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Snapshots of Success

SNAPSHOTS OF SOME EDPMA SUCCESS STORIES

EDPMA is a well-respected and nimble association representing the practice groups, billing and coding companies, and others involved in emergency care.   EDPMA takes the lead on important issues, works closely with our coalition partners, and stays in regular contact with CMS and other key decision makers.

  • EDPMA was formed when Medicare Administrative Contractors (MACs) would not allow physicians to reassign their payment to physician groups because the physicians were not “employees” of the group.  EDPMA led the charge to change this policy -- lobbying CMS, the Office of Inspector General, and Congress, and asking ACEP, AMA and others to join the fight.  Legislation was passed in 2003 which reversed this practice.  EDPMA continued to work closely with CMS to ensure that the implementing regulations and guidance work for physician groups, billing and coding companies, and our partners.  

  • EDPMA was a leader in promoting physician participation in testing quality measures reporting mechanisms.   Emergency medicine had more early adopters of the Patient Quality Reporting Initiative (PQRI) than any other specialty.  CMS now recognizes EDPMA as an important and credible partner as it continues to develop new ways to tie reimbursement to quality.

  • For over a decade, EDPMA has successfully urged CMS to address delays in 855 application processing times and to improve enrollment procedures.  EDPMA regularly meets with CMS officials on these matters.

  • EDPMA helped stop state efforts to deny coverage to Medicaid patients receiving care in the emergency room who were protected by the prudent layperson standard. 

  • EDPMA led the fight to protect the physicians’ right to continue to use the 1995 Medicare Documentation Guidelines for evaluation and management visits as an alternative to the 1997 Documentation Guidelines.  This important success makes it significantly easier to document care.

  • EDPMA joined with its coalition partners, such as ACEP and others, to prevent Washington State from limiting the number of emergency room visits covered by Medicaid.

 

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