EDPMA advocates for the practice of emergency medicine through federal, regulatory and state advocacy.
Priority issues include implementation of the No Surprises Act, fixing the Medicare physician fee schedule, protecting EMTALA and keeping patients out of the middle of payment disputes.
EDPMA Data Analysis: No Surprises Act Independent Dispute Resolutions – Deficiencies and Compliance Failures
EDPMA surveyed its membership to report on issues related to the implementation of the No Surprises Act (NSA) and its Independent Dispute Resolution (IDR) process since its enactment on January 1, 2022. This data documents our members’ experiences with the IDR process and represents a high-level summary of initial findings and represents at least one-fourth of all emergency department (ED) visits in the United States and prior to the August 3, 2023, closing of the federal IDR portal. See the full report here.
EDPMA’s study reveals:
- 91% of filed claims remain open and unadjudicated.
- 95.6% of outstanding claims are 5+ old from 127 health plans.
- 46% of the time, payers are not responding during the 30-day Open Negotiation period.
- 52% of the time, payers do not acknowledge an IDR had been filed.
- 75% of payers who actually respond in the IDR process do not make an actionable offer.
- 60% of payers are not updating the QPA amounts with the statutorily required inflationary update.
- Payers are not participating in a 30-day open negotiation period and IDR process as expected by statute.
- Rapid and effective enforcement is not happening.
- 87% of payers did not pay in accordance with the IDR Entity decision.
EDPMA offers these solutions:
- Implement the law as designed.
- Congressional involvement
- Rapid and effective enforcement
- EMTALA must now be funded.
EDPMA Data Analysis: Qualifying Payment Amounts and Health Plan Compliance Under the No Surprises Act
EDPMA surveyed its membership to report on issues related to the implementation of the No Surprises Act (NSA) since January 1, 2022.
See the study findings here.
EDPMA’s study reveals:
- 91% of claims surveyed did comply with the NSA’s statutory and regulatory QPA disclosure requirements.
- Post-NSA Out-of-Network Payments decreased 92% of the time, compared to Pre-NSA. The average decrease is 32% per ER Visit.
- The Independent Dispute Resolution volumes are driven by artificially low QPAs, payer intransigence, failure of Open Negotiation, health plan termination of in-network agreements, and CMS’ refusal to implement common sense recommendations.
- When reported, the QPA consistently equals the allowed amount for provider payments.
- Emergency Department staffing is in jeopardy.
EDPMA also offers solutions including:
- Congressional Involvement
- Rapid and effective enforcement
- Accurate QPAs
- Require and Clarify RARC Codes
- EMTALA Must Now Be Funded
See our solutions here.
EDPMA briefs the 118th Congress on our trade association EDPMA Hill Intro and asks for Congressional Oversight of the No Surprises Act Implementation EDPMA Hill Day Leave Behind March 2023.
EDPMA Lobby Day
EDPMA’s Lobby Day is Tuesday, November 14 in Washington DC. We focus on meetings with the House and Senate Leadership and Leadership with the key Committees overseeing health care. Interested in joining us? Complete the Interest Form and we will forward information as the event nears.
EDPMA Advocacy Primer
If you need help identifying your congressional delegation, finding contact information, or preparing for a meeting, please review the EDPMA Advocacy Primer.
For access to key letters to and from federal and state decision makers and payers, lobby packets, and other helpful information, please visit the toolboxes under the “Resources Tab.”