And almost 96% of outstanding claims are 5+ months old. Read more here.
And almost 96% of outstanding claims are 5+ months old. Read more here.
On February 21, 2023, EDPMA filed an amicus brief in support of the lawsuit led by Texas Medical Association (TMA) that demands the Department of Health and Human Services, Department of Labor and the Department of Treasury (the Departments) reverse its 600% administrative fee increase for clinicians to participate in the Independent Dispute Resolution (IDR) process as intended by the No Surprises Act. The dramatic, unprecedented increase in initial fees disproportionately affects providers, favors health plans, and will hurt patients.
Read the amicus brief and press release.
EDPMA Chair of the Board, Don Powell, DO FACEP, released the following statement regarding the summary judgement issued in favor of the Texas Medical Association (TMA), Dr. Adam Corley and UT Tyler Regional Hospital (collectively “The TMA Plaintiffs”) in “TMA II” and CMS’ subsequent freeze of the federal Independent Dispute Resolution (IDR) process… read more.
On January 31, 2023, EDPMA filed an amicus brief in support of the Texas Medical Assocation (TMA) to ensure the fair and equitable implementation of the No Surprises Act as intended. The TMA’s third lawsuit filed against the federal government asserts that the methodology to calculate the Qualified Payment Amount (QPA) is not only flawed but favors commercial health plan insurers and violates the Congressional intent of the No Surprises Act. TMA’s claims align with EDPMA’s members’ experiences. Read the amicus brief here and press release here.
Emergency medicine physician groups are expected to lose almost $1 billion annually, threatening patient access to emergency care. Read more here.
EDPMA Supports The Texas Medical Association’s Opposition To A 600% Increase In Administrative Fees For Physicians Utilizing The No Surprises Act Independent Dispute Resolution. Read more here.
On Thursday, January 26, 2023, a coalition of over 45 organizations sent a letter to CMS urging the extension of telehealth codes through CY 2024 to align with Congress’ intent under the Consolidated Appropriations Act, 2023, which extends telehealth flexibilities through CY 2024. The letter can be found here.
On Monday, January 23, 2023, EDPMA joined a coalition of over 100 organizations urging Congress to reform the Medicare payment system. The letter can be found here.
On Thursday, January 19, 2023, EDPMA and ACEP sent a letter to the Tri-Agencies thanking them for the early January conversation and providing additional input and more detailed recommendations. The letter can be found here.
On Monday, January 23, 2023, ACEP issued a press release regarding the letter and it can be found here.
WASHINGTON, DC, January 13, 2023 – The Radiology Business Management Association (RBMA), Emergency Department Practice Management Association (EDPMA), Healthcare Business Management Association (HBMA) and Medical Group Management Association (MGMA) all strongly oppose the U.S. Centers for Medicaid and Medicare Services (CMS) 600% administrative fee increase to utilize the Independent Dispute Resolution (IDR) process provided by the No Surprises Act (NSA). The Associations represent radiology and emergency healthcare clinicians across the country, and they call on CMS to immediately reverse this decision and on Congress to initiate oversight proceedings on this executive action.
“RBMA fully supports Congress’ intention of the NSA to protect patients from unexpected medical bills, and our physicians are committed to providing affordable, quality care to their patients across the country,” said Bob Still, Executive Director of the Radiology Business Management Association (RBMA). “As such, this 600% fee increase under the NSA puts physicians in the middle of health plans and CMS’ inadequate implementation process of those plans. By pricing out the method for dispute resolution with this excessive fee, our providers’ ability to perform important services, like cancer screenings, will be significantly hindered and inevitably hurt the healthcare of American consumers.”
“While EDPMA understands CMS’ need to address the IDR backlog, exorbitant fees are simply not the answer. These abrupt, inappropriate increases unnecessarily burden emergency medicine clinicians and significantly deter clinician’s access to the method of dispute resolution provided by Congress. This is another substantial mis-step that fails to address fundamental operational and policy-related issues involved in the No Surprises Act,” said Don Powell, DO, FACEP, EDPMA Chair. “CMS’s actions prevent the level playing field provided in the law, and contrary to the law’s interests, will drive more payer-driven contact terminations, while crippling the cash flow that supports emergency care for patients.”
“Increasing the administrative fees for the IDR process by 600% is not the appropriate way to address the backlog of IDR disputes,” said Landon Tooke, CHC, CPCO, President of HBMA’s Board of Directors. “The new fee – which is not reimbursed to the initiating party – is higher than many of the disputed payment amounts. This unfairly disincentivizes clinicians from utilizing the IDR process and does not align with how Congress intended this process to be used. The higher fee does not address the root cause of the backlog, which is health plans forcing many practices out of their networks which puts a greater burden on the IDR process. While we understand the need to address the high volume of initiated disputes, health plans share the responsibility to reduce the backlog by properly communicating if the NSA protections apply to a specific scenario and by negotiating in good faith during the open negotiation window.”
“MGMA supports the goals underpinning the No Surprises Act — we believe patients should have accurate and timely access to the costs of items and services. However, the law must be implemented in a manner that does not create undue burden on our nation’s medical groups, nor impede practices’ ability to deliver care,” said Anders Gilberg, Senior Vice President of Government Affairs for MGMA. “Increasing the administrative fee for the IDR process will disproportionally effect providers who are already suffering from significant financial strain stemming from staffing shortages, wage inflation, and drastic cost increases across the board. We encourage CMS to swiftly reevaluate the administrative fee, to make it equitable so as to not prohibit medical groups’ ability to initiate the IDR process to settle payment disputes with health plans as granted by the law.”
The Associations call on CMS to fairly rebalance the IDR process, keep administrative fees at fair and stable 2022 levels, and address their unsustainable backlog of claims under NSA. To ensure this appropriate and much needed reform at CMS, the Associations call on the new Congress to initiate oversight proceedings on these processes at CMS.
After first announcing in October 2022 that the 2023 administrative fee would remain stable, in a last-minute move in late December 2022, CMS announced a 600% increase in non-refundable administrative fees for any party to file out-of-network claims disputes through the NSA’s IDR process. Additionally, CMS had previously announced fee increases of up to 117% for IDR entities. The dramatic, unprecedented increase in initial fees with less than a week’s notice disproportionately affects providers, favors health plans, and will hurt consumers.
The Radiology Business Management Association (RBMA) is an industry-leading organization comprised of more than 2,100 professionals who focus on the business of radiology. RBMA members support diagnostic imaging, interventional radiology and radiation oncology providers in the full spectrum of practice settings. RBMA connects members nationwide to valuable information, education, and practice-related resources and serves as an authoritative industry voice on behalf of shared member interests.
The Emergency Department Practice Management Association (EDPMA) is the nation’s largest professional physician trade association focused on the delivery of high-quality, cost-effective care in the emergency department. EDPMA’s membership includes emergency medicine physician groups of all sizes, as well as billing, coding, and other professional support organizations that assist healthcare providers in our nation’s emergency departments. Together, EDPMA’s members deliver (or directly support) health care for about half of the 146 million patients that visit U.S. emergency departments each year. Visit http://www.edpma.org.
The Healthcare Business Management Association (HBMA), a non-profit professional trade association, is a major voice in the revenue cycle management industry in the United States. HBMA is a recognized revenue cycle management (RCM) authority by both the commercial insurance industry and the governmental agencies that regulate or otherwise affect the U.S. healthcare system. To learn more, visit www.hbma.org.
Founded in 1926, the Medical Group Management Association (MGMA) is the nation’s largest association focused on the business of medical practice management. MGMA consists of 15,000 group medical practices ranging from small private medical practices to large national health systems representing more than 350,000 physicians. MGMA helps nearly 60,000 medical practice leaders and the healthcare community solve the business challenges of running practices so that they can focus on providing outstanding patient care. Specifically, MGMA helps its members innovate and improve profitability and financial sustainability, and it provides the gold standard on industry benchmarks such as physician compensation. The association also advocates extensively on its members’ behalf on national regulatory and policy issues. To learn more, go to MGMA.com or follow us on LinkedIn, Twitter and Facebook.
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