letter can be found here.

EDPMA Joins Coalition Urging Medicare Payment Reform

On Monday, January 23, 2023, EDPMA joined a coalition of over 100 organizations urging Congress to reform the Medicare payment system. The letter can be found here.

EDPMA-ACEP Follow-up on NSA Implementation

On Thursday, January 19, 2023, EDPMA and ACEP sent a letter to the Tri-Agencies thanking them for the early January conversation and providing additional input and more detailed recommendations. The letter can be found here.


On Monday, January 23, 2023, ACEP issued a press release regarding the letter and it can be found here.

Top Medical Associations Oppose 600% Independent Dispute Resolution Fee Increase, Call on Congress for Oversight

WASHINGTON, DC, January 13, 2023 – The Radiology Business Management Association (RBMA), Emergency Department Practice Management Association (EDPMA), Healthcare Business Management Association (HBMA) and Medical Group Management Association (MGMA) all strongly oppose the U.S. Centers for Medicaid and Medicare Services (CMS) 600% administrative fee increase to utilize the Independent Dispute Resolution (IDR) process provided by the No Surprises Act (NSA). The Associations represent radiology and emergency healthcare clinicians across the country, and they call on CMS to immediately reverse this decision and on Congress to initiate oversight proceedings on this executive action.


“RBMA fully supports Congress’ intention of the NSA to protect patients from unexpected medical bills, and our physicians are committed to providing affordable, quality care to their patients across the country,” said Bob Still, Executive Director of the Radiology Business Management Association (RBMA). “As such, this 600% fee increase under the NSA puts physicians in the middle of health plans and CMS’ inadequate implementation process of those plans. By pricing out the method for dispute resolution with this excessive fee, our providers’ ability to perform important services, like cancer screenings, will be significantly hindered and inevitably hurt the healthcare of American consumers.”


“While EDPMA understands CMS’ need to address the IDR backlog, exorbitant fees are simply not the answer. These abrupt, inappropriate increases unnecessarily burden emergency medicine clinicians and significantly deter clinician’s access to the method of dispute resolution provided by Congress. This is another substantial mis-step that fails to address fundamental operational and policy-related issues involved in the No Surprises Act,” said Don Powell, DO, FACEP, EDPMA Chair. “CMS’s actions prevent the level playing field provided in the law, and contrary to the law’s interests, will drive more payer-driven contact terminations, while crippling the cash flow that supports emergency care for patients.”


“Increasing the administrative fees for the IDR process by 600% is not the appropriate way to address the backlog of IDR disputes,” said Landon Tooke, CHC, CPCO, President of HBMA’s Board of Directors. “The new fee – which is not reimbursed to the initiating party – is higher than many of the disputed payment amounts. This unfairly disincentivizes clinicians from utilizing the IDR process and does not align with how Congress intended this process to be used. The higher fee does not address the root cause of the backlog, which is health plans forcing many practices out of their networks which puts a greater burden on the IDR process. While we understand the need to address the high volume of initiated disputes, health plans share the responsibility to reduce the backlog by properly communicating if the NSA protections apply to a specific scenario and by negotiating in good faith during the open negotiation window.”


“MGMA supports the goals underpinning the No Surprises Act — we believe patients should have accurate and timely access to the costs of items and services. However, the law must be implemented in a manner that does not create undue burden on our nation’s medical groups, nor impede practices’ ability to deliver care,” said Anders Gilberg, Senior Vice President of Government Affairs for MGMA. “Increasing the administrative fee for the IDR process will disproportionally effect providers who are already suffering from significant financial strain stemming from staffing shortages, wage inflation, and drastic cost increases across the board. We encourage CMS to swiftly reevaluate the administrative fee, to make it equitable so as to not prohibit medical groups’ ability to initiate the IDR process to settle payment disputes with health plans as granted by the law.”


The Associations call on CMS to fairly rebalance the IDR process, keep administrative fees at fair and stable 2022 levels, and address their unsustainable backlog of claims under NSA. To ensure this appropriate and much needed reform at CMS, the Associations call on the new Congress to initiate oversight proceedings on these processes at CMS.


After first announcing in October 2022 that the 2023 administrative fee would remain stable, in a last-minute move in late December 2022, CMS announced a 600% increase in non-refundable administrative fees for any party to file out-of-network claims disputes through the NSA’s IDR process. Additionally, CMS had previously announced fee increases of up to 117% for IDR entities. The dramatic, unprecedented increase in initial fees with less than a week’s notice disproportionately affects providers, favors health plans, and will hurt consumers.




About RBMA:

The Radiology Business Management Association (RBMA) is an industry-leading organization comprised of more than 2,100 professionals who focus on the business of radiology. RBMA members support diagnostic imaging, interventional radiology and radiation oncology providers in the full spectrum of practice settings. RBMA connects members nationwide to valuable information, education, and practice-related resources and serves as an authoritative industry voice on behalf of shared member interests.


About EDPMA:

The Emergency Department Practice Management Association (EDPMA) is the nation’s largest professional physician trade association focused on the delivery of high-quality, cost-effective care in the emergency department. EDPMA’s membership includes emergency medicine physician groups of all sizes, as well as billing, coding, and other professional support organizations that assist healthcare providers in our nation’s emergency departments. Together, EDPMA’s members deliver (or directly support) health care for about half of the 146 million patients that visit U.S. emergency departments each year. Visit


About HBMA: 

The Healthcare Business Management Association (HBMA), a non-profit professional trade association, is a major voice in the revenue cycle management industry in the United States. HBMA is a recognized revenue cycle management (RCM) authority by both the commercial insurance industry and the governmental agencies that regulate or otherwise affect the U.S. healthcare system. To learn more, visit


About MGMA:

Founded in 1926, the Medical Group Management Association (MGMA) is the nation’s largest association focused on the business of medical practice management. MGMA consists of 15,000 group medical practices ranging from small private medical practices to large national health systems representing more than 350,000 physicians. MGMA helps nearly 60,000 medical practice leaders and the healthcare community solve the business challenges of running practices so that they can focus on providing outstanding patient care. Specifically, MGMA helps its members innovate and improve profitability and financial sustainability, and it provides the gold standard on industry benchmarks such as physician compensation. The association also advocates extensively on its members’ behalf on national regulatory and policy issues. To learn more, go to or follow us on LinkedInTwitter and Facebook.


RBMA Media Contact:

Will Sweet


EDPMA Contact:

Cathey Wise
703.506.3282 (direct) | 817.905.3310 (cell)


HBMA Contact: 

Brad Lund
(877) 640-4262


MGMA Contact:

Emily Dowsett
(703) 376-1134

Omnibus Bill Partially Addresses Medicare Payment Cuts

After Congress passed a one-week continuing resolution (CR) to avoid a government shutdown, legislators released the text of the long-awaited Omnibus in the early hours of Tuesday morning. The 4,155-page legislation must be enacted by Friday December 23rd to avoid a government shutdown.


With regard to Medicare payment, the legislation fully averts the 4% PAYGO sequestration in 2023 and 2024. As to the Medicare Physician Fee Schedule conversion factor, however, the bill provides only 2.5% worth of relief for the almost 4.5% cut scheduled for 2023, leaving providers with an approximately 2% reduction to absorb next year. For 2024, the bill provides only 1.25% worth of relief. Given that the 2024 conversion factor is unknown as of yet, the real-world impact of that 1.25% is more speculative at this time, but it is expected under this provision that physicians will again suffer an additional payment cut in 2024, relative to both 2023 and 2022.


In the final weeks leading up to release of the Omnibus, lawmakers on both sides of the aisle pressured leadership to ensure that the 4.5% conversion factor reduction was averted in full. A bipartisan letter signed by 115 legislators led by Rep. Wild (D-Pa.) and Rep. Miller-Meeks (R-Iowa) requested that both the PAYGO and conversion factor cuts be stopped entirely, noting that these two reductions would be piled onto the 2% Medicare sequestration cut, which resumed on July 1st of this year. Furthermore, the letter stated opposition “to paying for preventing these cuts with additional provider cuts.” The House GOP Doctors Caucus weighed in with another letter to leadership, requesting a solution to the impending Medicare payment cuts. On the Senate side, Sen. Kennedy (R-La.) introduced legislation to avert the full 8.5% cut to Medicare in 2023, but that legislation was objected to by Finance Committee Chairman Wyden (D-Ore.), because the Kennedy bill bypassed the Committee process and because addressing the physician cuts via standalone legislation may jeopardize inclusion of other priorities in the larger year-end legislation.


The Omnibus does contain a two-year extension of pandemic-related Medicare telehealth flexibilities, as well as an extension of a provision allowing coverage of telehealth services in high deductible health plans with Health Savings Accounts. The legislation would also extend separate COVID-related waivers that allow for the treatment of some emergency department patients and inpatients from their home. The legislation also extends (at 3.5%) an expiring 5% bonus for providers participating in alternative payment models.


Physician groups expressed disappointment that Congress would allow any level of reimbursement reduction to go into effect at a time when providers are facing record inflation and staffing shortages, particularly since the legislation extends the 2% Medicare sequester on providers by another year in 2032, to help pay for other priorities in the bill. Overall, the Omnibus contains over $1.6 trillion dollars of spending. The bill is expected to pass by Friday’s deadline without major changes, but EDPMA will closely monitor all amendments and alert members to any relevant changes, if needed.


Looking ahead, EDPMA will aggressively pressure legislators for permanent reform to Medicare payment, since these annual last-minute crises cause instability in the Fee Schedule that affects beneficiary access to care.

Updates Released on No Surprises Act Federal IDR Process

As the Federal agencies tasked with implementing the No Surprises Act continue to work through the backlog of disputes that have been stuck in the IDR process with the contractors hired by the Federal government to administer dispute resolutions (referred to as certified independent dispute resolution entities or IDREs), several recent announcements have been made that are important for providers who are seeking to have disputes resolved under the Federal IDR process.

  • IDRE Reselection Process: As has been the case since the initial implementation of the No Surprises Act, under the Federal IDR process, disputing parties must agree on an IDRE to administer the dispute resolution, and where the parties cannot agree, the regulations allow for the federal agencies to randomly assign the IDRE. Until recently, this “back-and-forth” of selecting an IDRE has been primarily conducted via email communications.  Beginning on December 12th, the U.S. Department of Health and Human Services (HHS) launched a new web functionality intended to streamline this process during the “initiation of IDR” phase. The new form is referred to as the “IDR Entity Reselection Response Form.” HHS has released an instructional video for disputing parties to familiarize themselves with the new process.
  • New Requirement for Parties Challenging IDR Initiation to Provide Documentation: The Centers for Medicare and Medicaid Services (CMS) made a positive announcement that, beginning the week of December 19th, parties that are challenging IDR initiation must now provide documentation in support of their challenge rather than just making unsubstantiated accusations that can slow down the IDR process. As described in the CMS announcement, instances that will now require documentation from health plans when making a challenge to Federal IDR initiation include:
    • “Specified State Law or All-Payer Model Agreement”: If an entity attests that a dispute is eligible for a state process to determine the out-of-network rate, the entity must provide: specific citation(s) for the state law or regulation that constitutes a specified state law or all-payer model agreement that applies to the items or services in the dispute; and documentation that confirms that the state law applies, including proof of the health plan type.
    • “Open Negotiation Not Completed”: If an entity attests that the open negotiation period was not completed for a dispute, the entity must provide: the date when the open negotiation period will be completed; and documentation that confirms the open negotiation start date.
    • Late IDR Initiation: If an entity attests that more than four business days have elapsed since the open negotiation period ended, the entity must provide: the date that was the last day in the four business day period after the open negotiation period; and documentation that confirms when the open negotiation period was initiated for the claim or claims subject to the dispute.
    • Not Covered by NSA”:
      • If an entity attests that a dispute includes items or services not covered under the No Surprises Act, the entity must provide a list of which items and services included in the dispute were not covered under the No Surprises Act and, for each item or service listed, an explanation as to why it is not covered under the No Surprises Act.
      • If an entity attests that a dispute includes items or services that are covered by a coverage type not subject to the No Surprises Act, the entity must provide a list of items or services covered by the coverage type not subject to the No Surprises Act and the coverage type that applies to them.
      • If an entity attests that the coverage year for an item or service in a dispute started prior to the No Surprises Act implementation date of January 1, 2022, the entity must provide: the plan or policy year associated with the dispute; and documentation to confirm the date that the plan or policy year started.
    • Not Covered by Current Insurance Policy: If an entity attests that the dispute includes items or services not covered by the patient’s insurance policy, the entity must provide: a list of items or services in the dispute that are not covered; and documentation that confirms these items or services are not covered by the patient’s insurance policy (such as a copy of the policy).
    • Improperly Batched or Bundled: If an entity attests that a dispute includes items or services that were improperly batched or bundled, the entity must provide a list of the items or services that were improperly batched or bundled, and for each item or service on the list, indicate the batching or bundling requirement that was not met.
    • Cooling Off Period Not Completed: If an entity attests that a 90-calendar-day cooling off period applies to the dispute and has not been completed, the entity must provide: the dispute number for the payment determination that initiated the 90-calendar-day cooling off period; and a copy of the payment determination that initiated the 90-calendar-day cooling off period.

EDPMA Sends Letter in Support of S 5194

On Monday, December 12, 2022, EDPMA sent a letter to Senator John Kennedy thanking him for introducing the Protecting Medicare Patients and Physicians Act (S.5194), which would avert two major looming reductions to Medicare provider reimbursement and creates a call to action for Congress and the Administration to pursue long-term reform of Medicare physician payment. The letter can be found here.

NSA Update: CCIIO Issues New Guidance and Platform Updates for IDR Initiation

The Center for Consumer Information and Insurance Oversight (CCIIO) released new guidance in November related to several stages of the No Surprises Act’s (NSA’s) Federal Independent Dispute Resolution (IDR) process.

  • CCIIO announced that beginning the week of November 28th:

. . . a party seeking to initiate a payment dispute through the federal Independent Dispute Resolution (IDR) portal will be required to include certain documentation with the notice of initiation submission. Specifically, any party initiating a payment dispute must now upload the following:

    1. Documents to confirm the open negotiation period start date (for example, the notice of open negotiation).
    2. Documents to confirm the claim and Qualifying Payment Amount information (i.e., the notices associated with the initial payment or notice of denial of payment).

 Additionally, any party that enters an open negotiation start date more than 34 business days earlier than the date on which the form was completed must now upload documents to confirm that the claim is still eligible for the IDR process. The initiating party must upload at least one of the following: 

    1. Documents to confirm the extension approval received from the federal IDR mailbox.
    2. Documents to confirm the certified IDR entity’s request to re-submit the dispute due to batching or bundling errors.
    3. Documents to confirm the 90-day cooling off period has expired. 

 An entity that does not upload the required documentation will not be able to submit the notice of IDR initiation. 

EDPMA has confirmed that this requirement to upload documentation related to the QPA does not preclude providers from initiating IDR in instances where the health plan has failed to make the required disclosures. In those cases, disputing parties should include the remittance advice or other documentation where you believe the QPA should have been disclosed had the health plan met its disclosure obligations.  For departmental guidance on this topic, consult the August 2022 FAQs which state:

Q20: If a plan or issuer has failed to disclose the information it is required to provide when making an initial payment or sending a notice of denial of payment, may a provider, facility, or provider of air ambulance services initiate an open negotiation period and then proceed to the Federal IDR process? 

Yes. In general, providers, facilities, and providers of air ambulance services have 30 business days from the day they receive an initial payment or a notice of denial of payment from the plan or issuer regarding an item or service to initiate open negotiation with respect to that item or service, including in cases in which information required to be provided is missing. However, a plan’s or issuer’s failure to satisfy the disclosure requirements in 26 CFR 54.9816-6T(d)(1) or (2), 26 CFR 54.9816-6(d)(1), 29 CFR 2590.716-6(d)(1) or (2), and 45 CFR 149.140(d)(1) or (2) could adversely affect a provider’s, facility’s, or provider of air ambulance services’ ability to meaningfully participate in negotiations during the open negotiation period and Federal IDR process. 

In these cases, when a plan or issuer fails to comply with the disclosure requirements in 26 CFR 54.9816-6T(d)(1) or (2), 26 CFR 54.9816-6(d)(1), 29 CFR 2590.716-6(d)(1) or (2), and 45 CFR 149.140(d)(1) or (2), providers, facilities, or providers of air ambulance services retain the right to initiate the open negotiation period within 30 business days of receiving the initial payment or notice of denial of payment. In initiating the open negotiation period, the provider, facility, or provider of air ambulance services, must provide the standard open negotiation notice to the plan or issuer, as required in 26 CFR 54.9816-8T(b), 29 CFR 2590.716-8(b), and 45 CFR 149.140(b). After the 30-business-day open negotiation period has lapsed, the provider, facility, or provider of air ambulance services may initiate the Federal IDR process in accordance with the normal timelines. 

Alternatively, in cases in which a plan or issuer fails to comply with the disclosure requirements in 26 CFR 54.9816-6T(d)(1) or (2), 26 CFR 54.9816-6(d)(1), 29 CFR 2590.716-6(d)(1) or (2), and 45 CFR 149.140(d)(1) or (2), providers, facilities, or providers of air ambulance services may request an extension to initiate the Federal IDR process, and provide applicable attestations, by emailing a request for extension due to extenuating circumstances to, including the time period(s) for which they are seeking an extension. 

Failure by either party to supply information that is required to be submitted to the certified IDR entity (for example, failure to provide the QPA) may lead to a finding by the certified IDR entity that does not take into consideration the absent information, or may lead to the certified IDR entity drawing an inference about the absent information that is adverse to that party. Providers, facilities, and providers of air ambulance services with concerns about a plan’s or issuer’s compliance with the requirements of 26 CFR 54.9816-6T(d)(1), 26 CFR 54.9816- 6(d)(1), 29 CFR 2590.716-6(d)(1), and 45 CFR 149.140(d)(1), including concerns that a plan or issuer is not acting in good faith with respect to this requirement, may contact the No Surprises Help Desk at 1-800-985-3059 or submit a complaint at The Departments will generally enforce the applicable provisions of the No Surprises Act, in conjunction with states where applicable. (Footnotes omitted).

  • CCIIO released an updated document, Independent Dispute Resolution (IDR) Notice of Initiation Web Form, which can be accessed here, with the following highlighted changes:
    • Requiring all initiating parties to submit the health plan type associated with the dispute. The plan should have provided this information when they submitted the initial payment or notice of denial of payment or during open negotiation. If the plan fails to provide this information to the provider, the provider may choose the No Plan/Issuer Response option.
    • Requiring an initiating party that is a provider, facility, or a provider of air ambulance services to provide a Tax I.D. number or National Provider Identifier (NPI) number.
    • Adding the ability for initiating parties to include mailing address and other contact information for additional points of contact.

EDPMA continues its close work with ACEP on implementation and advocacy related to the No Surprises Act and will continue to provide additional updates and information.

CMS Finalizes Rural Emergency Hospital (REH) Rules For January 1st Implementation

On November 1st,  the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment System final rule. This rule also finalized policies for the new Medicare enrollment designation of Rural Emergency Hospitals (REHs), which were authorized under law to be eligible for Medicare payments beginning on January 1, 2023. Here are the key takeaways from the finalized provisions related to REHs:

  • CMS Finalized Provisions from 2 Separate Proposed Rules: The proposed rules for REHs were released in two parts: (1) a standalone proposed rule to set the Conditions of Participation (CoPs) for REHs; and (2) in the CY 2023 OPPS proposed rule where CMS laid out its proposed policies for payment, enrollment, and quality reporting. In this OPPS final rule, CMS finalized provisions for both the CoPs as well as the proposals from the OPPS proposed rule.
  • CMS Replied to EDPMA Request For Clarification on Closed CAHs/Rural Hospitals That Would Otherwise Be Eligible to Enroll as an REH. One of the statutory criteria for a facility to be eligible to convert to an REH sets out that the facility must have been a critical access hospital (CAH) or a rural hospital with not more than 50 beds as of December 27, 2020. EDPMA sought clarification about CAH/rural hospitals in existence as of December 27, 2020 but that subsequently closed.  In response to our requests, CMS clarified that “facilities that were CAHs or rural hospitals with not more than 50 beds as of the date of enactment of the CAA and then subsequently closed after that date, would be eligible to seek REH designation after the closure of the facility.”
  • CMS Encourages Presence of Emergency-Trained Personnel. As part of the final CoPs related to staffing and emergency services. CMS continued to state that it wanted to proceed cautiously given workforce concerns and provide REHs with the flexibility to staff the facility as appropriate for that facility’s setting. However, in response to requests for requirements that there be some emergency medicine expertise, CMS will require that “the REH be staffed at all times by an individual who is competent in the skills needed to address emergency medical care. The individual must be able to receive patients and activate the appropriate medical resources to meet the care needed by the patient.” CMS also states that it will require that the “individual has the ability to effectively communicate information regarding the condition of patients presenting to the emergency department for treatment to the physician or other practitioner notified of the patient’s arrival.” In addition, under the final CoP requiring a Quality Assessment & Performance Improvement Program (QAPI) Program, CMS also added that an REH must “specifically measure, analyze, and track staffing as a quality indicator.”
  • CMS Reverses Course on creation of new REH Stark Exception. CMS did not finalize the creation of a new specific “REH Exception” to the physician-self referral prohibition, which would have allowed physician ownership and investment in REHs, due to stakeholder concerns. CMS reminds stakeholders, however, that for REHs located in rural areas, the “Rural Provider Exception” is available.
  • CMS Lays Out REH Quality Reporting Program Framework But No Immediate Reporting Requirements Finalized. With regard to the REH Quality Reporting Program (REHQR), CMS sought feedback on potential measures and criteria for measure selection that it could adopt in the future. While CMS discusses some of this feedback, it did not finalize the use of any specific measures, which means that quality reporting will almost certainly not begin in 2023. However, CMS did finalize that for REHs to participate in the REHQR Program, they must 1) have an account for the purpose of submitting data to the Hospital Quality Reporting (HQR) system and 2) designate a Security Official (SO).

CMS Releases 2023 Medicare Physician Fee Schedule Rates & Policies

On November 1st, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) final rule. The rule finalizes changes to the MPFS and other Medicare Part B payment policies, along with changes to the Quality Payment Program (QPP).

Here are the big takeaways for emergency medicine from the final rule:

  • CMS Finalizes Cut to the 2023 Conversion Factor Teeing Up End of Year Congressional Action. CMS set the final CY 2023 MPFS conversion factor is set at $33.0607, which is down approximately 4.47 percent, or $1.55, from CY 2022. While CMS estimates that emergency medicine will have no overall financial impact form the finalized policies, this does not account for the evaporating 3% conversion factor remedy Congress provided in 2022. Without additional action by Congress, that payment cut will go into effect for 2023. See EDPMA’s action alert to contact your members of Congress.
  • CMS Maintains Level 4 ED Visit Value, Departing from AMA RUC Recommendation. CMS generally accepted the CPT and RUC revisions for the following E/M code sets: ED visits, inpatient and observation services; discharge management; nursing facility visits; home and residence visits; and cognitive assessment and care planning services. This included accepting the RUC recommended values for those codes with one exception: CMS finalized its proposal to depart from the RUC recommendation for ED level 4 to preserve the current RVUs of 2.74 rather than reducing it to 2.60 as the RUC had recommended. As part of this package of policies, CMS also finalized adoption of the revised CPT documentation guidelines for emergency department (ED) evaluation and management (E/M) visits. (For more information on the ED E/M documentation guideline changes coming January 1, 2023, see information from AMA CPT via this link.)
  • CMS Speaks to Concerns about “8 to 24 Hour Rule.” CMS made clarifications from what it had stated in the proposed rule. While CMS states that the final policy is meant to reflect what is already in the Medicare Claims Processing Manual, CMS admitted it made mistakes in articulating its intended policy in the proposed rule and seeks to clarify these in the final rule. CMS clarified and finalized that the general principles are as follows:
    • When a patient receives inpatient or observation care for less than 8 hours, only the “initial” service shall be reported by the practitioner for the date of admission; no discharge day management code shall be reported
    • When a patient is admitted for inpatient/observation and then is discharged on a different calendar date, the practitioner shall report the “initial service” and the appropriate discharge day management code
    • When a patient receives inpatient or observation care for at least 8 hours and is discharged on the same calendar date, the practitioner should bill the appropriate “same day discharge” code
  • CMS Delays Problematic “Time Only” Split (or Shared) E/M Visit Policy But 2024 Rulemaking Will Prove Crucial: As requested by EDPMA, CMS finalized its one year delay of its planned implementation of defining the “substantive portion” (and thus the billing practitioner) of a split/shared visit as “more than half of the total time.” This policy had been set to go into effect on January 1, 2023. Until January 1, 2024 or until CMS issues new rulemaking, substantive portion will continue to be defined as “one of the three key components (history, exam, or MDM)” of the E/M.
  • CMS Finalized Continuation of Favorable Medicare Telehealth Services for Emergency Medicine But Advocacy Continues for Post-PHE Policies. CMS reiterated that it will issue program instruction or other subregulatory guidance to implement the extension of the telehealth flexibilities that the Consolidated Appropriations Act, 2022 provided for a period of 151 days after the end of the COVID-19 PHE. With the expected extension of the PHE well into 2023, these issues will need to be addressed later in the year.
  • CMS Finalized the Statutorily-Required Category Weights for MIPS and Keeps Performance Threshold to Avoid a Penalty Steady. Per the Medicare and CHIP Reauthorization Act of 2015 (MACRA), the 2023 MIPS performance category weights are as follows: 30% quality; 30% cost; 15% improvement activities; 25% PI. The MIPS performance threshold, which is the minimum number of points needed to avoid a penalty in 2025 based on 2023 performance, will remain at 75 points. As a reminder, under statute, the exceptional performance bonus will no longer be available starting with the 2023 performance year.
  • CMS Makes Facility-Based Clinicians Eligible for “Complex Patient Bonus.” Facility-based clinicians will be eligible for the complex patient bonus, even if they do not submit MIPS data.
  • CMS Finalizes Emergency Medicine “MIPS Value Pathway.” The MIPS Value Pathways (MVP) titled, “Adopting Best Practices and Promoting Patient Safety within Emergency Medicine,” was finalized as proposed as an optional MIPS participation pathway starting in 2023. More information about the Emergency Medicine MVP can be downloaded here. General information about the MVP pathway, including scoring and registration requirements, can be found here.
  • CMS Finalizes Changes to the MIPS Emergency Medicine Specialty Measure Set. Changes to the Emergency Medicine Specialty Set:
    • Added #65: Appropriate Treatment for URI
    • Added #134: Screening for Depression and Follow up Plan
    • Added #226: Tobacco Use: Screening and Cessation Intervention
    • Added #431: Unhealthy Alcohol Use: Screening and Brief Counseling
    • Added new #487: Social Drivers of Health measure
    • Removed Part B claims collection type for #416: ED Utilization of CT for Minor Blunt Health Trauma for Patients Aged 2 through 17 Years
  • Questions Remain About 2023 COVID-19 Exception. CMS has not yet announced whether it will continue to offer the MIPS Extreme and Uncontrollable Circumstances (EUC) Exception due to COVID-19 in 2023.