EDPMA's May 2022 Membership Newsletter

In this month’s issue, we detail the QPA Data Collection Project being conducted by EDPMA and ACEP. We also highlight new NSA resources and opportunities for different workgroups. Finally, members can access the Federal IDR Portal webinar and attendees can complete an attendee survey for the 2022 Solutions Summit to help plan future conferences.

Concerned About Insurer Non-Compliance Harming Your Clients’ Bottom Line? EDPMA Needs Your Help!

We all feel the administrative burden of navigating the No Surprises Act and determining how it impacts you or your clients.

EDPMA and ACEP remain on-point to advocate for emergency medicine physician fair payments and to ensure patients receiving emergency care are kept out of the middle of payment disputes.

We need your help to ensure out-of-network (OON) payments focused specifically on the Qualifying Payment Amount (QPA) are complying with the federal law through a simple data collection exercise:

PHYSICIAN GROUPS – PLEASE AUTHORIZE PARTICIPATION

RCM COMPANIES – ASK YOUR CLIENTS TO AUTHORIZE PARTICIPATION

We understand full authority must be granted to participate in this project. Consider using/sending this sample fill-in-the-blank language to your clients /compliance team:

I am writing to authorize (fill in the name of the independent RCM or internal RCM function of the hospital) to produce and report (fill in group name) data and complete the spreadsheet for the QPA Reporting Project. The targeted date to have the raw data submitted is Friday, May 27, 2022. Thank you.”

UPLOAD

Once you receive authority from your client, upload 100 evaluation and management (E/M) services claims into this spreadsheet per physician group or RCM company to determine the QPA by health plan, whether the QPA was the initial OON reimbursement and relevant Remittance Advice Remark Codes (RARCs) regarding the remittance advice provided by the health plan. Be sure to exclude claims paid under specified state laws (see chart).

WHY 100 CLAIMS?

We fully recognize the workload and bandwidth of your compliance and coding teams. So, to make this project more manageable, we believe 100 codes will provide us with a robust data set while not overburdening your teams. We prefer your 100 claims from the four main commercial payers: Blue Cross/Blue Shield, United Healthcare, CIGNA and Aetna. So, a single site Emergency Department group would aim for 25 claims from each of these four payers. For multi-state groups, you may limit your scope to 3-5 states that focus on reporting on problem areas. Even across this broader base of practices, only 100 claims are requested.

WE DON’T HAVE 100 CLAIMS YET TO SUBMIT.

That’s OK! Send us what you have – some data is better than no data!

PRO TIP

Recall that the ACEP/EDPMA QPA Data Project seeks claims and data for ONLY federal No Surprises Act (NSA) services, not those services governed by state law. To simplify your data collection efforts, please request that your RCM service teams sort the data by “Remittance Advice Remark Codes” (RARCs) and specifically codes “N859” and “N860”—these RARCs indicate that the federal NSA was applied to the processing of the claim. While we would prefer the larger range of RARCs that could apply to NSA applicable services, using these two RARCs may jumpstart your data collection efforts.

View Remittance Advice Remark Codes (RARCs) for the QPA Data Project.

Note that data from this survey will be collected and reported in compliance with the antitrust “safety zones” as established by the U.S. Department of Justice and the Federal Trade Commission.

DEADLINE

Submit your claims by Friday, May 27.

QUESTIONS AND FAQs

See this Frequently Asked Questions document that defines the project. Greg Hufstetler, CPA, the third-party data analyst, will answer your questions at 267.563.3884 and [email protected].

Thank you for your consideration to provide data that will drive successful advocacy efforts.

Additional Resources:

Opportunity: Practice Management Committee Workgroups

The Practice Management Committee is forming two workgroups, one focusing on telehealth and the other on financial practice management.

If you are interested in learning more, please contact [email protected].

Opportunity: Rural Emergency Hospital Working Group

Congress passed the Consolidated Appropriations Act (CAA) of 2021 (Public Law 116-260), which, in Section 125, created a new Medicare provider type called the Rural Emergency Hospital (REH). The REH will be a new rural hospital type that does not provide inpatient care but will provide 24-hour emergency services. The REH comes as a response to ongoing hospital closures in rural communities and to the concerns of access to emergency services in rural areas. Policymakers believe the REH will provide an option for communities that are perhaps too small to support a full-service hospital but need more than ambulatory care.

As per the legislation, a Critical Access Hospital (CAH) or small rural hospital with no more than 50 beds can convert to the REH provider type and begin providing services beginning January 1, 2023. Once the rule comes out, EDPMA will convene a workgroup to provide comments on the rule. In the meantime, we are identifying these workgroup members so we can be poised to respond. Interested? Contact Cathey Wise at [email protected]. Information: Rural Emergency Hospital Policy Brief

NEW EDPMA MEMBER-ONLY RESOURCE: NSA Health Plan Communication Checklist

To help you monitor the information a health plan MUST provide you per the NSA, what a health plan SHOULD provide you upon request, and where to register a complaint if you believe the health plan and issuer are not in compliance with the NSA requirements, EDPMA created a check-list resource. The checklist can be accessed in the Out-of-Network Reimbursement Toolbox – Federal. You must be logged in to your EDPMA account to access this new resource.

Education on Demand

FREE EDPMA MEMBER-ONLY WEBINAR RECORDING: The Federal IDR Portal Is Launching: Now What?

Members can log in to their EDPMA account to access the webinar recording to help prepare to file claims through the Federal IDR Portal.

2022 Solutions Summit Survey

Your feedback matters! If you attended the Solutions Summit in Florida, please complete this attendee survey to help us plan future conferences.

Welcome Our New Member

Welcome our newest member, Certified Emergency Medicine Specialists, Cleveland, OH.

Support Our Sponsors Who Support Our Mission

Because of the generous support of our sponsors, EDPMA has the resources to be your voice and your advocate. Learn more about your sponsors by clicking on their links to learn about their company and how they can complement your efforts.

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