Archive for News – Page 3

EDPMA-ACEP Comment Letter on IDR Portal

On March 22, 2022, EDPMA and ACEP sent a joint letter to the Departments of Health & Human Services, Labor, and Treasury providing feedback on the independent dispute resolution (IDR) Portal, which will be used to help facilitate claims through the federal IDR process under the No Surprises Act. The letter can be found here.

The Emergency Department Practice Management Association Announces Cathey Wise as New Executive Director

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.

EDPMA News Alert: Administration Responds to Court Ruling for Texas Medical Association re: No Surprises Act

As reported in yesterday’s EDPMA Advocacy Newsletter, on February 23rd, 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 Defendants’ 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.”
Late yesterday, the Administration provided its first official response to the lawsuit, issuing guidance from both the Department of Labor (DOL) and the Department of Health and Human Services (HHS). Regarding the changes that must be made related to the Federal Independent Dispute Resolution (IDR) process to comply with the court ruling, while more details must be issued, in particular, the Departments actions include:
  • Effective immediately, withdraw guidance documents that are based on, or that refer to, the portions of the Rule that the court invalidated. Once these documents have been updated to conform with the court’s order, we will promptly repost the updated documents.
  • Provide training on the revised guidance for certified IDR entities and Disputing Parties. This training will be offered through webinars and roundtable discussions, and will occur after the above-referenced documents are updated.
  • Open the IDR process for submissions through the IDR Portal. For disputes for which the open negotiation period has expired, the Departments will permit submission of a notice of initiation of the IDR process within 15 business days following the opening of the IDR Portal.

Importantly, the Departments note that all previous patient protections provided by the No Surprises Act remain in effect.

EDPMA is please and supportive of this result, both for clinicians and for patients, believing that this ruling restored the processes intended by Congress as the law was originally passed.
For the full announcements:
  • The HHS guidance (via the Centers for Medicare and Medicaid Services) can be found here.
  • The DOL guidance (via the Employee Benefits Security Administration) can be found here.
EDPMA will continue to provide updates as they become available.

Court Rules in Favor of EDPMA Amicus Brief

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.”

EDPMA Files Amicus Briefs

So far, EDPMA filed an amicus brief in three cases challenging the No Surprises Act rule implementing the independent dispute resolution process. Here is a related press release.

EDPMA has filed an amicus brief in a lawsuit filed in Texas by the Texas Medical Association, in the District of Columbia by the American Medical Association and American Hospital Association, and in Georgia by Georgia ACEP. EDPMA also plans to file an amicus brief in Illinois in the suit filed by ACEP.

EDPMA letter to HHS on PRF Accounting

On January 7, 2022, EDPMA urged the Administration to provide a more thorough accounting of the COVID-19 Provider Relief Funds to better understand how remaining funds may be dispersed: 1/7/22 EDPMA letter to HHS on PRF Accounting.

EDPMA’s Advocacy Successes in 2021

The Summary of EDPMA’s Advocacy Successes in 2021 can be found here.

EDPMA Action Alert: 12.06.2021!

Urge Congress to Eliminate or Delay Scheduled Cuts to Medicare Physician Reimbursement

This week the House of Representatives is likely to consider legislation that will address some of the 9.75% cut to Medicare provider reimbursement that is scheduled to take effect in January 2022. The Senate will likely consider legislation soon thereafter. We urge you to reach out to your congressional delegation and ask them to support legislation that will eliminate or delay the scheduled Medicare cuts.

You can identify your member of the House and find their contact information by visiting www.house.gov and typing your zip code in the upper right corner. You can identify your two senators and find their contact information by visiting www.senate.gov and searching by senators by state. Since the vote is imminent, we recommend making these three phone calls and leaving your message with the person who answers the phone.

Get the background and talking points you need here

EDPMA Fights Medicare Cuts

On November 29 EDPMA and a coalition of providers continue to push Congress to stop the impending 9.75% cut to Medicare reimbursement: 11/29/21 EDPMA/Coalition Letter on Medicare Cuts.

EDPMA-ACEP Letter to Tri Agencies Opposing SMB IFR on IDR

On November 11, 2021, EDPMA and ACEP sent a joint letter to the tri-agencies opposing the Interim Final Rule on the No Surprises Act which conflicts with the statute and is expected to significantly reduce provider reimbursement and asked them to immediately change the rule: 11/11/21 EDPMA ACEP Letter to Tri Agencies Opposing SMB IFR on IDR.

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