August 4, 2023 – EDPMA is very pleased that the United States District Court in Texas accepted the position of the Texas Medical Association, other plaintiffs, EDPMA, and others that filed amicus briefs that two actions by the federal agencies responsible for implementing the No Surprises Act were not taken in compliance with law and were therefore struck down. EDPMA applauds the decision of the District Court. We believe that the challenged actions were contrary to fundamental fairness. Click here to read the full statement and court ruling.
Author Archive for Madison Williams – Page 3
July 21, 2023 – As providers on the front lines of emergency care in this country, the Emergency Department Practice Management Association (EDPMA) is deeply troubled by the
proposal to expand the use of the significantly flawed Qualified Payment Amount (QPA) benchmark to establish further government price controls in the commercial market for our fellow physicians and hospitals. The QPA was meant to establish a measure of patient cost sharing, not a benchmark for payment of providers. To read the issue brief and full statement, click here.
Planning for Profitable Growth
Date: September 28, 2023
Time: 1:00pm – 4:00pm EST
Overview
Healthcare costs have risen over the years, and payment programs have shifted to quality and cost reduction rather than services performed or time spent. Thus far, Emergency Medicine has yet to benefit from this movement. Given the strain on revenue and operating margins, organizations primarily dependent on traditional fee-for-service in-person EM services must adapt their business model.
For more information click here.
Fulcrum Strategies is a health care consulting firm specializing in payer contract negotiation, strategic planning, and public relations for physician practices. Founded in 2004, by President and CEO Ron Howrigon, Fulcrum’s vision is to provide medical practices professional negotiation and planning resources to improve managed care contracts for medical professionals. Fulcrum has over 70 clients in 18 states.
Ron Howrigon spent 18 years in the Managed Care Industry as a Negotiator, Network Manager and in Senior Management for several large managed care companies. Since 2004 he has helped over 5000 physicians in practices across the country with their contract negotiations. He holds degrees in business and economics, is a husband and father of three children.
During his time in the managed care corporate structure, he realized that medical practices were at a disadvantage in our current system, and he wanted to level the playing field in his area of expertise. After nearly twenty years, his passion for helping physicians has not wavered.
When asked about why Fulcrum Strategies joined EDPMA Mr. Howrigon stated, “One of the strongest components of our U.S. Healthcare system is our ability to provide the best in emergency medicine. This success sets the U.S. above many other nations’ and only comes through the collaboration of professionals across the country. Throughout my nearly four decades in healthcare, my respect for those delivering healthcare, especially those in our emergency departments, has only increased. I needed to be a part of the discussion to improve myself and better help those on the front lines.”
Mr. Howrigon currently serves as the Chairman of the Board of Directors for the Autism Society of North Carolina and volunteers for their events and other events supporting children and those with special needs.
Join EDPMA for a reception on Tuesday, October 10 for a reception at ACEP23 in Philadelphia. We will be at Maggiano’s Little Italy across the street from the ACEP23 hotel.
Date: Tuesday, October 10
Time: 6pm – 7:30pm EST
Location: Maggiano’s Little Italy. Across the street from the ACEP23 hotel.
Thank you to our sponsor!
Wednesday, June 28
1p – 2p EDT / 2p – 3p CDT
We are excited to bring the EDPMA community together for an interactive and engaging discussion on what matters most to our members.
Led by EDPMA Chair, Dr. Andrea Brault, we will update you on recent initiatives and resources, share what EDPMA is currently doing, and actively listen to your ideas and concerns that will help shape what we do next. Click here to register!
EDPMA knows that Envision Healthcare’s challenges are not unique. Factors like workforce shortages, wage inflation, NSA flawed implementation, lower physician reimbursement & unchecked payer practices harm our healthcare system & threaten the ED safety net. Read our statement.
EDPMA advocates for policies protecting emergency care access. While Envision Healthcare ensured their clinicians & patients will not be impacted by restructuring, it’s a foreshadowing to groups facing challenges because of NSA implementation & unchecked payer practices. Our statement.
The Emergency Department Practice Management Association (EDPMA) strongly supports the goal of the No Surprises Act – to keep patients out of the middle of billing disputes.
A lawsuit on appeal before the Second Circuit has sought to dismantle the No Surprises Act (NSA) by holding it unconstitutional. The EDPMA supports the NSA and the patient protections it affords patients however the EDPMA and its partners believe the courts could side with the defendants in this case and make Independent Dispute Resolution (IDR) process the exclusive remedy for resolving billing disputes between payers and providers. For EDPMA, access to courts to pursue out-of-network billing disputes is paramount. EDPMA encourages the court to preserve the NSA and its patient protections, while also preserving providers’ access to the courts as a viable alternative to IDR.
Insurers have abused the NSA and have used it as a tool to slash physician reimbursement. Patient access to care, particularly in the critical emergency medicine context, depends on physicians having efficient and economical means to resolve billing disputes. Accordingly, EDPMA encourages the court to affirm that the No Surprises Act does not interfere with a physician’s right to pursue all available legal remedies, including litigation, to obtain fair reimbursement from insurers. That’s why EDPMA continues to advocate for its members and patients,” says Andrea Brault MD FACEP, EDPMA Chair of the Board.
Click here to view the Amicus Brief.
Learn how to combat reasons for payer denial of claims in IDR with actual NSA statute language, and benefit from a curated list of what IDREs MUST do and CANNOT do to strengthen your success rate in the IDR process.
Date: Monday, May 22
Time: 1pm – 2pm EST
Audience: Physician Groups + RCM Operations Managers
Register Now
And almost 96% of outstanding claims are 5+ months old. Read more here.