Zotec Partners’ Edward R. Gaines Serves as a Non-clinical Leader on “Fair Coverage” and Out-of-Network Balance Billing Issues for Physicians

By a News Reporter-Staff News Editor at Insurance Weekly News -- Zotec Partners, a national firm providing coding, billing and practice management services to medical groups and physicians, announces its Chief Compliance Officer in Emergency Medicine, Edward (Ed) R. Gaines, III JD, CCP is serving as a non-clinician, ex-officio advisor to the newly formed non-profit advocacy organization known as Physicians for Fair Coverage (PFC), Ltd. The PFC is a growing multi-specialty alliance of physician groups advocating to improve patient protections in OON billing situations and to end the "Surprise Insurance Gap," while promoting transparency and improving access to care.

The PFC is comprised of tens of thousands of emergency physicians, anesthesiologists, and radiologists nationwide who annually serve tens of millions of patients. Mr. Gaines says of the PFC, "The Coalition believes strongly that the issues must be framed to indicate that Insurance Carriers are narrowing networks, the vast majority of patients do not understand their insurance coverage, and with the high deductible plans of today, patients are essentially self-insured outside of a major hospitalization or an extensive procedure."

In addition to his ex-officio role with PFC, Mr. Gaines has also been appointed for the third consecutive year as Chair to the Joint Task Force (JTF) of the American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA). The JTF is charged with developing consensus solutions and recommendations for the Out of Network (OON), Balance Billing and Medicaid Payment issues to members of both organizations.

Mr. Gaines adds, "For myself and on behalf of Zotec, I believe it is our duty to put these high-priority issues at the forefront, and I am honored to be among a group of highly respected peers in these healthcare specialties who continue to develop strategies that will assist both patients and providers in the long-term."

T. Scott Law, founder and CEO of Zotec Partners states, "Ed is unique in the healthcare field, as one of the only non-clinicians to be invited to serve as chair to the ACEP/EDPMA joint task force and to hold an advisory leadership role with a physician-based coalition on these critical healthcare issues." Law notes that as Zotec continues to develop reimbursement strategies that assist physicians with balance billing and out-of-network services, he also supports the industry and believes Mr. Gaines' work within these committees is vital. "One of the things that makes Zotec stand out from the industry is our people, as demonstrated by Ed's passion for this industry, paired with his decades of experience, extensive knowledge and remarkable energy that will undoubtedly affect and shape policy change in the coming years," Mr. Law says.

Mr. Gaines has more than 22 years' experience specializing in emergency medicine. He and his colleagues established the first voluntary corporate compliance program in the emergency department coding and billing industry in 1994. Mr. Gaines is responsible for compliance and coding quality assurance and training for Zotec's emergency medicine clients. He is actively involved with Zotec's clients in the areas of Medicare fee schedule, CPT coding, MACRA/MIPS and balance billing issues at the state and federal levels. He obtained a Bachelor of Arts Degree with Honors from Alma College and graduated from Wake Forest University School of Law with a Juris Doctor.

Ed is a member of the ACEP Reimbursement Committee and is a co-founder, past chairman, current Board of Directors and Executive Committee member of the EDPMA. His honors and awards include: ACEP Honorary Membership Award 2012; EDPMA's Founder's Award 2008; ACEP's Outstanding Speaker of the Year Award 2008; NC ACEP's Emergency Medicine Outstanding Advocate Award 2006 and he was named a Fellow in the Health Ethics Trust in 2000. He is a member of the North Carolina State Bar, North Carolina Bar Association's Health Law Section, the American Health Lawyers Association (AHLA) and the Bar of the United States Supreme Court. Mr. Gaines currently works out of Zotec's Greensboro, North Carolina offices. About Zotec Partners Founded in 1998 by CEO T. Scott Law, Zotec Partners is the Indianapolis-based industry leader in specialized medical billing and practice management services for the hospital-based specialty market. Zotec Partners is committed to the continual pursuit of excellence in the physician revenue cycle and practice management industry by delivering effective solutions through its innovative technology, personalized service and measurable client results. Currently, the company serves more than 8,000 physicians in all 50 states. For more information about Zotec Partners, visit http://www.zotecpartners.com. View source version on businesswire.com: http://www.businesswire.com/news/home/20170213005084/en/

Keywords for this news article include: Legal Issues, Zotec Partners.

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