Heading into the end of the year, CMS responded to the AANEM House sign-on letter which was sent back in October requesting information on quality, fraud, and abuse in EDX medicine. In a lengthy reply
, CMS largely ducked issues of quality and patient care while claiming to be collaborating with stakeholders over areas of ongoing concern. “AANEM is seeking clarification from CMS regarding what collaboration they are having with stakeholders since AANEM has not been able to meet with the appropriate CMS representatives,” noted AANEM Executive Director, Shirlyn Adkins, JD. In the letter, CMS cited the following steps recently taken to curb fraud and abuse in EDX medicine:
Implementation of a Fraud Prevention System related to high-billing of EDX tests.
Hosting a webinar and issuing two comparative billing reports to educate physicians.
Reviewing a sampling of claims from the top 100 physicians ranked by questionable amounts billed.
Congressional supporters and community stakeholders, including AANEM, view these actions identified by CMS as insufficient and ineffective. “While it is good to see that CMS is taking some affirmative action in the area of EDX fraud, these actions are inadequate and largely misplaced, focusing on physicians who specialize in EDX medicine,” said AANEM Health Policy Director Millie Suk, JD, MPP. “The focus needs to be expanded to include nonphysicians and physicians without proper EDX training,” explained Suk.
Moving into the next Congress and administration, AANEM will continue to work with policymakers to educate them about issues impacting quality in EDX medicine while also advancing meaningful solutions that ensure proper stewardship of federal healthcare spending and improved outcomes for patients.