The Emergency Department Practice Management Association (EDPMA) is pleased to announce Cathey Wise, CAE as its new executive director. Wise will lead the EDPMA’s professional team to meet the organization’s mission to advocate for emergency department physician groups and their business partners to enhance quality patient care through operational excellence and financial stability.
“As the leader in the business of emergency medicine, EDPMA looks to Wise to guide and strengthen its advocacy efforts to ensure fair payment to emergency medicine physicians and their business partners,” says EDPMA Board Chair, Don Powell, DO. “We are confident her skills and experience will help EDPMA to continue to thrive in membership and member value, education and resources, revenue, and advocacy.”
Wise comes with an extensive background in emergency medicine and non-profit management. She most recently served as Executive Director of the Emergency Medicine Residents’ Association (EMRA). She helped increase EMRA’s membership by 63 percent, member-centric events by 240%, and non-dues revenue by triple digits.
“I’m beyond thrilled to have this opportunity to be part of an organization that is so important when it comes the care that patients receive—both when they are facing a crisis that has brought them to the emergency room—and in managing what can be very complex billing scenarios after,” commented Wise. “Likewise, I’m also excited to work to ensure that policies enable and support emergency department providers in operating successful businesses.”
Wise will meet with EDPMA members in person at the organization’s annual meeting, Solutions Summit 2022—Quality Connections: Ready, Set, Grow!, taking place April 24-27 at the Omni Amelia Island Resort in Florida. EDPMA members and stakeholders will convene to learn, engage, and network with the leaders in emergency medicine. The event will also kick-off the celebration of EDPMA’s 25-year anniversary.
WASHINGTON – On February 23, 2022, the U.S. District Court for the Eastern District of Texas granted the Motion for Summary Judgment filed by the Plaintiffs – the Texas Medical Association and Dr. Adam Corley – regarding their lawsuit challenging the federal government’s interim final rule implementing the independent dispute resolution process for reimbursement disputes between physicians and insurers.
The Memorandum Opinion and Order states “the Court concludes that the Rule conflicts with the Act and must be set aside under the Administrative Procedure Act (“APA”). … In sum, the Court holds that (1) Plaintiffs have standing to challenge Defendents’ September 2021 interim final rule implementing the No Surprises Act, (2) the Rule conflicts with the unambiguous terms of the Act, (3) the Departments improperly bypassed notice and comment in implementing the challenged portions of the Rule, and (4) vacatur and remand is the proper remedy.”
The Emergency Department Practice Management Association (EDPMA), an organization representing the practice of Emergency Medicine, filed an amicus brief, along with Texas ACEP and Virginia ACEP, in support of the Texas Medical Association’s and Dr. Adam Corley’s Motion for Summary Judgment. Throughout the legislative process, stakeholders agreed that patients should be removed from billing disputes and held only to their in-network cost-sharing amounts. EDPMA strongly supports the patient protections.
The Motion for Summary Judgment did not challenge these protections. The focus of the Motion and the court’s order is the process for resolving reimbursement disputes between insurance plans and physicians. Early legislative proposals that relied on a benchmark set at the plan’s typical in-network rate were rejected in favor of a compromise that considered evidence submitted by both the plans and the physicians. The statute clearly provides that the arbiter “shall consider” eight factors before deciding appropriate payment. The interim final rule would have inappropriately prohibited the arbiter from considering seven of those required factors except in special circumstances.
“EDPMA is thrilled that the Court has vacated and remanded the problematic Rule. Congress was clear when it passed the landmark No Surprises Act last year: protect patients from unavoidable and unexpected costs without jeopardizing patient access to care,” said Don Powell, D.O., Board Chair of EDPMA. “The Rule would have allowed insurers to manipulate payment standards with little or no transparency on the health plan’s calculation of ‘median in-network’ rates. This would have harmed not just commercially insured patients, but the rural, medically vulnerable and indigent populations who rely on our nation’s emergency departments as an important safety net.
“With the COVID-19 pandemic, and the latest wave of new variants, emergency department safety net resources have been stretched to the breaking point. We see the Rule would have led to dire effects on the overall viability of our emergency medical care system. We urged the Administration to amend the Rule to be consistent with the language of the statute and Congressional intent — and now the Court has forced them to do so.”
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.
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.
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
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 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
8/30/21 EDPMA Letter to Cigna re: Down Coding
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.