Author Archive for Madison Williams – Page 2

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.

EDPMA New Member Spotlight: Fulcrum Strategies

Fulcrum Strategies is a health care consulting firm specializing in payer contract negotiation, strategic planning, and public relations for physician practices. Founded in 2004, by President and CEO Ron Howrigon, Fulcrum’s vision is to provide medical practices professional negotiation and planning resources to improve managed care contracts for medical professionals. Fulcrum has over 70 clients in 18 states.

Ron Howrigon spent 18 years in the Managed Care Industry as a Negotiator, Network Manager and in Senior Management for several large managed care companies.  Since 2004 he has helped over 5000 physicians in practices across the country with their contract negotiations. He holds degrees in business and economics, is a husband and father of three children.

During his time in the managed care corporate structure, he realized that medical practices were at a disadvantage in our current system, and he wanted to level the playing field in his area of expertise. After nearly twenty years, his passion for helping physicians has not wavered.

When asked about why Fulcrum Strategies joined EDPMA Mr. Howrigon stated, “One of the strongest components of our U.S. Healthcare system is our ability to provide the best in emergency medicine. This success sets the U.S. above many other nations’ and only comes through the collaboration of professionals across the country. Throughout my nearly four decades in healthcare, my respect for those delivering healthcare, especially those in our emergency departments, has only increased. I needed to be a part of the discussion to improve myself and better help those on the front lines.”

Mr. Howrigon currently serves as the Chairman of the Board of Directors for the Autism Society of North Carolina and volunteers for their events and other events supporting children and those with special needs.

Fulcrum Strategies LinkedIn 

EDPMA Reception at ACEP23 in Philadelphia

Join EDPMA for a reception on Tuesday, October 10 for a reception at ACEP23 in Philadelphia. We will be at Maggiano’s Little Italy across the street from the ACEP23 hotel.

Date: Tuesday, October 10
Time: 6pm – 7:30pm EST
Location: Maggiano’s Little Italy. Across the street from the ACEP23 hotel.

 

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