MGMA advocacy update: New bill improves APMs, ACOs

MGMA supports a recently introduced House of Representatives bill, the Value in Health Care Act, which makes important updates to Medicare alternative payment models (APMs). The Act would:

·     Extend the advanced APM bonus for an additional six years (from 2024 to 2030);

·     Provide a mechanism to receive advanced funding to join an accountable care organization (ACO);

·     Increase the shared savings rate for Medicare Shared Savings Program (MSSP) ACOs;

·     Make other technical updates to MSSP benchmarking and risk adjustment methodologies. 

Secretary Azar renews public health emergency, continuing telehealth flexibilities

Following MGMA advocacy, Department of Health & Human Services Secretary Alex Azar renewed the declaration that a national public health emergency exists due to COVID-19. The renewal is effective July 25, 2020 until October 23, 2020, unless the Secretary terminates it earlier. The public health emergency declaration must be renewed every 90 days to remain active. This renewed declaration authorizes HHS to continue implementing important telehealth and other flexibilities. To learn more about emergency declarations, review MGMA’s new resource. 

CAQH seeks input on prior authorization burdens

The 2020 CAQH Index survey is now open, and practice leaders are encouraged to share their perspectives and experiences. This year the Index will focus on prior authorization, assessing the resources needed to determine if a prior authorization is required, gathering information to populate the authorization, following up after the initial submission, and submitting additional clinical information. The survey will also measure practice use of manual versus automated administrative transactions, including insurance eligibility verification, claim payment, and remittance advice. The cost that practices incur to conduct these transactions with health plans will also be measured. The results of this research will help MGMA advocate for improved transactions and decreased administrative costs for practices. Respondents receive an honorarium and individualized reports. MGMA serves on the CAQH Index Advisory Board. 

UnitedHealthcare to phase out paper checks

UnitedHealthcare (UHC) announced a new claim payment policy that seeks to eliminate paper checks and requires practices move to electronic funds transfer (EFT) payments. Beginning next month for its commercial lines of business, UHC is starting a campaign of emails, letters, and phone calls to encourage practices that have not already enrolled in its EFT program to do so. UHC’s Medicare Advantage plans will start later in the fall and Community and Medicaid plans in 2021. Those practices who refuse to move to EFT will be paid using “virtual” credit cards and incur credit card merchant fees. Practices can sign up for the UHC EFT program and view the enrollment guides here. The MGMA member-benefit EFT-ERA Guide outlines the benefits of moving to automated payments.