ACEP Offers Proposed Framework for Protecting Patients When Emergency Care is Out-of-Network

Patients can’t choose where and when they will need emergency care – so they should not be punished financially for having emergencies. As legislators on Capitol Hill prepare to address the surprise billing issues that are affecting millions of patients across the country, ACEP has released a framework of proposed solutions to protect emergency patients.

 

Prudent Layperson Standard (PLP) and Medicaid Issues

Collection of ACEP comment letters on past PLP and Medicaid issues at the state and national level. Resources include a response to insurers on non-urgent use of the ED and non-emergent diagnosis lists, letters to CMS regarding PLP and managed care plans as well as Medicaid and Medicare PLP issues in the ED, and reimbursement for Medicaid services in the ED, including copayments.

 

ACEP - EDPMA Joint Task Force Strategies to Address Balance Billing and OON Benefits 

Developed in conjunction with the Task Force, the ACEP Reimbursement Committee and the ACEP State Legislative/Regulatory Committee in 2016, this strategy document discuses critical terms and their definitions, key provisions in out-of-network benefit legislation, alternative approaches to balance billing prohibitions, and the status of state laws on the subject as of 2016.

 

Consensus Principles - ACEP ASA ASPS and ACR 
Key principles related to the out-of-network payment issue that ACEP, the American Society of Anesthesiologists, and the American College of Radiologists agreed to as of 2017 to hopefully help form the foundation for a united effort by hospital-based specialties and other allies in combatting legislative efforts by insurance companies.  

 

Consensus Solutions - ACEP ASA ASPS and ACR 
Legislative solutions supported by the three organizations that give chapters proposals they can bring forth in their state legislatures that will successfully protect patients from balance billing while still ensure fair payment for physicians.

 

Advocating for a Minimum Benefit Standard (MBS) Linked to the 80^th Percentile of a FAIR Health-Type Usual & Customary Charge Database

An Information Paper from the ACEP-EDPMA Joint Task Force