This webinar is designed to provide EDPMA members like you with insight into the latest news on Medicare reimbursement, including detailed updates on MIPS, the new Emergency Medicine MVP, and other topics covered under the Final Rule. Don’t miss this opportunity to learn from the experts and ask questions on how to prepare for the coming year.
November 30, 2023 – 1:00pm ET
This webinar is sponsored by Brault. Click here to register.
Join us for an informative and engaging webinar that delves into the critical aspects of denial prevention in the modern world. Denial prevention is an essential component of safeguarding your organization’s assets, reputation, and security. In this webinar, we will explore the four key pillars that form the foundation of effective denial prevention strategies.
November 1, 2023 – 1:00pm ET
Cost: Free to EDPMA Members.
Location: Hosted on Zoom (Zoom link received upon registration)
Faculty: Christine Fontaine, Solution Strategist, Waystar
Click here to register.
On Friday October 6th, the Centers for Medicare & Medicaid Services (CMS) announced new guidance in response to the August ruling in Texas Medical Association v. United States Department of Health and Human Services (“TMA III”) that vacated several provisions of the existing No Surprises Act (NSA) regulations. Our organizations are strongly opposed to this newest guidance, which further broadens the already significant discretion health plans had on how they may calculate qualifying payment amounts (QPAs) under the NSA’s original implementation. In the announcement, the Departments state that no additional guidance is expected to be provided to health plans about how to calculate the QPA, and instead, simply leaves insurers the discretion to calculate QPAs using their own “good faith” interpretation of the TMA III ruling and remaining regulations. Read more.
As the No Surprises Act’s Independent Dispute Resolution (IDR) portal surpasses the 8-week mark since its halt of full operations for the filing of new IDRs, the American College of Emergency Physicians, American College of Radiology, American Society for Anesthesiology, the Emergency Department Practice Management Association, and Radiology Business Management Association together urged the U.S. Department of Health and Human Services to reopen the national portal. Read More.
On September 18, EDPMA filed an amicus brief in the Court of Appeals for the Fifth Circuit in support of the challenge by the Texas Medical Association to a provision of the Final Regulation of the Department of Health and Human Services under the No Surprises Act (“NSA”). The challenged provision implicitly calls upon Independent Dispute Resolution (“IDR”) entities to give paramount importance to the Qualifying Payment Amount (“QPA”) in the IDR process under the NSA. Our brief explains why the district court was correct in concluding that the provision wrongly tilts that process in favor of insurers — and is contrary both to the language of the NSA and to the congressional goal of assuring fair payment to out-of-network physicians.
Our brief highlights the problems caused by the challenged provision for emergency physicians and for patients. It provides factual support, based in part on EDPMA studies, that insurers’ manipulation of the QPA has adversely affected not only out-of-network payments, but in-network payments as well. It stresses that, in light of EMTALA and other factors, the challenged provision would be particularly harmful for the delivery of emergency medical care to patients.
The issues in the case are still being briefed, and we don’t know when the Court of Appeals is likely to issue a ruling. But we have taken a strong stand in support of our members and the patients we serve. See the EDPMA brief here.
PearsonRavitz is a physician-founded, physician-led disability and life insurance advisory firm. With deep industry expertise, we specialize in offering tailored insurance solutions to medical professionals. We are committed to safeguarding physicians’ well-being, careers, and families through education and empowerment.
As an OB/GYN at the pinnacle of her career, a shoulder injury abruptly ended Dr. Stephanie Pearson’s medical practice. This experience showed her how crucial disability insurance is for physicians, and in 2017, she co-founded PearsonRavitz, a disability and life insurance brokerage. Fueled by her own struggle and the loss of her physician identity, she became an advocate, educating and empowering her fellow physicians so that they can protect their health, career, and families.
When asked why PearsonRavitz joined EDPMA, Dr. Pearson stated, “I joined EDPMA because I believe in their mission to provide high quality, cost-effective care in emergency rooms nationwide. As a physician myself, I admire the support that EDPMA provides to our nation’s emergency room physicians.”
When asked to describe PearsonRavitz, Dr. Pearson noted, “When we founded PearsonRavitz, we knew that we wanted our company to reflect our core values of Ownership, Transparency, Empathy, and Respect at every level. From our employees to our clients, we’ve made it our mission to ensure that everyone experiences those values when they become a part of our network.”
When asked what motivates Dr. Pearson, she shared, “After I experienced a career-ending injury during the prime of my career as an OBGYN, I discovered that my disability insurance didn’t provide the coverage I needed to protect my health and family. I have since made it my mission – and my second career – to ensure that other physicians are educated and empowered to make decisions that protect their ability to earn income and care for the people they love.”
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As of Tuesday, August 29th, the Federal IDR portal remains closed to initiation of new disputes. The portal has been closed to new disputes since August 3, 2023, after a court ruling vacated the 2023 administrative fee of $350 as well as one of the batching requirements. Read More.
The RCM Workshop focuses on the full spectrum of regulatory and business changes of the No Surprise Act (NSA), strategy perspectives, and tactical planning for revenue cycle management.
December 13 – 14, 2023
The Wynn Resort, Las Vegas, NV
The beautiful Wynn Resort in Las Vegas will host EDPMA’s annual RCM Workshop on December 13 and 14. And we are betting on YOU as “An RCM Wynner! This conference includes (2) half-day sessions (to minimize your time out of the office) and will equip you with the latest strategies, best practices, and tools to optimize your revenue cycle and enhance overall financial performance.
Our first-ever Pre-Conference Session (8am – 12pm PST) will be held on the morning of December 13 before the RCM Workshop starts.
After this pre-conference session, attendees will:
Click here for more information.
EDPMA Chair of the Board, Andrea Brault, MD MMM FACEP, released the following statement regarding the summary judgement-in-part issued in favor of the Texas Medical Association (TMA), et al., in “TMA IV” and CMS’ subsequent freeze of the IDR and patient dispute process:
“On three consecutive occasions, the courts have vacated regulatory decisions related to the implementation of the No Surprises Act that deviate from statute to favor insurers at the expense of clinicians,” said Dr. Brault. “We will continue to support initiatives that bring regulations in line with the statute, with an emphasis on protecting clinicians and their patients.” To read the full statement, click here.
On Friday, August 4th, the U.S. Department of Health and Human Services (HHS) suspended the No Surprises Act’s Federal IDR process after the August 3rd court ruling against the federal Departments on the increase of the 2023 IDR Administrative Fee and a portion of the Departments’ IDR batching criteria.
We understand that this will be a severe disruption for emergency medicine providers seeking fair reimbursement from health plan underpayments for services furnished to patients in the emergency department. EDPMA will keep members apprised of additional developments and attempt to obtain clarity and additional information. In the meantime, see the HHS announcement on the suspension of Federal IDR below:
