Click here to view a PDF of the December 2025 IEPC Newsletter.
In this issue:
Happy Holidays from IEPC!
IEPC would like to wish you and your families a happy holiday season! We are looking forward to a great year in 2026!
2026 IEPC Speaker Series
FREE TO ALL FRIENDS OF IEPC!
IEPC is excited to continue its Speaker Series in 2026!
Sessions take place from 9:00 AM – 9:30 AM PT on the fourth Monday of each month! (January-November).
January 26, 2026
Dr. Michael Granovsky
More information on the 2026 IEPC Speaker Series, including the lineup of speakers and topics will be available soon. Keep an eye on your email!
Best Practices for Selecting an RCM Partner: Insights from ACEP Experts
At a recent ACEP Democratic Group Practice Section meeting, leaders in emergency medicine discussed one of the most important decisions independent groups face, selecting the right revenue cycle management (RCM) partner. This discussion offered practical lessons that apply directly to IEPC member groups navigating today’s increasingly complex reimbursement environment.
While cost is often the first factor considered, speakers emphasized that the strongest RCM partnerships are built on transparency, shared goals, and consistent communication. For independent California groups, choosing an RCM partner that understands local payer patterns and the state’s regulatory environment is particularly critical.
Key Takeaways and Lessons Learned:
- Elevate communication and responsiveness.
Regular, structured communication with your RCM company is one of the clearest indicators of success. Look for a partner that provides a dedicated point of contact and consistent performance reports. Responsiveness is especially important when payer or coding issues arise that can delay payments. - Prioritize long-term partnership over short-term cost savings.
Selecting an RCM company should be approached as a strategic decision, not just a financial one. The best partners operate as an extension of your practice, invested in your long-term success, not only immediate collections. This type of alignment leads to higher overall performance and stability. - Define and track key performance metrics.
Before implementation, establish clear KPIs such as days in accounts receivable, denial rates, and first-pass resolution rates. Review these regularly to identify trends and improvement opportunities early. Data transparency and consistent benchmarking are essential for accountability. - Limit the number of vendors when possible.
Working with multiple RCM vendors may seem appealing, but can complicate reporting, increase costs, and blur accountability. For smaller or mid-sized independent groups, a single partner with strong alignment and reporting systems typically yields more consistent results. - Expect challenges and plan for change.
Every RCM transition brings challenges, from payer policy shifts to EHR integrations. A reliable partner will anticipate issues, communicate proactively, and problem-solve collaboratively to prevent small issues from becoming major disruptions.
The discussion reinforced that the foundation of a successful RCM relationship is trust, transparency, and shared accountability. For IEPC member groups, especially those operating independently, these principles can make the difference between short-term financial strain and long-term sustainability.
Announcing the IEPC 2026 Board of Directors!
The IEPC Board takes office for 2026 in January. We thank you for your continued service!
Robert Chavez, MD – President
Clay Whiting, MD – Treasurer
Don Shook, MD – Vice President
Sameer Mistry, MD – Vice President
Andrew Fenton, MD – Vice President
Mike Gertz, MD – Secretary
2025-2026 IEPC Benchmarking Survey
IEPC would like to invite everyone to complete the 2025-2026 IEPC Benchmarking Survey. Your responses will be visible only to other participating groups. Please provide your best estimates if exact numbers are not available. This survey covers health insurance, malpractice coverage, payroll, and compensation practices.
To complete the survey, click here.
Thank you!
IEPC Newsletter – October 2025
Click here to view a PDF of the October 2025 IEPC Newsletter.
In this issue:
2025 IEPC Speaker Series
FREE TO ALL FRIENDS OF IEPC!
Time & Date: 9:00 AM – 9:30 AM PT on the fourth Monday of each month.
Don’t Miss our Final 2 Speakers of 2025!
October 27, 2025: The EM Labor Market, presented by Dr. Leon Adelman
November 24, 2025: Legal Updates for Emergency Physicians, presented by Andrew Selesnick
Register at www.IEPC.org!
Stay tuned for more information on the 2026 Speaker Series!
Summary of Dr. Ed Gains’ IEPC Speaker Series Presentation
Presentation took place September 22, 2025
Independent ED Physician Coalition – 2025 Reimbursement, Regulatory & Advocacy Updates for EM
Dr. Ed Gains, JD, CCP, VP of Zotec Partners
- Zotec Partners Overview
Founded: 1998 by T. Scott Law, CPA | HQ: Carmel, IN.
Scale: 30,000+ clinicians | $8B+ collections | 130M procedures | 12M ED visits annually
Core: Proprietary SOC-1 and HITRUST certified RCM platform serving all specialties.
Among largest privately held U.S. RCM companies.
Mission: “Leading the way to improve the business of healthcare for everyone.” - Zotec Advocacy & ZPAC
7,640+ advocates nationwide sent 55,986 messages to lawmakers.
The advocacy team tracks hundreds of bills affecting business and reimbursement,
ZPAC (Zotec Political Action Committee): Interactive grass-roots tool enabling clinicians to influence state and federal policy.
Regular updates on legislation impacting clinicians and patients. - 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule
Released July 14, 2025; final rule expected Nov. 2025; effective Jan. 1, 2026, but the final
rule could be delayed due to the federal government shutdown.
Conversion Factors (CF):
Split CFs under MACRA:
– MIPS physicians: +0.25% update.
– Advanced APM participants: +0.75% update.
2026 CFs (proposed):
– A-APM = $33,5875 (+3.83%).
– MIPS = $33,4209 (+3.32%).
– Includes +2.5% temporary OBBBA bump and +0.55% budget-neutrality adjustment.
2025 payments fell 2.83% as 2024 temporary relief expired; no current bill fixes that cut.
Special Impact (Table 92 estimates)
Specialty Combined Impact
Emergency Medicine ≈ -1% overall (-2% facility / +7% non-faculty)
Anesthesiology -1%
Critical Care -4%
Radiology / IR ≈0 to +2% range
(excludes CF, sequestration, PAYGO effects)
Efficiency Adjustment Proposal
New -2.5% reduction to work RVUs & intraservice time (non-time-based codes).
Based on assumed “efficiency gains” over time; uses 5-year MEI look-back
Exempt from cut: E/M, care management, behavioral health, telehealth codes.
Depending on the procedures, there may be significant cut in procedure reimbursements.
Estimated -1% overall reduction if finalized in 2026.
Additional Potential Reductions
PAYGO sequestration: returns in 2026 due to unfunded American Rescue Plan, unless Congress acts again.
Zotec advocating for permanent fix to prevent future cuts.
E/M and Practice Expenses Notes
ED E/M work RVUs unchanged from 2025.
Practice expense methodology revision may lower procedure reimbursement.
Net: slight increase in ED E/M, slight decline in procedures (variance by code mix). Overall EM reimbursement will be flat to slightly negative in 2026 if the proposed rule is finalized as it is in the proposed rule.
- “One Big Beautiful Bill Act” (OBBBA)
Adds +2.5% temporary CF increase for 2026 (expiring 12/31/26).
Creates Rural Health Transformation Program (RHTP)
– $50B investment – largest since 2003.
– Addresses low volume, workforce, technology, and infrastructure needs.
– 50% funds split equally to participating states; 50% by CMS formula.
– Each state could receive ≈ $100M annually for 5 years.
Strengthens rural hospital sustainability and state-clinician partnerships. - Continuing Appropriations & Extensions Act (H.R. 5371): Passed by the House but has not yet passed the Senate, hence the government shutdown.
“Republican CR Stopgap Funding Bill” – extends key health programs through Nov. 21, 2025.
§ 206: Extends 1.0 work GPCI floor.
§ 207: Continues telehealth flexibilities.
§ 208: Extends Acute Hospital Care at Home waivers.
§ 209: Maintains Part D coverage for oral antivirals.
§ 401: Delays Medicaid DSH cuts until Nov. 21, 2025; remaining cuts FY26-28. - No Surprises Act (NSA) & Independent Dispute Resolution (IDR)
Litigation & Regulatory Timeline
Oct. 30, 2024: 5th Circuit en banc reversed TMA III panel decision.
Sept. 24, 2025: Oral arguments before 5th Circuit en banc.
Demonstrates continued instability in NSA implementation and physician burden.
IDE Process Highlights
Pre-IDR steps: open negotiation –> initiation –> selection of certified IDRE.
Federal IDR steps: submission of offers –> payment determination –> loser pays fees.
CMS Backlog & Eligibility Data
CMS reports significant progress in clearing backlog and reducing ineligible claims (see CMS Fact Sheet Sept. 2025).
FHAS data (Dec. 2024): ≈ 90% of claims now eligible for IDR.
ED E/M win rates: 85-90%, stable or improving.
Financial Impact
Typical IDR recoveries = 3-6x initial (QPA) payments.
Health plans must pay IDRE fees under “loser-pays” structure.
Successful IDR appeals help ED groups maintain hospital contracts and negotiate lower stipends.
- Key Takeaways & Action Steps
Expect continued volatility in Medicare rates through 2026 pending Congressional action on PAYGO & OBBBA expirations.
Engage with ZPAC to advocate for long-term stability in physician payment.
Monitor 2026 final rule (Nov. 2025) for RVU adjustments and efficiency factor finalization.
Leverage IDR process aggressively – data shows high success and material ROI.
Continue education on NSA litigation (TMA III/IV) and federal IDR reform proposals.
Welcome from New IEPC Executive Director
Kavitha Weaver, MBA
Executive Director, IEPC
I am honored to step into the role of Executive Director of IEPC, following Dr. Roneet Lev, whose leadership has guided this organization with distinction for so many years.
To share a little about myself, I have been part of IEPC since its inception through my group, Monterey Bay Emergency Partners. It has been truly rewarding to watch the organization grow and evolve alongside its member groups. My background is in emergency medicine administration, and for more than a decade I have served in leadership roles, currently as Chief Operating Officer of Monterey Bay Emergency Partners, where I oversee operations, strategy, and team development for our Emergency Medicine practice.
Through my time with IEPC, I have seen firsthand the value of connecting members with resources, information, and opportunities to collaborate. Looking ahead, I hope to build on that foundation by making the website more user-friendly and resource-rich, strengthening connections across our membership, and bringing in speakers who share practical, relevant insights based on member needs.
I look forward to working with the board and all members to ensure these initiatives are both meaningful and beneficial. I am excited to help IEPC continue growing as a strong, connected community for independent emergency groups.