Author Archive for arobertson – Page 11

EDPMA Action Alert: 12.06.2021!

Urge Congress to Eliminate or Delay Scheduled Cuts to Medicare Physician Reimbursement

This week the House of Representatives is likely to consider legislation that will address some of the 9.75% cut to Medicare provider reimbursement that is scheduled to take effect in January 2022. The Senate will likely consider legislation soon thereafter. We urge you to reach out to your congressional delegation and ask them to support legislation that will eliminate or delay the scheduled Medicare cuts.

You can identify your member of the House and find their contact information by visiting www.house.gov and typing your zip code in the upper right corner. You can identify your two senators and find their contact information by visiting www.senate.gov and searching by senators by state. Since the vote is imminent, we recommend making these three phone calls and leaving your message with the person who answers the phone.

Get the background and talking points you need here

EDPMA Fights Medicare Cuts

On November 29 EDPMA and a coalition of providers continue to push Congress to stop the impending 9.75% cut to Medicare reimbursement: 11/29/21 EDPMA/Coalition Letter on Medicare Cuts.

EDPMA-ACEP Letter to Tri Agencies Opposing SMB IFR on IDR

On November 11, 2021, EDPMA and ACEP sent a joint letter to the tri-agencies opposing the Interim Final Rule on the No Surprises Act which conflicts with the statute and is expected to significantly reduce provider reimbursement and asked them to immediately change the rule: 11/11/21 EDPMA ACEP Letter to Tri Agencies Opposing SMB IFR on IDR.

8/31/21 EDPMA/ACEP Comment Letter on No Surprises Act IFC#1
8/10/21 EDPMA/ACEP Letter to Labor/HHS/Treasury on IDR
6/16/21 EDPMA/ACEP Letter to OMB Re No Surprises Act Implementation
06/14/21 Third EDPMA/ACEP letter to CIIO on NSA Implementation
5/14/21 EDPMA/ACEP NSA Letter 2 re: Technical RCM Advice
3/24/21 EDPMA/ACEP Joint Letter to Biden Administration on No Surprises Act Implementation

2022 EDPMA Solutions Summit Call for Speakers

The form to submit a proposal you would like to present at the 2022 EDPMA Solutions Summit is now open!  As experts in the business of emergency medicine, we hope that you are interested in presenting at the 2022 Solutions Summit on April 24-27, 2022 in Amelia Island, Florida. If you are interested, we’d like to receive your application. EDPMA also encourages you to share this link with coworkers and industry colleagues you think would be great speakers on issues facing the business of emergency medicine.

Don’t forget, all applications must be completed in full and received by December 5, 2021 and submitted through the link below, which includes the application questions.

Submit Your Proposal

Workshop: Flat is the New Up – So More Tools Please

Book your travel and make plans to attend: Back Together Live & Riding the EM Reimbursement Tsunami: Flat is the New Up – So More Tools Please on December 8-9, 2021, at Caesar’s Palace, Las Vegas, NV.

Learn more and register!

New Member Spotlight: Quality Care ER

Quality Care ER is a Texas-based company that owns and operates two freestanding emergency centers: one in Paris, Texas, and a second just opened in Greenville, Texas. Quality Care ER’s mission is focused on providing high-quality care in rural areas, expanding healthcare services to those with limited access, and serving the local communities. For more information on Quality Care ER click HERE.

Excerpts from a conversation with Byron Prince, Executive Vice President

Byron Prince is an ER nurse with years of experience in emergency medicine management. Mr. Prince joined Quality Care ER almost two years ago and oversees all areas of their business operations. Byron has worked as an ER nurse in a cardiac ER and the main ER. As he moved into managing and the business side, he also worked as a divisional director in a major health system for the emergency department and several outpatient departments. Mr. Prince helped that team expand their services and skills into a sustainable, scalable model. Byron joined Quality Care ER to bring these skills and capabilities to this freestanding emergency company and to support its mission of providing high-quality care with a grassroots and community-driven focus in rural communities.

Mr. Prince decided to join EDPMA based on the recommendation of a current member. He was especially drawn to the collaborative style and networking of EDPMA members in sharing best practices and ideas. Byron highlighted that he sees the dynamism and fast-moving environment in EM not only in coding and documentation but also in communication, billing, building relationships, and networking. For Byron and his team, he’s aware that it’s critical to have trusted information sources and to stay up-to-date and knowledgeable about legislation and regulatory matters impacting EM. Plus, he encourages his department leaders to get involved and stay close to the information on EM because of its dynamic and fast-moving nature.

Byron is particularly interested in coding and documentation as every day he sees how these issues drive and directly impact billing and insurance reimbursement. Byron wants his team to understand how coding and documentation impact billing and reimbursement and understand the whole process. Mr. Prince highlights that EDPMA’s collaborative approach helps support gaining this important information about coding and documentation processes. In addition, the relationships and networking within EDPMA membership help connect colleagues who are willing to give feedback on how to approach various situations. These relationships are especially important for a young and growing company. Byron points out that he expects payers to treat similar care decisions fairly. With his company’s membership in EDPMA, he can gain insight into whether various coding and documentation of health situations are being managed fairly by payer companies.

Mr. Prince and his colleague, Lisa Parker, Revenue Cycle Director, plan on attending EDPMA’s 2021 Solutions Summit conference on September 26-29 at the Omni Hotel in Fort Worth, Texas. Byron said he “looks forward to connecting with colleagues and meeting many new EM professionals as well.” Byron plans to attend Committee Day on Sunday, September 26th, to hear directly about the issues and updates in the Quality, Coding and Documentation Committee.

EDPMA Comments on Problematic Surprise Billing Rule

On October 1, 2021, EDPMA and others blasted the Interim Final Rule that contradicts both the intent and language of the No Surprises Act (NSA) in a windfall for profitable commercial insurers which threatens patient access to care.  Early versions of the NSA — which could not pass due to lack of Congressional support — tied out-of-network reimbursement to the plan’s in-network rate.  In order to garner enough Congressional support to pass the bill, the bill was amended to include a list of factors the arbiter may consider and a list of factors the arbiter may not consider.  The rule released on September 30th directs arbiters to ignore these lists and simply choose the payment amount that is closest to the plan’s in-network rate in most cases.  Moreover, the rules provide that the plan’s in-network rate (also known as the Qualifying Payment Amount (QPA)) should not reflect any bonus payments or other related compensation earned by providers.

EDPMA Comment Letter on Proposed 2022 Update to OPPS

On September 13, 2021, EDPMA commented on the Proposed 2022 Update to the Outpatient Prospective Payment System. Read the full letter below.

 

9/13/21 EDPMA Comment Letter on Proposed 2022 Update to OPPS

EDPMA Comment Letter on Proposed 2022 Medicare Physician Fee Schedule

On September 13, 2021, EDPMA commented on the Proposed 2022 Medicare Physician Fee Schedule. Read the full letter below.

 

 9/13/21 EDPMA Comment Letter on Proposed 2022 Medicare Physician Fee Schedule.

EDPMA Sends Sixth Letter Commenting on Implementation of the No Surprises Act

EDPMA and ACEP sent the following six joint letters to the federal decision makers (HHS, DOL, IRS, CCIIO, and OMB) on provisions we would like included in the rules implanting the federal No Surprises Act. The No Surprises Act establishes a process for payment and dispute resolution for out-of-network emergency care (and some nonemergency care). Many important issues were left open for the Administration to address in the rulemaking phase. The sixth letter, sent on August 31, 2021, comments on the first Interim Final Rule with Comment on the No Surprises Act.

8/31/21 EDPMA/ACEP Comment Letter on No Surprises Act IFC#1
8/10/21 EDPMA/ACEP Letter to Labor/HHS/Treasury on IDR
6/16/21 EDPMA/ACEP Letter to OMB Re No Surprises Act Implementation
06/14/21 Third EDPMA/ACEP letter to CIIO on NSA Implementation
5/14/21 EDPMA/ACEP NSA Letter 2 re: Technical RCM Advice
3/24/21 EDPMA/ACEP Joint Letter to Biden Administration on No Surprises Act Implementation