MGMA Washington Connection 01/21/2021

01/21/2021 9:32 AM | Rebekah Francis (Administrator)

MGMA 2021 policy outlook: What group practices need to know

A new chapter has begun in Washington, DC, with President Biden’s inauguration yesterday and Democrats taking control of the Senate. MGMA Government Affairs has offered its unique perspective on what medical groups should expect this year from our nation’s capital. We outline what's on the horizon for healthcare policy and how these trends will impact your practice. Read our 2021 Policy Outlook to find out and share your thoughts on social media with #MGMAAdvocacy.

Let your voice be heard: Take MGMA’s health policy poll before it closes!

As a new Administration and Congress are poised to address a number of healthcare policies, MGMA asks that you complete a brief survey to better understand where medical group practice leaders stand on a variety of issues. MGMA will use the information collected to inform our advocacy efforts and educate policymakers. Your submission will remain anonymous. MGMA’s Medical Group Leaders Health Policy Poll will close this Friday, Jan. 22 at 11:59 pm ET. Don’t miss this opportunity for your voice to be heard!

Provider Relief Fund reporting delayed

Following changes made by Congress to Provider Relief Fund (PRF) reporting requirements, the Department of Health and Human Services (HHS) is delaying the reporting deadline for providers that received over $10,000 in PRF payments. Previously, the reporting period was set for Jan. 15 to Feb. 15, 2021; however, HHS has removed this deadline altogether for the time being. 

As of Jan. 15, HHS is encouraging providers who received PRF payments exceeding $10,000 in the aggregate to register through the PRF Reporting Portal. The Portal is currently open for registration only and cannot be used to report data elements yet. MGMA has updated its PRF resource to reflect the latest HHS and congressional changes and encourages members to review this guidance and reach out with questions. 

CMS issues final rule on prior authorization

The Centers for Medicare & Medicaid Services (CMS) hastily released a final rule requiring a limited number of federally-controlled payers to support application programming interface (API) standards. Covered payers are mandated to provide patients and other payers access to their claims information via APIs and support APIs for prior authorization transactions with physician practices. The rule also requires payers to support automated approaches to coverage determinations and transmit to practice EHRs the clinical documentation template for the authorization. Payers are permitted 72 hours to respond to an urgent prior authorization and seven days for all others. MGMA is concerned that with CMS not requiring Medicare Advantage or commercial payers to comply with the rule, practices will be forced to continue using multiple, manual approaches to prior authorization. 

The Stark Law is never easy: Attempts to clarify may fuel confusion

MGMA, together with our Washington counsel’s office, drafted an article for members highlighting changes to group practice compensation arrangements under the final Physician Self-referral (Stark) Law regulations. On Dec. 2, 2020, CMS finalized massive rulemaking to modernize and clarify the Stark Law. The new rule has a number of benefits, including new exceptions for certain value-based payment arrangements and modest relaxation of certain terms that underlie the law’s existing exceptions for compensation relationships between physicians and outside entities to which they refer their patients. Buried in the final rule is one “clarification” that may complicate compensation planning for practice leaders, particularly large and mid-sized multispecialty groups using different compensation practices for different specialties or departments. Review MGMA’s article to learn more.


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