You did it! A tremendous show of support by AAEM membership has successfully secured CMS language that states physicians have “unrestricted access to claims submitted” in their name. In the Federal Register on November 14th where CMS issued its final rule on the Medicare Modernization Act (MMA) it was reported that “numerous members of that association (AAEM) commented” on the reassignment matter. As you may recall, through the efforts of AAEM, the issue of open book was brought to the attention of CMS and, more importantly, the congressional conference committee for the MMA where this wording was incorporated into the CMS integrity safeguards. The footprint of AAEM is on this important ruling from beginning to end and can be clearly seen if one reviews the comments and CMS’ responses in the Federal Register (p372-833).
Equally important to note is the vigorous opposition launched by the contract groups to prevent emergency physicians from having access to this information. Opposition that proves the importance of this ruling for the working emergency physician. Here is a direct quote from the Federal Register:
“Three commenters representing groups that utilize independent contractor emergency physicians strongly oppose our implementation of the two proposed program integrity safeguard requirements: (1) joint and several liability/responsibility for Medicare overpayments; and (2) unrestricted access to the billings for services provided by independent contractors.”
I’m a Fellow of both AAEM and ACEP, and it’s fun to watch them joust.
AAEM was founded when it seemed ACEP was ‘in the pockets of’ the major Emergency Medicine contract holders, and was much more interested in representing their views than those of the EP’s who actually do the work. (An aside: those docs in your ED don’t just show up by magic. The hospital decided it wants to have a 24/7/365 ED, and needs it to have the right doc staffing to do the job. There are a lot of ways to skin that cat, the most common being for the hospital to contract with one person/group/company to provide docs for the ED, after which the hospital can honestly say the docs don’t work for them. The contract holder then gets to decide how to staff the ED with docs, and there are several ways to go about it: employees, independent contractors, and then under that, is it a democratic group, is there partnership, is it a dictatorship, etc.)
The big contract groups basically took (an probably continue to take) enormous advantage of their employed / contracted docs, and fought to keep the docs who work for them from finding out how much the group bills Uncle and friends for their work, and also won’t let the docs see the books.
To say this is a setup for abuse is an understatement. This leaves the working doc in the dark, while lining the pockets of the contract holder. In most groups, squawking about this is a good way to be looking for a new job. I have a couple of colleagues who left such groups after they did the math and figured out the contract holder was making a killing off their work, more than the docs made.
So, I see this as a very positive step for all docs, but especially ER docs, who have been on the short end of the stick for way too long. Way to go AAEM! I’ll be renewing my membership.