On Friday, August 4^th, the U.S. Department of Health and Human Services (HHS) suspended the No Surprises Act’s Federal IDR process after the August 3^rd 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:

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.

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 knows that Envision Healthcare’s challenges are not unique. Factors like workforce shortages, wage inflation, NSA flawed implementation, lower physician reimbursement & unchecked payer practices harm our healthcare system & threaten the ED safety net. Read our statement.

EDPMA advocates for policies protecting emergency care access. While Envision Healthcare ensured their clinicians & patients will not be impacted by restructuring, it’s a foreshadowing to groups facing challenges because of NSA implementation & unchecked payer practices. Our statement.

The Emergency Department Practice Management Association (EDPMA) strongly supports the goal of the No Surprises Act – to keep patients out of the middle of billing disputes.  

A lawsuit on appeal before the Second Circuit has sought to dismantle the No Surprises Act (NSA) by holding it unconstitutional.  The EDPMA supports the NSA and the patient protections it affords patients however the EDPMA and its partners believe the courts could side with the defendants in this case and make Independent Dispute Resolution (IDR) process the exclusive remedy for resolving billing disputes between payers and providers.  For EDPMA, access to courts to pursue out-of-network billing disputes is paramount. EDPMA encourages the court to preserve the NSA and its patient protections, while also preserving providers’ access to the courts as a viable alternative to IDR.  

Insurers have abused the NSA and have used it as a tool to slash physician reimbursement. Patient access to care, particularly in the critical emergency medicine context, depends on physicians having efficient and economical means to resolve billing disputes. Accordingly, EDPMA encourages the court to affirm that the No Surprises Act does not interfere with a physician’s right to pursue all available legal remedies, including litigation, to obtain fair reimbursement from insurers. That’s why EDPMA continues to advocate for its members and patients,” says Andrea Brault MD FACEP, EDPMA Chair of the Board. 

Click here to view the Amicus Brief.

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.