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.
Archive for News – Page 7
EDPMA Comment Letter on Proposed 2022 Medicare Physician Fee Schedule
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
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.
EDPMA urges decision makers to maintain the 3.75% increase in the Medicare Conversion Factor
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.
On February 22, 2021, EDPMA urged United Healthcare (UHC), not to implement its auto-downcoding policy for 99285 because it violates the prudent layperson standard. A week later, UHC announced that the implementation date for that policy has been delayed.
2020 was an extremely busy, but successful year for advocacy. To take a look back on all of EDPMA’s Advocacy Successes, please click here