Reader Question: Will new CMS position on billing affect EDs?

Question: I’ve heard the Centers for Medicare & Medicaid Services (CMS) recently issued instructions that require us to provide emergency physicians more detail on what procedures are billed under their names. How is this going to affect billing for my ED?

Answer: The change should help emergency physicians avoid billing fraud, but it may have little noticeable effect on EDs, says George Molzen, MD, past president of the Irving, TX-based American College of Emergency Physicians (ACEP).

CMS has long had a rule that says physicians should be able to see what is billed in their name, but there was concern that it didn’t always happen, Molzen says. ACEP encouraged CMS to make changes that would ensure ED physicians know more about billing. CMS issued reassignment instructions that specifically state the doctor must be provided a detailed accounting of billing under his or her name, whether the hospital or a third-party company handles the billing.

"This has been controversial in emergency medicine when some of the largest companies bill for their doctors, and then it is perceived as a very negative thing when they ask what was done under their names," he says. "We hope this will encourage those groups to open up and inform the doctors what was done in their names. It is important because for Medicaid fraud issues, it is the doctor who is on the hook."

Physician groups and hospitals that handle billing for ED physicians will have to start providing doctors with regular updates on billing. But physicians also may decline detailed reports if they are comfortable with more general reports, Molzen says.

ED managers should see little effect from the CMS instruction, Molzen says. The most direct impact on EDs comes from another provision of the instruction that allows carriers to make Medicare payments to entities, regardless of where they rendered services.

"If an ED employs independent contractors, CMS now allows them to reassign so that the hospital can handle collections on what they do," Molzen says. "I wouldn’t worry about this change creating any more work at all for EDs."


For more on the reassignment change, contact:

  • George Molzen, MD, Past President , American College of Emergency Physicians, 1125 Executive Circle, Irving, TX 75038-2522. Phone: (800) 798-1822.