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.
Author Archive for arobertson – Page 12
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
On August 31, 2021, EDPMA and ACEP urged Cigna not to implement its policy of down coding based on diagnosis because it violates the Prudent Layperson Standard and coding standards. See the letter below
On July 1, the Department of Health and Human Services (HHS) officially opened the Reporting Portal for entities who received one or more Provider Relief Fund payments exceeding, in the aggregate, $10,000 from April 10, 2020 to June 30, 2020. Those entities will have until September 30, 2021 to complete the reporting process. Any unused funds from the period of availability must be returned by October 30, 2021. If no report is submitted by the deadline, then all funds are considered unused. HHS has detailed a series of steps for completing the reporting process, which include (1) registering in the Provider Relief Fund Reporting Portal; (2) reading the Reporting Requirements Notice, which was revised on June 30, 2021; (3) watching the reporting technical assistance webinar, and then (4) submitting your information through the Reporting Portal. All of these steps and key information related to the Reporting Portal can be found here. Attached is a resource guide to help with the process and answer additional questions as you navigate your reporting requirements.
Phoenix Coding and Consulting is a Texas-based firm specializing in medical coding and consulting for physician groups, urgent care, FSECs and hospital-based emergency departments. The company prides itself on delivering its services with accuracy, integrity, and in a timely manner. Phoenix achieves this by working in tandem with its business partners to provide the best experience possible for clients. For more information on Phoenix Coding and Consulting, click here.
Excerpts from a conversation with Terri Tamez, CPC, CEO and Matt Tamez, CPB, B.S., COO
Terri and Matt Tamez started Phoenix Coding and Consulting in 2016 with over 25 years of experience in coding, technology and business process management. Terri has over 20 years of experience in emergency medicine coding and has worked for large emergency medicine RCM companies. Terri is considered by clients and peers as a subject matter expert in emergency medicine coding and frequently provides audit and consulting services to clients with RCM challenges. Matt has over 20 years of experience in data center management, information technology, risk and compliance and business process management. Matt started his career as a Combat Medic with the 101st Airborne Division and volunteering as an EMT with his local fire department. They combine their skills along with their customer-service-first attitude to bring a wealth of knowledge to their clients. Their goal is to drive a positive patient experience along with client satisfaction which ultimately leads directly to better levels of reimbursement. Terri and Matt believe that the highest levels of reimbursement are driven by a partnership between Phoenix and clients and providing consistent education to their teams.
Both Terri and Matt have been to several EDPMA Solutions Summit conferences and have many colleagues in the emergency medicine field. They decided to join EDPMA as they view educating their clients as a key responsibility which provides a competitive advantage. Matt said, “that the educational and networking opportunities at the Solutions Summit are a valuable use of his time.” And Terri commented that “the educational events, the webinars and workshops, all help keep them informed and knowledgeable about the key issues impacting emergency medicine.” Phoenix stays focused on meeting their client needs by updating their team on what is happening in emergency medicine reimbursement and keeping their clients and business partners educated on these topics.
Mr. Tamez highlighted that many of the key issues in emergency medicine relate directly to coding as insurance companies are working to downcode various procedures. Being a member of EDPMA keeps Phoenix informed as to the strategy and plans for combatting these problems. And, as Matt points out, “being part of the strategy discussion and the solution is a great part of EDPMA membership.” The efforts in working with colleagues and getting ahead of bad payer policies or finding ways to change or minimize these bad payer policies provides a real return on their investment in EDPMA. It also directly supports Phoenix’s business strategy of being an effective business and solutions partner.
Matt and Terri will be attending the 2021 Solutions Summit (September 26-29 in Fort Worth, TX). Matt recently joined the Practice Management Committee and Terri joined the Quality, Coding and Documentation Committee. They are planning to attend Committee Day on Sunday, September 25, to hear first-hand about the issues under discussion and participate in these sessions.
EDPMA and ACEP sent the following five 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. An Interim Final Rule implementing portions of the Act is expected soon.
3/24/21 EDPMA/ACEP Joint Letter to Biden Administration on No Surprises Act Implementation
5/14/21 EDPMA/ACEP NSA Letter 2 re: Technical RCM Advice
06/14/21 Third EDPMA/ACEP letter to CIIO on NSA Implementation
6/16/21 EDPMA/ACEP Letter to OMB Re No Surprises Act Implementation
Concord Medical Group is a physician-owned and -operated organization founded by Dr. Kyle Sheets in 2001. The group’s beginning focused on supporting rural hospitals in Texas. Concord has grown over the years and, in addition to emergency medicine, the group offers hospitalist and radiology specialties. Concord is now in ten states, managing over 80 programs with over 1,300 providers. Emergency medicine continues to be the group’s main focus. For more information on the Concord Medical Group, click here.
Excerpts from a conversation with Steve Kearney, Executive Vice President, and Chief Financial Officer
Concord Medical Group prides itself on its bespoke approach. There is no cookie-cutter approach as they focus carefully on meeting the needs of each of their clients. This includes providing the highest-quality patient care; supporting their physicians and other professionals with scheduling, training, and recruitment; and ensuring the effectiveness of their programs. Mr. Kearney joined Concord Medical Group over four years ago after managing two other emergency medicine groups. He comes with years of experience in developing and improving accounting, financial reporting, and financial planning & analysis as well as supporting financial systems that support higher levels of performance.
Mr. Kearney was familiar with EDPMA since he had worked in emergency medicine for years and had attended several Solutions Summit conferences. Steve recommended joining EDPMA, in part, due to the productive Solutions Summit conferences indicating a level of professionalism within the association. Steve said, “the conference has always been so well run and the programming informative and timely.” Mr. Kearney believes EDPMA’s member mix of physician groups and suppliers is useful. He said, “if we were looking for a supplier, of course, we would look at who is a member of EDPMA as a starting point.”
Mr. Kearney sees some of the current challenges in emergency medicine related to the implementation of the No Surprises Act and issues that regularly come up with payers. Mr. Kearney emphasized all the resources available to EDPMA members including the Toolboxes which provide detailed information on legislative and regulatory matters at the state and federal levels, including templates for taking action. And Steve wants to be sure his senior-level team is exposed to all these resources as they provide hands-on, practical and useable information. Steve also highlighted that being a member of EDPMA provides a collaborative approach to identifying and solving issues in emergency medicine. He knows the “go-it-alone” approach usually is not successful but working with so many knowledgeable colleagues provides the best avenue for meeting the challenges in emergency medicine and being successful.
Mr. Kearney and Dr. Sheets will be attending the 2021 Solutions Summit (September 26-29 in Fort Worth, TX). They look forward to seeing their colleagues, hearing the latest updates on business issues, legislation, and regulatory updates, and enjoying the great networking events. Steve has joined the Practice Management Committee and is encouraging his senior management team to join other EDPMA Committees such as Federal Health Policy, State Regulatory and Insurance, and the Quality, Coding, and Documentation committees.
On July 23, 2021, EDPMA and 108 other physician advocates urged Congress and the Administration to maintain the 3.75% increase in the Medicare Conversion Factor at least through calendar year 2022 or 2023. The letter is available here
This webinar is sponsored by Brault and presented by Dr. Andrea Brault and Dr. Lisa Maurer. The No Surprises Act will establish a federal ban on surprise billing and is scheduled to take effect on January 1, 2022. But, there are still many details that must be clarified during the current rule-making phase – including the definition for qualified payment amounts, specific plan obligations, and the rules/criteria for independent dispute resolution (IDR).
This webinar will take a deep dive into these critical topics and offer practical insights into planning and preparing for the coming year.
EDPMA Members can access the recording and slides here.
Using data from the Emergency Department Benchmarking Alliance’s annual survey, Dr. James Augustine’s presentation will focus on the NOW issues in ED management, with the data to help guide the C-suite leadership. The Covid-19 pandemic-tested Emergency Departments (EDs) across the country are now adapting to a post-pandemic reality. ED visits are increasing in 2021, on a new trajectory from 2020. Data shows that around 70% or higher of patients are admitted from the ED, but an increasing percentage have long stays in the ED before being admitted, impacting staff and space capacities. EDs also manage care for many mental health and substance abuse patients, and there has been an increasing focus on directing them into treatment. This has led to opportunities for ED staff to seek to help these patients outside the law enforcement/EMS/ED pathway. All these shifts in patient care and management will lead to reevaluation and design change in EDs across the country.
For more information and to register click here.