Author Archive for Madison Williams – Page 2

EDPMA and Others Urge HHS to Reopen The Federal IDR Portal

As the No Surprises Act’s Independent Dispute Resolution (IDR) portal surpasses the 8-week mark since its halt of full operations for the filing of new IDRs, the American College of Emergency Physicians, American College of Radiology, American Society for Anesthesiology, the Emergency Department Practice Management Association, and Radiology Business Management Association together urged the U.S. Department of Health and Human Services to reopen the national portal. Read More.

EDPMA Files Amicus Brief to Support TMA II Appeal

On September 18, EDPMA filed an amicus brief in the Court of Appeals for the Fifth Circuit in support of the challenge by the Texas Medical Association to a provision of the Final Regulation of the Department of Health and Human Services under the No Surprises Act (“NSA”).  The challenged provision implicitly calls upon Independent Dispute Resolution (“IDR”) entities to give paramount importance to the Qualifying Payment Amount (“QPA”) in the IDR process under the NSA. Our brief explains why the district court was correct in concluding that the provision wrongly tilts that process in favor of insurers — and is contrary both to the language of the NSA and to the congressional goal of assuring fair payment to out-of-network physicians.

Our brief highlights the problems caused by the challenged provision for emergency physicians and for patients. It provides factual support, based in part on EDPMA studies, that insurers’ manipulation of the QPA has adversely affected not only out-of-network payments, but in-network payments as well.  It stresses that, in light of EMTALA and other factors, the challenged provision would be particularly harmful for the delivery of emergency medical care to patients.

The issues in the case are still being briefed, and we don’t know when the Court of Appeals is likely to issue a ruling.  But we have taken a strong stand in support of our members and the patients we serve.  See the EDPMA brief here.

EDPMA New Member Spotlight: PearsonRavitz

PearsonRavitz is a physician-founded, physician-led disability and life insurance advisory firm. With deep industry expertise, we specialize in offering tailored insurance solutions to medical professionals. We are committed to safeguarding physicians’ well-being, careers, and families through education and empowerment.

As an OB/GYN at the pinnacle of her career, a shoulder injury abruptly ended Dr. Stephanie Pearson’s medical practice. This experience showed her how crucial disability insurance is for physicians, and in 2017, she co-founded PearsonRavitz, a disability and life insurance brokerage. Fueled by her own struggle and the loss of her physician identity, she became an advocate, educating and empowering her fellow physicians so that they can protect their health, career, and families.

When asked why PearsonRavitz joined EDPMA, Dr. Pearson stated, “I joined EDPMA because I believe in their mission to provide high quality, cost-effective care in emergency rooms nationwide. As a physician myself, I admire the support that EDPMA provides to our nation’s emergency room physicians.”

When asked to describe PearsonRavitz, Dr. Pearson noted, “When we founded PearsonRavitz, we knew that we wanted our company to reflect our core values of Ownership, Transparency, Empathy, and Respect at every level. From our employees to our clients, we’ve made it our mission to ensure that everyone experiences those values when they become a part of our network.”

When asked what motivates Dr. Pearson, she shared, “After I experienced a career-ending injury during the prime of my career as an OBGYN, I discovered that my disability insurance didn’t provide the coverage I needed to protect my health and family. I have since made it my mission – and my second career – to ensure that other physicians are educated and empowered to make decisions that protect their ability to earn income and care for the people they love.”

PearsonRavitz Facebook
PearsonRavitz Instagram
PearsonRavitz LinkedIn

Dr. Stephanie Pearson’s Instagram
Dr. Stephanie Pearson’s LinkedIn

IDR Portal Closure

As of Tuesday, August 29th, the Federal IDR portal remains closed to initiation of new disputes. The portal has been closed to new disputes since August 3, 2023, after a court ruling vacated the 2023 administrative fee of $350 as well as one of the batching requirements. Read More.

Be An RCM WYNNER Workshop

The RCM Workshop focuses on the full spectrum of regulatory and business changes of the No Surprise Act (NSA), strategy perspectives, and tactical planning for revenue cycle management. 

December 13 – 14, 2023
The Wynn Resort, Las Vegas, NV

The beautiful Wynn Resort in Las Vegas will host EDPMA’s annual RCM Workshop on December 13 and 14. And we are betting on YOU as “An RCM Wynner! This conference includes (2) half-day sessions (to minimize your time out of the office) and will equip you with the latest strategies, best practices, and tools toptimize your revenue cycle and enhance overall financial performance.  

Our first-ever Pre-Conference Session (8am – 12pm PST) will be held on the morning of December 13 before the RCM Workshop starts.  

After this pre-conference session, attendees will:  

  • Understand the impact lawsuits are having on the regulations. 
  • Understand the perspective from an IDRE CEO on how the IDR process is evolving; 
  • Learn how EDPMA’s No Surprises Act I-Tact Committee and advocacy with CMS & CCIIO informed and impacted improved health plan compliance and the IDR process in general; 
  • Ask questions to an expert panel who are responsible for filing IDRs and from an IDRE CEO.

Click here for more information. 

EDPMA Statement Re IDR Freeze After TMA IV Ruling

EDPMA Chair of the Board, Andrea Brault, MD MMM FACEP, released the following statement regarding the summary judgement-in-part issued in favor of the Texas Medical Association (TMA), et al., in “TMA IV” and CMS’ subsequent freeze of the IDR and patient dispute process:

“On three consecutive occasions, the courts have vacated regulatory decisions related to the implementation of the No Surprises Act that deviate from statute to favor insurers at the expense of clinicians,” said Dr. Brault. “We will continue to support initiatives that bring regulations in line with the statute, with an emphasis on protecting clinicians and their patients.” To read the full statement, click here.

EDPMA Member Alert: HHS Halts IDR in Wake of TMA IV Ruling

On Friday, August 4th, the U.S. Department of Health and Human Services (HHS) suspended the No Surprises Act’s Federal IDR process after the August 3rd court ruling against the federal Departments on the increase of the 2023 IDR Administrative Fee and a portion of the Departments’ IDR batching criteria.

We understand that this will be a severe disruption for emergency medicine providers seeking fair reimbursement from health plan underpayments for services furnished to patients in the emergency department. EDPMA will keep members apprised of additional developments and attempt to obtain clarity and additional information. In the meantime, see the HHS announcement on the suspension of Federal IDR below:

EDPMA Applauds TMA IV Ruling

August 4, 2023 – EDPMA is very pleased that the United States District Court in Texas accepted the position of the Texas Medical Association, other plaintiffs, EDPMA, and others that filed amicus briefs that two actions by the federal agencies responsible for implementing the No Surprises Act were not taken in compliance with law and were therefore struck down. EDPMA applauds the decision of the District Court.  We believe that the challenged actions were contrary to fundamental fairness. Click here to read the full statement and court ruling.

EDPMA Opposes Expanded Use of QPA Benchmark

July 21, 2023 – As providers on the front lines of emergency care in this country, the Emergency Department Practice Management Association (EDPMA) is deeply troubled by the
proposal to expand the use of the significantly flawed Qualified Payment Amount (QPA) benchmark to establish further government price controls in the commercial market for our fellow physicians and hospitals. The QPA was meant to establish a measure of patient cost sharing, not a benchmark for payment of providers. To read the issue brief and full statement, click here.

EDPMA Virtual Workshop: Planning for Profitable Growth

Planning for Profitable Growth 

Date: September 28, 2023
Time: 1:00pm – 4:00pm EST

Overview

Healthcare costs have risen over the years, and payment programs have shifted to quality and cost reduction rather than services performed or time spent.  Thus far, Emergency Medicine has yet to benefit from this movement.  Given the strain on revenue and operating margins, organizations primarily dependent on traditional fee-for-service in-person EM services must adapt their business model.

For more information click here.