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. 

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.

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

The form to submit a proposal you would like to present at the 2022 EDPMA Solutions Summit is now open!  As experts in the business of emergency medicine, we hope that you are interested in presenting at the 2022 Solutions Summit on April 24-27, 2022 in Amelia Island, Florida. If you are interested, we’d like to receive your application. EDPMA also encourages you to share this link with coworkers and industry colleagues you think would be great speakers on issues facing the business of emergency medicine.

Don’t forget, all applications must be completed in full and received by December 5, 2021 and submitted through the link below, which includes the application questions.

Submit Your Proposal

On October 1, 2021, EDPMA and others blasted the Interim Final Rule that contradicts both the intent and language of the No Surprises Act (NSA) in a windfall for profitable commercial insurers which threatens patient access to care.  Early versions of the NSA — which could not pass due to lack of Congressional support — tied out-of-network reimbursement to the plan’s in-network rate.  In order to garner enough Congressional support to pass the bill, the bill was amended to include a list of factors the arbiter may consider and a list of factors the arbiter may not consider.  The rule released on September 30th directs arbiters to ignore these lists and simply choose the payment amount that is closest to the plan’s in-network rate in most cases.  Moreover, the rules provide that the plan’s in-network rate (also known as the Qualifying Payment Amount (QPA)) should not reflect any bonus payments or other related compensation earned by providers.

On September 13, 2021, EDPMA commented on the Proposed 2022 Medicare Physician Fee Schedule. Read the full letter below.

 9/13/21 EDPMA Comment Letter on Proposed 2022 Medicare Physician Fee Schedule.

On August 31, 2021, EDPMA and ACEP urged Cigna not to implement its policy of down coding based on diagnosis because it violates the Prudent Layperson Standard and coding standards. See the letter below

  8/30/21 EDPMA Letter to Cigna re: Down Coding

On July 1, the Department of Health and Human Services (HHS) officially opened the Reporting Portal for entities who received one or more Provider Relief Fund payments exceeding, in the aggregate, $10,000 from April 10, 2020 to June 30, 2020.  Those entities will have until September 30, 2021 to complete the reporting process. Any unused funds from the period of availability must be returned by October 30, 2021. If no report is submitted by the deadline, then all funds are considered unused.  HHS has detailed a series of steps for completing the reporting process, which include (1) registering in the Provider Relief Fund Reporting Portal; (2) reading the Reporting Requirements Notice, which was revised on June 30, 2021; (3) watching the reporting technical assistance webinar, and then (4) submitting your information through the Reporting Portal.  All of these steps and key information related to the Reporting Portal can be found here.  Attached is a resource guide to help with the process and answer additional questions as you navigate your reporting requirements.

On July 23, 2021, EDPMA and 108 other physician advocates urged Congress and the Administration to maintain the 3.75% increase in the Medicare Conversion Factor at least through calendar year 2022 or 2023.  The letter is available here

EDPMA and ACEP sent a 5/5/21 EDPMA/ACEP Joint Letter to Moda Health regarding its new policy for emergency department claims that violates PLP.