On Monday, June 26, representatives of the AANEM met with leaders of CMS to discuss problems and potential solutions related to quality EDX care. Drs. Peter Grant and Vince Tranchitella described some of the current fraud and abuse trends in EDX medicine and suggested potential solutions including adopting AANEM’s EDX Laboratory Accreditation Program as prerequisite for billing Medicare patients. This is similar to what was done in sleep medicine with their sleep labs. Other options discussed included adopting specific requirements in the Accreditation Program.
CMS officials acknowledged that they are aware of the issues and shared a memo that was sent to all Medicare Administrative Contractors (MACs) back in December 2016. The memo urged MACs to keep an eye out for:
Physicians with an unusually high average number of EDX test claims for the same beneficiary on the same day; and Physicians with an unusually high percentage of EDX test claims without both an NCS and a needle EMG.
“The CMS representatives seemed very engaged and knowledgeable on the issues. They also seemed interested in continuing to work with AANEM on solutions to EDX fraud and abuse, as well as ways in which to ensure that patients receive only quality EDX medicine. We hope to continue this dialogue,”
stated Shirlyn Adkins JD, AANEM Executive Director
AANEM plans to follow-up with the meeting attendees and will continue to keep our members informed about our continued progress.
AANEM was represented by AANEM staff, Shirlyn Adkins, JD (Executive Director), Millie Suk, JD, MPP (Health Policy Director), AANEM Past Presidents and current Advocacy Advisers, Peter Grant, MD and Vince Tranchitella, MD, and AANEM Washington representatives, Dane Christiansen and Dale Dirks.