In a bold, unprecedented move, ACEP sued the federal government to contest a regulation that impedes emergency physicians from receiving reasonable payment for out-of-network services.
At issue is a regulation from the Centers for Medicare & Medicaid Services (CMS) for out-of-network emergency physician payment, which outlines the “greatest of three” options. As written, this rule opens the door for insurers to use black box methods to determine physician payment without providing any means to verify the data.
“It’s clear from the recent CMS ruling that, despite our best efforts, the insurance companies have more influence in terms of federal regulation than physicians do,” said ACEP President Jay Kaplan, MD, FACEP. “The term ‘health insurance company’ is an oxymoron—they exist just to make profits for the shareholders, not for the health care of our patients.”