Reimbursement: Trends and Strategies in Emergency Medicine

February 24-26, 2019

Schedule subject to change. Check back closer to event for final schedule.

Sunday – February 24

7:00 am - 8:00 am Registration and Continental Breakfast
8:00 am - 9:00 am

2019 Reimbursement Update and National Trends
Michael A. Granovsky, MD, CPC, FACEP; David A. McKenzie, CAE

The latest hot off the presses information pertaining to RVUs, the Conversion Factor, CPT coding changes, and updates to the CMS quality programs.


  • Identify critical factors impacting 2019 emergency medicine reimbursement.
  • Review the updated 2019 RVU values for key ED services.
  • Identify the highlights of 2019 CPT and CMS regulatory changes impacting emergency physician payments. 
9:00 am – 10:00 am

ED Benchmarking and Throughput Strategies to Impress Your Hospital C-Suite
James J. Augustine, MD, FACEP 

For optimized groups, throughput is the final frontier for staff satisfaction and economic success. Group financial performance is increasingly dependent on identifying key ED bottlenecks and developing solutions to ensure smooth patient flow. The perception of the ED by the C-suite is based on measurements against benchmarks and best practices. Successful messaging of ED benchmark and throughput performance has become a key element of strengthening the value-added partnership with your hospital.
Benchmarking - Increasingly, the perception of the ED by the C-suite is based on measurements against benchmarks and best practices. Successful messaging of ED benchmark performance has become a key element of strengthening the value-added partnership with your hospital.


  • Discuss key drivers of patient throughput.
  • Identify strategies to monitor, report, and improve throughput.
  • Identify goals and metrics for key components of the ED care process.
  • Describe methods for successful messaging of your benchmarking performance.
10:00 am - 10:15 am Break 
10:15 am - 11:00 am

Alternative Payment Models: Regulatory Framework and A Statewide Case Study
Michael A. Granovsky, MD, CPC, FACEP; William P. Jaquis, MD, FACEP

CMS has a 5 percent bonus available for those meeting the tough APM requirements, with an added incentive of being excused from the MIPS complexities. Gear up to understand your group’s options.


  • Review the impact of federal regulations that will define APMs.
  • Identify characteristics of successful possible APM programs and todays models being developed.
  • Analyze the statewide Maryland experience.
11:00 am - 11:45 am

APMs: Refining the Emergency Medicine Solution
Susan M. Nedza MD, MBA, FACEP

ACEP is developing 2 potential alternative payment models that have been presented to CMS.
Successful groups will need to understand the CMS review process and the inner workings of the 2 potential Alternative Payment models to position themselves for success.


  • Review the Alternative Payment model submission and CMS approval process.
  • Discuss the two specific Emergency Medicine alternative payment models under development.
  • Analyze the economic data driving the viability of the proposed models in actual ED practice.
11:45 am - 1:15 pm Lunch (On your own)
1:15 pm - 2:15 pm

5 Pernicious Commercial Carrier Behaviors & Strategies to Address
Edward R. Gaines, III, JD, CCP

Several commercial health plans have targeted emergency medicine (EM) with coding policies, restrictive diagnosis lists and practices that challenge the "prudent lay-person" (PLP) protections that EM fought hard to obtain over 20 years ago in most states and the federal law. Over 20 states and 125+ separate bills in the past year sought to limit or severely restrict OON balance billing and many are aimed at EM. Maintaining a steady state reimbursement environment is ever more challenging.


  • An environmental assessment of unfair payor reimbursement practices—Medicare, Medicaid and commercial health plans--and how to fight back.
  • Updates on the work of the OON state and federal landscape, how to respond and resources available in the fight.
2:15 pm - 3:15 pm

When Negotiations Fail and It's Time for Legal Action: Your Best Strategies
Andrew H. Selesnick, JD

Today's payer relationships are becoming increasingly tense. Learn from an experienced attorney how to come out on top. An industry leader who has fought many battles will share tricks of the trade and how to employ legal strategies when all else fails.


  • Understand your legal rights in payer disputes.
  • Review the history of private payer actions.
  • Develop a plan for pre-litigation and litigation success.
3:15 pm - 3:30 pm Break 
3:30 pm - 4:30 pm

"The Ends Do Not Justify the Means"—Why ED Coding, Billing and Compliance "Means" Matter
Edward R. Gaines, III, JD, CCP

There is little defense in today's healthcare enforcement scheme for "not knowing" how claims are billed in the clinicians' name and provider number. Knowing the coding and billing potential pitfalls can lead to compliance programs that may mitigate the enforcement and audit risks. While one size does not fit all, compliance programs must also have essential features so that they are deemed "effective" if and when government officials come calling. Post billing challenges of communicating with patient's mobile phones via voice or text should be considered given today's "high deductible health plan" environment where the patient is the largest payor outside of the governmental plans.


  • Describe and update ED group practice and RCM compliance risks and operationalizing compliance standards.
  • How should the OIG's corporate compliance program (CCP) effectiveness resource guide be used to assist in gap analysis and changes to the CCP?
4:30 pm - 5:00 pm Question & Answer Session
Michael A. Granovsky, MD, CPC, FACEP (Moderator); Edward R. Gaines, III, JD, CCP; David A. McKenzie, CAE; Susan M. Nedza MD, MBA, FACEP; Andrew H. Selesnick, JD

Monday – February 25

7:30 am - 8:00 am Continental Breakfast
8:00 am - 9:00 am

The State of the States: ACA update and Medicaid Expansion
Michael A. Granovsky, MD, CPC, FACEP; Adam Krushinskie

Each year the payment landscape grows more complex. Federal and state payment regulations are redefining the ED payer mix. Medicaid challenges include evolving state mandates for co-pays, work requirements, and denial of the prudent layperson standard. Can you navigate the maze?


  • Describe the latest ACA impacts on physician reimbursement.
  • Review the key state regulatory elements influencing patient responsibilities.
  • Identify defense strategies to uphold the prudent layperson standard for emergency care.
9:00 am - 10:00 am

The Big Private Payers: What Do They Care About?
Susan M. Nedza, MD, MBA, FACEP

Market forces are reshaping the private payer health care delivery process. It is of paramount importance to understand the role of Emergency Medicine in future commercial payer delivery models


  • Review the current state of commercial payer healthcare delivery evolution.
  • Analyze opportunities for Emergency Medicine to add value in the next generation of private payer healthcare realities.
  • Develop strategies for success and creating a win-win with private payer value models.
10:00 am - 10:45 am Break – Visit the Exhibits
10:45 am - 11:45 am

ERISA: Increasingly Important and To Big To Ignore
Andrew H. Selesnick, JD

The Employee Retirement Income Security Act (ERISA) sets minimum standards for health plans in private industry. Understanding how these laws impact the appeals process is important for successfully managing your ED claims for patients covered under ERISA plans.


  • Review the basics or ERISA and how it relates to claims appeals.
  • Understand how ERISA claims work in the ED setting.
  • Develop strategies for successful ERISA appeals.
11:45 pm - 1:00 pm Lunch (on your own)
1:00 pm - 2:00 pm

Integrated Service Lines in the Age of Bundled Payments: Where Does the ED Add Value?
Kevin M. Klauer, DO, EJD, FACEP

The ED is the hub of the health care delivery system. Increasingly ED groups are being asked to provide integrated solutions involving outpatient care, Observation care, and Inpatient Hospital Medicine. The successful ED group of the future will be able to add value broadly across the spectrum of care.


  • Incorporate into practice disease specific practice guidelines, as opposed to those limited to Emergency Medicine.
  • Develop strategies to improve patient outcomes for an episode of care.
  • Improve collaboration with other service lines and specialties to improve patient safety, patient outcomes and optimize reimbursement.
2:00 pm - 2:45 pm Break – Visit the Exhibits
2:45 pm - 3:30 pm

Strategic Compensation Structures in the Age of Alternative Payment Models
Kevin M. Klauer, DO, EJD, FACEP

As pressure mounts to deliver the right care in the right setting groups are being faced with aligning provider incentives with future payment methodologies. Do you have a compensation plan for the future?


  • Describe effective management strategies related to productivity and quality-based compensation.
  • Review the key components of effective incentive programs.
  • Analyze measurement strategies to promote successful participation in ACOs and bundles.
3:30 pm - 4:00 pm Question & Answer Session
Michael A. Granovsky, MD, CPC, FACEP (Moderator); Kevin M. Klauer, DO, EJD, FACEP; Adam Krushinskie; David McKenzie, CAE
4:00 pm - 5:00 pm Reception with Exhibitors

Tuesday – February 26

7:30 am - 8:00 am Continental Breakfast
8:00 am - 9:00 am

MACRA and MIPs Reporting Complexities for 2019: Strategies for Success
Pawan Goyal, MD, MHA, CBA, PMP, FHIMSS, FAHIMA; Bill Malcom, MS, MBA, PMP

PQRS has been retired, but we may long for the devil we know. Are you prepared for the next round of quality programs influencing up to 18 percent of physician reimbursement?


  • Identify the barriers to successfully meeting the MIPS reporting requirements.
  • Develop strategies to ensure your group's financial success under MIPS.
  • Analyze the various approaches to reporting ED Quality measures.
  • Review reporting strategies for MIPS Improvement Activities.
9:00 am - 9:45 am Break – Visit the Exhibits
9:45 am - 10:45 am

How CEDR Allows You to Meet MIPS Reporting Requirements 2019
Pawan Goyal, MD, MHA, CBA, PMP, FHIMSS, FAHIMA; Bill Malcom, MS, MBA, PMP

ACEP has developed the Clinical Emergency Data Registry (CEDR), as part of its ongoing commitment to provide the highest quality of emergency care. CEDR is a qualified clinical data registry (QCDR) designated by CMS for the 2016 Performance Year and beyond. CEDR is the first Emergency Medicine specialty-wide registry at a national level, designed to measure healthcare quality, outcomes, practice patterns and trends in emergency care. Learn how CEDR will provide a unified method for ACEP members to collect and submit Physician Quality Reporting System (PQRS) data, Maintenance of Certification (MOC), Ongoing Professional Practice Evaluation (OPPE), and other related and applicable quality and patient outcome elements to meet quality improvement and regulatory requirements.
ACEP has launched the Emergency Quality Network (E-QUAL) with the support of the Center for Medicare & Medicaid Innovation's (CMMI) Transforming Clinical Practice Initiative (TCPI). E-QUAL plans to support up to 24,000 emergency clinicians to move healthcare towards the triple aim of better health outcomes, more effective health care and lower costs.
ACEP is connecting EDs across the U.S. interested in demonstrating the value of emergency care through learning collaboratives designed to support ED Directors, front-line clinicians, practice managers, and reimbursement and coding staff with QI activities that also meet regulatory and educational requirements, as well as, meet the intent of Merit-based Incentive Payment System (MIPS).


  • Learn about MACRA and MIPS as they relate to Emergency Medicine.
  • Gain understanding of ACEP's quality initiatives.
  • Understand how your organization can participate in CEDR and E-Qual.
10:45 am - 11:15 pm Question & Answer Session
Michael A. Granovsky, MD, CPC, FACEP (Moderator); Pawan Goyal, MD, MHA, CBA, PMP, FHIMSS, FAHIMA; Bill Malcom; David A. McKenzie, CAE