A list of approved qualified clinical data registries was finally released late last month, five months into the first reporting period for the CMS Merit-based Incentive Payment System. Among the list of approved QCDRs was ACEPs Clinical Emergency Data Registry. Read more
Emergency physicians charge uninsured or out of network patients as much as four times more than what they are willing to accept in payment from Medicare, according to a recent study from Johns Hopkins School of Medicine. But the American College of Emergency Physicians says the study relies on flawed methodology and incorrect assumptions about the cost of emergency care. Read more
Emergency physicians in Kansas and Missouri are raising new concerns about insurers refusing to pay or paying only a screening fee for patients being treated for conditions which they claim are non-urgent. Is Indiana next? Read more
According to a recent audit from the Government Accountability Office, Medicare’s payment and coverage restrictions are largely responsible for holding back progress and access to telehealth services. But cost savings and innovative uses of telehealth in the Emergency Department may help push the industry toward greater adoption. Read more
The removal of moderate (or conscious) sedation from hundreds of CPT codes and the creation of six new codes to be used for billing the service means providers who perform moderate sedation, even those who also are performing primary services, have more options for being reimbursed for their work. Read more
In the ongoing debate about out-of-network balance billing, or so-called “surprise billing,” a recent national study found that the average emergency physician charges at least four times what Medicare reimburses for the same services. But the American College of Emergency Physicians says the study focuses on the wrong issues. Read more
Choosing your data submission option and which measures you will perform in the Merit-based Incentive Payment System may take some detailed analysis, especially as you consider which measures are available for which reporting option and make sense for your practice. For some specialties, like emergency medicine, CMS offers some help. Read more
More than one in five emergency department patients received an unexpected bill for out-of-network services when the hospital they were treated in was in-network. The real surprise, however, is that in most other settings, patients have to prepay before they are even treated. Read more
Final details of the MACRA Quality Payment Program (QPP) for the 2017 reporting year were recently released by the Centers for Medicare and Medicaid Services (CMS). While much of the proposed rule was included in the final draft, CMS made a few provisions especially for small practices, hospital-based clinicians, and eligible providers who aren’t quite ready to dive in for 2017. Read more
EDPMA, in cooperation with ACEP, submitted to CMS a number of comments about the Notice of Benefit and Payment Parameters for 2018, “urging it to require ACA health plans to offer fair coverage including adequate reimbursement for emergency care.” Read more
