Executive Committee:

Vituity: Bing Pao, MD, FACEP, Chair

*BSA Healthcare: Jeffrey Bettinger, MD, FACEP, Vice Chair

*Brault: Andrea Brault, MD, MMM, FACEP, Immediate Past-Chair

Emergency Care Specialists: Don Powell, DO, FACEP, Chair-Elect

*R1: Jackie Willett, CHBME, Treasurer

*TeamHealth: Aron Goldfeld, JD, MBA, At Large

EPOWERdoc, Inc.: David Ernst, MD, FACEP, At Large

St. Vincent Emergency Physicians: William Freudenthal, MD, FACEP, At Large

Zotec Partners: Ed Gaines, JD, At Large

Other Board Members:

*Acute Care, Inc.: Paul Hudson, MBA, MHA, FACHE

*CIPROMS Medical Billing, Inc.: Andrea Halpern Bryan

*Edelberg & Associates: Caral Edelberg, CPC, CPMA, CCS-P, CHC, CAC

*Envision Healthcare: Bob Kneeley

*Gottlieb: Shanna Howe

*Medical Coding Solutions: Mark E. Owen

*Reimbursement Technologies, Inc.: Gary Gelbart, MBA

Rev4ward, LLC.: Juli Forde

*SCP Health: Randy Pilgrim, MD, FACEP

*US Acute Care Solutions: L. Anthony Cirillo, MD, FACEP

New Member Spotlight:  Sound Physicians  

Sound Physicians is a physician-founded and led organization providing services across the acute episode of care - through emergency medicine, critical care, hospital medicine, telemedicine and physician advisory services. Sound Physicians entered emergency medicine in 2016. Sound Physicians has grown steadily and now serves 28 emergency departments across the country. For more information about Sound Physicians, please click here .

Excerpts from a conversation with Janet Carr, BSME, MBA, Senior Vice President of Emergency Medicine

Janet Carr is an engineer by education and training and worked in manufacturing for over 15 years before moving into healthcare. As Janet said, "the transition from manufacturing to healthcare operations was not a big leap as both focus on the people, processes and technology organized to serve all stakeholders." Janet not only worked in manufacturing for many years but also was a principal in a small consulting firm and worked for a major ED physician group before joining Sound Physicians in 2017.

Ms. Carr decided to recommend that Sound join EDPMA after attending the Solutions Summit for a couple of years. Janet said she found the content to be consistently excellent, relevant to the current issues in emergency medicine and actionable. Plus, Janet highlighted that exposure to experts in emergency medicine has also proved to be valuable.

Janet explained that she sees the key challenges and opportunities in emergency medicine around the issues of uncertainty and big potential changes. This relates to possible changes in insurance and the Affordable Care Act (ACA) as well as out-of-network billing legislation. These are areas of concern for the company and for the industry. Sound Physicians, through their membership with EDPMA, wants to be aligned with EDPMA on advocacy issues and leadership to benefit the specialty, its patients and providers. Janet sees strength in being associated with EDPMA. Ms. Carr and the Sound team recognize that EDPMA brings high-quality information to its members that keep the group up-to-date. With the action alerts and summaries of legislative issues (in the Advocacy Newsletter), Sound sees EDPMA membership as a cost-effective method of staying "in the know" and identifying key areas for follow-up advocacy or other action items.

Lastly, Ms. Carr said that she and her team plan to attend the 2020 Solutions Summit (May 3-6, Nashville). In particular, Janet said that she found Committee Day, usually the day before the conference begins, to be particularly useful. Janet is now looking at joining one or more Committees to increase Sound's involvement in and benefits from their membership in EDPMA.

We encourage you to join an EDPMA committee.  The real work at EDPMA is done at the committee level. Committee members work together in a variety of ways including:

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 invite you to join one of EDPMA's committees. Information about each committee is available here.  (Don't be shy: if you want, you can just listen in.)

For More Information:

MIPS: Virtual Group Election Period Open Through December 31

To form a virtual group for the 2020 Merit-based Incentive Payment System (MIPS) performance year, you must follow an election process and submit your election to CMS via email by December 31.

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Qualified Medicare Beneficiary Billing Requirements

Are you in compliance with Qualified Medicare Beneficiary (QMB) billing requirements? People with Medicare who are in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. Medicare providers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. Providers who inappropriately bill individuals enrolled in QMB are subject to sanctions.

Establish processes to routinely identify the QMB status of Medicare beneficiaries prior to billing for items and services:

States require providers to enroll in their Medicaid systems for claim review, adjudication, processing, and issuance of Medicaid RAs for payment of Medicare cost-sharing.  Check with the states where your beneficiaries reside to determine the enrollment requirements.

Correct billing problems that occur. If you erroneously bill individuals enrolled in the QMB program, recall the charges (including referrals to collection agencies), and refund the invalid charges they paid.

For More Information:

 

Quality Payment Program: 2019 APM Incentive Payment Fact Sheet

Starting in September, clinicians who were qualifying Alternative Payment Model (APM) participants based on their 2017 performance will begin receiving 5% APM incentive payments. CMS posted a new  2019 APM Incentive Payment Fact Sheet  to explain:

For More Information:

 

Billing Information for Rural Providers and Suppliers - Revised

A revised  Billing Information for Rural Providers and Suppliers  Medicare Learning Network Booklet is available. Learn about: