MGMA Washington Connection 03/23/2023

03/24/2023 5:45 PM | Anonymous


On Monday, MGMA Government Affairs submitted a letter to the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) in response to a request for information (RFI) about how address the healthcare workforce shortage. The letter thanked the Committee for their attention on this pressing issue and offered the following recommendations:

  • Physician payment reform: Medicare physician payment continue to be a problem due to decreases in the Medicare Conversion Factor and other congressionally mandated cuts. Congress should provide an annual inflation-based payment update tied to the Medicare Economic Index (MEI) and oppose efforts to use sequestration and PAYGO rules to offset unrelated congressional spending.
  • Prior authorization reform: The Committee should work to reduce the burden of prior authorization requirements by supporting the Improving Seniors’ Timely Access to Care Act which will likely be reintroduced this Congress in substantially the same form as last year.
  • Telehealth: While many telehealth flexibilities have been extended until Dec. 31, 2024, there is a critical need for permanent telehealth reform, including removing geographic and originating site restrictions, allowing permanent coverage of audio-only services, and reimbursing telehealth at an appropriate rate.
  • Advancing value-based care: Congress should work with stakeholders to advance value-based care by improving alternative payment models (APMs) through offering proper incentives, support, and flexibility.

The letter also discussed the importance of strengthening graduate medical education programs to alleviate the projected shortage of doctors in the coming years. MGMA Government Affairs will continue to advocate with the HELP Committee and the rest of Congress for commonsense policies to help mitigate the healthcare workforce shortage.


On Mar. 17, 2023, certified Independent Dispute Resolution (IDR) entities resumed making payment determinations for disputes that occurred on or after Oct. 25, 2022, under the No Surprises Act (NSA) IDR process. Previously, the Administration paused all payment determination on Feb. 10, 2023, and instructed certified IDR entities to recall any payments issued on or after Feb. 6, 2023. On Feb. 27, 2023, certified IDR entities were instructed to resume making payment determinations for disputes occurring before Oct. 25, 2022.

These actions were taken by the Centers for Medicare & Medicaid Services (CMS) as a result of a Federal District Court vacating part of CMS’ rule for IDR entities determining the payment amount in disputes between health plans and providers. The Texas Medical Association brought a lawsuit challenging CMS’ methodology for calculating the Qualifying Payment Amount (QPA) as favoring health plans, and the judge ruled in favor of providers. The Administration has instructed certified IDR entities to resume making payment determinations following revised guidance CMS issued for determinations on or after Oct. 25, 2022. CMS released updated guidance for disputing parties as well regarding items or services furnished on or after Oct. 25, 2022.

CMS also stated that on Mar. 17, 2023, disputing parties will receive a majority of their payment determinations from the IDR portal. There are other lawsuits still ongoing related to different parts of the NSA that MGMA Government Affairs is monitoring. MGMA is in the process of updating our NSA resource.  


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