On Tuesday, September 6, EDPMA submitted a comment letter on the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule. The letter can be found here.

On Thursday, August 25, 2022, EDPMA filed a comment letter with CMS on the Conditions of Participation for Rural Emergency Hospitals (REH) and Critical Access Hospital conditions of participation updates. The letter can be found here.

On Friday, August 19, 2022, The U.S. Departments of Labor, Health and Human Services, and the Treasury this afternoon released a final rule further implementing provision of the No Surprises Act.

This rule addresses the IDR components of the legislation and responds to the federal court ruling from earlier this year regarding the approach that arbiters must take when making a payment determination in federal IDR.

NOTE: this is separate from the proposed rule which has cleared OMB and we are expecting soon, which will focus on the Advanced EOB provisions of the NSA as well as “Other Provisions.”

Additional resources:

• Link to final rule
• Link to DOL press release
• Link to DOL fact sheet

Stay tuned for additional information and analysis.

#EDPMAHasYourBack

The Emergency Department Practice Management Association (EDPMA) is concerned about health plans’ systemic and drastic reductions in emergency medicine physician reimbursement and threats to physician group contracts under their misinterpretation of the No Surprises Act. To read the full letter click HERE.

On July 27 EDPMA joined medical societies urging Congress to pass legislation that provides at least a 4.5% CF adjustment for 2023 and waives the 4% statutory PAYGO requirement. We also ask for legislation to provide a one-year inflationary update based on the Medicare Economic Index. These important policy changes will undoubtedly provide our members with crucial short-term fiscal stability while simultaneously laying the foundation for necessary long-term payment reforms.  The letter can be found here.

This afternoon, the Centers for Medicare and Medicaid Services released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.  While physician payments under the Medicare Physician Fee Schedule continue to be cut due to statutory budget neutrality provisions, CMS proposes to increase hospital outpatient payments by 2.7%. 

Also included in this proposed rule are several new provisions for Rural Emergency Hospitals (REHs). Congressionally-created in the Consolidated Appropriations Act, 2021, REH is the new enrollment designation for hospitals that “were CAHs [critical access hospitals] or rural hospitals with not more than 50 beds, participating in Medicare, as of the date of enactment” (December 27, 2020) and wish to convert to and enroll in Medicare as an REH. REHs must provide emergency and observation care. As you will recall, we recently announced a proposed rule directed at the Conditions of Participation (CoPs) for REHs.  The provisions included here in the CY 2023 OPPS proposed rule are directed at REH enrollment, payment, and quality reporting.  A CMS fact sheet on REHs is available here.  CMS notes that it will finalize the REH CoPs with the enrollment, payment, and quality reporting provisions later this Fall. 

For those interested in more details, CMS also issued a related press release and fact sheet.   

EDPMA will continue to review all of the provisions of the rule and provide additional details.  EDPMA plans to file comments on the proposed rule by the September 13, 2022 deadline.
#EDPMAHasYourBack

McLean, Virginia – The Emergency Department Practice Management Association (EDPMA) is concerned that payers are denying payments to emergency medicine physicians for essential and lifesaving care they provide to patients. EDPMA believes that emergency physicians should be able to deliver high-quality, cost effective care in the emergency department and that payers should reimburse highly-trained emergency physicians based on a patient’s presenting symptoms.

However, many payers prioritize profits over patient care with the systemic practice to unnecessarily delay, deny, or reduce payments. EDPMA believes this is wrong and advocates on the regulatory, federal, and state levels to combat this practice on behalf of its members.

EDPMA also supports the efforts of our member organizations to advocate on behalf of their emergency physicians, such as Fremont Emergency Services’ litigation to hold UnitedHealthcare accountable for its policy to withhold payment to ER doctors after services have been rendered. In this vein, we support our colleague’s efforts to advocate for emergency physicians and patients by any means necessary, including litigation.

“EDPMA continues to hold payers accountable for systemic practices that do not acknowledge or compensate for medical decision making in the emergency department,” says Don Powell, DO, FACEP, EDPMA Chair of the Board. “We strongly believe that emergency physicians should be fairly reimbursed for the delivery of emergency care, and payers should do their part to not undermine the emergency medical health care delivery system or the overall health of our healthcare system. EDPMA is in the business of emergency medicine and will continue to advocate for its members and patients.”

About EDPMA
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 https://edpma.currentmediagroup.net.

Contact:
Cathey Wise
703.506.3282 (direct) l 817.905.3310 (cell)
cathey.wise@edpma.org

This afternoon, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) proposed rule.  For CY 2023, CMS proposes an MPFS conversion factor of $33.0775. That represents a 4.42% reduction from the CY 2022 MPFS conversion factor due to the expiring 3.0% boost to the conversion factor provided by Congress for CY 2022 as well as an additional budget neutrality adjustment generated by the CY 2023 proposed policies.

• Emergency Medicine Overall Impact. CMS estimated that the overall impact of the rule on emergency medicine is a 1% increase in payments. However, note that this estimate does not factor in the expiring CY 2022 congressionally-mandated 3% boost to the conversion factor.
• ED E/M Codes: Generally speaking, CMS proposes to adopt the revised CPT documentation guidelines for emergency department (ED) evaluation and management (E/M) visits. These changes are intended to align documentation for all E/M code sets (other than critical care services) with the documentation guidelines adopted for office and outpatient E/Ms in CY 2021. (For more information on the ED E/M documentation guideline changes coming January 1, 2023, see information from AMA CPT via this link.)

Because of these documentation guideline changes, the AMA RUC also embarked on a revaluation of all affected codes sets. In this proposed rule, CMS proposes to accept the values for emergency department (ED) evaluation and management (E/M) services as recommended by the AMA RUC for CPT 99281, 99282, 99283, and 99285.  However, CMS rejected the RUC recommendation of 2.60 for CPT 99284 and instead proposes to maintain the current work RVU of 2.74.

• Split (or Shared) Visits. CMS had previously finalized a new January 1, 2023 billing policy for instances in which a physician delivers an E/M service along with a non-physician practitioner. As EDPMA requested, CMS has delayed the policy that would have based the determination of the billing practitioner solely on time. This policy is proposed for delay through January 1, 2024 while CMS collects additional input.
• QPP. Per usual, CMS proposes modifications to the reporting requirements under the Quality Payment Program (QPP), including the Merit-based Incentive Payment System. As a reminder, CY 2023 reporting under the QPP will affect payment adjustments for services furnished in CY 2025.

EDPMA will continue to analyze the proposed rule and provide additional details. EDPMA plans to comment on the proposed rule before the end of the 60-day comment period.

• A link to the full rule can be found here.
• A CMS press release is available here.
• A CMS fact sheet can be accessed here.
• CMS also provided additional resources on the CY 2023 QPP policies in a zip file available here.

EDPMA in our partnership efforts with the American College of Emergency Physicians (ACEP) have worked to highlight the issues our members are experiencing with health plan compliance with their obligations under the No Surprises Act.  After sending multiple letters with examples of health plan non-compliance and meeting with staff from the Center for Consumer Information and Insurance Oversight (CCIIO), EDPMA is pleased to announce that CCIIO has released a new guidance document, Federal Independent Dispute Resolution Process Checklist of requirements for group health plans and group and individual health insurance issuers.

The full document can be accessed here.