Concerned about Insurer Non-Compliance Harming Your Clients’ Bottom Line? EDPMA Needs Your Help!
We all feel the administrative burden of navigating the No Surprises Act and determining how it impacts you or your clients.
EDPMA and ACEP remain on-point to advocate for emergency medicine physician fair payments and to ensure patients receiving emergency care are kept out of the middle of payment disputes.
We need your help to ensure out-of-network (OON) payments focused specifically on the Qualifying Payment Amount (QPA) are complying with the federal law through a simple data collection exercise.
PHYSICIAN GROUPS – PLEASE AUTHORIZE PARTICIPATION
RCM COMPANIES – ASK YOUR CLIENTS TO AUTHORIZE PARTICIPATION
We understand full authority must be granted to participate in this project. Consider using/sending this sample fill-in-the-blank language to your clients /compliance team:
I am writing to authorize (fill in the name of the independent RCM or internal RCM function of the hospital) to produce and report (fill in group name) data and complete the spreadsheet for the QPA Reporting Project. The targeted date to have the raw data submitted is Friday, May 27, 2022. Thank you.”
UPLOAD
Once you receive authorization from your client, upload 100 evaluation and management (E/M) services claims into this spreadsheet per physician group or RCM company to determine the QPA by health plan, whether the QPA was the initial OON reimbursement and relevant Remittance Advice Remark Codes (RARCs) regarding the remittance advice provided by the health plan. Be sure to exclude claims paid under specified state laws (see chart).
WHY 100 CLAIMS?
We fully recognize the workload and bandwidth of your compliance and coding teams. So, to make this project more manageable, we believe 100 codes will provide us with a robust data set while not overburdening your teams. We prefer your 100 claims from the four main commercial payers: Blue Cross/Blue Shield, United Healthcare, CIGNA and Aetna. So, a single site Emergency Department group would aim for 25 claims from each of these four payers. For multi-state groups, you may limit your scope to 3-5 states that focus on reporting on problem areas. Even across this broader base of practices, only 100 claims are requested.
WE DON’T HAVE 100 CLAIMS YET TO SUBMIT.
That’s OK! Send us what you have – some data is better than no data!
PRO TIP
Recall that the ACEP/EDPMA QPA Data Project seeks claims and data for ONLY federal No Surprises Act (NSA) services, not those services governed by state law. To simplify your data collection efforts, please request that your RCM service teams sort the data by “Remittance Advice Remark Codes” (RARCs) and specifically codes “N859” and “N860”—these RARCs indicate that the federal NSA was applied to the processing of the claim. While we would prefer the larger range of RARCs that could apply to NSA applicable services, using these two RARCs may jumpstart your data collection efforts.
Note that data from this survey will be collected and reported in compliance with the antitrust “safety zones” as established by the U.S. Department of Justice and the Federal Trade Commission.
DEADLINE
Submit your claims by Friday, May 27.
