At the end of 2016, the Centers for Medicare and Medicaid Services (CMS) finally responded to repeated requests for information on agency efforts to curb fraud and abuse while ensuring quality of care in electrodiagnostic (EDX) medicine. In their official statement to Congress, CMS pointed to numerous pay-and-chase style efforts to target physicians with high utilization of the corresponding codes. CMS also stated that the agency was working to raise awareness and educate physicians about appropriate utilization and billing in EDX medicine.
AANEM has provided members of Congress with a response to the stated CMS position expressed through a recent letter
. The letter points out that CMS’s response ignores the real and immediate threat posed by organized efforts to provide inappropriate, unnecessary, and harmfully misleading tests that take place indiscriminately, provide no actionable healthcare information, and focus solely on volume. Such suspect efforts have traditionally stayed away from federal payers and targeted private payers, but they are now increasingly beginning to bill Medicare and Medicaid. These efforts are, in part, responsible for the increased utilization of EDX codes (that led to 2013 reimbursement cuts) and, more seriously, undermine patient health and wellness.
It is important to note that while looking at these issues, legislators are also considering and confirming new leadership for the Department of Health and Human Services and CMS. It is possible that new leadership will bring a new perspective on the challenges facing EDX medicine and, perhaps, a more collaborative approach to working with community stakeholders to address issues undermining the quality of care. During this time of change, AANEM is committed to continuing to educate and work with policymakers to ensure federal and private payers effectively address fraud and abuse as well as promote optimal care for patients.