Latest News

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  • 01/16/2020 9:31 PM | Rebekah Francis (Administrator)

    Some medical group practices have been told to immediately purchase and use Clinical Decision Support Mechanism (CDSM) software to comply with the Appropriate Use Criteria (AUC) program, with vendors suggesting that claims payment would be impacted in 2020. In a posting on its website, the Centers for Medicare & Medicaid Services (CMS) reiterated that 2020 is an educational and operational testing period and there are no payment consequences this year.

    The AUC program will require ordering professionals to consult CDSM software for certain advanced imaging tests and require rendering professionals to include that consultation code on their Medicare claims starting in 2021. Practices are encouraged, however, to plan for implementation of CDSM software and test workflows at some point this year. Access the MGMA AUC Toolkit for additional information on the program.

  • 01/16/2020 9:30 PM | Rebekah Francis (Administrator)

    MGMA joined over 60 other groups to express support for the Social Determinants Accelerator Act (H.R. 4004), which would provide communities assistance in developing innovative, evidence-based approaches to coordinate health and social services while encouraging cross-sector coordination. The letter also asks the U.S. House of Representatives Energy & Commerce Committee to hold a hearing to discuss H.R. 4004, including the challenges and opportunities in addressing social determinants of health at large.

  • 01/16/2020 9:29 PM | Rebekah Francis (Administrator)

    The deadline to apply for the Primary Care First (PCF) Model and Kidney Care Choices (KCC) Model is fast approaching. PCF will build off the existing CPC+ Model and be offered in 26 geographic regions, while KCC will expand upon the existing Comprehensive ESRD Care Model through four payment options. Practices selected for each program will begin implementation in the latter half of 2020. If your practice is interested in applying for either of these programs, you can do so through the online PCF or KCC application portal. Each model will become an advanced alternative payment model starting in CY 2021.

  • 12/13/2019 3:30 PM | Rebekah Francis (Administrator)

    Physicians are encouraged to review open payments data for program year 2018 that has been submitted from healthcare entities including drug and device manufacturers. Review of this information is voluntary, but incorrect data can only be disputed during the year it is published. For more information visit the CMS Open Payments website.

  • 12/13/2019 3:29 PM | Rebekah Francis (Administrator)

    Starting Jan. 1, Medicare will only accept the Medicare Beneficiary Identifier (MBI) on claims. CMS has indicated that 86% of Medicare claims currently contain the MBI. If patients do not present with their new Medicare card, you can access the MBI through your Medicare Administrative Contractor web portal. Download the member-benefit New Medicare Card Toolkit for additional information.

  • 12/13/2019 3:28 PM | Rebekah Francis (Administrator)

    MGMA joined with 46 leading healthcare organizations urging the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma to support efforts to more accurately match patient records. Currently, Congress prohibits CMS from working on establishing a national patient identifier. Physician practices and others often experience challenges ensuring that patients are correctly matched with their health records. Incorrectly matched records can lead to patient safety issues and additional administrative burdens. We request that Administrator Verma support lifting the prohibition on CMS providing technical assistance to private-sector led initiatives to more accurately identify patients and match them to their health information.

  • 12/05/2019 10:15 AM | Rebekah Francis (Administrator)

    Practices interested in joining the Primary Care First (PCF), Direct Contracting, or Kidney Care Choices models should note the application periods are currently open. These models have various start dates, but financial accountability under all models will not begin until CY 2021, which is the first year each model will qualify as an Advanced alternative payment model (APM).

    ·     PCF: Applications are due by Jan. 22 for participation starting in 2021. 

    ·     Direct Contracting: A letter of intent to apply is due by Dec. 10 and applications are due by Feb. 25 for participation in the “Implementation Period” in 2020. The Implementation Period is intended to allow practices time to build relationships and develop infrastructure before assuming financial accountability in CY 2021. Alternatively, practices may forgo participation in an Implementation Period and begin participation in CY 2021; these practices do not need to submit an application at this time.

    ·     Kidney Care Choices: Like the Direct Contracting model, this model will have an Implementation Period in 2020, performance will begin in 2021, and only those seeking to participate in the Implementation Period need to submit an application by Jan. 22.

    For more information, including links to application materials, visit MGMA’s APM landing page.

  • 12/05/2019 10:14 AM | Rebekah Francis (Administrator)

    Group practices or individual eligible clinicians interested in applying for a hardship exception to the promoting interoperability category or an extreme and uncontrollable circumstances exception to other MIPS categories for the 2019 performance year must submit an application by Dec. 31. For more information, visit the Quality Payment Program resource library, which outlines eligibility, where to submit applications, and information on how approval will be noted.

  • 12/05/2019 10:13 AM | Rebekah Francis (Administrator)

    MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the agency’s request for information on Medicare’s use of prior authorization. CMS is exploring the possibility of expanding the use of prior authorization for the Medicare program in an attempt to decrease cost. The Association highlighted the many administrative burdens physician practices face in meeting health plan prior authorization requirements and emphasized that these processes can delay or deny care to patients. MGMA recommended that Medicare limit any expansion of prior authorization, reduce the volume of prior authorization through exempting physicians who meet established clinical guidelines, and automate prior authorization in the limited situations when it is required.

  • 11/14/2019 10:33 AM | Rebekah Francis (Administrator)

    A small group of leading healthcare organizations, including MGMA, American Medical Association, American Hospital Association, America’s Health Insurance Plans, and Blue Cross Blue Shield Association were invited to meet with top officials of the Centers for Medicare & Medicaid Services (CMS), including Administrator Seema Verma, to discuss prior authorization challenges. With MGMA members ranking prior authorization as their leading administrative burden, Anders Gilberg, Senior Vice President of MGMA Government Affairs, took the opportunity to advocate for reducing the overall volume of authorization requirements through gold carding and eliminating authorizations for routine services with high health plan approval rates. He also emphasized to CMS the need to standardize health plan medical necessity requirements, called for transparency of health plan approval rates by service and provider, and encouraged automation of prior authorization processes by leveraging national standards for electronic transactions and electronic clinical documentation attachments.

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