EDPMA Membership Newsletter 
April 2020
April 2020 Articles:
  1. EDPMA Webinar on COVID-19 Reimbursement:Telehealth, Medicare, and CARES Act Funding for Providers - Tomorrow (Friday)
  2. The EDPMA 2020 Solutions Summit Is Cancelled
  3. EDPMA Board Election Results
  4. Join an EDPMA Committee Today!
  5. Call for Speakers: EDPMA Workshop, Webinar or the 2021 Summit
  6. Join a Virtual EDPMA Roundtable
  7. Coverage for COVID-19 Testing and Care for the Uninsured 
  8. New Member Spotlight: Dumas Law, PLLC
  9. Welcome New Members!
  10. We've Moved, Please Update Your Records

EDPMA Webinar on  COVID-19 Reimbursement:
Telehealth, Medicare, and CARES Act Funding for Providers -  Tomorrow (Friday)

Don't delay; register today!  This webinar is tomorrow! 
 
The Emergency Department Practice Management Association (EDPMA) is offering a webinar on  FridayApril 10, 2020, from 2-3pm Eastern , entitled "COVID-19 Reimbursement: Telehealth, Medicare, and CARES Act Funding for Providers."  This webinar is free to members of EDPMA 
 
The COVID-19 reimbursement landscape is rapidly changing.  We know that new information is released daily and it is difficult to keep up.   Some Medicare relief applies to hospitals, but not providers.  And, as interim guidance is finalized, the government has often changed course, such as with coding telehealth in the emergency department.  Further, the government is still finalizing how it will distribute COVID-19 funding to emergency physician groups.  EDPMA wants to make sure you have access to our experts to understand the most recent information.   
 
Presenters will include:
 
Shana Christrup , MPH, is the Vice President of Health Policy at Hart Health Strategies.  She has been with Hart Health for over 11 years, focusing on legislative affairs.  During her time on the Hill, Ms. Christrup was a lead negotiator with several of the key bills related to bioterrorism and pandemic response.

Robert Jasak, JD, is the Vice President of Coverage and Payment Policy at Hart Health Strategies. He has been with Hart Health for over 7 years and has worked at several professional associations in health policy roles and has served in several positions in the federal government.
 
Rachel Groman , MPH, is the Vice President of Clinical Affairs and Quality Improvement at Hart Health Strategies. She has been with Hart Health for 8 years, focusing on federal and private payer quality measurement programs and value-based payment initiatives. 
 
Cindy Moon , MPH, MPP, is the Vice President of Health Care Payment and Delivery Reform at Hart Health Strategies.  She has been with Hart Health Strategies for 3 years, focusing on regulatory affairs. Prior to joining Hart Health Strategies, Ms. Moon worked at the White House Office of Management and Budget where she advised on policy solutions affecting the Medicare program.
 
How To Register for the Webinar:
  • For step-by-step directions, please click here.  In order get the member discount code, you must enter your email address where it asks for the discount code).  You must create an account with CommPartners before you can register for the event.  Please note that any old accounts have been deleted to eliminate confusion as you go through the registration process.   
  • You must create an account with CommPartners before you can register for the event.  To begin the registration process click here
  • Registered webinar attendees will receive an email on how to enter the webinar closer to the date of the event.
If you have registration issues or questions, please contact Paul Gerard at (703) 506-2892) or pgerard@edpma.org.
 
In the meantime, don't forget EDPMA has a COVID-19 resources page that can be accessed from a link on the EDPMA homepage under "Latest News and Updates."
 
The EDPMA 2020 Solutions Summit Is Cancelled



Thank you all for your support and patience during this trying time. It was with heavy heart that we announced  EDPMA is cancelling the 2020 EDPMA Solutions Summit scheduled for May 3-6, 2020, in Nashville, TN. EDPMA does not plan to reschedule the event this year.  More information about the cancellation is available  here.   EDPMA remains committed to offering targeted education, effective solutions, and quality networking opportunities to our members. Some of these ideas are discussed in this newsletter. 

EDPMA Board Election Results

The EDPMA Board is staggered with 13 of the 19 Board seats up for election in 2020.  Congratulations to the following 13 members elected to serve on the EDPMA Board from May 2020 until May 2022:

BSA Healthcare: Jeffrey Bettinger, MD, FACEP, Vice Chair
Brault: Andrea Brault, MD, MMM, FACEP, Immediate Past-Chair
R1: Jackie Willett, CHBME, Treasurer
TeamHealth: Aron Goldfeld, JD, MBA, Executive Committee 
Acute Care, Inc.: Paul Hudson, MBA, MHA, FACHE
CIPROMS Medical Billing, Inc.: Andrea Halpern Bryan
Envision Healthcare: Bob Kneeley
Gottlieb: Shanna Howe
LogixHealth: James Blakeman
Medical Coding Solutions: Mark E. Owen
SCP Health: Randy Pilgrim, MD, FACEP
Sound Physicians: Mike Presley, MD, FACEP
US Acute Care Solutions: L. Anthony Cirillo, MD, FACEP

We would like to welcome two new member to the Board: LogixHealth, represented by James Blakeman, and Sound Physicians, represented by Dr. Mike Presley.   We look forward to working with you!

Edelberg & Associates and Reimbursement Technologies, Inc. are stepping down from the Board.  EDPMA would like to thank Caral Edleberg of Edelberg & Associates and Gary Gelbart of Reimbursement Technologies, Inc., for their many contributions to EDPMA through their years of service.  Thank you to everyone who ran for a seat this year.   

Join an EDPMA Committee Today!

It's time to look for alternative networking opportunities since the 2020 EDPMA Solutions Summit has been cancelled. EDPMA's committees offer a great opportunity to hear from experts in the business, work on common problems together, highlight your own expertise, and get to know others in the business.  Most committees have open membership where any member can join.  Committee membership should not be seen as a new responsibility you need to fit into your busy schedule.  In fact, you can skip meetings when they are inconvenient and can just listen in if you do not want to participate. So, please do not be shy. Join us!

Committee members work together in a variety of ways including:
  • Urging the federal government to provide streamlined COVID-19 relief to emergency physician groups,
  • Developing federal and state proposals addressing surprise gaps in insurance,
  • Editing letters to commercial payers who inappropriately down code payments,
  • Developing best practices around the Merit-based Incentive Payment System or Alternative Payment Models,
  • Identifying speakers for conferences, workshops, and webinars,
  • Organizing meetings with CMS on provider enrollment, and
  • Building strong business relationships.
Experts work side-by-side with newcomers, new leaders shine, and everyone's contribution is greatly appreciated. Many members report that insight shared on committee conference calls is one of the most important and unique benefits of their EDPMA membership. We understand your schedules are busy, but we need you to join- the committee if you want to know when and how to join the calls! Please email
pgerard@edpma.org if you would like to be added to a committee distribution list.

Federal Health Policy (FHPC)
Co-Chairs - Randy Pilgrim, randy_pilgrim@scp-health.com, Andrea Brault, andrea@brault.us and Rebecca Parker, Rebecca.Parker@envisionhealth.com 
This committee tackles the association's response to proposed federal rules, regulations, bills and policies on surprise insurance gaps, the Affordable Care Act (ACA), Medicare, Medicaid and other key legislative and regulatory issues occurring at the federal level. It coordinates federal advocacy efforts with other EDPMA committees and reviews, edits, and approves letters to Congress, CMS and other decision makers.

State Regulatory & Insurance (SRIC)
Co-Chairs - Nancy Dumas, nancyd@brault.us, Shanna Howe,  howes@gottlieb.com
This committee's primary objective is to identify and develop the appropriate response to legislative and regulatory challenges at the state level, including limits on balance billing, Medicaid expansion, health exchanges, Medicaid copays and more. When appropriate, EDPMA takes action to advocate at the state level on these issues.

Practice Management (PMC)
Co-Chairs - Douglas Brosnan, Douglas.Brosnan@vituity.com, Alan Eisman, alan.eisman@d2ihc.com, Denise O'Brien, dobrien@ciproms.com, and Mark Jones,
This is EDPMA's newest committee addressing a wide variety of issues including gathering data that supports our advocacy efforts, legal compliance, provider enrollment, rural health, alternative payment models, telehealth and emerging ED technology, medical bad debt, and more.

Quality, Coding & Documentation Committee (QCDC)
Co-Chairs - Jason Adler, JasonA@brault.us, Hamilton Lempert, Hamilton_Lempert@teamhealth.com and Mark Owen, mowen@mcscodes.com 
This committee focuses on quality reporting under Medicare's Merit-Based Incentive Payment System (MIPS), coding issues including inappropriate prospective down coding by commercial and ERISA plans, documentation issues, preparing for audits, and more.

Conference Planning Committee (CPC)
Chair - Iva Lee Clement, Ivalee_Clement@scp-health.com 
This committee develops the agenda, invites speakers, and oversees all aspects of the Solutions Summit.

Membership and Marketing
Co-Chairs - David Ernst, dernst@epowerdoc.com and Julie Forde, jforde@rev4ward.com
This committee helps ensure that EDPMA's membership continues to grow at a healthy pace each year. It also oversees member benefits, satisfaction and our marketing efforts.

Education
Co-Chairs - Paul Hudson, paulh@acutecare.com and Iva Lee Clement, Ivalee_Clement@scp-health.com
This Committee works year-round to provide valuable educational opportunities for EDPMA members, including workshops, interactive webinars, our EMRA scholarship program, and the development of a possible fellowship.

Please contact Paul Gerard at pgerard@edmpa.org today and ask him to put you on the distribution list for one or more committees. Most committees meet monthly.

Call for Speakers: EDPMA Workshop, Webinar, or the 2021 Solutions Summit 

As experts in the business of emergency medicine, we hope that you are interested in presenting at an upcoming workshop, webinar, or the 2021 Solutions Summit in Seattle, Washington, May 2 - May 5, 2021. Since EDPMA's 2020 Summit has been cancelled, we are looking into providing education to our members in a variety of forms in 2020 including webinars, podcasts, blogs, round tables, a virtual workshop in July, and a potential in-person event later in the year. If you are interested, we'd like to receive your application. EDPMA also encourages you to share this link with coworkers and industry colleagues you think would be great speakers on issues facing the business of emergency medicine.

We are accepting applications on a rolling basis for now.  The application is available here:  


The submission form asks what other areas of interest you might be willing to address if your topic is not chosen. Below are some topics the conference and workshop planning committees have mentioned as topics of interest:   
  • Leadership
  • Advocacy - State & Federal
  • Coding and Compliance
  • Legal
  • Freestanding Emergency Centers (FSEC)
  • Physician Reimbursement
  • Prudent Layperson (PLP) Standard
  • Alternative Payment Models (APMs)
  • EMTALA
  • Staffing
  • Artificial Intelligence (AI) in Emergency Medicine.
  • Disruptors in the Industry and Emergency Medicine's Response
  • Challenges Facing Rural ED's
  • Revenue Cycle Management Best Practices
  • Unfair Payment Practices by Health Plans
  • Innovative Solutions to Problems Facing the Industry
  • Behavioral Health
  • Telehealth
  • Medicare
  • Medicaid

We Look Forward to Receiving Your Applications!

Join a Virtual EDPMA Roundtable

EDPMA will start offering virtual roundtables on important issues, starting next week.  We will invite you to join us on Zoom to discuss timely questions and subjects with your colleagues.  This is intended to be a casual networking event where you all can connect with each other on the issues of the day.  Look for an upcoming announcement and join us!

Coverage of COVID-19 Testing and Care
for the Uninsured
 
The federal government is expected to provide further clarity on provider reimbursement for COVID-19 testing and care for the uninsured, so it makes sense to put those claims aside for now until more information is released. As outlined in HR 6201, coverage for the uninsured follows two potential routes - (1) either a State opts to temporarily expand its Medicaid program to allow for limited coverage for the uninsured under a section 1135 waiver for the COVID-19 test and professional services related to that test; or (2) for States that do not provide such expansion, reimbursement from the National Disaster Medical System (NDMS).
 
Section 1135 waivers:  To determine whether a particular State has opted to expand Medicaid to cover the uninsured for COVID-19 testing, please visit the CMS website .
 
National Disaster Medical System (NDMS):  For States that do not opt to expand Medicaid, then those services would be reimbursed through the NDMS. According to the payment rules of the NDMS (prior to the enactment of the recent COVID-19-related legislation), to receive payment for certain patients through the NDMS, any Medicare or Medicaid participating provider can receive reimbursement, provided that they register with the NDMS and submit specific claims . Generally, reimbursement rates are set at Medicare rates. At this time, additional direction has not been provided regarding the uninsured and its application to NDMS.
 
Subsequent Treatment: O n April 3, during the Task Force press conference, Secretary Azar noted that a portion of the $100B provided to the Public Health and Social Services Fund (PHSSEF) for health care providers in the CARES Act would be allocated to cover the cost of the treatment for the uninsured.  Such funding would be through the same mechanism as COVID-19 testing.  As a condition of receiving the funds, providers would have to agree not to balance bill, and the reimbursement rates would be set at Medicare rates. 
 
On April 7, CMS Administrator Seema Verma noted that $30B of the $100B fund through the PHSSEF for health care providers, $30 billion will be available via grants, based on Medicare revenue, and such funds will NOT be on a first come, first serve basis.  To receive the funds, providers will need to register with CMS.  Money can be direct deposited.  She acknowledged that certain providers (e.g., pediatricians, OB/Gyns, etc.) do not serve a large portion of the Medicare population.  As such, CMS will address those issues in the second wave of funding from the fund. During that announcement, there was no discussion regarding the uninsured.
 
On April 7, the Kaiser Family Foundation ( KFF ) released a report that estimated that "total payments to hospitals for treating uninsured patients under the Trump administration policy would range from $13.9 billion to $41.8 billion. At the top end of the range, payments on behalf of the uninsured would consume more than 40% of the $100 billion fund Congress created to help hospitals and others respond to the COVID-19 epidemic."
 
For additional information, see the EDPMA COVID-19 resources page accessible through EDPMA's home page.
  
New Member Spotlight: Dumas Law, PLLC

Dumas Law is a multi-faceted Houston-based firm dedicated to helping businesses and professionals throughout Texas with years of in-house counsel experience in freestanding EDs, hospitals, medical billing, and physician practices. In addition to its healthcare practice, Dumas Law provides services concerning corporate structuring and governance, outsourced general counsel needs, business litigation, merger and acquisitions, and more. For more information, please click this link .
 
Excerpts from a conversation with Cody Dumas, Principal Attorney of Dumas Law, PLLC
 
Mr. Dumas has worked in healthcare law for over seven years. During that time, Cody has worked as in-house counsel for an MSO with revenue cycle management operations, freestanding emergency departments throughout Texas, and an emergency physician group. He also served as the Chief Legal Officer for a growing hospital system where he focused on corporate restructuring, asset acquisition, and multi-discipline physician operations.
 
In April 2019, Mr. Dumas opened Dumas Law, PLLC to focus on corporate governance and structuring, civil litigation, and healthcare matters. In the healthcare sector, Dumas Law concentrates on relationship structuring and third-party payor matters through its representation of physicians and facilities against commercial carriers. Cody explained that in Texas, as of January 1, 2020, SB 1264 came into effect enabling out-of-network providers to request arbitration and mediation with insurance carriers without requiring the election by, or participation of, the patient. Cody and his team have been working with this new law as it relates to medical billing reimbursement with several providers and physician groups.
 
Mr. Dumas joined EDPMA to expand his access to resources and to assist in advocating for fairer reimbursement practices on behalf of emergency medicine providers. The signing of more emergency medicine clients led Mr. Dumas to join EDPMA in order to stay up to date on emergency medicine matters, especially the legislative and regulatory issues facing the industry. He finds the information EDPMA sends regularly (News Alerts, Action Alerts, weekly ED Newsletter and Advocacy and Membership Newsletters) contributes to his and his team's understanding of the needs and concerns of their clients.
 
Mr. Dumas said EDPMA provides an effective and efficient central repository for many emergency medicine issues. Cody has found the members-only toolbox to be especially helpful with state issues as it provides a level of detail not found elsewhere. He also joined the State Regulatory and Insurance Committee (SRIC). Cody said one of the best things about EDPMA is that it's an organization that takes action, such as lobbying and pro-actively writing letters to state, federal and other government officials to present the emergency medicine view of issues.
 
With the impact of COVID-19 across the country, Cody is seeing many changes taking place with billing and coding, commercial payor response, and other issues impacting the practice of medicine. EDPMA helps by providing critical assessment of the quickly changing environment of telemedicine. Cody described one area of opportunity in telehealth is the move towards tele-triage and mental health services, as he's already seeing an increase in new telehealth practices reaching out to his practice for guidance in these areas. Mr. Dumas is pleased to have joined EDPMA and looks forward to future educational sessions and the 2021 Solutions Summit.

Welcome New Members! 
 
EDPMA would like to welcome three new members this month: 

Integrative Emergency Services, Dallas, TX
Emergency Physicians Professional Association (EPPA), Bloomington, MN
VEP Healthcare, Concord, CA

We look forward to working with you!

We've Moved, Please Update Your Records

EDPMA is excited to announce that we have moved to new offices that will allow staff to serve you better. EDPMA's new address is  7918 Jones Branch Drive, Suite 300, McLean, VA 22102.

EDPMA's New Contact Information:
Phone Number: ( 703) 506-7675
Email: all  staff emails remain the same

EDPMA encourages you to update your records with our new address.