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ED physicians don’t obtain access to financial records to see what is being billed for or paid on their behalf, despite the fact that this puts them at risk, says Robert McNamara, MD, FAAEM, president of the American Academy of Emergency Medicine in Milwaukee and chief of emergency medicine at Temple University Hospital in Philadelphia.
Physicians should be able to determine if bills are being appropriately coded, he says. The ED is the only specialty that has allowed this lack of access, McNamara says.
"The AMA [American Medical Association] stance is that it’s ludicrous that physicians don’t see what is paid on their behalf," he notes.
This situation not only happens at contract group levels, but also with single group levels when one physician owns a contract, says McNamara. "It’s exceedingly common that the rank-and-file ED physician doesn’t have any idea how bills are being sent out or how bills are being coded. They get paid an hourly rate, and in most circumstances have no idea that they could be losing 25 to 30% of their fees."
The other problem in emergency medicine is the concept of fee-splitting, he says. "If they could get access to what is being billed and paid on their behalf, they could see if it’s consistent with fair market value," he explains. "I think all of us would be willing to pay fair market value for management services. The trouble is, we don’t know what we’re paying. And in many circumstances when we do find out, it’s excessive, and we feel we’re being exploited."