Tennessee MGMA News

MGMA Regulatory Alert - 11/20/2025

Thu, 20 Nov 2025 19:04:51 GMT

New CMS FAQ on 2026 Telehealth

CMS released an updated Telehealth FAQ on November 20, 2025, with information regarding the CY 2026 Medicare Physician Fee Schedule Final Rule and telehealth flexibility extensions through January 30, 2026. The FAQ includes clarifications that respond to concerns raised by MGMA members, including:

Retroactive Billing During Government Shutdown: CMS clarified that telehealth services provided during the recent government shutdown will be paid as if there had been no lapse in telehealth flexibilities. Telehealth flexibilities apply retroactively through January 30, 2026, and claims will continue to be processed in the same manner as before October 1, 2025.
Home Enrollment for Telehealth Services: CMS confirmed that distant site practitioners can provide telehealth services from their home and, in many cases, do not need to report their home address on their Medicare enrollment application.
- Practitioners who furnish telehealth services from home but maintain a physical practice location are not required to list their home address. They may enroll and bill from their physical practice location as if the telehealth service were furnished in person.
- Virtual-only telehealth practitioners whose only physical practice location is their home must enroll their home address as a practice location. CMS instructs these practitioners to mark the address as a “Home office for administrative/telehealth use only” in their enrollment application to suppress street address details on the CMS Care Compare website. Practitioners may also email QPP@cms.hhs.gov to suppress the street address and/or phone number.

See more information on Medicare Telehealth Coverage here.

MGMA Washington Connection - 11/20/2025

Thu, 20 Nov 2025 14:34:07 GMT

MGMA Requests Guidance from CMS and OIG on Rebilling of Repriced Part B Claims Starting Oct. 1

MGMA requested guidance from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) on the reprocessing and rebilling of claims on or after October 1, 2025, in localities subject to the 1.0 work geographic practice cost index (GPCI) floor. Congress passed legislation last week that reopened the federal government and included extensions of healthcare policies, such as the 1.0 work GPCI floor, which expired at the end of September and was extended through January 30, 2026. We wrote to CMS and OIG seeking guidance on the reprocessing of claims that were paid at a lower rate than the 1.0 work GPCI floor in localities during the government shutdown. We requested regulatory flexibility to avoid unnecessary rebilling costs for medical groups.

MGMA Advocates for WISeR Model Reform

MGMA urged the House Committee on Appropriations to work with the Centers for Medicare and Medicaid (CMS) to prioritize reforming the Wasteful and Inappropriate Services Reduction (WISeR) Model. The WISeR Model is scheduled to begin in January 2026 in six states and would create new prior authorization processes for certain services. MGMA is advocating for delayed implementation, enhanced transparency, and gold carding exceptions to reduce administrative burdens on practices. If you expect your practice to be impacted by the WISeR Model, please contact govaff@mgma.org.

MGMA Urges Anthem to Rescind its Out-of-Network Hospital Policy

MGMA, along with dozens of national medical societies and state medical associations, urged Anthem Blue Cross and Blue Shield to rescind its policy of penalizing hospitals with a 10% reimbursement cut when using out-of-network physicians to provide care. This policy is set to start in 11 states on January 1, 2026, and the announcement indicates Anthem will consider terminating hospitals from Anthem networks should they continue to use nonparticipating physicians. The letter discusses how this policy attempts to circumvent the No Surprises Act and reviews the negative impact it would have on physician practices.

MGMA Washington Connection 06/13/2024

Thu, 13 Jun 2024 21:07:19 GMT

BREACH NOTIFICATIONS

MGMA sent a letter to the Department of Health and Human Services’ Office for Civil Rights (OCR) in response to its recent position that covered entities (i.e., medical groups) with protected health information impacted by the Change Healthcare cyberattack may delegate HIPAA breach notification requirements to Change. Specifically, we urged OCR to offer further, definitive guidance that:

Change/United is fully and solely responsible for all HIPAA breach notification requirements,
No action needs to be taken by providers to ensure Change/United fulfill these obligations, and
Providers are protected from regulatory scrutiny in connection with breach notifications rightfully performed by Change/United.

PRIOR AUTHORIZATION BILL REINTRODUCED IN CONGRESS

The Improving Seniors’ Timely Access to Care Act has been reintroduced in Congress. This legislation would significantly improve the prior authorization process within the Medicare Advantage program by codifying the establishment of an electronic prior authorization process, increased transparency requirements for health plans on their prior authorization utilization, and more. The bill has widespread support from both chambers of Congress and over 380 endorsing organizations.

MGMA helped draft this legislation and strongly supports its passage. Utilize our Contact Congress portal to send a pre-populated letter to your congressional representatives expressing your support for the bill.

CFPB RELEASES PROPOSED RULE ON MEDICAL DEBT

The Consumer Financial Protection Bureau (CFPB) released a proposed rule that would ban medical bills from credit reports, stop credit reporting companies from sharing medical debts with lenders, and bar lenders from using medical debt to make lending decisions. This is a proposed rule and still has to go through a public comment period prior to CFPB issuing a final rule. MGMA plans to submit comments on the proposal.

MGMA Washington Connection 05/30/2024

Thu, 30 May 2024 14:13:18 GMT

MGMA RESPONDS TO CMS RFI ON MEDICARE ADVANTAGE TRANSPARENCY

MGMA responded to the Centers for Medicare and Medicaid Services’ (CMS) Request for Information on Medicare Advantage (MA) transparency. As the number of MA beneficiaries continues to grow, it is imperative that the MA program ensures adequate and transparent coverage to patients, timely payment to medical groups, and remains a viable pathway for medical groups to participate in value-based payment arrangements. These priorities cannot be achieved without accurate and robust data on MA utilization management practices including prior authorization, onerous care denials, and value-based contracts.

2024 QUALITY PAYMENT PROGRAM EXCEPTION
APPLICATIONS OPEN

CMS has opened the application window for 2024 Quality Payment Program (QPP) Exceptions through Dec. 31, 2024, at 8 p.m. ET. There are two types of exceptions groups can apply for if they are unable to report data for one or more Merit-based Incentive payment System (MIPS) categories — the MIPS Promoting Interoperability Performance Category Hardship Exception and the MIPS Extreme and Uncontrollable Circumstances (EUC) Exception.

Visit CMS’ QPP Exception website for more information.

MGMA Washington Connection 05/09/2024

Thu, 09 May 2024 21:23:06 GMT

MGMA SUPPORTS POLICIES TO ALLEVIATE ONEROUS REGULATORY BURDENS

The Senate Committee on the Budget and House Committee on Small Business both held hearings centered on over regulation in healthcare. MGMA submitted written testimony outlining the negative effects of onerous administrative burdens on medical groups and recommending policy solutions that promote innovative, high-quality, and cost-effective care delivery untethered from excessive, one-size-fits-all regulations.

Read our full testimony here. Utilize our Contact Congress portal to send letters to your policymakers on these critical issues.

OCR FINALIZES RULE ON NONDISCRIMINATION FOR PEOPLE WITH DISABILITIES

The Department of Health and Human Services Office for Civil Rights (OCR) finalized its rule updating regulations under Section 504 of the Rehabilitation Act that prohibit discrimination on the basis of disability in programs and activities that receive federal financial assistance. The rule clarifies and strengthens protections for people with disabilities – ensuring treatment decisions are not based on stereotypes or biases, adopts enforceable standards for accessible medical diagnostic equipment, sets forth a technical standard for accessible websites and mobile applications, and more.

See OCR’s fact sheet for more information.

MEDICARE BOARD OF TRUSTEES RELEASES 2024 ANNUAL REPORT

The Medicare Board of Trustees released their 2024 annual report, projecting the Hospital Insurance Trust Fund will be able to pay 100 percent of total scheduled benefits until 2036. This is five years later than the Board’s estimate from last year. The report also highlights physician payment and anticipates access to Medicare-participating physicians would become a significant issue in the long term without payment reform.

CMS RELEASES 2022 QPP PARTICIPATION & PERFORMANCE INFORMATION

The Centers for Medicare and Medicaid Services (CMS) released participation and performance data for the 2022 performance year of the Quality Payment Program (QPP). CMS has resources available in the QPP Resource Library that provide information on payment adjustments, final 2022 Merit-based Incentive Payment System (MIPS) scores, and more.

MGMA Washington Connection 04/25/2024

Thu, 25 Apr 2024 13:16:52 GMT

FTC ISSUES RULE BANNING NONCOMPETES

The Federal Trade Commission (FTC) voted to issue a final rule that would ban most noncompete clauses nationwide. Existing and new noncompetes for most workers would not be enforceable after the rule’s effective date; the rule does not ban existing noncompete agreements for senior executives earning more than $151,164 annually in policymaking positions.

Partners in a business, such as physician partners of an independent physician practice, would also generally qualify as senior executives, assuming the partners have authority to make policy decisions about the business. In contrast, a physician who works within a hospital system but does not have policymaking authority over the organization as a whole would not qualify.

The U.S. Chamber of Commerce has filed a lawsuit challenging the rule. Implementation is likely to be on hold pending resolution in the courts.

RULE PROHIBITING DISCLOSURE OF CERTAIN REPRODUCTIVE HEALTH INFORMATION FINALIZED

The Department of Health and Human Services Office for Civil Rights (OCR) finalized a rule to prohibit the disclosure of protected health information (PHI) related to lawful reproductive healthcare in certain situations. OCR is updating the HIPAA Privacy Rule to prohibit the use or disclosure of PHI when it is sought to investigate or impose liability against patients, healthcare providers, or others related to legal reproductive health services.

The final rule requires covered entities and business associates to obtain a signed attestation that certain requests for PHI potentially related to reproductive healthcare are not for prohibited purposes. Covered entities must also modify their Notice of Privacy Practices (NPP). For more information, see OCR’s fact sheet.

MGMA OPPOSES EXPANDING PRIOR AUTHORIZATION IN ASCS

MGMA commented on the Centers for Medicare and Medicaid Services' (CMS) proposed demonstration project to expand prior authorization requirements in traditional Medicare to Ambulatory Surgical Centers (ASCs) for certain procedures in ten states. Our letter outlines the onerous administrative burden that prior authorization places on medical groups and our opposition to expanding prior authorization requirements in ASCs for Medicare Part B.

MGMA Washington Connection 04/11/2024

Sat, 13 Apr 2024 22:13:03 GMT

MGMA ADVOCATES FOR PERMANENT TELEHEALTH REFORM

The House Committee on Energy and Commerce Subcommittee on Health held a hearing on legislative proposals to support telehealth. Congress and the Administration extended many of the telehealth flexibilities in place during the COVID-19 Public Health Emergency through 2024. MGMA submitted a statement for the record outlining our priorities for permanent telehealth reform. These recommendations included removing originating site and geographic restrictions, permanently covering audio-only services, and more.

RECOMMENDATIONS TO CONGRESS ON IMPROVING MEDICARE PAYMENT

MGMA sent a letter to the Senate Committee on Finance ahead of their hearing on bolstering Medicare payment for chronic care. The letter focuses on the importance of long-term, sustainable reform to the Medicare physician payment system by enacting an annual inflationary update and addressing budget neutrality. We also expressed support for the Chronic Care Management Act of 2023 and discussed making important changes to advanced alternative payment models.

MGMA Washington Connection 03/28/2024

Thu, 28 Mar 2024 20:38:13 GMT

FEDERAL GOVERNMENT FUNDED THROUGH FY 2024

President Biden signed into law legislation to fund the government through the end of FY 2024 (Sept. 30). The passage of this bill avoided a partial government shutdown, and funded Department of Health and Human Services (HHS) programs. Congress can now focus on next year’s spending bills.

CMS TO REQUIRE REVISED EFT APPLICATION

The Centers for Medicare and Medicaid Services (CMS) will require a revised electronic funds transfer (EFT) application starting May 1, 2024. If you need to request EFT for Medicare payments, Medicare Administrative Contractors will accept the current and revised CMS-588 EFT application through April 30, 2024. Starting on May 1, you must use the revised form that includes minor updates.

CONGRESS EXAMINES FDA LDT PROPOSED RULE

CMS provided updated billing requirements clarifying providers cannot bill comprehensive preventive medicine evaluation and management services (CPT codes 99381-99397) with annual wellness visits (AWV) or initial preventive physical exams (IPPE) (HCPCS codes G0402, G0438, G0439) services. CMS also strongly encourages, but does not require, physicians to provide an Advance Beneficiary Notice of Non-coverage to patients when providing and billing for comprehensive preventive medicine evaluation and management services.

MGMA Washington Connection 03/14/2024

Thu, 14 Mar 2024 21:53:00 GMT

BIDEN'S BUDGET FOCUSED ON HEALTHCARE CYBERSECURITY, MEDICAL SUPPLY CHAIN

Following the State of the Union, President Biden released his $7.3 trillion budget proposal for FY 2025, which included a hefty investment in healthcare cybersecurity, an expansion of Medicare’s drug negotiation program, an extension of the Medicare hospital insurance trust fund, and an investment in the domestic medical supply chain. Presidential budgets are not legally binding, rather they are used to message the Administration’s priorities.

CHANGE HEALTHCARE OUTAGE UPDATE

The Centers for Medicare and Medicaid Services (CMS) announced over the weekend the availability of advanced Medicare payments for medical groups in response to the Change Healthcare cyberattack. The agency sent a letter to healthcare leaders urging UnitedHealth Group and other insurance companies to take additional actions.

MGMA appreciates CMS heeding our calls to provide financial relief to medical groups and remains steadfast in our efforts to advocate with policymakers for additional support. CMS extended the MIPS submission window for performance year 2023 to April 15, 2024, in response to the Change Healthcare outage.

ENSURE YOUR PRACTICE'S COMPLIANCE WITH INFORMATION BLOCKING RULES

Join MGMA and Micky Tripathi, PhD, MPP, National Coordinator for Health Information Technology on Thursday, March 21 at 1 p.m. ET for a member-exclusive webinar reviewing information blocking regulations, including the proposed provider disincentive rule. Attendees will gain an understanding of the significance of compliance with the 21st Century Cures Act and the consequences which will result from committing information blocking. The webinar will outline key provisions, including proposed disincentives for providers participating in Medicare’s Promoting Interoperability Program, the Quality Payment Program, and the Medicare Shared Savings Program.

For more information, including how to register, please click here.

MGMA SUPPORTS PERMANENT TELEHEALTH REFORM

The House Committee on Ways and Means held a hearing this week examining ways to enhance access to care at home in rural and underserved communities. MGMA submitted a statement for the record outlining our 2024 advocacy priorities for telehealth. We recommended permanently extending many of the telehealth policies currently in place, allowing practitioners offering telehealth services from their home to continue reporting their work address for Medicare enrollment, and more.

MGMA Washington Connection 03/09/2024

Mon, 11 Mar 2024 16:14:38 GMT

CMS ANNOUNCES ADVANCED PAYMENTS TO MEDICAL GROUPS IN RESPONSE TO CHANGE HEALTHCARE OUTAGE

The Centers for Medicare and Medicaid Services (CMS) has announced the availability of advanced Medicare payments for medical groups in response to the Change Healthcare cyberattack. The advanced Medicare payments may be granted in amounts representative of up to 30 days of claims payments for eligible physician practices.

Medicare Administrative Contractors (MACs) will provide public information on how to request advanced payments as soon as today. MGMA appreciates CMS heeding our calls to provide financial relief to medical groups and remains steadfast in our efforts to advocate with policymakers for additional support. Please see the agency’s press release and fact sheet for more information.

CONGRESS PASSES PARTIAL PHYSICIAN PAYMENT FIX

President Biden has signed into law a legislative package to fund certain federal agencies for 2024. This legislation includes healthcare polices such as the extension of the 1.0 work GPCI floor, extension of the Advanced Alternative Payment Model (APM) incentive payment for 2024 at 1.88%, maintaining the 2023 Qualifying Participant (QP) threshold levels for 2024, and more.

Additionally included is an increase of 1.68% to Medicare physician payment effective today through the end of the year. This partially mitigates the 3.37% cut to the Medicare conversion factor that went into effect on Jan. 1, 2024, and leaves a reduction of 1.69% in place for the rest of the year. We are significantly disappointed by Congress’ failure to reverse the full cut and are calling on them to enact long-term sustainable Medicare reform that provides annual inflationary updates and modernizes the antiquated budget neutrality policies that jeopardize patient access to care.

MGMA Washington Connection 03/07/2024

Thu, 07 Mar 2024 16:33:36 GMT

CONGRESSIONAL ACTION ON MEDICARE REIMBURSEMENT

Congress has agreed on a legislative package including six bills that would fund certain federal agencies for the remainder of 2024. Proposals include a number of healthcare-specific policies, such as the extension of the 1.0 GPCI floor, extension of the Advanced Alternative Payment Model (APM) incentive payment for 2024 at 1.88%, maintaining the 2023 QP threshold levels for 2024, and more.

The legislation also includes a proposed, prospective increase of 1.68% to Medicare physician reimbursement effective March 9, partially mitigating the 3.37% cut to the Medicare conversion factor that went into place on Jan. 1. Medical groups would still be left with a 1.69% reduction in reimbursement for the rest of the year.

MGMA released a statement on Congress’ failure to reverse the full cut earlier this week and remains committed to sustainable reform to the Medicare payment system that includes an inflationary update. The legislative package was passed by the House late yesterday afternoon and now heads to the Senate.

CHANGE HEALTHCARE CYBERSECURITY ATTACK UPDATE

MGMA is closely monitoring the Change Healthcare cyberattack situation. We continue to hear concerning feedback from members about the myriad ways their practices are being impacted. Given the size of Change Healthcare and the breadth of services it provides to physician groups and the larger healthcare sector, the consequences of this malicious cyberattack have been significant and far-reaching.

We sent a letter to the Department of Health and Human Services (HHS) last Wednesday outlining the consequences medical groups have felt and requesting they utilize all the tools at their disposal to mitigate these impacts so medical groups do not have to take drastic actions to remain in operation. HHS released a statement in response to feedback from MGMA and other affected physician and hospital organizations on the fallout from the Change Healthcare outage, outlining flexibilities to assist providers.

MGMA is continuing to advocate for accelerated payments for physician practices, as well as additional support, as the consequences of the cyberattack remain.

MGMA Washington Connection 02/29/2024

Thu, 29 Feb 2024 23:07:37 GMT

CHANGE HEALTHCARE CYBERSECURITY ATTACK

MGMA Government Affairs is closely monitoring the cybersecurity attack against Change Healthcare and its impact on medical groups. We have been hearing from MGMA members about the wide-ranging effects they are experiencing. MGMA sent a letter to the Department of Health and Human Services (HHS) asking for guidance, financial resources, enforcement discretion, and more to support group practices and patient access to care.

We will continue update members as information becomes available.

CONGRESS REACHES SHORT-TERM AGREEMENT TO AVOID SHUTDOWN

Congress has reached an agreement on a short-term deal to fund the federal government before the March 1 deadline for a partial government shutdown. Congress has taken a tiered approach to attempting to fund the federal government for 2024 and passed numerous short-term funding bills over the last few months. This agreement is similar as it extends funding for some government agencies to March 8, and funding for the rest to March 22.

As part of these funding packages, Congress has been discussing numerous healthcare policies and potentially addressing the Medicare conversion factor cut that went into effect on Jan. 1, 2024. MGMA is continuing to advocate to reverse the full 3.37% cut, which remains our top priority. If you have not already, please send a pre-populated letter to your representatives through MGMA’s Contact Congress portal urging them to address the full cut in the 2024 appropriations package.

NIST RELEASES UPDATED CYBERSECURITY GUIDANCE

The National Institute of Standards and Technology (NIST) has updated its Cybersecurity Framework (CSF) for the first time since 2014. This guidance document is meant for all industry sectors to help reduce cybersecurity risk; NIST has developed resources to help users navigate the framework.

This follows additional recent actions from NIST and HHS meant to strengthen cybersecurity. NIST and HHS Office of Civil Rights (OCR) released an updated resource that reviews the HIPAA Security Rule and includes suggestions for medical groups to manage risk.

“WASHINGTON POLICY OUTLOOK” SESSION AT MGMA SUMMIT

Attending MGMA Summit next month? You won't want to miss MGMA Government Affairs' "Washington Policy Outlook" on Tuesday, March 12, from 12:55 p.m. to 1:45 p.m. ET. Discussions will center around the latest legislative and regulatory developments impacting group practices such as Medicare reimbursement, telehealth, quality reporting, and more.

For more information on MGMA Summit, including how to register, please click here.

MGMA Washington Connection 02/22/2024

Thu, 22 Feb 2024 13:58:28 GMT

NO SURPRISES ACT UPDATES

The Centers for Medicare & Medicaid Services (CMS) released new data on the implementation of the No Surprises Act (NSA). The number of disputes received by the Departments in the first half of 2023 was 13 times higher than the amount projected for the entire year.

CMS also confirmed that all applicable extensions for IDR dispute submissions following temporary closures of the IDR portal will end on March 14, 2024. The agency clarified that, effective March 14, “initiating parties who submitted a batched dispute before August 3, 2023, and received notification from a certified IDR entity that the dispute was improperly batched will have the standard 4-business-day period to resubmit, instead of the existing 10-business days.”

An updated version of MGMA’s 'Implementing the No Surprises Act' resource is now available to members containing new information following court decisions and various rulemaking.

MIPS 2023 DATA SUBMISSION WINDOW

The MIPS data submission window is open for the 2023 performance year for MIPS eligible clinicians. You can submit and update your data until 8 p.m. ET on April 1, 2024; you can’t correct errors after the submission period is over.

Preliminary scoring is no longer available. Previews of your 2023 final score will be available in June 2024 and your 2025 MIPS payment adjustment information will be available in Aug. 2024. Visit CMS' QPP Resource Library page for helpful tools such as the 2023 Traditional MIPS Data Submission User Guide.

MGMA Washington Connection 01/18/2024

Thu, 18 Jan 2024 17:31:14 GMT

URGENT: TELL CONGRESS TO STOP THE 3.4% MEDICARE PAYMENT CUT

Congress is working on passing a continuing resolution (CR) to fund the federal government before the expiration of funding for certain federal agencies on Jan. 19. The current draft of the CR would fund the government until early March. Due to political factors related to this funding, a fix for the 3.37% Medicare physician payment cut that took effect on Jan. 1, 2024, is not currently included despite collective efforts from MGMA and other healthcare organizations.

A group of bipartisan representatives introduced the Preserving Seniors’ Access to Physicians Act of 2023 near the end of last year. This MGMA-supported bill would avert the full 3.37% cut to the Medicare conversion factor. Use MGMA’s Contact Congress portal to send a pre-populated letter to your congressional representatives urging them to address the full cut this week in the new CR. This letter is different than previous iterations as it is specific to the upcoming Jan. 19 deadline.

CMS FINALIZES ITS PRIOR AUTHORIZATION AND INTEROPERABILITY RULE

The Centers for Medicare and Medicaid Services (CMS) finalized its Prior Authorization and Interoperability rule making numerous changes to the prior authorization process for Medicare Advantage and certain other health plans. Many of the provisions go into effect in 2026, such as reduced timeframes for payers to make prior authorization decisions, requiring payers post certain prior authorization metrics on their websites, and requiring payers to provide a specific reason for denying a prior authorization decision. Other sections of the final rule related to technological standards for transmitting prior authorization information must be implemented by Jan. 1, 2027.

MGMA commented on the proposed rule last year and will continue to analyze the final rule to provide additional information about upcoming changes. MGMA continues to support the Improving Seniors' Timely Access to Care Act which would provide additional relief for medical group practices.

MGMA Washington Connection 01/11/2024

Thu, 11 Jan 2024 15:03:37 GMT

MGMA SEEKS REBILLING CLARIFICATION SHOULD MEDICARE CUT BE RETROACTIVELY ADDRESSED

MGMA sent a letter to the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) asking for rebilling clarification should Congress retroactively address the 3.37% Medicare conversion factor cut. Specifically, the letter requests guidance to ensure medical groups do not violate the beneficiary inducement statute if they choose to waive small patient balances that could result from a retroactive payment increase.

Congress has returned from its holiday recess with only a few weeks before a partial government shutdown on Jan. 19 if funding for certain government agencies is not extended. Addressing the 3.37% cut to the conversion factor remains MGMA’s top priority.

ONC PUBLISHES FINAL HTI-1 RULE

The Office of the National Coordinator for Health Information Technology (ONC) published its final rule to advance health information technology (IT) and algorithm transparency (HTI-1) in the Federal Register after announcing it at the end of last year. The rule touches on many topics related to health IT such as updating the ONC health IT certification program, establishing transparency requirements for artificial intelligence and predictive algorithms included in certified health IT, revising certain information blocking definitions and exceptions, and more. MGMA provided comments on the proposed version of the rule last year.

HAVE YOUR PHYSICIANS RECEIVED A REQUEST FOR PATIENT-CARE HOURS INFORMATION FROM AMA/MATHEMATICA?

The physicians in your practice may have received a request from Mathematica to participate in a short patient-care hours study. If they have, please encourage them to participate. The Medicare physician payment schedule, which is used by many other payers, relies on 2006 cost information to develop practice expense relative values, the Medicare Economic Index and resulting physician payments. Mathematica is collecting the data needed to calculate updated practice expenses per hour of patient care by physician specialty. More information may be found here.

MGMA Washington Connection 12/21/2023

Thu, 21 Dec 2023 15:00:16 GMT

IMPORTANT UPCOMING DATES FOR MEDICAL GROUPS

The Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule earlier this year that included a 3.37% cut the Medicare conversion factor and other important policies for medical groups. MGMA has been and will continue to advocate that Congress avert the full cut in anticipation of the new year. Unfortunately, political issues related to legislation to fund the operations of the federal government and its agencies have prevented Congress from addressing critical end-of-year Medicare policies impacting medical groups. With Congress unlikely to intervene before the end of the year, here’s a timeline of upcoming key dates:

Dec. 31: 3.5% APM incentive payment expires
Jan. 1: Cut of 3.37% to the Medicare conversion factor takes effect
Jan. 1: Medicare begins paying for G2211 complexity add-on code
Jan. 1: Qualifying APM Participant threshold increases for the 2024 performance year
Jan. 19: Partial federal government shutdown deadline
Jan. 19: 1.0 work GPCI floor expires
Feb. 2: Second federal government shutdown deadline

MGMA sent a letter to congressional leadership with legislative recommendations to support medical groups ahead of the new year. We will continue these advocacy efforts in 2024. Send a letter to your congressional representatives, urging them to avert the full 3.37% cut to Medicare reimbursement!

NO SURPRISES ACT UPDATES

On Dec. 15,the No Surprises Act independent dispute resolution (IDR) portal was reopened for all disputes after previously being closed to batched disputes. The Administration released an FAQ detailing extended timelines for the submission of batched disputes and guidance for IDR entities in determining eligibility. Additionally, earlier this week a new rule was finalized setting the IDR administrative fee at $115 per dispute. The proposed rule had set the administrative fee at $150.

MGMA submitted comments on Wednesday about a separate IDR operations proposed rule. We asked for increased flexibility for batched disputes and highlighted the need to streamline the IDR process.

MGMA Washington Connection 09/07/2023

Thu, 07 Sep 2023 13:04:43 GMT

UPDATE: IDR PROCESS RESUMES FOR CERTAIN DISPUTES

Following the Texas court's ruling in favor of the Texas Medical Association to rescind several No Surprises Act (NSA) regulations related to the independent dispute resolution (IDR) process, the Centers for Medicare & Medicaid Services (CMS) has issued guidance directing certified IDR entities to proceed with eligibility determinations submitted on or before Aug, 3, 2023, effective Sep. 5, 2023. Disputing parties with eligibility determinations submitted on or before Aug. 3, 2023, may continue to engage in open negotiation and should respond to requests for information from a certified IDR entity. All other aspects of the Federal IDR process remain suspended.

The agency is reviewing the court's decision and will update directions for the IDR process in concordance with the court's order. MGMA Government Affairs will continue to monitor for this future guidance and provide updates to membership.

CMS ANNOUNCES NEW AHEAD MODEL

CMS announced the introduction of the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. This new voluntary state total cost of care model is intended to improve population health, curb healthcare cost growth, and advance health equity. Participating states will receive support to increase investment in primary care, provide financial stability for hospitals, and support connection for beneficiaries to community resources.

The AHEAD model is scheduled to operate for eleven years starting in 2024, and CMS will issue awards of up to $12 million to support implementation for up to eight states. The first Notice of Funding Opportunity for states to apply will be released in late fall 2023. CMS will host a webinar on Sep. 18 from 3 p.m. – 4:30 p.m. ET.

NEW PRIORITY BILL TRACKER RESOURCE FOR MEMBERS

To assist members in their advocacy efforts, MGMA Government Affairs created a priority bill tracker resource outlining legislative efforts that have been introduced during the 118th Congress impacting medical groups. This pending federal legislation reflects several of MGMA’s key advocacy priorities. We need your support to get these bills passed into law. Please visit MGMA’s Contact Congress portal to send a letter to your legislators on these important issues.

MGMA Washington Connection 08/03/2023

Thu, 03 Aug 2023 19:53:22 GMT

NEXT MONDAY: GOVCHAT LIVE ON PROPOSED 2024 PHYSICIAN FEE SCHEDULE

MGMA Government Affairs is hosting a GovChat Live next Monday, August 7, at 2 p.m. ET. During this member-exclusive discussion, the team will provide a high-level overview of policies included in the proposed 2024 Medicare Physician Fee Schedule (PFS), including changes to the conversion factor/reimbursement, telehealth, behavioral health, E/M visits, the Medicare Shared Savings Program, and the Quality Payment Program. MGMA will be seeking feedback from members to help inform our comments in response to the policy proposals and will answer questions during the interactive discussion.

For registration information, please visit the MGMA Member Community, log in, and navigate to the GovChat Community page where you will find details in the pinned post! Haven't checked out the GovChat Community yet? You can find it by utilizing the search bar at the top of the Member Community home page! If you have questions, please email govaff@mgma.org.

MGMA ENDORSES POLICIES TO REFORM PRIOR AUTHORIZATION

Congress continues to examine potential solutions to the prior authorization burden facing medical groups. The GOLD CARD Act was recently reintroduced by Representatives Michael Burgess and Vicente Gonzalez of Texas.

If enacted, the legislation would exempt qualifying physicians from prior authorization requirements if they had at least 90% of prior authorization claims approved in the previous year. Medicare Advantage organizations would be required to notify each provider who qualifies no later than 30 days prior to the first day of the plan year, and reviews for a Gold Card would be limited to no more than one per year. MGMA issued a statement in support of the legislation.

VALUE-BASED CARE LEGISLATION REINTRODUCED IN HOUSE

The Value in Health Care Act was reintroduced last week. This bipartisan legislation would make changes to alternative payment models (APMs) and provide support for practices transitioning from fee-for-service to value-based care. If enacted, the bill would extend the APM incentive bonus at 5%, allow the Centers for Medicare & Medicaid Services to adjust qualifying participant thresholds through rulemaking, and make changes to the Medicare Shared Savings Program to encourage participation. MGMA joined 16 partner healthcare organizations in a letter of support to the bill’s cosponsors.

MGMA Washington Connection 07/27/2023

Thu, 27 Jul 2023 14:32:32 GMT

HOUSE COMMITTEE ADVANCES LEGISLATION TO REFORM PRIOR AUTHORIZATION

The House Committee on Ways and Means held a markup of healthcare legislation yesterday. One of the bills considered, the Health Care Price Transparency Act of 2023, included provisions that would make critical changes to the prior authorization process for Medicare Advantage plans. Specifically, the legislative text incorporates language from the the Improving Seniors’ Timely Access to Care Act which MGMA has long supported and has broad bipartisan support among Congress.

MGMA Government Affairs issued a statement before the markup in support of the inclusion of the prior authorization provisions. The Committee agreed on a 25-16 vote to report the "Transparency Act" to the House floor. We will continue to monitor this legislation and advocate for commonsense prior authorization reform.

SAVE THE DATE: GOVCHAT LIVE ON PROPOSED 2024 PHYSICIAN FEE SCHEDULE

MGMA Government Affairs is hosting a GovChat Live on Monday, August 7, at 2 p.m. ET. During this member-exclusive discussion, the team will provide a high-level overview of policies included in the proposed 2024 Medicare Physician Fee Schedule (PFS), including changes to the conversion factor/reimbursement, telehealth, behavioral health, E/M visits, the Medicare Shared Savings Program, and the Quality Payment Program. MGMA will be seeking feedback from members to help inform our comments in response to the policy proposals and will answer questions during the interactive discussion.

Registration information is available on the MGMA GovChat Community page. If you have questions, please email govaff@mgma.org.

REMINDER: MID-YEAR POLICY UPDATE WEBINAR AVAILABLE ON-DEMAND

If you missed MGMA's mid-year policy update webinar earlier this month, it is now available to members on-demand. To learn about the current congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement, the recording may be accessed here.

For additional insights on the proposed cuts to Medicare reimbursement, prior authorization reform, Medicare site of service differentials, upcoming changes to health IT regulations, telehealth policies following the end of the COVID-19 public health emergency, and more, members are encouraged to read our latest article from the July 2023 issue of MGMA Connection magazine.

MGMA Washington Connection 07/20/2023

Thu, 20 Jul 2023 14:19:18 GMT

MGMA TO CONGRESS: CUT RED TAPE FOR MEDICAL GROUPS

MGMA submitted testimony to the House Committee on Small Business Subcommittee on Oversight, Investigations & Regulations ahead of its July 19 hearing, "Burdensome Red Tape: Over regulation in Health Care and the Impact on Small Businesses." The testimony highlights the ongoing challenges medical groups face related to MIPS, APM development and reporting, physician reimbursement, and prior authorization.

Notably, Committee Chair Van Duyne referenced data points from MGMA's annual regulatory burden report in her opening statement, saying, “89% of [medical group practices surveyed] feel that regulatory burden has increased in the past year." In the testimony, MGMA raised concerns that increasing regulatory burdens further impede practices' ability to ensure high-quality, timely patient care.

NOW ON-DEMAND: MID-YEAR POLICY UPDATE WEBINAR

If you missed MGMA's mid-year policy update webinar earlier this week, it is now available to members on-demand. To learn about the current congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement, the recording may be accessed here.

TRANSITION OF COVID-19 VACCINE TO COMMERCIAL MARKET

The Department of Health and Human Services has released guidance for the transition of the COVID-19 vaccine to the commercial market. Effective Aug. 3, 2023, at 4 p.m. ET, the U.S. Government will end their regular vaccine and ancillary kit distribution processes. Providers are encouraged to place any necessary orders in advance of the Aug. 3, 2023, deadline. The Public Readiness and Emergency Preparedness Act's liability protections to providers administering COVID-19 vaccines will not be impacted by this transition.

It is important to note that this guide is intended for planning purposes and its details may change pending future recommendations from the Food and Drug Administration and Centers for Disease Control. MGMA Government Affairs will continue to monitor this transition process and keep members apprised any relevant changes.

REGULATORY ALERT: Medicare proposes 2024 payment and quality reporting changes

Fri, 14 Jul 2023 16:10:35 GMT

Medicare proposes 2024 payment and quality reporting changes

The Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Physician Fee Schedule (PFS) proposed rule this afternoon, which includes proposed changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2024. Key proposals include:

Setting 2024 Medicare payment rates for physician services. For 2024, CMS proposes a Conversion Factor of $32.7476 and $20.4370 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, over final 2023 rates);
Extending flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time through at least 2024, following MGMA advocacy;
Reimbursing telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
Continuing to allow direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
Continuing coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
Pausing implementation and rescinding the Appropriate Use Criteria program regulations;
Increasing the performance threshold from 75 points to 82 points for all three MIPS reporting options;
Adding five new MIPS Value Pathways related to women's health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
Making numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
Ending the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitioning to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.

MGMA will submit detailed comments in response to these proposals to CMS and prepare a more detailed analysis of proposed changes in the coming weeks. Review the proposed rule, the PFS fact sheet, and the QPP fact sheet. The final 2024 PFS rule is expected by Nov. 1, 2023.

Next Tuesday: Join MGMA for our mid-year policy update webinar

Join MGMA Government Affairs for our member-exclusive, mid-year policy update to review current federal policies and their impact on group practices. Attendees will learn about the congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement. There will be time for Q&A at the end of the presentation, so come ready with your questions!

This webinar will be held next Tuesday, July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here.

MGMA Washington Connection 07/06/2023

Mon, 10 Jul 2023 15:01:56 GMT

NEW REQUIREMENT FOR DEA-REGISTERED PRACTICIONERS

All practitioners registered with the Drug Enforcement Agency (DEA) will be responsible for fulfilling a one-time, eight-hour training requirement on the treatment or management of patients with opioid or other substance use disorders. Practitioners need to satisfy this requirement before their initial or next scheduled DEA registration submission on or after June 27, 2023.

There are multiple ways that a practitioner may satisfy this new requirement — the DEA sent a letter outlining these options and providing a list of accredited groups that may provide trainings. The Substance Abuse and Mental Health Services Administration (SAMSHA) has additional information about frequently asked questions. MGMA Government Affairs will discuss this policy in more detail during our upcoming mid-year policy update webinar.

JOIN MGMA FOR OUR MID-YEAR POLICY UPDATE WEBINAR

Join MGMA Government Affairs staff for our member-exclusive, mid-year policy update to review current federal policies and their impact on group practices. Attendees will learn about the congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement. There will be time for Q&A at the end of the presentation, so come ready with your questions!

This webinar will be held on July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here.

NOW OPEN: PRF REPORTING PERIOD 5

Effective July 1, 2023, the Provider Relief Fund (PRF) Reporting Period 5 is open. Any American Rescue Plan Rural and/or PRF payment in excess of $10,000.00 received between Jan. 1, 2022, and June 30, 2022, should be included in this period's report. All reports must be submitted through the PRF Reporting Portal. The deadline to submit a report for this period is Sept. 30, 2023, at 11:59 p.m. ET.

Additional resources concerning the PRF can be found here. MGMA Government Affairs will continue to keep members apprised of relevant developments.

MGMA Washington Connection 06/29/2023

Fri, 30 Jun 2023 01:46:50 GMT

MGMA SHARES MEDICARE PAYMENT REFORM RECOMMENDATIONS WITH CONGRESS

MGMA submitted a letter for the record to the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations ahead of their hearing, “MACRA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.” The Subcommittee examined the Quality Payment Program (QPP) that was instituted under the Medicare Access and CHIP Reauthorizations Act of 2015 (MACRA) and discussed challenges practices face related to the legislation.

Our comments included recommendations on how to reform the program such as providing an annual inflationary-based physician payment update based on the Medicare Economic Index (MEI), providing positive financial incentives to support practices transitioning to value-based care, and opposing efforts to offset unrelated congressional spending to the detriment of Medicare providers. MGMA expects Congress to continue reviewing potential options for MACRA reform in the coming months and we will engage with policymakers to advocate for solutions that provide for sustainable reimbursement to medical groups.

MGMA ADVOCATES FOR BEHAVIORAL TELEHEALTH CARE

The House Committee on Energy and Commerce Subcommittee on Health held a hearing on the reauthorization of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) for Patients and Communities Act. The Subcommittee discussed numerous provisions of the SUPPORT Act with witnesses from several federal agencies tasked with enforcing the law.

MGMA sent a letter recommending policies to the Subcommittee that would support medical groups’ ability to offer high-quality mental health and behavioral telehealth care. The letter advocated for instituting an appropriate process for the administration of controlled substances via telehealth and to remove the in-person requirement for behavioral telehealth visits.

JOIN MGMA FOR OUR MID-YEAR POLICY UPDATE WEBINAR

This webinar will be held on July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here.

MGMA Washington Connection 06/15/2023

Thu, 15 Jun 2023 14:08:32 GMT

CMS ANNOUNCES NEW PRIMARY CARE MODEL

Last week, the Centers for Medicare and Medicaid Services (CMS) announced the launch of a new voluntary model focused on primary care, the Making Care Primary (MCP) Model. This 10.5-year model will launch on July 1, 2024, and be tested in eight states. CMS intends for the MCP Model to strengthen the primary care infrastructure in the county while focusing on safety net and smaller or independent primary care organizations.

There will be three participation tracks that build on previous primary care models and provide a pathway for primary care clinicians to adopt prospective, population-based payments. CMS is working with state Medicaid agencies in the eight participating states and plans to engage with private payers in the coming months to engage in full care transformation across payers. The application will open in late summer 2023 for primary care organizations within the participating states.

CMS RELEASES 2021 QUALITY PAYMENT PROGRAM EXPERIENCE REPORT

On Monday, CMS released its 2021 Quality Payment Program (QPP) Experience Report, an infographic, and a Public Use File (PUF) to provide insights into QPP participation. The report and infographic review performance and participation data for the MIPS and Advanced Alternative Payment Models (APMs) performance tracks, while the PUF provides individual clinicians who received a 2021 MIPS final score with detailed information.

The mean final score for MIPS eligible clinicians participating as individuals rose from 64.66 in 2020 to 71.61 in 2021, and the number of Qualifying Advanced Model Participants (QPs) rose from 235,225 in 2020 to 271,231 in 2021. See the 2021 QPP Experience Report for more key findings and to review elements important to the QPP.

“CURRENT LANDSCAPE OF HEALTHCARE ON THE HILL" MGMA SUMMIT SESSION ON-DEMAND

Did you miss our “Current Landscape of Healthcare on the Hill” virtual session at the MGMA Summit? It's now available to attendees on-demand! Director of Government Affairs Claire Ernst was joined by President & CEO of Medical Revenue Cycle Specialists Kem Tolliver for an interactive discussion on the latest developments in Washington, D.C. impacting medical group practices. View the recording today to get an inside look at Congress’ priorities pertaining to physician practices, as well as the steps the Administration is taking to address key issues.

Use your Summit credentials to log in and search “Current Landscape of Healthcare on the Hill” to find the session!

MGMA Washington Connection 06/01/2023

Thu, 01 Jun 2023 17:13:17 GMT

CMS WITHDRAWS COVID-19 HEALTHCARE FACILITY VACCINATION REQUIREMENTS

Yesterday evening, the Centers for Medicare & Medicaid Services (CMS) issued a rule which, in part, withdraws the COVID-19 healthcare staff vaccination requirements established in a November 2021 interim final rule. The November 2021 rule required most Medicare- and Medicaid-certified providers and suppliers to ensure COVID-19 vaccination of staff. This rule largely did not apply to physician offices. Although CMS is withdrawing the staff vaccination provisions, the agency intends to encourage ongoing COVID-19 vaccination through its quality reporting and value-based incentive programs.

MGMA SUBMITS TESTIMONY TO HOUSE COMMITTEE ON WAYS & MEANS SURROUNDING NO SURPRISES ACT

MGMA submitted testimony earlier this week to the House Committee on Ways and Means in response to its May 16 hearing, “Health Care Price Transparency: A Patient’s Right to Know.” The testimony centers on the No Surprises Act (NSA) and concerns about the way certain provisions may be implemented due to current limitations in the healthcare environment and available infrastructure.

While supporting the underlying goals of the transparency provisions of the NSA, MGMA raised concerns about increasing administrative burden for practices without increasing transparency regarding the Advanced Explanation of Benefits (AEOB) and convening/co-provider requirements. Specifically, MGMA highlighted the need for a uniform and automated standard to be available before the requirements go into effect. Policymakers must work with medical groups to institute polices that empower patients without impacting the delivery of care.

HOUSE PASSES DEBT CEILING BILL — A STEP CLOSER TO AVOIDING DEFAULT

On May 31, the House of Representatives voted to pass H.R. 3746 — the Fiscal Responsibility Act of 2023 — averting U.S. default on the debt limit and enabling continued Medicare and Medicaid payments. This politically fraught legislation includes a two-year debt ceiling suspension, discretionary spending caps, expanded work requirements for SNAP and TANF, and cuts to IRS funding. The Congressional Budget Office estimates the legislation will result in cuts to the federal deficit by $1.5 trillion over the next decade. The bill is now headed to the Senate — if the full Congress does not pass the bill by the Monday deadline, the U.S. could risk a default on the nation's debt. MGMA Government Affairs will continue to monitor and provide updates to membership.

MGMA Washington Connection 05/25/2023

Thu, 25 May 2023 14:31:12 GMT

POTENTIAL IMPLICATIONS OF DEBT CEILING DEBATE FOR MEDICAL GROUPS

On May 15, the United States Department of Treasury notified Congress that it would not be able to finance the government's obligations as early as June 1 if legislators do not raise or suspend the $34.1 trillion debt limit. The Administration and Congress are continuing to negotiate to prevent the federal government from defaulting on its agreements. Given the unprecedented nature of a default, it is unclear what federal payments will be prioritized although medical group practices could see delays or cuts to Medicare and Medicaid reimbursements within a few days of default.

As we approach the estimated default date, MGMA Government Affairs will continue to provide timely information on the implications of default to medical group practices.

CMS UPDATES TELEHEALTH GUIDANCE FOR VARIOUS SERVICES IN FACILITY-BASED SETTINGS

The Centers for Medicare & Medicaid Services (CMS) released an updated FAQ on waivers, flexibilities, and the end of the COVID-19 public health emergency (PHE). CMS states in the document that it will exercise enforcement discretion to continue paying for telehealth services offered by physical therapists (PT), occupational therapists (OT), and speech-language pathologists (SLP) in facility-based settings.

The agency updated its position on covering telehealth for PT, OT, and SPT after receiving numerous inquiries from providers and healthcare organizations. Telehealth services are allowed from hospital outpatient departments, rehabilitation agencies, skilled nursing facilities, and home health agencies. Providers should continue to furnish services and bill the same way they have been during the PHE according to the FAQ.

MGMA WRITES CONGRESS IN SUPPORT OF LEGISLATION TO EXPAND PHYSICIAN WORKFORCE

MGMA joined a coalition of nearly 80 healthcare organizations in sending a letter of support to the congressional Senate sponsors of the Resident Physicians Shortage Reduction Act of 2023. This bipartisan bill would create 14,000 additional Medicare-supported Graduate Medical Education (GME) positions over the next seven years. This legislation would help address the projected shortage of up to 124,000 primary care and specialty physicians by 2034, and build upon the 1,200 slots Congress added over the past few years.

Contact your members of Congress today to express your support for expanding the physician workforce.

MGMA Washington Update 05/18/2023

Thu, 18 May 2023 20:13:30 GMT

MGMA SUBMITS COMMENTS TO SENATE SUBCOMMITTEE FOR HEARING ON DENIALS AND DELAYS IN MA

On May 17, the Senate Committee on Homeland Security & Governmental Affairs Permanent Subcommittee on Investigations held a hearing titled, “Examining Health Care Denials and Delays in Medicare Advantage." The hearing’s witnesses included Medicare policy experts, a benefits specialist, and leadership from the Department of Health and Human Services (HHS) Office of Inspector General (OIG). In April 2022, OIG published a report that found some Medicare Advantage (MA) organization denials of prior authorization (PA) limited beneficiaries’ access to medically necessary care.

As part of the MGMA’s efforts to highlight the burden of PA on medical group practices and its negative impacts on patient care, MGMA Government Affairs shared our recent report on the escalating utilization of PA within the MA program and additional written comments outlining our mounting concerns with Subcommittee staff.

"HEALTHCARE ON THE HILL" SESSION AT MGMA SUMMIT

Attending MGMA Summit next month? You won’t want to miss our “Current Landscape of Healthcare on the Hill” virtual session on Thursday, June 8 at 11 a.m. ET. Director of Government Affairs Claire Ernst will be joined by Taya Gordon and Kem Tolliver for an interactive discussion on the latest developments in Washington, D.C. impacting medical group practices. Attendees will get an inside look at Congress’ priorities pertaining to physician practices, as well as the steps the Administration is taking to address key issues. This session will provide updates on Medicare reimbursement, prior authorization reform, surprise billing, and more!

Additional information on MGMA Summit, including registration details and a full schedule of events, may be found here.

MGMA RESOURCES OUTLINGING STATUS OF VARIOUS FLEXIBILITIES AND WAIVERS FOLLOWING PHE

The Biden administration ended the COVID-19 PHE on May 11, 2023. This decision came after multiple renewals over the previous three years. MGMA appreciates that the Administration heeded our call to provide at least 90-days’ notice prior to concluding the PHE. The end of the PHE has ramifications for a variety of flexibilities afforded by the pandemic over the last several years.

MGMA Government Affairs will continue to monitor all federal policy updates as they develop to ensure that our members are aware of all changes as we continue to navigate through this transition. For additional information concerning the end of the PHE, please review some of our member resources below:

GovChat Live: Unwinding of the PHE FAQ
GovChat Live: Unwinding of the PHE (slides & recording)
Flexibilities & policy following expiration of PHE *Updated May 17, 2023*
Medicare Telehealth Waivers *Updated May 17, 2023*

MGMA Washington Connection 05/04/2023

Thu, 04 May 2023 14:53:08 GMT

NEW MGMA REPORT TARGETS ESCALATING USE OF PRIOR AUTHORIZATION BY MA PLANS

Following substantial growth of enrollment in Medicare Advantage (MA) plans during the previous two decades, in April 2022, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) published a report which detailed how MA beneficiaries' care was often negatively impacted as a result of delayed and denied prior authorization requests, despite the requests meeting Medicare coverage rules.

To further understand the critical impact of prior authorization within the MA program, and to allow us to better educate Congress and the Administration about obstacles to delivering high-quality patient care to beneficiaries, in March of 2023, MGMA surveyed over 600 medical groups. Findings overwhelmingly show that prior authorization in MA is increasingly burdensome for medical group practices and contributes to increased practice administration costs, disrupted practice workflow, and dangerous delays and denials of necessary medical care.

CMS ACCEPTING APPLICATIONS FOR '23 MIPS EUC AND PROMOTING INTEROPERABILITY EXCEPTIONS

The Centers for Medicare and Medicaid Services (CMS) opened applications for the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Exception and the Promoting Interoperability Performance Category Hardship Exception for performance year 2023. The applications will close at 8 p.m. ET on Jan. 2, 2024. For MIPS eligible clinicians, groups, and virtual groups, extreme and uncontrollable circumstances are rare events entirely outside of a clinician’s or group’s control that would:

Cause you to be unable to collect information necessary to submit for a MIPS performance category;
Cause you to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example, if you were unable to collect data for the quality performance category for 3 months), and/or;

Impact your normal processes, affecting your performance on cost measures and other administrative claims measures.

BIDEN ADMINISTRATION ENDING SEVERAL COVID-19 VACCINATION REQUIREMENTS

The Biden administration announced it will end the COVID-19 vaccine requirements for federal employees, federal contractors, and international air travelers at the end of the day on May 11. These vaccination requirements were announced in 2021 and will end on the last day of the COVID-19 public health emergency (PHE).

The Department of Health and Human Services (HHS) also announced on Monday that it will start the process to end vaccination requirements for CMS-certified healthcare facilities and Head Start educators. HHS is expected to release further information in the coming days on the unwinding of its vaccination requirements. As a reminder, this policy is applicable to facilities that participate in/are certified under the Medicare/Medicaid programs and are regulated by Conditions of Participation, Conditions of Coverage, or Requirements for Participation — physician practices were largely outside of the scope.

MGMA Washington Connection 04/27/2023

Sat, 29 Apr 2023 21:53:21 GMT

MGMA COMMENTS ON CMS’ HIPAA ATTACHMENT STANDARDS PROPOSED RULE

Last week, MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to its proposed rulemaking to establish Health Insurance Portability and Accountability Act (HIPAA) attachment standards. The proposed rule would establish electronic standards for sending attachments in claims and prior authorization transactions. Attachments are currently transmitted through a primarily manual process, and CMS has been tasked with establishing attachment standards for decades.

MGMA’s comments focused on the need for CMS to ensure the prior authorization attachment standard aligns with all other aspects of the agency’s prior authorization reform efforts, instituting an improved HIPAA attachment standards development process focusing on real-world testing, and implementing a claims attachment standard that works for medical groups.

MGMA TO CONGRESS: REPEAL THE PATIENT ID PROHIBITION

MGMA joined over 150 other healthcare organizations in a letter asking Congress to repeal Section 510 in the Labor, Health and Human Services, and Education and Related Agencies (Labor-HHS) appropriations bill. A narrow interpretation of the language in Section 510 has prevented progress on a unique patient identifier resulting in numerous negative consequences to patient care and financial burdens to medical groups.

MGMA also joined nearly 50 organizations in a letter requesting $7 million of the funds appropriated to the Office of the National Coordinator for Health Information Technology (ONC) to be designated for patient matching in Fiscal Year 2024.

MGMA ENDORSES THE CHRONIC CARE MANAGEMENT IMPROVEMENT ACT OF 2023

MGMA and over two dozen other healthcare stakeholder organizations sent a letter to Congress in support of the Chronic Care Management Improvement Act of 2023. This bipartisan legislation would increase access to chronic care management (CCM) services for Medicare beneficiaries and enable group practices to better manage the chronic conditions of their patients by removing the burdensome cost sharing requirement. Currently, Medicare beneficiaries are subject to a 20% co-insurance requirement for CCM services, increasing the administrative burden on practices by requiring the continuous collection of minimal fees from patients.

Join in #MGMAAdvocacy today by sending a letter to your members of Congress urging them to pass legislation to remove patient cost sharing for CCM services!

PUBLIC HEALTH EMERGENCY: MEMBER QUESTION OF THE WEEK!

n preparation for the end of the declared COVID-19 Public Health Emergency (PHE) on May 11, 2023, MGMA has been tracking frequently asked member questions related to its unwinding. Please see a common member question on this issue below:

Q: Will the U0005 add-on payment for COVID-19 diagnostic testing run on high-throughput tech expire with the end of the PHE?

A: When the PHE ends, the Healthcare Common Procedure Coding System (HCPCS) codes created by CMS during the PHE (U0003, U0004, U0005) will no longer be payable. Payment rates for these types of COVID-19 tests will be reimbursed under standard Clinical Laboratory Fee Schedule.

MGMA Washington Connection 04/06/2023

Fri, 07 Apr 2023 15:21:21 GMT

CMS FINALIZES MA RATE NOTICE - PHASES IN CHANGES

Last Friday, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). The Rate Announcement finalized policies like making technical changes to the growth rate estimate, implementing changes to the Part D drug program from the Inflation Reduction Act, and changes to the risk adjustment model.

MGMA advocated to pause the implementation of changes to the risk adjustment model to mitigate any potential unintended consequences impacting beneficiary access to care and value-based care initiatives critical to the success of medical group practices. In response to the concerns of MGMA and other stakeholders, CMS announced that the changes to the risk adjustment model will be phased in over three years rather than all at once. MGMA will continue to monitor the potential impact that these changes will have on group practices.

MEDICARE BOARD OF TRUSTEES RELEASE 2023 REPORT

The Medicare Board of Trustees has released its 2023 report, projecting that the Hospital Insurance Trust Fund would only be able to pay 100% of total scheduled benefits until 2031. The Board had previously estimated that the program would become insolvent three years earlier. The report also outlines projections showing that steep increases in Medicare costs will lead to lower relative reimbursement rates for provider groups. Compounding these concerns, it's also been noted that physicians are slated for payment reductions in future years and that the updates to physician payment in the law do not tie reimbursement to underlying economic conditions like inflation.

MGMA Government Affairs will continue to advocate for policy solutions that will ensure reimbursement rates reflect the true costs of delivering care.

MGMA Washington Connection 03/30/2023

Fri, 31 Mar 2023 17:49:36 GMT

HOUSE SUBCOMMITTEE HOLDS HEARING ON HEALTHCARE TRANSPARENCY AND COMPETITION

On Tuesday, the House Committee on Energy & Commerce Subcommittee on Health held a hearing on transparency and competition in healthcare. Five panelists testified including the CEO of Pullman Regional Hospital and a Senior Fellow from the American Enterprise Institute.

The majority of the discussion focused on the hospital price transparency rule, the transparency in coverage rule, pharmacy benefit managers, drug pricing policies, and consolidation. Committee members and the panel highlighted potential areas for oversight and legislation such as codifying price transparency policies. MGMA Government Affairs will continue to engage with the Committee on these and other priority issues.

MGMA Washington Connection 03/23/2023

Fri, 24 Mar 2023 21:45:46 GMT

MGMA SUBMITS FEEDBACK TO SENATE HELP COMMITTEE ON HEALTHCARE WORKFORCE SHORTAGES

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.

CMS ISSUES UPADTED GUIDANCE ON NO SURPRISES ACT INDEPENDENT RESOLUTION PROCESS

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.

MGMA Washington Connection 03/16/2023

Thu, 16 Mar 2023 19:24:58 GMT

MGMA COMMENTS ON PRIOR AUTHORIZATION AND INTEROPERABILITY PROPOSED RULE

On Monday, MGMA submitted comprehensive comments to the Center for Medicare & Medicaid Services (CMS) on its proposed rulemaking to reform prior authorization and interoperability within Medicare Advantage (MA) and several other payers. CMS proposed to make numerous changes such as implementing a process to facilitate prior authorizations, requiring affected payers to publicly publish aggregated prior authorization data, and more. MGMA offered the following key recommendations:

Finalize the inclusion of MA plans in the scope of the rule,
Finalize the proposal to require plans to provide specific reasons for prior authorization denials,
Shorten the proposed timeframes to 48 hours for standard prior authorizations and 24 hours for expedited prior authorizations,
Encourage the use of gold-carding programs in the MA program, and
Not link electronic prior authorization requirements to CMS’ Quality Payment Program (QPP).

CMS will now review comments submitted by the public before it finalizes the rule. Reforming the prior authorization process has long been one of MGMA’s top priorities. It is our hope that CMS will include MGMA's recommendations in its final rule and expeditiously publish it later this year.

HHS' BUDGET REQUEST FOR FY 2024

Last Thursday, President Biden released his budget for fiscal year (FY) 2024. The Department of Health and Human Services (HHS) proposed $144.3 billion in discretionary and $1.7 trillion in mandatory budget authority. HHS’ section of the budget focused on addressing the following challenges the agency identified:

Addressing a growing behavioral health crisis,
Preparing for future health threats,
Strengthening insurance coverage and lowering health care costs,
Increasing funding to the Indian Health Service,
Improving the well-being of children, families, and seniors,
Growing the health workforce,
Improving departmental operations, and
Advancing research to improve health.

Agencies posted their budget justifications to Congress on Monday. CMS specifically identified three key initiatives regarding opioid and substance use disorders, health equity, and nursing homes in its 2024 congressional justification. As a reminder, the President’s budget is meant to be a messaging tool, especially in a divided Congress. It does not have the force of law and Congress will work through the appropriations process to fund the federal government in the coming months.

CMS PROVIDES 2021 QPP PERFORMANCE INFORMATION

CMS has updated the 'Doctors and Clinicians' section of Medicare Care Compare and the Provider Data Catalog (PDC) with new Quality Payment Program (QPP) performance information for 2021. The Care Compare website is meant to allow for Medicare patients and caregivers to compare doctors, clinicians, accountable care organizations, and groups enrolled in Medicare.

CMS is required to report Merit-based Incentive Payment System (MIPS) eligible clinicians’ final scores, performance scores under each MIPS performance category, and the names of eligible clinicians in Advanced APMs. CMS is also required, to the extent feasible, to report the names and performance of Advanced APMs. The performance information is shown under percent performance scores, checkmarks, and measure-level star ratings.

MGMA Washington Connection 02/23/2023

Fri, 24 Feb 2023 22:15:15 GMT

BPCI ADVANCED MODEL 2024 APPLICATION PORTAL OPEN

On Feb. 21, the Centers for Medicare & Medicaid Services (CMS) opened the application portal for year 7 (2024) of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model. This model was set to end on Dec. 31, 2023, but CMS announced a two-year extension last October. CMS has requested applications from Medicare Accountable Care Organizations (ACOs), suppliers, and Medicare-enrolled entities for participation in the model starting Jan. 1, 2024.

New convener applicants must be an ACO or Medicare-enrolled entity, while current model participants can continue participation by signing an amended and restated participation agreement for model year 7. Former participants can apply as a convener, non-convener, or episode initiator under a convener. The application portal will stay open for 100 days and close on May 31, 2023, at 5 p.m. ET. More information is available on the BPCI Advanced applicant resources page.

FEDERAL POLICY SESSION AT MEDICAL PRACTICE EXCELLENCE: FINANCIAL & OPERATIONS CONFERENCE

Planning on attending Medical Practice Excellence: Financial and Operations Conference next month in Orlando? You won't want to miss the Washington Policy Outlook (Monday, March 20, from 11:15 a.m. to 12:15 p.m. ET) where MGMA Government Affairs will fill you in on the latest federal policy developments impacting medical practice operations, including changes to the 2023 payment and quality rules, the status of surprise billing and transparency requirements, and other key regulatory changes. MGMA Government Affairs will also give an update on congressional activity that has the potential to impact group practices and recent #MGMAAdvocacy efforts. Attendees will have the opportunity to ask questions at the conclusion of this presentation.

JOIN MGMA'S GOVCHAT ONLINE MEMBER COMMUNITY

By signing up for our GovChat online community, MGMA members have the benefit of engaging with both colleagues and the MGMA Government Affairs team on current regulatory and legislative developments. Recent discussion topics include surprise medical billing, prior authorization "gold carding" legislation, and our 2023 policy priorities.

Sign up for GovChat today to join the #MGMAAdvocacy discussion!

MGMA Washington Connection 02/02/2023

Thu, 02 Feb 2023 22:35:43 GMT

BIDEN ADMINISTRATION TO END COVID-19 PHE on MAY 11

The Biden Administration announced that it plans to end the COVID-19 public health emergency (PHE) on May 11, 2023. This decision comes after multiple renewals over the past three years. MGMA appreciates that the Administration heeded our call to provide at least 90-days’ notice prior to concluding the PHE. The end of the PHE will have ramifications for a variety of flexibilities afforded by the pandemic over the last several years, such as HIPAA penalty waivers, controlled substance prescription waivers, and COVID-19 testing and treatment coverage.

For more information on the flexibilities that will conclude along with the PHE, download MGMA’s member-exclusive resource .

MGMA SUBMITS FEEDBACK ON THE CONNECT FOR HEALTH ACT

On Monday, MGMA sent feedback to the Senate Telehealth Working Group and House Telehealth Caucus on a potential reintroduction of the CONNECT for Health Act (CONNECT Act). Previous iterations of the CONNECT Act aimed to permanently expand access to telehealth services and the last version was endorsed by more than 170 organizations including MGMA.

MGMA offered the following suggestions to include in a new version of the bill:

Remove geographic and originating site restrictions,
Allow permanent coverage of audio-only services,
Reimburse telehealth visits at an appropriate rate,
Preserve the patient-physician relationship,
Eliminate the in-person requirement for mental telehealth services, and
Provide training and resources to practices.

With the Administration announcing its plans to end the COVID-19 PHE on May 11, there is ample opportunity to permanently install vital telehealth flexibilities to promote access to high-quality care.

MGMA Washington Connection 01/26/2023

Thu, 26 Jan 2023 16:26:25 GMT

ADVOCACY IN ACTION: MGMA JOINS CMS FOR ROUNDTABLE ON PRIOR AUTHORIZATION REFORM

On Jan. 17, the Centers for Medicare & Medicaid Services (CMS) convened a stakeholder roundtable to discuss prior authorization and several recent proposals for reform. MGMA was one of a handful of organizations invited to participate in discussion alongside CMS Administrator Chiquita Brooks-LaSure and U.S. Surgeon General Dr. Vivek Murthy. During the meeting, MGMA Board Chair Jeff Smith and SVP of Government Affairs Anders Gilberg shared feedback on the many challenges medical groups face surrounding prior authorization. MGMA will share comments on the proposed rules to reform prior authorization in the coming months.

TODAY: HEALTH CARE VALUE WEEK PANEL FEATURING MGMA

Health Care Value Week is underway! This multi-day event includes a variety of no-cost educational content, including presentations from CMS leadership and other key industry leaders with the goal of developing a path forward to advance opportunities to participate in value-based care models. Of note, we hope you can tune in at 1 p.m. ET today for a panel on barriers and opportunities for independent physicians in value-based care featuring MGMA’s SVP of Government Affairs Anders Gilberg.

For more information, including a full schedule of events and registration links, please visit the Health Care Value Week website.

MGMA TO CONGRESS: SUPPORT PHYSICIAN PRACTICES

On Monday, MGMA and over 100 other leading organizations signed a letter urging Congress to work with stakeholders to explore long-term physician payment issues. Since 2021, medical groups have faced annual cuts due to the effect of budget neutrality requirements stemming from the revaluation of certain codes. The combination of these yearly cuts paired with inflation is unsustainable. We ask Congress to begin holding hearings as soon as possible to explore potential payment solutions to ensure that America’s seniors continue to receive access to high-quality care.

MGMA Washington Connection 01/12/2023

Fri, 13 Jan 2023 04:29:29 GMT

COVID-19 PHE RENEWED

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) yesterday. This renewal extends the PHE through mid-April 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. HHS has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

While many telehealth flexibilities are tied to the PHE, it is important to note that the recently passed Consolidated Appropriations Act, 2023, does ensure certain ones will remain in effect through Dec. 31, 2024, regardless of PHE status. More information may be found in MGMA Government Affairs’ newly updated telehealth resource.

CMS PROPOSES FIVE NEW MVPS FOR 2024

2023 is the first year clinicians may voluntarily report under a MIPS Value Pathway (MVP), with the Centers for Medicare & Medicaid Services (CMS) having finalized 12 MVPs for 2023. On Monday, as part of the “MVP Candidate Feedback Process,” CMS announced it is accepting comments on the following five draft MVPs under consideration for 2024:

1. Quality Care in Mental Health and Substance Use Disorder

2. Prevention and Treatment of Infectious Disorders Including Hepatitis C and HIV

3. Musculoskeletal Care and Rehabilitative Support

4. Quality Care for Otolaryngology

5. Focusing on Women’s Health

Comments on these five draft MVPs will be accepted through Feb. 8, 2023. CMS will display feedback it received for each MVP on the Quality Payment Program website, but won’t respond to those submitting feedback directly. If you would like to provide feedback on any of the draft MVPs, additional information may be found here.

For more information on MVPs, check out MGMA Government Affairs’ newly updated resource.

PRF REPORTING PORTAL OPEN FOR REPORTING PERIOD 4

The Provider Relief Fund (PRF) Reporting Portal is now open for reporting on use of funds in Reporting Period 4. Providers who received one or more PRF (General or Targeted) and/or American Rescue Plan Rural payments exceeding $10,000, in the aggregate, during the fourth Payment Received Period (July 1 to December 31, 2021) must report on their use of funds by March 31, 2023. First time reporters can get started by registering in the PRF Reporting Portal. If a reporting entity has previously reported, they do not need to register again and may log into the Portal with their username, TIN, and password. For more information visit the PRF Reporting webpage.

MGMA Washington Connection 01/05/2023

Fri, 06 Jan 2023 18:01:16 GMT

NEW MEMBER RESOURCE ON OMNIBUS PROVISIONS IMPACTING MEDICAL GROUPS

On Dec. 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (CAA, 2023), into law, which contained a handful of provisions that impact medical group practices, including mitigating provider reimbursement cuts under Medicare for two years and extending certain telehealth flexibilities. To assist members, MGMA Government Affairs created a high-level resource outlining those provisions included within the CAA, 2023, likely to have an effect on practice operations.

Interested in additional information on 2023 policies? Make sure to review MGMA’s 2023 Physician Fee Schedule Analysis and 2023 Medicare Outlook webinar recording!

MIPS EXTREME AND UNCONTROLLABLE CIRCUMSTANCES APPLICATION DEADLINE EXTENDED

The Centers for Medicare and Medicaid Services (CMS) extended the deadline to file a 2022 MIPS Extreme and Uncontrollable Circumstances (EUC) hardship exception application for those citing COVID-19 as a triggering event until March 3, 2023 at 8 p.m. ET. The deadline originally was Jan. 3, 2023. CMS notes that applications received between Jan. 3, 2023 and March 3, 2023 will not override submitted data for individuals, groups, and virtual groups. Additionally, APM Entities participating in MIPS APMs can submit a MIPS EUC exception application, but should note the following differences:

APM Entities are required to request reweighting for all performance categories.
At least 75% of the MIPS eligible clinicians in the APM Entity will need to qualify for reweighting in the Promoting Interoperability performance category.

Data submission for an APM Entity won't override performance category reweighting from an approved application.

ADDITIONAL GOOD FAITH ESTIMATE GUIDANCE RELEASED

CMS has released additional guidance regarding the good faith estimates (GFE) for uninsured (or self-pay) individuals as established in the No Surprises Act. The FAQs cover how federally qualified health centers with sliding fee discounts can comply with GFE requirements, when an abbreviated GFE can be used, and what types of contact information providers should include in a GFE. CMS includes a sample template that group practices can utilize for abbreviated GFEs.

For more information on the No Surprises Act, please review MGMA’s updated member-exclusive resource.

MGMA Washington Connection 12/22/2022

Thu, 22 Dec 2022 13:00:00 GMT

CONGRESS RELEASES YEAR-END LEGISLATION, ADDRESSING MEDICARE CUTS AND TELEHEALTH

Earlier this week, Congress released the text of their year-end spending package, which contains a handful of healthcare provisions that will impact medical groups.

Medicare physician payment: The legislation averts 6.5% of the scheduled 8.5% reduction to physician reimbursement in Medicare, resulting in an approximate 2% cut to the Medicare conversion factor for 2023. By way of background, in 2021, CMS shifted funds in the physician fee schedule to pay for an increase in work RVUs, which raised reimbursement for office visits. This shift resulted in a decrease to the conversion factor due to a statutorily mandated budget neutrality adjustment. Congress provided funds to offset the adjustment in 2021 and partially offset it again in 2022. Going into 2023, we expected a cut of 8.5%, resulting from both a decrease to the conversion factor (4.5%) and PAYGO cut (4%). For the third year in a row, we’ve urged Congress to address the de facto cuts — this year in the form of adding 4.5% back into the fee schedule and waiving PAYGO. Unfortunately, despite 10,000 letters from MGMA members, Congress did not have the appetite to fully waive budget neutrality requirements to address the slated 4.5% cut. Instead, Congress will only partially mitigate it by allowing a 2% cut in 2023. This is in addition to legislation waiving the 4% PAYGO for 2023 and 2024. MGMA has voiced its disappointment that Congress is allowing a 2% cut to occur in 2023 and will continue working to find a more sustainable and comprehensive solution.

Alternative Payment Models (APMs): The 5% incentive bonus is set to expire at the end of this year. The legislation would extend the bonus for an additional year, through 2023, at 3.5%.

Telehealth: Many telehealth waivers, including being able to treat a patient in their home, were extended through 2024. This is positive development supported by MGMA to ensure continuity from pandemic-era telehealth policies.

Lab cuts: Pending the passage of this legislation, practices will receive a one-year reprieve from the laboratory cuts of up to 15% that would have gone into effect in January 2023. This provision was also supported by #MGMAAdvocacy.

We expect Congress to pass this legislation into law by Friday. We will let you know if Congress modifies the current text.

HRSA BEGINS ISSUING REPAYMENT NOTICES

The Health Resources & Services Administration (HRSA) began issuing Repayment Request Notices to Provider Relief Fund (PRF) recipients who must repay funds. If your practice receives a Repayment Request Notice based on a HRSA finding of non-compliance or the results of an audit, you can request a Decision Review. As a reminder, the Decision Review is not related to payment calculations and determinations. If you believe your payment was incorrectly calculated, visit the Payment Reconsideration page.

More information about the repayment process can be found here.

NEW RESOURCES AVAILABLE FROM MGMA GOVERNMENT AFFAIRS

As we approach 2023, many new federal policies will take effect that will impact your medical group. MGMA Government Affairs has updated and created new resources to help your practice prepare! Take advantage of these member-exclusive resources today:

2023 MIPS Value Pathways (MVPs) resource *new*
No Surprises Act resource *updated*
2023 Medicare Outlook webinar *new*
2023 Medicare Physician Fee Schedule Analysis

MGMA members can reach out to govaff@mgma.org with any questions regarding these new and updated resources.

MGMA Washington Connection 12/08/2022

Thu, 08 Dec 2022 16:02:27 GMT

MGMA AND PARTNER ORGS. URGE CONGRESS TO PREVENT FULL 4.5%

On Monday, MGMA and over 100 other healthcare stakeholder organizations sent a letter to congressional leadership urging action to avert the entire 4.5% reduction to Medicare payment rates scheduled to take effect Jan. 1, 2023. The letter illustrates the severity of this pending cut and the negative impact it will have on practices, especially in light of current inflationary pressures. As the Medicare physician fee schedule is the only Medicare payment system without an annual inflationary update, the pending 4.5% reduction will only exacerbate current financial concerns.

MGMA is continuing to advocate against this harmful reduction and for permanent payment reforms. Join in #MGMAAdvocacy today by sending a letter to your members of Congress to pass legislation to stop the full 4.5% payment reduction from taking effect.

CMS FURTHER DELAYS CONVENING/CO-PROVIDER REQUIREMENTS FOR GOOD FAITH ESTIMATES

Following months of #MGMAAdvocacy, CMS announced that they are extending enforcement discretion, pending future rulemaking, for the convening/co-provider good faith estimate (GFE) requirements. Therefore, CMS will NOT begin enforcing these requirements on Jan. 1, 2023. If enforced, practices acting as “conveners” would be responsible for requesting and compiling estimates from each co-provider or co-facility expected to provide a service in connection with the convening provider or facility’s service. This is in addition to the convening provider’s other GFE responsibilities. MGMA previously urged CMS to continue to exercise enforcement discretion past Jan. 1, 2023, due to challenges associated with transferring this information and the tight timeframes.

As a reminder, the advanced explanation of benefits (AEOB) requirements are similarly not being enforced pending further rulemaking.

CMS PROPOSES PRIOR AUTHORIZATION REFORM IN MEDICARE ADVANTAGE CUT TO MEDICARE PAYMENT RATES

On Tuesday, CMS released its proposed rule on electronic prior authorization (ePA) after months of MGMA urging the agency to do so. If finalized, this rule would apply to Medicare Advantage (MA) organizations, state Medicaid and CHIP Fee-for-Service (FFS) programs, Medicaid managed care plans and Children's Health Insurance Program (CHIP) managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs). The rule proposes, in part, to require the aforementioned plans to: (1) Provide a clear reason for PA denials, (2) Publicly report on PA approvals, denials, and appeals, (3) Respond to PA requests within certain timeframes (72 hours for urgent, 7 days for non-urgent), and (4) Implement and maintain an API to support and streamline the PA process.

MGMA will comment on this proposed rule and work with CMS to further refine it. We are also hopeful that this rule will help get MGMA-supported PA legislation (the Improving Seniors' Timely Access to Care Act) across the finish line before the end of the year. Please continue to urge your members of Congress to support this legislation by sending a letter through our Contact Congress portal.

MGMA SVP OF GOVERNMENT AFFAIRS NAMED ONE OF THE HILL'S 2022 TOP LOBBYISTS

Yesterday, MGMA’s Senior Vice President of Government Affairs Anders Gilberg was named one of The Hill’s 2022 Top Lobbyists — an award recognizing “the corporate lobbyists, hired guns, association leaders and grassroots activists who leveraged their expertise and connections to make a difference in the nation’s capital this year.” This prestigious recognition is reflective of the work Anders and MGMA have undertaken this past year representing the interests of our members and medical groups nationwide.

The Government Affairs team would like to extend a huge ‘thank you’ to everyone who has participated in #MGMAAdvocacy this past year, as you all undoubtedly contributed to this win!

MGMA's Final 2023 Physician Fee Schedule Analysis

Tue, 22 Nov 2022 21:49:52 GMT

Your guide to 2023 Medicare payment rules

The Centers for Medicare & Medicaid Services released its final 2023 Physician Fee Schedule (PFS) rule, which includes payment and coding updates for Medicare services, modifications to telehealth, and changes to the Quality Payment Program.

MGMA Government Affairs reviewed, analyzed, and distilled over 2,000 pages of the final rule to draft this member-benefit analysis. The resource breaks down significant payment and quality reporting changes for 2023 and offers practical takeaways for busy medical group practice executives. Key regulatory provisions include:

Setting the CY 2023 PFS conversion factor at $33.0607 (a reduction of 4.47%) and the CY 2023 national average anesthesia conversion factor at $20.6097. MGMA is advocating for a legislative fix to address the reimbursement cuts resulting from the lower conversion factor;
Delaying the split/shared E/M billing policy until CY 2024, permitting the billing clinician to bill for services based on history, exam, medical decision marking or time in 2023;
Continuing payment for Medicare telehealth services that are temporarily included on the telehealth list for 151 days following the conclusion of the COVID-19 public health emergency and maintains payment parity between in-person and telehealth visits through 2023;
Permitting auxiliary personnel to furnish behavioral health services incident to a physician or NPPs services under general instead of direct supervision;
Increasing Qualifying APM Participant (QP) and partial QP threshold in performance year 2023; and
Finalizing 5 new MIPS Value Pathways (MVPs), for a total of 12 MVPs available for voluntary reporting in 2023.

DOWNLOAD THE ANALYSIS!

Interested in learning more about the updates to Medicare physician payment and quality reporting that will be in effect come Jan. 1, 2023? Join MGMA Government Affairs on Dec. 13 at 1 p.m. ET for our member-exclusive 2023 Medicare Outlook webinar to gain insights about payment and policy changes outlined in the final 2023 PFS rule. Register here.

MGMA Washington Connection 11/17/2022

Thu, 17 Nov 2022 20:31:35 GMT

MGMA sends Congress year-end legislative recommendations

On Monday, MGMA sent a letter to congressional leadership urging them to address significant Medicare cuts and other important healthcare policies before the end of this year. The letter highlights current issues with Medicare reimbursement that projected payment cuts will exacerbate and asks Congress to act by:

Offsetting the 4.47% reduction to the Medicare physician conversion factor;
Waiving the 4% statutory Pay-As-You-Go sequester; and,
Extending the 5% alternative payment model (APM) incentive payment for six additional years.

Further, MGMA encouraged Congress to pass additional commonsense legislation to address significant administrative burdens impacting group practices and improve the timeliness of clinical care delivery. These recommendations included passing the Improving Seniors’ Timely Access to Care Act, extending telehealth waivers for at least two years after the conclusion of the public health emergency, passing the Saving Access to Laboratory Services Act, and appropriating additional funds to continue rewarding high performing clinicians within the Merit-based Incentive Payment System (MIPS).

Visit MGMA's Contact Congress portal to send a letter to your legislators on these important issues!

MGMA submits feedback on AEOB requirements

On Tuesday, MGMA submitted feedback to the Department of Health and Human Services about the upcoming advanced explanation of benefits (AEOB) requirements stemming from the No Surprises Act. The AEOB policies would require group practices to send good faith estimates to health plans, thereby allowing the plans to generate AEOBs to send to patients. As a reminder, these requirements are not being enforced until rulemaking is completed. MGMA encouraged HHS to not enforce the AEOB requirements until there are workable solutions that are developed, tested, and implemented as well as to continue soliciting input and working with medical groups to implement these solutions.

JOIN MGMA FOR OUR 2023 MEDICARE OUTLOOK WEBINAR

Interested in learning more about the updates to Medicare physician payment and quality reporting that will be in effect come Jan. 1, 2023? Join MGMA Government Affairs on Dec. 13 at 1 p.m. ET for a for our member-exclusive 2023 Medicare Outlook webinar to gain insights about payment and policy changes outlined in the 2023 Medicare Physician Fee Schedule final rule. Additionally, we’ll provide details about MIPS reporting requirements, the MIPS Value Pathways implementation timeline, and APM participation and reporting options for 2023. The hour-long session will conclude with a discussion of MGMA’s advocacy initiatives and an interactive Q&A session with Government Affairs staff.

For more information, or to register, please click here.

MGMA Washington Connection 11/10/2022

Thu, 10 Nov 2022 14:27:46 GMT

AVAILABLE NOW: MEDICARE CUTS ADVOCACY SOCIAL MEDIA TOOLKIT

On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model participation options and requirements for 2023. MGMA issued a statement expressing disappointment in the final rule and its negative impact to physician payment, urging Congress to take action to avert the cuts and waive the 4% PAYGO sequestration before the end of the year.

To assist others in their advocacy efforts surrounding the Medicare cuts, the Government Affairs team created a social media toolkit which includes several resources for actions to take from now until Congress acts, motivating others to participate in our critical #MGMAAdvocacy grassroots efforts. Join the conversation online and encourage others to do the same by using the hashtag #AvertTheMedicareCuts!

ICYMI: Updated PI requirements for 2023

As a reminder, those reporting under MIPS and wishing to receive credit for Promoting Interoperability (PI) will be required to only use certified technology updated to the 2015 Edition Cures Update for an EHR reporting period or performance period in CY 2023. Group practices are not required to demonstrate they are using updated technology to meet the CEHRT definitions immediately — participants must use technology meeting these requirements during a self-selected EHR reporting period or performance period of a minimum of any consecutive 90 days in 2023 (i.e. – October 1, 2023).

PROVIDER RELIEF FUND UPDATE: AUDIT PORTAL

Practices that spend a total of $750,000 or more in federal funds, including Provider Relief Fund (PRF) payments during their fiscal year, are subject to Single Audit requirements. The Health Resources & Services Administration (HRSA) recently announced the availability of a Commercial Audit Reporting Portal. Commercial (i.e., for-profit) entities may log into the portal with the same username and password as the PRF Reporting Portal. Non-profit organizations should continue to submit their Single Audits to the Federal Audit Clearinghouse (FAC).

MGMA Washington Connection 11/03/2022

Fri, 04 Nov 2022 16:54:35 GMT

FINAL 2023 MEDICARE PHYSICIAN FEE SCHEDULE

On Tuesday, the Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements for 2023.

Immediately following, MGMA issued a statement expressing disappointment in the final rule and its negative impact to physician payment, urging Congress to take action to avert the cuts and waive the 4% PAYGO sequestration before the end of the year. Join in #MGMAAdvocacy today by sending a letter to your congressional members imploring them to act swiftly to avert these significant payment cuts!

In the coming weeks, we will release a detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP). Until then, additional information about the final rule is available in the PFS fact sheet and the QPP fact sheet.

MGMA Washington Connection 10/20/2022

Thu, 20 Oct 2022 14:38:37 GMT

COVID-19 public health emergency renewed

The COVID-19 public health emergency (PHE) was renewed again, effective Oct. 13, 2022. This renewal extends the PHE through mid-January 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. The U.S. Department for Health and Human Services has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

To understand what waivers will expire upon the eventual conclusion of the PHE, review MGMA’s Flexibilities and Policy Following the Expiration of the COVID-19 PHE member-exclusive resource.

Join in #MGMAAdvocacy to prevent Medicare payment cuts

With just over two months left in 2022, MGMA needs your help urging Congress to take action to avert significant Medicare payment cuts set to take effect in 2023. Send a letter to your members of Congress today encouraging the passage of legislation to avert the 4.5% reduction to the Medicare conversion factor, waive the statutory 4% Pay-As-You-Go sequester, and provide an inflationary update based on the Medicare Economic Index. MGMA Government Affairs’ latest report on Medicare cuts showcases what medical groups around the country have to say about these proposed payment cuts, including how they would significantly disrupt patient access to care, practice operations, and overall investment throughout the healthcare industry.

The time to act is now! Join in #MGMAAdvocacy today by sending a letter to your members of Congress urging for the swift passage of legislation to avert these significant payment cuts!

Available now: MGMA's '22 Annual Regulatory Burden Report

Last week, the MGMA Government Affairs team released its 2022 Annual Regulatory Burden Report. With responses from over 500 medical group practices, the survey findings demonstrate the impact that increasing regulatory burden has on practices. An overwhelming majority (89%) of respondents reported that the overall regulatory burden on their medical practice has increased over the past 12 months. And an even greater number of respondents (97%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

Thank you again to all of our members who participated in this survey! For more information about how to engage in current advocacy efforts, please visit the MGMA Advocacy webpage.

MGMA Washington Connection 09/29/2022

Thu, 29 Sep 2022 13:51:28 GMT

Next week: New information blocking requirements take effect

Beginning on and after Oct. 6, 2022, a medical group must respond to a request to access, exchange, or use electronic health information (EHI) more broadly to the extent that EHI would be included in a designated record set that is defined in HIPAA, unless any of eight exceptions can be applied. The new definition of EHI includes medical records, billing records, payment and claims records, case management records, and other records used, in whole or in part, by a medical group to make decisions about individuals. Until Oct. 6, the definition of EHI remains narrower in scope.

For more information on the information blocking requirements, download MGMA’s member-exclusive Information Blocking Toolkit. MGMA is urging U.S. Department of Health and Human Services Secretary Becerra to postpone information blocking deadlines for one year and asking for additional clarity on requirements.

Reporting deadline Friday: Provider Relief Fund

Medical practices that received Provider Relief Fund (PRF) assistance exceeding $10,000, in aggregate, from Jan. 1, 2021, through June 30, 2021 (RP3), must report on their use of funds by tomorrow, Sept. 30, 2022 at 11:59 p.m. ET. The next reporting period (RP4) opens Jan. 1, 2023.

Those impacted by Hurricane Ian will be allowed the opportunity to submit a request to report late due to extenuating circumstances. For more information related to reporting requirements and auditing, visit the Health Resources & Services Administration (HRSA)’s FAQs. For all other questions related to reporting, call the Provider Support Line at 866-569-3522.

Promoting interoperability deadline fast approaching

The last day to start a 90-day reporting period under the Promoting Interoperability (PI) performance category for the Merit-based Incentive Payment System (MIPS) is Oct. 3, 2022. The PI program requirements include a set of objectives and measures that focus on patient access to health information and electronic exchange of information that is worth 25% of an eligible clinician or group’s MIPS final score, and requires a minimum continuous 90-day reporting period during the calendar year. In addition to this, providers must use the appropriate edition of Certified Electronic Health Record Technology (CEHRT) and attest to required objectives and measures for the required EHR reporting period.

To learn more about the 2022 MIPS PI performance category, please review this guide from the Centers for Medicare & Medicaid Services.

National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience

Tue, 27 Sep 2022 20:46:20 GMT

The National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience will soon publish a National Plan for Health Workforce Well-Being on October 3. The imminent launch of the National Plan will allow leaders in health care and public health, government, payers, health IT, education, professional societies, and health workers to use the National Plan to cultivate a health system to better support our care providers and patient care.

Register to attend the launch event in person in Washington, DC, or virtually on Monday, October 3, 10:00 am-12:00 pm ET: bit.ly/NationalPlanLaunchEvent.

The free event, co-hosted by the NAM, Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges, will describe how the newly published Plan will address the needs of the health workforce, and share leaders’ commitments to building momentum for a health workforce well-being movement.

Note the complete written plan will be accessible on 10/3 at nam.edu/NationalPlan.

For more information on the Clinician Well-Being Collaborative, visit nam.edu/CW. Join our listserv to receive updates: bit.ly/NAMListserv.

MGMA Washington Connection 09/15/2022

Thu, 15 Sep 2022 13:00:53 GMT

House passes MGMA-supported prior authorization legislation

Yesterday, the House of Representatives passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). This MGMA-supported bill is a step forward in reforming prior authorization practices within the Medicare Advantage (MA) program. In part, the legislation would increase transparency around MA prior authorization, establish an electronic prior authorization program, and streamline the prior authorization process for routinely approved items and services.

Keep the momentum going by contacting your senators and urging the swift passage of S. 3018. Medical practices can use MGMA’s Contact Congress portal to send letters today!

MGMA sends year-end legislative priorities to Congress

On Monday, MGMA sent a letter to congressional leadership outlining the legislative priorities that we would like addressed before the end of the year. Before 2023, MGMA urges Congress to mitigate cuts to Medicare reimbursement slated to take effect on January 1, extend telehealth flexibilities, reform prior authorization practices, and support value-based care.

Congress has since taken steps to address the Medicare cuts — the House of Representatives introduced the Supporting Medicare Providers Act of 2022 on Tuesday, which would avert almost 4.5% of the projected 8.5% cuts. MGMA supports this legislation, but calls on Congress to fully avert cuts to Medicare stemming from the 4% statutory Pay-As-You-Go (PAYGO) sequester and provide an inflationary updated based on the Medicare Economic Index.

MGMA Government Affairs at MPE: Leaders Conference

MGMA’s annual Medical Practice Excellence (MPE): Leaders Conference is less than a month away. Register now to join us in Boston and attend one of our "Washington Update" sessions, during which the Government Affairs team will share insights on current federal policy developments impacting medical practice operations. We'll delve into upcoming Medicare payment and quality rules, the status of surprise billing and transparency requirements, information blocking, and other key regulatory changes to come in 2023.

Mark your calendars today for either of the below sessions and be sure to compare prepared with your questions!

Monday, Oct. 10 at 9:15 - 10:15 a.m. ET
Tuesday, Oct. 11 at 2:45 - 3:45 p.m. ET

MGMA Washington Connection 09/08/2022

Fri, 09 Sep 2022 03:03:18 GMT

MGMA provides feedback to CMS in response to the 2023 Medicare PFS

On Tuesday, Sept. 6, MGMA provided comprehensive feedback to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed 2023 Medicare Physician Fee Schedule (PFS). MGMA urges CMS to make important adjustments to the proposed policies to support medical group practices going into 2023, including updating the Medicare conversion factor to avert a 4.5% reduction in payment and adjusting certain reporting requirements under the Merit-based Incentive Payment System. In the coming weeks, MGMA will launch an advocacy campaign to avert these cuts.

The agency will review comments submitted by stakeholders before issuing the final rule in November. Following the release of the final rule, MGMA will provide an in-depth analysis of the 2023 Medicare policies.

Support prior authorization reform

With only a few months left in the 117^th Congress, it is time to voice your support for prior authorization reform! MGMA Government Affairs drafted a template letter that you can send directly to your members of Congress today. The letter urges Congress to pass the Improving Seniors’ Timely Access to Care Act, which puts commonsense guardrails around prior authorization processes in the Medicare Advantage program. With your help, MGMA hopes to see this legislation pass into law by the end of the year!

Final Reminder: Regulatory burden questionnaire closes Sept. 9

MGMA needs your feedback - complete the Annual Regulatory Burden Questionnaire by tomorrow, Friday, Sept. 9!

This annual research project is your opportunity to provide critical feedback on the impact that federal programs have on your practice. The findings of this research will guide MGMA's advocacy efforts in Washington, D.C., to improve the regulatory landscape in which group practices operate, including critical policies related to prior authorization, surprise billing, and the Quality Payment Program.

MGMA Washington Connection 08/18/2022

Thu, 18 Aug 2022 13:55:20 GMT

HHS expected to renew COVID-19 PHE in October

MGMA expects the U.S. Department of Health and Human Services (HHS) to renew the COVID-19 public health emergency (PHE) in October, since the 60-day notice period passed with no word from the Department. Recently, the Administration reiterated its promise to provide a 60-day notice prior to ending the PHE. If HHS does renew the PHE for an 11^th time, it is expected to be in effect through at least mid-January.

Last week, MGMA wrote to HHS Secretary Becerra, asking him to renew the PHE and provide medical groups at least a 90-days’ notice prior to ending it so they may sufficiently wind down flexibilities that have been in effect for over two years.

MIPS facility-based scoring unavailable in PY 2022

Due to the continued impact of COVID-19 on measure performance under the Hospital Value-Based Purchasing (VBP) program, the Centers for Medicare and Medicaid Services (CMS) announced that facility-based scoring will be unavailable in performance year (PY) 2022 under the Merit-based Incentive Payment System (MIPS). CMS utilizes performance under the Hospital VBP to calculate quality and cost scores under MIPS for facility-based clinicians and groups.

In 2022, affected clinicians must report MIPS quality measures; there are no reporting requirements under the cost performance category. However, CMS notes, that if facility-based clinicians or groups do not have available measures to report, they can submit a MIPS Extreme and Uncontrollable Circumstances Exception application to reweight selected performance categories. Additional information is available in the Quality Payment Program Resource Library.

CMS releases new IDR resources

Yesterday, CMS released new resources related to the federal Independent Dispute Resolution (IDR) process under the No Surprises Act. CMS launched a new page on the surprise billing website, linking helpful IDR resources and common mistakes when submitting a dispute resolution claim. Additionally, the agency published a new technical guidance document for IDR entities which includes additional information about eligibility for the federal IDR process, batching claims, and submission of supplemental information to IDR entities.

While the resources will help practices better understand the IDR claim submission process, MGMA continues to advocate for critical improvements to be made to the IDR portal to streamline the dispute resolution process. Additional resources related to the requirements under the No Surprises Act are available on the MGMA surprise billing issue page.

Has a Health Plan Kicked You Out of its Network?

Mon, 15 Aug 2022 13:33:19 GMT

Has a Health Plan Kicked You Out of its Network?
TMA Wants to Know About It as Well as Your IDR Experience

Several TMA members recently reported that health insurance plans issued network termination letters to several practices and physicians. It appears that hospital-based physicians are the primary targets of these actions. Some members received follow-up letters from the health plans offering to reinstate them into the networks only if they agree to deep cuts in reimbursement for their services.

If this is happening to TMA members, TMA would like a copy of the termination letter. TMA plans to share the letters with the Centers for Medicare and Medicaid Services (CMS). The Secretary of Health and Human Services has authority under the No Surprises Act to study the effect of the Act on access to medical services. Additionally, the Government Accountability Office (GAO) is tasked with submitting a report on the effects of the Act with respect to provider networks, fee schedules, contracted rates, and amounts of health care services. Let us know as well the impact in terms of reduction in reimbursement the health plans’ actions have on your practice.

TMA is also interested in submitting member feedback from physicians or practices which have participated in the independent dispute resolution process pursuant to the No Surprises Act. Please share your experiences with us.

Please submit letters and feedback to Tabitha Lara, TMA’s Director of Insurance Affairs, by email Tabitha.Lara@tnmed.org, or by mail to Tennessee Medical Association, Attention: Tabitha Lara, 701 Bradford Avenue, Nashville, TN 37204, as soon as possible. Any information submitted will be first be redacted so that no practice or physician identifying information will be shared with any agency of the federal government.

MGMA Washington Connection 08/11/2022

Thu, 11 Aug 2022 15:57:02 GMT

Inflation Reduction Act slated to pass tomorrow

On Sunday, the U.S. Senate passed the Inflation Reduction Act of 2022 (IRA) by a 51-50 vote, with the Vice President breaking the tie. This legislation would, for the first time, provide the U.S. Department of Health and Human Services (HHS) Secretary the authority to negotiate the cost of certain drugs in the Medicare program and establish an annual out-of-pocket cap of $2,000 for Medicare beneficiaries. Price negotiation would first apply to 10 high-cost drugs under Medicare Part D in 2026, later expanding to certain high-cost physician administered drugs under Medicare Part B in 2028. In addition to updates to prescription drug policy, the IRA would also extend expiring tax subsidies under the Affordable Care Act and invest over $400 billion to address climate change.

The bill heads to the House tomorrow, Friday, August 12; pending its passage, the legislation is expected to then be immediately signed into law by the President.

Join MGMA in a GovChat Live on August 23

The MGMA Government Affairs team is hosting a GovChat live on Tuesday, August 23, from 2:00 – 3:00 p.m. (ET). During this member-exclusive discussion, the team will provide a high-level overview of policies included in the 2023 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) proposed rule. MGMA will be seeking feedback from members to help inform our comments in response to the policy proposals and will answer questions during the interactive discussion.

Registration information is available on the MGMA GovChat Community page. Additionally, we encourage you to review our member-exclusive key takeaway analysis of the 2023 PFS and QPP proposed rule if you haven't done so yet. Please reach out to the Government Affairs team at govaff@mgma.org with any questions.

Post-pandemic flexibilities resource available now

Since January 2020, the HHS Secretary has determined that a public health emergency (PHE) has been in effect due to the COVID-19 pandemic. Under the declared PHE, HHS has the authority to waive certain program requirements, however, following the termination of the PHE, many of these flexibilities will expire. MGMA has published a member-exclusive resource highlighting key flexibilities that will expire after the end of the COVID-19 PHE to help practices prepare for policy changes post-pandemic.

The COVID-19 PHE is currently in effect through October 13, 2022, and MGMA anticipates HHS will again renew the PHE at that time.

MGMA Washington Connection 06/30/2022

Thu, 30 Jun 2022 14:43:01 GMT

CMS announces new oncology payment model

On June 27, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced the Enhancing Oncology Model (EOM), a new oncology payment model. Building off of lessons learned in previous oncology models, the EOM will be a nation-wide, episode-based payment model focused on patient-centered care delivery. Expected to launch in July 2023, the EOM request for applications is now open through September 30, 2022.

This episode-based payment model will include seven cancer types: breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer. Group practices that participate will be accountable for total spending during six-month episodes of care, and will be required to provide certain patient care enhancement benefits, including care planning and access to 24/7 care. More information is available on the EOM model website.

Updated resource highlights language access requirements

MGMA recently updated a key member resource outlining language access requirements for group practices. This resource reflects updates made in a 2020 final rule making changes to patient protections against discrimination in health programs and activities under Section 1557 of the Affordable Care Act. Please note, no changes to the language access requirements have been made since the 2020 final rule.

These updates include the four factor analysis the Office of Civil Rights (OCR) will use to determine if “meaningful access” is provided to limited English proficiency patients. In the 2020 final rule, OCR eliminated tagline requirements for all documentation, and instead, OCR will apply the four-factor standard to ensure taglines are provided to achieve “meaningful access.”

MGMA Washington Connection 06/23/2022

Thu, 23 Jun 2022 13:42:04 GMT

Final Reminder: Avert projected 7-10% Medicare payment cuts

The Medicare member research questionnaire to support #MGMAAdvocacy in averting potential significant payment cuts to Medicare in 2023 closes on Friday, June 24.

In 2023, group practices are facing potential 7-10% cuts to Medicare payment rates, compared to Jan. 1, 2022, reimbursement amounts. After two years of financial uncertainty caused by the COVID-19 pandemic, the projected payment cuts will have long-term resounding impacts on practice financial sustainability. MGMA needs to hear from you! If you haven't done so already, complete the questionnaire today!

Full Medicare sequester phase-in begins July 1

On July 1, 2022, the full 2% Medicare sequester is set to phase-in. The Medicare sequester, which has been in effect since 2013, was suspended at the beginning of the pandemic through March 31, 2022. On April 1, 1% of the full 2% sequestration was reintroduced, and on July 1, an additional 1% will phase-in, signaling the complete reintroduction of the Medicare sequestration. The 2% sequester will apply to care with dates of service on or after July 1.

Earlier this year, MGMA and other national healthcare organizations sent a letter to Congress urging for a continuation of the moratorium on the Medicare sequester for the duration of the declared COVID-19 public health emergency.

Deadline to register for CAHPS for MIPS survey is June 30

The deadline for groups and virtual groups to register for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey closes on June 30, 2022, at 8 p.m. (ET). The CAHPS for MIPS survey is an optional quality measure that groups, virtual groups, and alternative payment model (APM) entities can report. The CAHPS for MIPS survey is a required measure for groups and APM entities reporting via the APM Performance Pathway.

More information, including the approved list of survey vendors, is available in the 2022 CAHPS for MIPS fact sheet.

MGMA Washington Connection 06/16/2022

Thu, 16 Jun 2022 22:06:21 GMT

New telehealth guidance from HHS in preparation for PHE expiration

The U.S. Department of Health and Human Services (HHS) released new guidance this week surrounding telehealth and HIPAA compliance following the eventual conclusion of the COVID-19 public health emergency (PHE). Throughout the pandemic, the Department instituted various flexibilities tied to the PHE that waive many of the generally applicable rules governing Medicare telehealth services. While largely not new information, HHS’ guidance does provide helpful clarifications surrounding when the Office for Civil Rights will stop utilizing enforcement discretion, as well as important clarifications on audio-only telehealth visits which were not reimbursable under Medicare prior to the pandemic.

Of note, HIPAA enforcement discretion was not one of the waivers extended by Congress for five months following the conclusion of the PHE. In an effort to ensure medical groups are aware of their obligations immediately following the expiration of the PHE, MGMA Government Affairs will soon release a member-exclusive resource outlining the reintroduction of HIPAA requirements for audio-visual and audio-only telehealth services.

MGMA provides recommendations to HHS on provisions of the HITECH Act

Last week, MGMA provided feedback to HHS Secretary Becerra in response to the Department’s request for information on certain provisions from the Health Information Technology for Economic and Clinical Health (HITECH) Act. With cybersecurity attacks on healthcare organizations escalating in recent years, medical groups have had to become more vigilant and take increased precautions to protect themselves and the patients they treat.

MGMA applauds HHS for engaging with stakeholders to better understand what recognized and effective cybersecurity practices medical groups have voluntarily implemented and offers the following recommendations as the Department considers future cybersecurity regulations:

Offer flexibility to medical groups surrounding which security programs they implement;
Provide best practices and frameworks to help medical groups as they implement acknowledged cybersecurity policies into their practices; and
Take steps to prevent unnecessary confusion and burden by considering other rules and policies impacting medical groups while developing additional regulations.

Additional education opportunities needed on information blocking

On Monday, MGMA and other leading healthcare organizations wrote to HHS Secretary Becerra urging that the Office of the National Coordinator (ONC) for Health Information Technology, Office of the Inspector General, and Centers for Medicare & Medicaid Services, work collectively to provide additional educational opportunities and content — including best practices and implementation guides — for medical groups surrounding the implementation and enforcement of information blocking requirements. The letter also requests that the agencies provide medical groups with warning communications that include corrective action steps prior to imposing any penalties related to information blocking adjudication.

More information about information blocking requirements, including FAQs and webinars, may be found on the ONC’s website

MGMA Washington Connection 05/26/2022

Thu, 26 May 2022 13:45:56 GMT

CMS to launch MIPS final score preview

The Centers for Medicare and Medicaid Services (CMS) announced a new performance feedback process for the Merit-based Incentive Payment System (MIPS). MIPS clinicians will now be able to preview final 2021 MIPS scores in June prior to the publication of final MIPS scores and payment adjustments. During the preview period, clinicians will be able to review the data used to calculate their highest attributed final score and the data used to calculate the scores. The final score preview period will not include payment adjustment information.

With the introduction and review of MIPS scores, CMS hopes to address any potential scoring issues prior to calculating payment adjustments. More information about the MIPS performance, scoring, and payment adjustment can be found on the Quality Payment Program website.

Real-world examples needed on information blocking

MGMA is soliciting feedback from medical groups experiencing information blocking and encountering challenges when requesting patient health information from other actors such as electronic health record (EHR) vendors. Questions to consider: (1) What issues have you experienced when requesting patients’ electronic health information from an EHR vendor? (2) Any functions or features your EHR vendor does not provide to comply with information blocking regulations? (3) Does your practice release lab, diagnostic, or any medical information immediately to patients? If not, what’s the typical timeframe? (4) Any additional concerns or challenges while complying with information blocking regulations?

If you have examples, please email MGMA Associate Director of Government Affairs Swapna Pachauri at spachauri@mgma.org by Thursday, June 16. Any information you provide will be kept confidential and will be deidentified as MGMA continues to engage with the Department of Health and Human Services to advocate for more flexibility and clarity regarding the rules.

MGMA to Congress: Refine LDT legislation

MGMA and 70 leading health organizations wrote to Congress this week urging for more time to refine the VALID Act before passing it into law. The VALID Act, as written, contains language that would change the way laboratory developed tests (LDTs) are regulated.

MGMA is concerned that the legislation as drafted could potentially unduly restrict access to tests that medical groups deem necessary to care for patients.

MGMA Washington Connection 05/12/2022

Thu, 12 May 2022 13:31:22 GMT

MGMA to Congress: Repeal Patient ID prohibition

MGMA joined with more than 120 healthcare organizationsto urge Congress to repeal Section 510 in the Labor, Health and Human Services, and Education and Related Agencies (Labor-HHS) appropriations bill, which would prohibit the Department of Health and Human Services from spending federal dollars to accept a national unique patient health identifier standard. Patient misidentification is one of the top threats to patient safety and MGMA is requesting that Congress find solutions and identify a national strategy that protects patient privacy in a cost-effective way.

Open Payments pre-publication review ends May 15

The deadline for covered recipients under the Open Payments program to review 2021 data is quickly approaching. Providers covered under the Open Payments program have the opportunity to review and dispute any attributed data until May 15, 2022, prior to its publication in June 2022. The Centers for Medicare and Medicaid Services (CMS) have published additional resources to assist providers in reviewing Open Payments data.

The goal of the Open Payments program is to increase transparency and accountability. For additional information about Open Payments, and to understand providers that qualify as covered recipients, please visit the CMS Open Payments website.

MGMA Washington Connection 04/07/2022

Thu, 07 Apr 2022 13:16:28 GMT

Update: If missed deadline, complete PRF reporting by April 22

Due in large part to #MGMAAdvocacy, the Health Resources & Services Administration (HRSA) will allow medical groups who missed the Provider Relief Fund (PRF) reporting deadline to submit a “Request to Report Late Due to Extenuating Circumstances for Reporting Period 1” between April 11 and April 22, 2022, at 11:59 p.m. ET. Physician practices should receive information about how to submit a request directly from HRSA via email. Recipients must attest to an extenuating circumstance, examples of which are listed in the linked guidance above.

If HRSA approves the extenuated circumstances form, you will receive a notification to proceed with completing PRF Period 1 reporting shortly thereafter. Providers will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal.

New surprise billing FAQ released

The Centers for Medicare and Medicaid Services (CMS) released a new FAQ document providing additional information about the uninsured and self-pay good faith estimate (GFE) requirements. These new policies went into effect on Jan. 1, 2022, and were implemented under the No Surprises Act.

MGMA is encouraged by the continued engagement from CMS to provide necessary clarifications; however, we are continuing to advocate for additional guidance and education to ensure all practices have the information necessary to comply with the requirements.

Open Payments pre-publication review deadline May 15

Covered recipients under the Open Payments program can now review 2021 data through May 15, 2022. Providers covered under the Open Payment program have the opportunity to review and dispute any attributed data prior to its publication in June 2022.

The goal of the Open Payments program is to increase transparency and accountability. Additional information about Open Payments and to understand providers that qualify as covered recipients is available on the CMS Open Payments website.

MGMA Washington Connection 03/31/2022

Thu, 31 Mar 2022 13:05:48 GMT

MGMA submits comments on prior authorization automation

Last week, MGMA submitted comments to the Office of the National Coordinator (ONC) on electronic prior authorization (ePA). Within the comments, MGMA outlines key recommendations and considerations including its primary goal of reducing the number and frequency of PA, noting that without addressing broader PA, automation could simply increase PA.

While reiterating support for ONC's goal to advance ePA, MGMA also encourages ONC, as well as the Centers for Medicare & Medicaid Services (CMS), to identify and consider other areas of reform. MGMA believes that the burden associated with PA could be reduced through automation, but only if implemented appropriately. Proper implementation includes robust piloting and testing, as well as ensuring an appropriate timeline for implementation. It also includes ensuring there are adequate guardrails in place.

PA requirements continue to increase year after year. To get involved in #MGMAAdvocacy on the matter, send a template letter to Congress advocating for commonsense PA reforms in the Medicare Advantage program!

President Biden releases FY 2023 budget request

On Monday, President Biden released his $5.8 trillion budget proposal for fiscal year (FY) 2023, which included several healthcare related policies that would support the temporary expansion of telehealth, bolster access to behavioral health, and make investments for future pandemic preparedness. The FY 2023 budget also includes a proposal to cut the nation’s deficit by $1.3 trillion from last year.

Presidential budgets do not have the force of law and are intended to serve as statements of administrative priorities, while Congress negotiates the budget. MGMA will continue to advocate on behalf of our members throughout the budget negotiation process.

MGMA to CMS: Improving health equity within value-based care

Yesterday, MGMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) providing feedback to the agency on how to support practices in value-based care arrangements and improve health equity. CMS recently hosted a roundtable discussion with leaders across the healthcare industry to identify how CMS can support safety net providers participating in payment models.

Within the comments, MGMA recommended CMS expand the definition of safety net to include small and rural practices, as they similarly provide critical care to sicker, poorer, and disadvantaged patient populations. Extending support within value-based care to these practice types will help CMS achieve their goal to improve health equity within the healthcare system.

MGMA Washington Connection 03/25/2022

Fri, 25 Mar 2022 02:08:01 GMT

COVID-19-era Uninsured Program runs out of funds

The Health Resources & Services Administration (HRSA) is no longer accepting COVID-19 testing and treatment claims — and will soon stop accepting vaccination claims — made under the Uninsured Program due to lack of sufficient funds. The Uninsured Program was established during the pandemic to provide claims reimbursement to healthcare providers generally at Medicare rates for testing uninsured individuals for COVID-19, treating uninsured individuals with a positive COVID-19 diagnosis, as well as administering COVID-19 vaccines to uninsured individuals.

Claims submitted prior to the below deadlines will be paid subject to the availability of funds:

On March 22, 2022 at 11:59 p.m. ET, the Uninsured Program stopped accepting claims for testing and treatment

On April 5, 2022 at 11:59 p.m. ET, the Uninsured Program will also stop accepting vaccination claims

2021 MIPS data reporting period ends March 31

The data reporting period for the Merit-based Incentive Payment System (MIPS) 2021 performance year closes on March 31, 2022. Eligible clinicians must submit all data through the Quality Payment Program (QPP) website prior to the deadline. The Centers for Medicare and Medicaid Services (CMS) will calculate final scores that will be used to apply the appropriate MIPS payment adjustment in CY 2023.

For the 2021 performance year, CMS is applying the automatic Extreme and Uncontrollable Circumstances (EUC) policy to individual MIPS clinicians and has reopened the EUC application for groups, virtual groups, and Alternative Payment Model entities through March 31. Under the EUC policy, clinicians that have all performance categories reweighted will receive a neutral payment adjustment in CY 2023. More information is available on the QPP website.

Telehealth waivers extended 5 months past PHE conclusion

On March 15, 2022, President Biden signed the $1.5 trillion omnibus spending package into law, which extended certain telehealth flexibilities related to the COVID-19 public health emergency (PHE). A handful of PHE-related waivers will be in effect for an additional 151 days following the conclusion of the PHE, including the ability to treat patients virtually in their homes.

An overview of the PHE-related telehealth waivers — including those extended by the omnibus — may be found in MGMA’s updated Medicare Telehealth Waivers resource.

MGMA Washington Connection 03/02/2022

Thu, 03 Mar 2022 21:45:19 GMT

MGMA to Congress: Extend Medicare sequester moratorium

Last Friday, MGMA and 50 other leading healthcare organizations sent a letter to Congress urging for an extension of the 2% Medicare sequester moratorium that has been in effect since 2020. Specifically, the letter asks that they extend the full moratorium for the duration of the COVID-19 public health emergency (PHE).

Without this extension, the Medicare sequester will phase in at 1% this April and return to the full 2% this July. Prior to the COVID-19 pandemic, the 2% Medicare sequester was in effect for almost a decade. It is unlikely that the moratorium will last indefinitely — instead, it will most likely require greater reform.

Court rules against HHS in surprise billing case

On Feb. 23, 2022, a federal court in Texas issued a ruling in one of the surprise billing cases filed against the U.S. Department of Health and Human Services (HHS). In this ruling, the court invalidated certain aspects of the federal independent dispute resolution (IDR) process — specifically, the requirement that the median in-network rate would be the assumed out-of-network rate for all payment disputes.

Additionally, while the federal protections against surprise billing took effect on Jan. 1, 2022, the federal IDR portal where providers can initiate an IDR dispute has not been yet been launched. HHS announced that for all disputes for which the negotiation period has expired, providers will have 15 business days following the opening of the federal IDR portal to submit a dispute. More information about surprise billing is available on the MGMA surprise billing page.

CMS reopens MIPS EUC application

The Centers for Medicare & Medicaid Services (CMS) has reopened the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) policy for providers impacted by the COVID-19 pandemic until March 31, 2022.

Eligible groups, virtual groups and APM Entities can request MIPS performance category reweighting for the 2021 performance year. Individual clinicians will still receive automatic reweighting and do not need to submit an EUC application. More information about the CMS MIPS EUC reweighting policy is available on the Quality Payment Program website.

MGMA Washington Connection 02/24/2022

Thu, 24 Feb 2022 16:54:57 GMT

CMS publishes surprise billing state enforcement letters

The Centers for Medicare and Medicaid Services (CMS) has published a comprehensive list of state enforcement letters for the requirements under the No Surprises Act. These state letters, including letters to the District of Columbia and U.S. territories, outline CMS’ current understanding of which surprise billing requirements each state is enforcing and what requirements CMS will enforce.

The letters also outline whether the federal independent dispute resolution and patient-provider dispute resolution processes apply in each state, and under what circumstances. These state-specific letters will help providers determine what governing body oversees their surprise billing requirements. More information about surprise billing is available on the MGMA surprise billing landing page.

Biden administration renews national emergency

President Biden recently announced that the U.S. national emergency declared in March 2020 related to the COVID-19 pandemic will be extended beyond March 1, when it was set to expire. This emergency declaration is separate from the COVID-19 public health emergency (PHE), which was extended through April 16 by U.S. Department of Health and Human Services (HHS) Secretary Becerra. However, the extension of the president’s national emergency declaration is necessary for the HHS Secretary to temporarily waive certain Medicare and Health Insurance Portability And Accountability Act (HIPAA) privacy requirements, such as the telehealth waivers currently in effect.

Join CMS March 9 for webinar on Open Payments

On Wednesday, March 9, from 1:00-1:30 p.m. (ET), CMS is hosting a webinar on the Open Payments program to provide an overview of the data review, dispute, and correction period, and to answer stakeholder questions. Covered recipients will have the opportunity to review data between April 1 and May 15, prior to the publication of 2021 Open Payments data by June 30, 2022.

The goal of the Open Payments program is to increase transparency and accountability. Additional information about Open Payments, including how to understand which providers qualify as covered recipients, is available on the CMS Open Payments website.

MGMA Washington Connection 02/17/2022

Thu, 17 Feb 2022 14:29:20 GMT

MGMA urges Congress to extend QPP-SURS program

The Quality Payment Program Small, Underserved, and Rural Support (QPP-SURS) program provides direct technical assistance to eligible clinicians required to participate in the Merit-based Incentive Payment System (MIPS). However, after five years of providing support to small practices, the program expired on Feb. 15, 2022.

MGMA is urging Congress to extend this critical program through the passage of the SURS Extension Act to ensure practices of all sizes have the resources available to succeed in the MIPS program. Join #MGMAAdvocacy by sending a letter to your congressional representatives today urging for the extension of the QPP-SURS program.

Register now for GovChat Live on good faith estimate mandates

Join MGMA Government Affairs in a GovChat Live on Tuesday, March 1 at 1 p.m. (ET), to have your questions answered and hear about MGMA advocacy related to the uninsured or self-pay good faith estimate (GFE) mandates, which took effect on Jan. 1, 2022 as part of the No Surprises Act. The team will discuss the types of providers required to issue uninsured or self-pay GFEs, what information is required to be communicated with patients, and provide an overview of the patient-provider dispute resolution process.

Registration information for the event can be found on MGMA Communities and additional information about the federal surprise billing requirements is available on the MGMA surprise billing landing page.

MGMA to CMS: Fix, don't end, Direct Contracting

MGMA, alongside 221 other leading healthcare organizations, sent a letter to the Centers for Medicare and Medicaid Services (CMS) Innovation Center urging the agency to provide improvements to the Direct Contracting model instead of ending it entirely.

The letter followed criticism from members of Congress of certain model participation tracks. However, MGMA and others maintain that with certain model improvements, Direct Contracting will remain a critical participation option for groups interested in advancing in value-based care arrangements.

MGMA Washington Connection 02/10/2022

Fri, 11 Feb 2022 02:21:43 GMT

MIPS technical assistance program ends Feb. 15

Funding for the Quality Payment Program Small, Underserved, and Rural (QPP-SURS) technical assistance program ends on Feb. 15, 2022. This program supports practices participating in the Merit-based Incentive Payment System (MIPS) by providing guidance in determining MIPS eligibility, submitting data, and transitioning to voluntary participation in alternative payment models (APMs).

MGMA is urging Congress to provide funding for the QPP-SURS program through 2027 to ensure small and rural practices can continue to succeed in the MIPS program. Join #MGMAAdvocacy by sending a letter to your congressional representatives today!

Reminder: Medicare telehealth changes

The Centers for Medicare and Medicaid Services (CMS) recently published an article regarding changes to telehealth billing that were included in the 2022 Medicare Physician Fee Schedule (PFS). The changes mostly cover the expansion of mental telehealth services available following the conclusion of the COVID-19 public health emergency, including the ability to treat patients at home and via audio-only technology if certain conditions are met. The article also includes the two new mental telehealth modifiers – FQ and FR.

For more information on the telehealth changes included in the final 2022 PFS rule, download MGMA’s member-benefit analysis.

Join #MGMAAdvocacy on 2022 priority issues

While the MGMA Government Affairs team works tirelessly in Washington, D.C., advocating on top issues impacting group practices, we need your help to amplify the message to Congress. In less than five minutes you can send a personalized email advocating for change on all of the issues listed below!

Learn more about MGMA federal advocacy, access member-exclusive resources, and find out how you can be involved by visiting the MGMA advocacy webpage.

MGMA Washington Connection 02/03/2022

Thu, 03 Feb 2022 22:16:13 GMT

MGMA to Congress: Support practices in funding legislation

Last Friday, MGMA sent a letter to Congress urging for the following priorities to be considered while they negotiate the upcoming February funding legislation:

Extend Medicare sequester relief beyond March 2022;
Continue telehealth flexibilities through at least CY 2024;
Extend the alternative payment model (APM) 5% bonus;
Update the Qualifying Participant (QP) threshold; and
Delay implementation of the good faith estimate (GFE) and advanced explanation of benefits (AEOB) requirements.

2020 MIPS participation results now available

The Centers for Medicare & Medicaid Services (CMS) has released participation results for the 2020 performance year of the Merit-based Incentive Payment System (MIPS). MIPS participation slightly decreased from 2019 to 2020 and 81% of clinicians received a final score at or above the exceptional performance threshold.

Throughout 2020, many clinicians were significantly impacted by the COVID-19 pandemic, and as a result, CMS provided clinicians with the option to apply for reweighting of all or some MIPS performance categories. In 2020, 26% of participants received reweighting of at least one performance category.

MGMA urges Congress to extend telehealth flexibilities

MGMA and hundreds of other leading organizations wrote to Congress asking for a pathway to comprehensive permanent telehealth reform. At the beginning of the COVID-19 pandemic, Congress and the Administration acted quickly to expand Medicare telehealth, allowing millions of beneficiaries access to virtual care. These flexibilities hinge on whether the COVID-19 public health emergency (PHE) is in effect, leading to uncertainty surrounding how long these waivers will remain.

The letter urges Congress to continue all current telehealth waivers through Dec. 31, 2024, allowing time to collect the necessary evidence needed to support permanent policy.

MGMA Washington Connection 01/27/2022

Thu, 27 Jan 2022 15:39:32 GMT

MGMA to HHS: Delay good faith estimate mandate

In a letter sent yesterday, MGMA urged the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to use their enforcement discretion and delay implementation of the uninsured or self-pay good faith estimate (GFE) requirements until practices have had appropriate time to understand and implement the requirements.

Passed as part of the No Surprises Act, these GFE requirements took effect on Jan. 1, 2022. Additional information about the No Surprises Act and member-exclusive resources are available on the MGMA surprise billing landing page.

OSHA withdraws COVID-19 vaccination and testing ETS

Following a U.S. Supreme Court ruling, the Occupational Safety and Health Administration (OSHA) published an announcement that it is withdrawing its COVID-19 vaccination and testing emergency temporary standard (ETS).

Although OSHA is withdrawing the ETS, the agency conveyed its intention to pursue future action on COVID-19 workplace safety down the road.

HRSA announces $2 billion in Provider Relief Fund assistance

On Tuesday, the HHS, through the Health Resources and Services Administration (HRSA), announced it will make $2 billion in Provider Relief Fund (PRF) Phase 4 payments this week. More than 7,600 providers nationwide should receive these funds, which are based on lost revenues and expenses due to COVID-19. Medical groups must have previously applied for relief funds.

For more information on the PRF, visit HRSA’s PRF landing page.

MGMA Washington Connection 01/20/2022

Thu, 20 Jan 2022 14:39:20 GMT

MGMA releases 2022 Advocacy Agenda

As we enter a new year, MGMA continues to ensure the voice of medical groups is heard in Washington. Our 2022 Advocacy Agenda outlines key federal issues we are tackling, such as protecting the financial viability for medical group practices, improving the implementation of surprise billing requirements, and advancing value-based care.

Follow the MGMA Government Affairs team on Twitter for updates on the latest #MGMAAdvocacy efforts this year:

@AndersGilberg, @ClaireErnstJD, @KelseyMHaag, and @EmilyRDowsett.

HHS renews COVID-19 PHE

The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective Jan. 16, 2022. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90-days. In a letter to HHS, MGMA called on the Department to expeditiously renew the PHE to ensure groups practices can continue to leverage existing critical flexibilities as they continue to respond on the frontlines of the pandemic.

Unless further extended, the current PHE will lapse on April 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide a 60-day notice prior to allowing the COVID-19 PHE to lapse.

Provider Relief Fund portal open for 'Period 2' reporting

Medical groups who received Provider Relief Fund (PRF) payments exceeding $10,000 in the aggregate from July 1, 2020 to Dec. 31, 2020 (‘Period 2’) can now report on the use of those funds. Providers have until March 31 to complete the reporting.

Additionally, the Health Resources and Services Administration released new reporting resources specific to ‘Period 2,' which can be accessed here.

COVID-19 Vaccine Mandate Alert: Supreme Court blocks OSHA ETS, allows CMS facilities rule

Thu, 13 Jan 2022 21:33:51 GMT

Today, the U.S. Supreme Court ruled on both the Occupational Safety and Health Administration (OSHA) vaccination and testing emergency temporary standard (ETS) and the Centers for Medicare & Medicaid Services (CMS) facilities rule. The Supreme Court blocked the OSHA ETS, which would have required workers of large employers (100+ employees) to get vaccinated or tested weekly for COVID-19. The CMS facilities rule, which would require vaccination of healthcare employees in facilities that receive Medicare and Medicaid payments, is allowed to move forward nationally. The CMS facilities rule generally does not apply to physician practices, although some might be subjected to it based on how they are structured.

The OSHA ETS opinion can be viewed here.

The CMS facilities rule opinion can be viewed here.

The CMS facilities rule FAQs can be viewed here.

MGMA Washington Connection 01/06/2022

Thu, 06 Jan 2022 15:17:33 GMT

MGMA successfully advocates for sunsetting of healthcare ETS

On Dec. 27, 2021, the Occupational Safety and Health Administration (OSHA) issued a statement on the status of its COVID-19 healthcare emergency temporary standard (ETS), confirming that it is withdrawing the ETS with the exception of the recordkeeping portions.

Last August, MGMA urged OSHA to not make this standard permanent, due to it disrupting ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. Although OSHA is letting this ETS sunset, it expressed its intentions to revisit the issue of protecting healthcare workers from COVID-19 in the future by issuing another standard. MGMA will urge the Agency to solicit input from stakeholders, such as medical groups, when developing such a standard.

Updated member resources to navigate surprise billing

On Jan. 1, 2022, the No Surprises Act requirements prohibiting certain out-of-network balance billing and new uninsured (or self-pay) good faith estimate price transparency requirements took effect. Throughout 2021, the Biden Administration released several rules implementing these newly effective requirements. The Administration will continue to release additional rules throughout 2022 outlining the remaining patient protections that have not yet been implemented.

The MGMA Government Affairs team has updated member-exclusive resources to help group practices better understand the requirements in place. Check out the most up-to-date resources on the MGMA Surprise Billing landing page.

MIPS 2021 data submission window open

Clinicians can now submit and review data for the 2021 performance year for the Merit-based Incentive Payment System (MIPS). The data submission window closes on March 31, 2022 at 8 p.m. (ET). The Centers for Medicare and Medicaid Services provided several flexibilities for clinicians due to the COVID-19 public health emergency, including applying an automatic reweighting of performance scores for individual clinicians.

In other MIPS updates: on Jan 1. 2022, the 2022 payment adjustment, based on clinician 2020 MIPS performance scores took effect and will be applied to Part B covered services. Additionally, looking ahead to the 2022 performance year, clinicians can now review their preliminary MIPS eligibility by signing into the Quality Payment Program website

MGMA Washington Connection 12/16/2021

Fri, 17 Dec 2021 15:59:02 GMT

MGMA to HHS: Provide flexibilities for surprise billing requirements

In a letter to the U.S. Department of Health and Human Services (HHS), MGMA called for additional flexibilities for group practices as new surprise billing requirements are implemented on Jan. 1, 2022. The final rules implementing requirements related to surprise billing were released less than three months before their effective date, not allowing practices sufficient time to understand and implement new workflows in compliance with these new requirements.

MGMA recently published a surprise billing FAQ and launched a new surprise billing landing page containing member-exclusive resources, advocacy materials, and federal resources to help guide practices as they begin complying with the new requirements in the new year.

Dec. 31: Upcoming MIPS deadlines

As 2021 comes to a close, clinicians must prepare for the upcoming deadlines for the Merit-based Incentive Payment System (MIPS) program. There are two key deadlines on Dec. 31, 2021:

EUC Application deadline for groups, virtual groups and APM entities, and
Virtual group election for PY 2022

While the automatic and extreme and uncontrollable circumstances (EUC) policy applies to individual MIPS clinicians due to the COVID-19 pandemic, groups, virtual groups, and APM entities must apply to have performance categories reweighted for PY 2021. Virtual group election must be made before the start of PY 2022. More information about both of these deadlines may be found on the Quality Payment Program website.

MGMA Washington Connection 12/02/2021

Thu, 02 Dec 2021 22:41:46 GMT

MGMA to Congress: Prevent cuts to Medicare in CY 2022

On Monday, MGMA and hundreds of other healthcare organizations sent a letter to congressional leadership urging them to address the cuts to Medicare reimbursement slated to take effect Jan. 1, 2022. More specifically, the groups asked Congress to extend the 3.75% payment adjustment through at least CY 2022. Last year, Congress appropriated funds to the Medicare physician fee schedule (PFS) to mitigate cuts stemming from payment policy changes that went into effect in CY 2021. That 3.75% increase to the PFS expires at the end of this year. MGMA will soon share resources and grassroots letters addressing these impending cuts for members to engage in #MGMAAdvocacy! The letter may be viewed here.

MGMA to Congress: Prevent cuts to labs in CY 2022

This week, MGMA and two dozen other leading healthcare organizations wrote to Congress asking to extend the hold on laboratory payment cuts and the private payer data reporting period under the Clinical Laboratory Fee Schedule (CLFS) for a year. In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) with the goal of giving Medicare beneficiaries access to critical health services, such as laboratory tests. The way that the U.S. Department of Health and Human Services implemented PAMA led to severe cuts to laboratories under Medicare. The CARES Act, passed in 2020, delayed the implementation of the CLFS cuts in 2021. Without congressional intervention, physician office laboratories could see cuts up to 15% for tests. The letter may be viewed here.

MGMA Washington Connection 11/11/2021

Thu, 11 Nov 2021 15:06:22 GMT

New MGMA vaccine mandate resource

Last week, the Biden administration published new rules pertaining to COVID-19 vaccination and testing. To assist medical groups in navigating these complex mandates, MGMA Government Affairs created a new member-exclusive resource covering both mandates: (1) the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) published an emergency temporary standard (ETS) requiring employers with 100 or more employees to implement a COVID-19 vaccination and testing policy; and (2) the Centers for Medicare & Medicaid Services (CMS) issued an Interim Final Rule (IFR) requiring healthcare workers at facilities participating in Medicare and Medicaid to be fully vaccinated. Both mandates are slated to go into full effect on Jan. 4, 2022, although have already been challenged in court.

Additional information:

New MGMA surprise billing resource

Several federal requirements related to surprise billing and related patient transparency requirements take effect on Jan. 1, 2022. To assist members in implementing these new requirements, MGMA Government Affairs created a member-exclusive resource outlining critical surprise billing policies impacting group practices.

While the federal regulation of balance billing generally only applies to clinicians providing care at in-network facilities, other patient transparency requirements may impact clinicians providing care in group practice settings. MGMA will also be hosting a member-exclusive informational session and answering questions about the new surprise billing requirements later this month. More information will be posted in the member-exclusive Government Affairs Communities page in the coming weeks.

Additional information:

MGMA Washington Connection 11/04/2021

Tue, 09 Nov 2021 21:11:26 GMT

CMS finalizes 2022 Physician Fee Schedule

On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) released the final 2022 Medicare Physician Fee Schedule rule, finalizing changes to physician payment policies, including changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements. Most of the final policies will take effect Jan. 1, 2022. MGMA submitted detailed comments in response to the proposed rule and thanks CMS for incorporating MGMA’s feedback into the final rule.

CY 2022 CF:
- Physician: $33.5983
- Anesthesia: $20.9343

Additional information:
PFS fact sheet
QPP fact sheet
MGMA comments

CMS finalizes 2022 outpatient facility and ambulatory surgical center rule

On Nov. 2, CMS released the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. This rule finalizes CY 2022 OPPS and ASC payment rates and policies, including updates to improve transparency and quality reporting.

Additionally, CMS is finalizing, as proposed, to use CY 2019 claims data for payment rate setting due to the impact of the COVID-19 public health emergency.

Additional information:
OPPS/ASC fact sheet
CMS press release

2021 Annual Regulatory Burden Report Released

Thu, 28 Oct 2021 15:48:45 GMT

This week, the MGMA Government Affairs team released the 2021 Annual Regulatory Burden Report. This annual report captures the impact of federal regulations on medical group practices, and these data points and stories will help drive #MGMAAdvocacy.

With responses from 420 medical group practices, the survey findings demonstrate the impact that increasing regulatory burden has on practices. An overwhelming majority (91%) of respondents reported that the overall regulatory burden on their medical practice has increased over the past 12 months. And an even greater number of respondents (95%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

Thank you to all of our members who participated in this survey! This is only one of many opportunities for members to partner with the Government Affairs team in #MGMAAdvocacy. For more information about how to engage in current advocacy efforts, please visit the MGMA Advocacy webpage.

MGMA Washington Connection 10/21/2021

Thu, 21 Oct 2021 15:35:32 GMT

Prior authorization reform bill introduced in the Senate

Yesterday, the Senate introduced an MGMA-supported bill which would deliver much-needed reform to prior authorization under the Medicare Advantage program. The bipartisan Improving Seniors’ Timely Access to Care Act of 2021 (S. 3018) is the companion bill to the House legislation introduced earlier this year.

As prior authorization continues to rank as one of the most burdensome issues for medical groups year over year, MGMA is committed to working with lawmakers to expedite the passage of this critical legislation.

MGMA engages in advocacy around electronic payments, value-based care, and vaccines

As the voice of medical practices in Washington, D.C., MGMA actively engages with other leading health organizations and coalitions to promote our advocacy agenda. This past week, MGMA joined in advocacy around a variety of pertinent issues, including the electronic funds transfer (EFT) transaction standard, the Medicare Shared Savings Program (MSSP), and COVID-19 vaccine access. Read more about these recent advocacy initiatives below:

• MGMA urged the Centers for Medicare & Medicaid Services (CMS) to affirm providers’ right to receive EFT payments without being forced to pay percentage-based fees for additional services.

• MGMA requested that CMS allow MSSP accountable care organizations to elect pre-pandemic years to set benchmarks for agreements beginning in performance year 2022.

• MGMA encouraged the White House COVID-19 Response Coordinator and U.S. Surgeon General to leverage office-based physicians, including primary care physicians and pediatricians, in the COVID-19 vaccine rollout.

HHS extends COVID-19 Public Health Emergency

The Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective Oct. 18, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90 days.

Unless it is further extended, the current PHE determination will lapse on Jan. 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide the healthcare community with 60 days' notice prior to allowing the PHE to lapse.

MGMA Washington Cconnection 10/14/2021

Fri, 15 Oct 2021 00:13:28 GMT

Help #MGMAAdvocacy prevent cuts to Medicare in 2022!

MGMA has prepared a template letter for members to send to their congressional representatives urging them to prevent Medicare cuts slated to go into effect on Jan. 1, 2022. In July, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the CY 2022 Medicare Physician Fee Schedule (PFS), which included a proposed conversion factor (CF) of 33.5848 (3.75% lower than the CY 2021 CF).

This decrease is attributed to the expiration of a short-term legislative fix that Congress passed at the end of last year to prevent cuts stemming from PFS payment policy updates and corresponding budget neutrality requirements. To prevent cuts to Medicare reimbursement in CY 2022, Congress must act again. Send a letter to your congressional representatives urging them to maintain the 3.75% increase to the conversion factor through at least CYs 2022 and 2023!

Deadline: Apply for Phase 4 Provider Relief funding by Oct. 26

Applications for Phase 4 of the Provider Relief Fund (PRF) General Distribution are due by Oct. 26. This new $17 billion round of funding will be similar to the previous round distributed in Phase 3, which covered up to 88% of reported losses and net changes in operating expenses from patient care from the first half of 2020. However, Phase 4 will focus on lost revenues and changes in operating expenses from July 1, 2020 - March 31, 2021.

Phase 4 will also include new elements specifically focused on equity, including reimbursing smaller providers for their lost revenues and COVID-19 related expenses at a higher rate compared to larger providers and "bonus" payments based on the number of services furnished to patients in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). An additional $8.5 billion Rural Distribution, intended for providers who furnish services to Medicare, Medicaid, and CHIP patients in defined rural areas, is also available for consideration via the same application. For additional details on the PRF, you can reference MGMA's member resource.

MGMA Washington Cconnection 10/07/2021

Thu, 07 Oct 2021 19:37:07 GMT

Surprise billing rule establishes dispute resolution process for patients, providers, and plans

The Office of Personnel Management and the Departments of Health and Human Services (HHS), Labor, and Treasury released the second interim final rule (IFR) implementing provisions of the No Surprises Act. This rule follows prior rulemaking outlining patient protections against surprise medical bills, establishing out-of-pocket limits, and notice and consent requirements.

This rule implements independent dispute resolution (IDR) processes for providers, patients, and health plans and takes effect Jan. 1, 2022. The rule also outlines the process the agencies will use to evaluate and certify IDR entities for the arbitration process.

More information is available on the associated Centers for Medicare & Medicaid Services (CMS) fact sheet and agency press release. As the agencies release additional information, it will be posted on the new CMS surprise billing landing page. Be on the lookout for MGMA’s analysis and comments in response to the second IFR.

New guidance from HHS on HIPAA and COVID-19 vaccination status

HHS, through its Office for Civil Rights, issued new guidance on the relationship between the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and COVID-19 vaccination status in the workplace. This practical guidance serves to help businesses and healthcare entities better understand when the HIPAA Privacy Rule applies to disclosures of vaccination status, particularly as it pertains to employees and patients.

Notably, the guidance is an important reminder that the HIPAA Privacy Rule does not apply to employers because they are not included in the definition of a HIPAA covered entity or business associate.

Members may also wish to consult the MGMA HIPAA landing page for additional resources.

MIPS virtual group election period for PY 2022 now open

The virtual group election process for the 2022 performance year for the Merit-based Incentive Payment System (MIPS) is now open. CMS has published a 2022 Virtual Group Toolkit providing detailed information about the virtual group election and participation process. Virtual group elections must be submitted via email to CMS by Dec. 31, 2021, at 11:59 PM (ET).

More information about MIPS participation options and the virtual group election process is available on the CMS Quality Payment Program website.

MGMA Washington Connection 09/23/21

Thu, 23 Sep 2021 14:14:41 GMT

New Provider Relief funding available next week

The U.S. Department of Health and Human Services (HHS) plans to open applications for a new round of Provider Relief Fund payments totaling $25.5 billion in distributions beginning Sept. 29, 2021. This new funding includes $8.5 billion for providers furnishing services to Medicaid, Children's Health Insurance Program (CHIP), or Medicare patients in defined rural areas, and an additional $17 billion for a Phase 4 General Distribution for providers who can document lost revenue and changes in operating expenses between July 1, 2020, and March 31, 2021. Consideration for both distributions will be determined through a single application on the Health Resources & Services Administration (HRSA) website, and HRSA will use Medicaid, CHIP, and Medicare claims data in the calculation of payments.

As a reminder, HHS is allowing a 60-day grace period following the upcoming Sept. 30 reporting deadline for providers that received greater than $10,000 in Provider Relief funds between April 10 and June 30, 2020. HHS indicated it will not initiate any recoupment or enforcement actions for 60 days following the deadline, allowing for a period of enforcement discretion from Oct. 1 – Nov. 30, 2021. For additional information on the Provider Relief Fund, reference MGMA’s recently updated resource detailing program updates, requirements, and deadlines.

MIPS automatic neutral payment adjustment applies to clinicians impacted by Hurricane Ida

The Centers for Medicare & Medicaid Services announced that certain clinicians participating in the Merit-based Incentive Payment System (MIPS) will automatically receive a neutral payment adjustment for the 2021 performance year/2023 payment year due to the impact of Hurricane Ida. Clinicians located in declared disaster areas, including Louisiana, Mississippi, New York, New Jersey, and Missouri, will automatically have their performance scores across all four MIPS categories reweighted to 0% and receive a neutral payment adjustment in 2023.

However, impacted clinicians can still choose to submit MIPS performance data. If data is submitted for at least two performance categories, the clinician will be scored and have payment adjustments applied in 2023. While the automatic reweighting policy does not apply to groups or virtual groups, these MIPS participants can apply for reweighting of one or more MIPS performance categories.

MGMA Washington Connection 09/09/21

Thu, 09 Sep 2021 13:21:12 GMT

MGMA urges HHS to delay enforcement of surprise billing requirements

MGMA wrote to the U.S. Department of Health and Human Services (HHS) urging the agency to delay the implementation and enforcement of the surprise medical billing requirements. Beginning Jan. 1, 2022, certain providers will be prohibited from balance billing for services provided to out-of-network patients, while other clinician types will be required to provide strict notice and consent documentation before services are rendered in order to seek payment from out-of-network patients. In the letter, MGMA expressed serious concerns regarding the arbitrary and overburdensome requirements for the notice and consent process and fears that it could disrupt clinical care and practice operations. HHS will be releasing additional regulations in the coming months further implementing the ban on surprise billing.

MGMA to Congress: Support the physician workforce

MGMA and other leading healthcare organizations sent a letter to congressional leadership asking to include policies in the budget reconciliation legislation that would increase Medicare support for graduate medical education (GME). These additional positions would alleviate the physician shortage by gradually providing new Medicare-supported GME positions. MGMA members can participate in #MGMAAdvocacy by sending a template letter to their congressional representatives.

Tax credits for paid leave set to expire at end of month

Eligible medical groups have until the end of September to take advantage of the tax credits available to employers to help fund paid FMLA and sick leave for reasons related to COVID-19. The Families First Coronavirus Response Act (FFCRA) provided funds in the form of refundable tax credits to businesses with fewer than 500 employees who offer employees paid FMLA and sick leave under the Act. Although the requirement to offer paid leave under the FFCRA is no longer mandatory, the refundable tax credits are only available to businesses that offer the paid leave. To learn more about the requirements to report qualified sick and family wages, see the updated guidance from the Internal Revenue Services issued this week.

MGMA Washington Connection 08/26/21

Thu, 26 Aug 2021 19:50:23 GMT

MIPS Value Pathways demystified in member exclusive resource

The Centers for Medicare & Medicaid Services introduced seven new Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) for optional reporting beginning in the 2023 performance year. Check out this MGMA member exclusive resource that details the key MVP policy proposals and the proposed reporting pathways included in the CY 2022 Physician Fee Schedule. The goal of this new MIPS alternative is to provide clinicians with more meaningful reporting options through cohesive MVPs specific to physician specialties, patient populations, or clinical conditions. MIPS has caused many administrative challenges for MGMA members and has provided limited financial reward for high performance in the quality reporting program. MGMA will submit comments responding to these proposals and will provide an updated analysis highlighting key policies after the final rule is released in November.

MGMA to HHS: Extend Provider Relief Fund reporting deadline

In a letter to U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, MGMA urged HHS to extend the upcoming Sept. 30 reporting deadline for the Provider Relief Fund (PRF). Per current HHS guidance, recipients of more than $10,000 in the aggregate in PRF payments received between April 10 and June 30, 2020, are required to report their use of funds through the PRF Reporting Portal by Sept. 30, 2021. However, due to the sharp increase in COVID-19 cases across the country coupled with the complex and arduous reporting requirements of the program, MGMA has heard concerns from many practices struggling to complete reporting by the deadline. In addition to requesting an extension of the reporting deadline through 2023, MGMA urged HHS to clarify its existing reporting guidance to address outstanding confusion around acceptable uses of funds and to allow PRF recipients to use payments through the end of the COVID-19 public health emergency.

MGMA to OSHA: Exempt medical groups from new COVID-19 requirements

MGMA submitted written comments in response to the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) COVID-19 healthcare emergency temporary standard (ETS). The ETS places requirements, which are already in effect, on medical groups that are unable or choose not to avail themselves to relevant exemptions. In its comments, MGMA expressed concerns regarding the burdens associated with compliance and recommended that OSHA not make the ETS permanent. As MGMA continues to advocate on this issue, please send any examples of how compliance would be burdensome and/or difficult to MGMA Government Affairs.

MGMA Washington Connection 08/19/21

Thu, 19 Aug 2021 13:35:07 GMT

MGMA to CMS: Prohibit insurers from charging EFT fees

MGMA sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure urging the Agency to use its authority under the Affordable Care Act to prohibit insurers and their payment processing vendors from imposing electronic funds transfer (EFT) fees on medical groups. A recent MGMA Stat poll indicated that 57% of medical groups report being charged fees by health insurers and payment processors to accept reimbursement through EFT direct deposit. This is a dramatic increase from the 26% who reported paying these fees only a year ago. The poll also showed that practices are typically charged 2-3% of the reimbursement amount with no clear value-add. MGMA believes EFT fees are prohibited under current law and will continue to strongly advocate against such predatory business tactics.

#MGMAAdvocacy opportunity: Urge Congress to prevent Medicare cuts in CY 2022!

With more than half of the congressional session behind us, now is the time to ask Congress to support physician practices by avoiding reimbursement cuts in CY 2022. In July, CMS released the proposed rule for the CY 2022 Medicare Physician Fee Schedule. The proposed CY 2022 conversion factor (CF) is 3.75% lower than the current CF because the funds that Congress allocated to the fee schedule to mitigate the projected CY 2021 reimbursement cuts were only for CY 2021. To prevent cuts to Medicare reimbursement in CY 2022, Congress must act before the end of the year. Send a letter to your congressional representatives urging them to maintain the 3.75% increase to the conversion factor through at least CYs 2022 and 2023!

Don’t miss it: CMS and OIG join MGMA in fraud series
part 2

In the second installment of the “Protect your Practice” webinar series, MGMA Government Affairs invites you to register for the second installment of the member-exclusive "Protect your Practice" webinar series on Tuesday, Aug. 31 at 1pm ET. During this session, MGMA will be joined by two of our national partners, the CMS Center for Program Integrity and the Department of Health and Human Services Office of Inspector General (OIG). Practice managers will be equipped with vital information necessary to avoid clinician-recruitment schemes from fraudsters, detect COVID-19-specific fraud and abuse, and will learn about the tools and programs the federal government uses to protect patients, medical practices, and federal healthcare programs.

MGMA Washington Connection 08/12/2021

Thu, 12 Aug 2021 12:54:28 GMT

Biden administration proposes to rescind MFN model

After pushback from MGMA and other industry stakeholders, the U.S. Department of Heath and Human Services (HHS) proposed to withdraw the Trump administration’s Most Favored Nation (MFN) model. The mandatory model would have tied reimbursement for Medicare Part B drugs to prices paid in other countries, resulting in lower reimbursement rates to physician practices. The model and corresponding rule was finalized in late 2020, but blocked by federal judges and subsequently frozen by President Biden. Although HHS proposes to rescind the MFN model, it is clear that the Biden administration and Congress will look for other avenues to curb rising drug prices.

Support advocacy to remove patient cost sharing for CCM services

Join #MGMAAdvocay efforts by sending a template letter to your congressional representative urging for support of the recently introduced legislation to improve patient access to chronic care management (CCM) services. MGMA sent a letter alongside numerous other national stakeholder groups supporting the reintroduction of the Seniors’ Chronic Care Management Improvement Act of 2021. This important legislation would remove the 20% patient co-insurance amount for CCM services, reducing administrative burdens and enabling group practices to utilize these services to better manage the chronic conditions of their patients. Send a letter to your representative today!

Can't miss resource: 2022 Medicare Physician Fee Schedule analysis

The CY 2022 Physician Fee Schedule proposed rule includes many complex policy proposals, and the MGMA member exclusive key takeaway analysis highlights the top policy proposals impacting group practices. This can’t miss resource will help you and your practice understand and anticipate proposed changes to physician payment in CY 2022. The proposed rule includes policy proposals that would update the annual conversion factor, make changes to telehealth covered services, modify the definition of an E/M split (or shared) visit, and introduce the Merit-based Incentive Payment System Value Pathways as a voluntary reporting option for the 2023 performance year. This resource is only the first opportunity to engage with MGMA to understand the changes to physician payment in 2022, so be on the lookout for other key insights and resources from MGMA.

MGMA Washington Connection 07/29/2021

Thu, 29 Jul 2021 15:22:24 GMT

MGMA to Congress: Prevent Medicare cuts in 2022

MGMA and other leading health organizations wrote to Congress urging for a legislative solution to avoid Medicare reimbursement cuts in CY 2022. Specifically, the letter calls for Congress to maintain the 3.75% increase to the Medicare conversion factor through at least CYs 2022 and 2023. Following #MGMAAdvocacy, Congress mitigated the significant cuts slated for CY 2021 by injecting $3 billion into the physician fee schedule, which resulted in a 3.75% increase to the conversion factor. MGMA will continue to work with Congress to avoid further cuts in CY 2022.

Hundreds of stakeholders ask Congress to make telehealth flexibilities permanent

MGMA and hundreds of other stakeholders sent a letter to congressional leadership this week highlighting shared Medicare telehealth reform priorities and voicing concern over the “telehealth cliff,” which would occur once the COVID-19 public health emergency (PHE) ends. In part, the groups asked to permanently remove geographic and originating site restrictions, remove the in-person visit requirement for mental telehealth services, and allow for audio-only reimbursement when clinically appropriate. Currently, most telehealth flexibilities are only in effect through the duration of the COVID-19 PHE. MGMA will continue to engage with Congress and the Administration to craft policies that allow medical practices to leverage telehealth to reach vulnerable patients while maintaining continuity of care.

Tell Congress to support improvements to APMs

Join #MGMAAdvocacy efforts to support recently reintroduced legislation that will make improvements to accountable care organizations (ACOs) and other alternative payment models (APMs) by sending a template letter to your congressional representatives. MGMA worked in tandem with the bill’s cosponsors and other national stakeholder groups to ensure that the Value in Health Care Act would be reintroduced. In addition to modifying and extending the advanced APM bonuses through 2030, the bill would make important modifications to risk adjustment rules and fix the “rural glitch” for ACOs in the Medicare Shared Savings Program. Send a letter to your representatives today!

MGMA expresses support for reintroduced value-based care bill

Thu, 22 Jul 2021 14:02:42 GMT

MGMA joined 13 other national health stakeholder groups in supporting the reintroduction of the Value in Health Care Act, a bipartisan House bill that would help to accelerate the move to value-based care models in the Medicare program. Specifically, the bill would strengthen Medicare accountable care organizations (ACOs) and other alternative payment models (APMs) by:

• Providing a mechanism to receive advanced funding when joining or advancing in an ACO;

• Extending the advanced APM incentive payments for an additional six years through 2030;

• Increasing shared savings rates for ACOs in the Medicare Shared Savings Program (MSSP); and

• Making other technical improvements to MSSP by modifying benchmarks and risk adjustment methodologies.

HHS again renews public health emergency for COVID-19

Thu, 22 Jul 2021 14:02:02 GMT

Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective July 20, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to this determination. As with previous determinations, the renewed PHE will end 90 days after its effective date on Monday, Oct. 18, 2021, unless it is extended further. The Biden Administration has indicated that it intends to continue renewing the COVID-19 PHE at least for the remainder of 2021 and to provide the healthcare community with 60 days' notice prior to allowing the PHE to lapse.

HHS releases regulation banning surprise billing

Thu, 08 Jul 2021 17:20:17 GMT

Last week, the Department of Health and Human Services (HHS) released its first regulation implementing parts of the No Surprises Act, which was passed late last year. This interim final rule is the first of several rules in the surprise billing area that HHS plans to issue over the coming months. The law goes into effect on Jan. 1, 2022.

For more information, review HHS’ fact sheet and the interim final rule. MGMA will release a comprehensive analysis of the rule to members in the coming weeks.

PRF portal open for reporting

Thu, 08 Jul 2021 17:18:43 GMT

As a reminder, the Provider Relief Fund (PRF) Reporting Portal is open for recipients to report on funds (exceeding $10,000 in aggregate) received from April 10, 2020 to June 30, 2020. Providers who received one or more payments exceeding $10,000 in the aggregate during one of the four Payment Received Periods are required to report in each applicable reporting period. Following #MGMAAdvocacy efforts, providers now have 90 days, instead of 30, to report their use of funds. For more information, see MGMA’s updated PRF resource.

Surprise billing regulation released

Thu, 01 Jul 2021 21:39:14 GMT

This afternoon, the Department of Health and Human Services (HHS) released its first regulation implementing provisions of the No Surprises Act. On Dec. 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021, with the goal of protecting patients from receiving surprise medical bills. The law, in part, allows providers and insurers to use an independent dispute resolution (IDR) process when disagreements arise over reimbursement. MGMA was successful in advocating that Congress forbid arbitrators from considering public payer reimbursement rates during the IDR process. The law goes into effect on Jan. 1, 2022.

For more information, review HHS’ fact sheet and the interim final rule. MGMA will release a comprehensive analysis of the rule to members in the coming weeks.

MGMA urges DOL to rescind OSHA Healthcare ETS

Thu, 01 Jul 2021 13:46:55 GMT

Earlier this week, MGMA sent a letter to the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) asking it to rescind or delay its emergency temporary standard (ETS) aimed at protecting workers facing the highest coronavirus hazards — those working in healthcare settings where suspected or confirmed coronavirus patients are treated. MGMA believes the ETS was issued much too late and will disrupt the ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. MGMA hopes that OSHA will rescind the ETS, or at a minimum, delay its effective date until stakeholders have adequate opportunity to provide input on the standard.

2021 APM incentive payment details now available

Thu, 01 Jul 2021 13:44:57 GMT

The Centers for Medicare & Medicaid Services (CMS) announced that 2021 alternative payment model (APM) incentive payment details are now available on the QPP website. After logging in, organizations will be able to see the amount paid for eligible clinicians that achieved qualifying participant (QP) status during the 2019 performance year. Clinicians who were QPs in an advanced APM entity in 2019 should begin receiving a 5% APM incentive payment this month.

No action is required to receive these payments unless CMS is unable to verify a clinician's Medicare billing information. If payment is not received, check the CMS public notice, which indicates the names of clinicians whose billing information could not be verified. Such clinicians will need to verify their Medicare billing information by November 1, 2021, in order to receive their APM incentive payment. For additional information, download CMS' 2021 Learning Resources for QP Status and APM Incentive Payment zip file.

COVID-19 vaccines in medical practices

Thu, 24 Jun 2021 14:08:26 GMT

While COVID-19 cases have slowed considerably in Tennessee, the work is far from over. With fewer than 50% of Tennesseans having received at least one dose of a COVID-19 vaccine, the unknown impact of the upcoming fall respiratory season, increasing variant strains, and booster vaccines likely on the horizon, the TN Department of Health is asking Tennessee’s health care providers to assist with vaccinating Tennesseans at every opportunity. If your practice is already administering COVID-19 vaccines, thank you! If your practice is not, please consider signing up to do so! Our team will walk you through the process. Patients trust you, and your strong recommendation to get vaccinated is critical to protecting Tennesseans from the next surge. Please visit COVID-19 Vaccine Information for Healthcare Providers (tn.gov) For more information on becoming a pandemic vaccine provider, or email vaccine.onboarding@tn.gov to get started in the process. Please help us protect the people of Tennessee!

MGMA expresses support for ACO legislation

Thu, 24 Jun 2021 13:43:01 GMT

MGMA joined 12 leading healthcare organizations in supporting the Accountable Care in Rural America Act, a recently reintroduced bill that addresses the way financial targets are set for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. This piece of legislation would improve the accuracy and fairness in evaluating ACOs by fixing the "rural glitch," a flaw in the benchmarking methodology that disproportionately affects rural ACOs. We hope Congress acts to correct this flaw and levels the playing field for all ACOs to achieve savings when they improve quality and reduce costs.

CMS to begin disbursing 2019 APM incentive payments

Thu, 24 Jun 2021 13:41:13 GMT

The Centers for Medicare & Medicaid Services (CMS) has notified MGMA that it plans to start distributing 2019 performance year advanced alternative payment model (APM) incentive payments beginning Thursday, June 24. Group practices that participated in an advanced APM in 2019 and whose clinicians achieved qualifying participant (QP) status by meeting patient or payment thresholds in 2019 should begin receiving these 5% bonus payments in the coming days. CMS plans to publish a notice for any providers that expect to receive these payments but do not, so that they can provide the agency with the appropriate information to receive their payment.

MGMA Breaking News: U.S. Supreme Court upholds ACA

Thu, 17 Jun 2021 18:27:59 GMT

This morning, the U.S. Supreme Court dismissed a challenge to the Affordable Care Act (ACA), leaving the law intact. In the 7-2 decision, the justices said the challengers of the law lacked standing to bring the case. The case, California v. Texas, centered around the ACA’s individual mandate, which required individuals to obtain minimum health insurance coverage or face a tax penalty. Once the tax penalty was set to $0 in a subsequent tax law, the plaintiffs argued that without the tax consequences associated with the individual mandate, the individual mandate was unconstitutional and the rest of the ACA must be found unconstitutional as well. The Court threw out this challenge to the law today due to lack of legal standing because the plaintiffs could not show injury.

MGMA Washington Connection 06/17/21

Thu, 17 Jun 2021 18:26:52 GMT

HHS releases updated PRF reporting guidance, establishes new deadlines

The Department of Health & Human Services (HHS) released long-awaited updates to reporting guidance for the Provider Relief Fund (PRF). According to the press release and the newly updated Post-Payment Notice of Reporting Requirements document, only relief funds received prior to June 30, 2020, must be expended by June 30, 2021, a deadline that the Department established previously. HHS designated four different reporting periods and deadlines to use funds based on the dates relief funds were initially received. HHS also heeded MGMA's recommendation to extend the 30-day reporting period to a full 90 days following the spending deadline for each period. Finally, the announcement indicates that the PRF Reporting Portal will allow providers to begin reporting their use of funds on July 1, 2021. Providers that received one or more payments exceeding $10,000 in the aggregate during a single Payment Received Period will be required to report. Additional resources, including a reporting toolkit, will become available upon the opening of the Reporting Portal.

OSHA announces new COVID-19 temporary standard for healthcare settings

The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) issued a COVID-19 emergency temporary standard (ETS) and accompanying FAQ with implications for healthcare employers. In part, under the ETS, a covered employer must:

• Develop a “COVID-19 plan,” which includes a workplace-specific hazard assessment,
•  Clean and disinfect the workplace,
•  Screen employees for COVID-19 and follow requirements for removing employees from the workplace,
•  Ensure physical distancing,
•  Screen and monitor patients upon arrival,
•  Report COVID-19 fatalities and hospitalizations, and
•  Provide reasonable time and paid leave for COVID-19 vaccinations.

See the full ETS for a complete list of requirements. Certain requirements are waived if workers are vaccinated and are in well-defined areas where there is no reasonable expectation that a person with suspected or confirmed COVID-19 will be present.

MGMA Washington Connection 06/10/21

Fri, 11 Jun 2021 15:29:19 GMT

HHS Secretary Becerra addresses PRF, guidance forthcoming

During a House Ways and Means Committee hearing on the Department of Health and Human Services' (HHS) budget request, Secretary Xavier Becerra addressed the Provider Relief Fund (PRF) and told lawmakers that the Department would be releasing additional guidance this month. Physician practices still only have until June 30 to use any PRF money received. Last month, MGMA sent a letter to HHS recommending modifications to the PRF program, including an extension of the spending deadline and the expeditious distribution of the remaining relief funds to medical group practices and other providers.

MSSP 2022 application period now open

The application period for a Jan. 1, 2022, agreement start date in the Medicare Shared Savings Program (MSSP) is open now through June 28, 2021. Accountable care organizations (ACOs) seeking to apply or renew their agreement in the MSSP for 2022 must have an authorized ACO contact submit all Phase 1 application materials by June 28 at 12pm ET. For additional information, medical groups are encouraged to reference the Application Types & Timelines webpage and the MSSP Application Toolkit.

MGMA Washington Connection 06/03/2021

Thu, 03 Jun 2021 15:27:20 GMT

MGMA outlines priorities in letter to new CMS Administrator

In a welcome letter to Chiquita Brooks-LaSure, the new head of the Centers for Medicare & Medicaid Services (CMS), MGMA outlined a number of priorities it is eager to work with the agency on that will deliver high-quality, cost effective care, and help reduce regulatory burden on medical practices. The letter includes the following recommendations:

• Include Medicare Advantage plans in the scope of CMS' interoperability and prior authorization rule;
• Allow permanent coverage of audio-only services;
• Support the development of new, voluntary alternative payment models (APMs); and
• Provide transparency regarding MIPS cost category.

MGMA provides recommendations on APM development

MGMA joined the American Medical Association and 40 other healthcare organizations in providing recommendations on APM development to the new Director of the Center for Medicare and Medicaid Innovation (CMMI). In the letter, the provider community recommends improving the way CMMI designs and implements APMs to increase transparency, reduce health inequities, and provide up-front funding to participants to facilitate successful APM implementation. Additionally, the letter recommends engaging the physician community in the development of APMs to create alignment in priorities, dedicating funds to physician-developed APMs, and providing feedback and data to physician organizations seeking to collaborate in this process.

President’s proposed budget gives HHS significant bump

Last Friday, President Biden released his $6 trillion fiscal year 2022 budget request, which included notable increases to the National Institutes of Health, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration. President Biden also requested a 23% funding increase for the Department of Health and Human Services. Presidential budget requests do not have the force of law and are intended to display the Administration’s priorities, while Congress negotiates the budget.

MGMA Washington Connection 04/29/21

Thu, 29 Apr 2021 23:01:07 GMT

MGMA advocates for telehealth expansion

MGMA submitted written comments to the House Ways and Means Health Subcommittee regarding its hearing on “Charting the Path Forward for Telehealth.” MGMA urges the Subcommittee and other lawmakers to consider the following when drafting Medicare telehealth legislation:

Preserve the patient-physician relationship;
Permanently remove geographic and originating site restrictions;
Allow permanent coverage of audio-only visits; and
Reimburse telehealth visits equally to in-person visits.

During the hearing, Subcommittee members and witnesses engaged in a robust discussion covering interstate licensure legislation, the potential for using telehealth to address health disparities, and the potential for fraud. MGMA was pleased to see congressional support for audio-only services and for the removal of geographic and originating site restrictions. As Congress continues to discuss how to chart a path forward for telehealth, MGMA will advocate for policies that put medical groups in the best position to treat their patients.

CMS releases 2022 IPPS proposed rule

This week, the Centers for Medicare & Medicaid Services (CMS) issuedthe 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital proposed rule. The proposed rule would update Medicare payment policies and rates for acute care hospitals for FY 2022. Following MGMA advocacy and in accordance with the Consolidated Appropriations Act, 2021, CMS is proposing to distribute Medicare-funded medical residency positions to qualifying hospitals. Specifically, the 1,000 new slots will be phased in at no more than 200 slots per year beginning in FY 2023. Additionally, CMS is proposing to allow eligible Accountable Care Organizations participating in the BASIC track of the Medicare Shared Savings Program to elect to forgo automatic advancement along the glide path’s increasing levels of risk and potential reward for the 2022 performance year. CMS will accept comments on the proposed rule through June 28, 2021, and the final rule is expected later this year.

New resources available on QPP website

Over the past few weeks, CMS has added new resources to the Quality Payment Program (QPP) Resource Library. For performance year 2021, the new batch of resources includes:

MIPS User Guides, which provides details on a variety of topics to help participants understand the 2021 MIPS performance year requirements;
MIPS Measures and Activities Specialty Guides;
Medicare Promoting Interoperability Program vs. MIPS Promoting Interoperability Performance Category Infographic;
Facility-based Quick Start Guide;
Quality Benchmarks; and
MIPS Data Validation criteria.

MGMA Washington Connection 04/22/2021

Thu, 22 Apr 2021 15:05:01 GMT

HHS renews public health emergency for COVID-19

Department of Health and Human Services (HHS) Secretary Xavier Becerra has renewed the public health emergency (PHE) for COVID-19 effective April 21, 2021. This extension will continue all telehealth waivers and other flexibilities pursuant to the determination. As with previous determinations, the renewed PHE will end 90 days after its effective date on Tuesday, July 20, 2021, unless it is further extended. The Biden administration has previously indicated that it plans to continue extending the COVID-19 PHE at least for the remainder of 2021.

MGMA supports bill to remove PRF negative tax implications

MGMA and other leading healthcare organizations sent aletter of support to the sponsors of the Eliminating the Provider Relief Fund Tax Penalties Act (H.R. 2079). This bill would remove the negative tax implications for Provider Relief Fund (PRF) recipients by ensuring that the funds are not taxable, while maintaining that expenses tied to the funds are tax-deductible. PRF assistance is currently taxable. For more information on the PRF, see MGMA’s comprehensive resource.

MGMA to HHS: Extend the Next Generation ACO model

MGMA joined 12 other organizations in urging HHS Secretary Xavier Becerra to extend the Next Generation ACO (NGACO) model through 2022. Without further action, the model will expire this year. However, in light of a recent announcement from the Centers for Medicare & Medicaid Services that it does not intend to accept new applicants for the 2022 cohort of the Direct Contracting model, current NGACO participants will no longer have that as an option once this performance year ends. In addition to extending the NGACO model, the coalition urges HHS to create a permanent full risk ACO option for the future and reexamine its model evaluation reports.

MGMA Washington Connection 04/08/21

Thu, 08 Apr 2021 13:41:41 GMT

MGMA to Congress: Repeal prohibition on a national patient identifier

MGMA, with over 100 other leading healthcare organizations, is urging Congress to reject legislative language that would continue to prohibit the Department of Health and Human Services (HHS) from spending any federal dollars to adopt a national patient identifier. The U.S. House of Representatives passed bipartisan legislation in the past two fiscal years that would repeal this prohibition. The absence of a consistent approach to accurately identify patient results is a significant cost to practices and hinders efforts to facilitate health information exchange, particularly during the COVID-19 pandemic. Inaccurate patient identification can lead to patient safety concerns when health data is either matched to the wrong patient or when a patient's data is not matched and is left out of the record. Lifting the prohibition will permit HHS to evaluate a range of patient identification solutions that are cost-effective, scalable, and secure.

CMS begins recouping Accelerated and Advance Payments

The Centers for Medicare & Medicaid Services (CMS) announced that the recoupment of Medicare Accelerated and Advance Payment (AAP) loans began for some providers as early as March 31, 2021. Following congressional action last year, repayment of AAP loans is set to begin one year from the date the payment was originally issued in the form of automatic withholds on Medicare claims. Medicare Administrative Contractors (MACs) will show the recoupment on the remittance advices issued for Medicare Part A and B claims processed after the one-year anniversary of when the first loan payment was issued. The recoupment will appear as an adjustment in the Provider-Level Balance section of the remittance advice. Providers with questions about the recoupment process or who would like to repay their AAP loan as a lump sum should contact their MAC directly.

MGMA Washington Connection 04/01/2021

Thu, 01 Apr 2021 13:09:21 GMT

Senate clears legislation to extend 2% Medicare sequester moratorium

On March 25, the Senate voted 90-2 to pass MGMA-supported legislation that would extend the 2% Medicare sequester moratorium through Dec. 31, 2021. Without further congressional action, the current moratorium was slated to expire on March 31, 2021. The House is expected to pass this legislation when it returns from recess in mid-April. The Centers for Medicare & Medicaid Services (CMS) instructed Medicare Administrative Contractors to hold all claims with dates of service on or after April 1 for a short period of time until the legislation passes the House and is signed into law. CMS does not expect this hold to affect providers’ cash flow and wants to minimize the number of claims that would need to be reprocessed if this legislation is passed. MGMA thanks our members who participated in #MGMAAdvocacy and sent letters to congressional members in support of an extension of the moratorium.

Legislation to extend PPP signed into law

Congress passed legislation to extend the Paycheck Protection Program (PPP) through May 31, 2021. The bill passed both chambers with overwhelming bipartisan support and was signed into law by President Biden earlier this week. Without the passage of this legislation, the PPP would have expired on March 31, 2021. This extension will give medical groups an additional two months to apply for either a first or second draw PPP loan.

MGMA voices support for legislation to expand physician workforce

MGMA and other leading health organizations sent a letter of support to the Senate and House sponsors of the Resident Physician Shortage Reduction Act. This bipartisan, bicameral legislation would gradually increase the number of Medicare-supported Graduate Medical Education positions by 2,000 per year for seven years, totaling 14,000 new slots. MGMA supports this legislation, which is critical to combat the impending physician shortage over the next decade.

MGMA Washington Connection 03/25/21

Thu, 25 Mar 2021 14:13:52 GMT

Prepare for upcoming information blocking compliance date

The compliance date for the federal government’s information blocking provisions of the 21st Century Cures Act final rule is currently set for April 5, 2021. This multifaceted regulation, released by the Office of the National Coordinator for Health Information Technology (ONC), generally prohibits physician practices from interfering with the access, exchange, and use of electronic health information. MGMA’s information blocking toolkit outlines key provisions of the information blocking rule, summarizes the eight permitted exceptions to the rule, and provides actionable steps to help medical groups comply with the rule. Medical groups should also reference ONC’s information blocking FAQ for the most up-to-date guidance.

Medicare loan repayment to begin as early as next week

On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the Medicare Accelerated and Advance Payment Program (AAP), making the program available for most Medicare physicians and group practices. The AAP provided loans to applicants facing financial disruption due to COVID-19 based on historic Medicare billing. Repayment of AAP loans begins one year from the date the payment was issued, which means repayment could begin as early as next week. Group practices that accepted AAP loans should note the following repayment options:

Automatic claims recoupment (default mechanism): Starting one year from loan disbursement, Medicare Administrative Contractors (MACs) will recoup outstanding AAP loans by automatically reducing Medicare payments owed to the provider by 25% for 11 months (e.g., a claims withhold). Following the initial 11-month repayment period, if the loan has not been repaid in full, Medicare payments will be recouped at 50% for another six months. Thereafter, any remaining balance must be paid within 30 days or it will accrue interest at a rate of 4% until repaid in full (there is no interest assessed on loans repaid before this time).
Repayment in lump sum amounts: Providers may repay AAP loans by making a lump sum payment or payments to their MAC. Group practices interested in this repayment option should consult with their MAC for details, including any forms that should accompany repayments.

CMS has not provided further details on the repayment process, such as when exactly claims recoupment will begin, so groups should direct questions to their MACs. For more information about the AAP and other financial relief programs, review MGMA’s COVID-19-related financial relief resources.

MGMA Washington Connection 03/18/21

Thu, 18 Mar 2021 14:06:10 GMT

MGMA to Congress: Act now to prevent Medicare cuts

MGMA and leading health organizations wrote to Congress expressing concern over the impending Medicare sequester cuts. Specifically, the letter asks Congress to act before April 1, 2021, to extend the 2% Medicare sequester moratorium and prevent the projected 4% Medicare spending cut scheduled to begin next year due to "Pay-As-You-Go," or PAYGO, statute reductions. Without further congressional action, the 2% Medicare sequester moratorium will end after March 31, and an additional 4% cut could be triggered due to the cost associated with the American Rescue Plan and its effect on government spending.

MedPAC recommends no payment update for physician services in 2022

On Monday, MedPAC released its March report on Medicare payment policy, which recommended no payment update for physician services in 2022. MedPAC serves as an advisor to Congress, however its recommendations are not binding. MGMA issued a statement expressing disappointment with the recommendation. Physician practices are subject to annual increases in staff salaries, rent, and supplies. Without a modest annual payment update to keep up with the cost of inflation, practices will ultimately be forced to make difficult decisions about Medicare participation.

MedPAC said it does not anticipate any long-term effects related to the public health emergency that would warrant changing the annual update to Medicare’s fee schedule for 2022. MGMA believes it is too early to assume that medical practices will not continue to experience financial challenges stemming from the COVID-19 pandemic next year, or an acceleration in post-pandemic practice-cost inflation.

Medicare increases payment for COVID-19 vaccine administration

This week, the Biden administration announced that Medicare will be increasing reimbursement for administering the COVID-19 vaccine. Effective for vaccines administered on or after March 15, 2021, the national average payment rate will be $40 to administer each dose of a vaccine. This represents an increase from approximately $28 to $40 for the administration of a single-dose vaccine and an increase from approximately $45 to $80 for the administration of two-dose vaccines. The final payment rate will also vary depending on the furnishing entity and geographic adjustments.

Even with the news of increased Medicare reimbursement for COVID-19 vaccine administration, MGMA has heard from many practices about difficulty obtaining vaccine doses for their patients. MGMA has called on the administration to include medical group practices in COVID-19 vaccine distribution strategies.

Apply now for Primary Care First Model 2022 participation

CMS released a request for applications for Cohort 2 of the Primary Care First (PCF) Model. Primary care practices in eligible regions may apply. PCF Cohort 2 will have five performance years and is scheduled to begin Jan. 1, 2022. The deadline for practice applications is April 30, 2021.

PCF is based on the Comprehensive Primary Care Plus Model and qualifies as an advanced alternative payment model.

MGMA Washington Connection 03/04/2021

Thu, 04 Mar 2021 13:30:53 GMT

MGMA submits telehealth policy recommendations to Congress

This week, MGMA submitted written testimony to the Subcommittee on Health of the House Committee on Energy and Commerce’s hearing on “The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care” for consideration as they begin discussing policies that would expand telehealth flexibilities beyond the COVID-19 pandemic. MGMA's testimony outlined certain policy recommendations to consider while drafting legislation. MGMA believes any future legislation expanding Medicare telehealth should:

Preserve the patient-physician relationship to promote high-quality care,
Remove geographic and originating site restrictions,
Allow permanent coverage of audio-only services, and
Reimburse telehealth visits equally to in-person visits.

CMS applies automatic MIPS hardship policy for 2020

Following MGMA advocacy, the Centers for Medicare & Medicaid Services (CMS) announced it will automatically apply the MIPS extreme and uncontrollable circumstances exception policy to all MIPS eligible clinicians for the 2020 performance period due to the COVID-19 public health emergency (PHE). This policy applies to individuals and groups that are unable to submit sufficient 2020 MIPS data during the submission period.

Additionally, the agency is reopening the 2020 hardship application portal through March 31, 2021. Physicians, groups, and alternative payment model (APM) entities may submit an application to reweight one or all MIPS performance categories due to the COVID-19 PHE. Submitting MIPS data in two or more categories, such as quality and improvement activities, will override a hardship exception on a category-by-category basis.

2020 MIPS hardship exceptions: Consider the COVID-19 impact on cost measures

Some physician practices may be able to and wish to report 2020 MIPS data, for example, to earn an exceptional performance bonus by reaching the 85 point threshold. In light of CMS’ announcement to reopen the MIPS hardship application portal, MGMA encourages groups, including those who have submitted or plan to submit MIPS data, to consider submitting an application to reweight the cost category to zero. The deadline to submit data and hardship applications is March 31.

MIPS cost measures are calculated automatically based on claims data and have no reporting requirement. However, we have concerns that cost measures will be significantly impacted by the COVID-19 PHE. Those approved for reweighting of the cost performance category pursuant to an application will never be scored on cost measures and the category will be reweighted to zero. Our concerns about cost measures include:

Because cost measures rely on national average benchmarks, physicians and practices in hot spots may have higher costs than the national average.
Postponing preventive and routine care may skew patient attribution toward the sickest patients.
Inadequate risk adjustment methodologies during a pandemic may severely affect patients who face economic hardships and social risk factors.

Lack of transparency into cost measure scoring, attribution, and benchmarks.

MGMA and ASTRO urge refinements to radiation oncology APM

MGMA partnered with the American Society for Radiation Oncology (ASTRO) in a letter voicing concerns about the radiation oncology (RO) APM. The letter sent to the Biden administration highlights that the RO model is overly focused on achieving cost savings at the risk of jeopardizing access to care and quality. MGMA will work with the new Administration to achieve shared goals of value-based care and encourages transparency and an open dialogue in model development going forward.

MGMA Washington Connection 02/25/21

Thu, 25 Feb 2021 15:30:40 GMT

SBA modifies PPP to support smaller businesses

On Feb. 22, the U.S. Small Business Administration (SBA) announced modifications to the Paycheck Protection Program (PPP). These reforms are meant to target smaller businesses and businesses that have been left out of previous relief efforts. To that effect, SBA instituted a 14-day period beginning on Feb. 24 during which only businesses with fewer than 20 employees can apply for PPP loans. Other changes, set to be implemented by the first week of March, include a revised funding formula for sole proprietors, independent contractors, and self-employed individuals, as well as the elimination of certain eligibility restrictions for those who are delinquent on their federal student loans and those who have non-fraud felony convictions.

Provider Relief Fund: Registration now open for Reporting Portal

The Department of Health & Human Services (HHS) delayed the Provider Relief Fund (PRF) reporting deadline in January and has yet to provide updates as to when reporting will begin for certain recipients of PRF payments. The Department is encouraging providers to register via its Reporting Portal, even though data cannot be submitted through the portal for reporting purposes at this time.

According to the most recent data available, about $26 billion remains in the PRF. HHS has not announced plans on how it intends to distribute remaining funds and is not currently accepting applications for payments. However, group practices can file claims for reimbursement from the PRF for COVID-19 testing, treatment, and vaccination of uninsured individuals.

MGMA Washington Connection 02/18/2021

Thu, 18 Feb 2021 14:55:07 GMT

Medicare loan repayment to begin as soon as next month

The Medicare Accelerated and Advance Payment (AAP) program was expanded at the outset of the pandemic to provide upfront loans for Medicare providers experiencing cash flow disruptions. Following MGMA advocacy, loan repayment terms were improved and recoupment was delayed until one year following loan disbursement. MGMA updated its AAP loan resource so groups that received these loans can understand the revised repayment terms.

Urge Congress to delay Medicare sequester cuts!

Last year, two pieces of legislation were signed into law that provided a reprieve from the 2% Medicare payment sequester. Unfortunately, the current Medicare sequester moratorium is set to end on March 31, 2021 and physicians continue to face financial challenges associated with the COVID-19 pandemic. MGMA, along with over 100 other organizations, is urging Congress to pass legislation that would continue the current Medicare sequester moratorium for the duration of the COVID-19 public health emergency. You can help #MGMAAdvocacy by using MGMA’s Contact Congress portal to send template letters to your congressional members urging them to further delay the cuts.

MGMA Washington Connection 01/28/2021

Fri, 29 Jan 2021 23:08:20 GMT

MGMA's 2021 Advocacy Agenda

With a new Congress and Administration now in place, MGMA is working diligently to ensure your voice is heard. MGMA’s 2021 Advocacy Agenda outlines key issues we are tackling in Washington, such as prior authorization, maintaining access to care through telehealth, and advancing value-based care. Ensuring the sustainability of medical group practices is the foundation of our advocacy priorities, and we will continue to work with policymakers to shape legislation and regulations on behalf of our member group practices. Help MGMA advocate for physician practices by using #MGMAAdvocacy on social media.

Results are in: Many medical groups left out of COVID-19 vaccine rollout

A new MGMA poll reveals a staggering 85 percent of independent practices and 45 percent of hospital- or health system-owned practices actively seeking the COVID-19 vaccine for their patients report having obtained none to date. The majority of practices that have obtained the vaccine report only receiving enough to vaccinate one percent or less of their patients. The MGMA survey reflects responses from over 400 medical group practices that are already administering or planning to administer the COVID-19 vaccine to their patients. MGMA strongly urged the Biden Administration to include group practices in COVID-19 vaccine distribution strategies moving forward.

MIPS APMs: Learn about 2021 reporting changes in new MGMA resource

In response to new changes to performance requirements starting this year, MGMA created a member-benefit resource outlining the new APM Performance Pathway (APP), which applies to group practices that report for MIPS through an APM Entity.

In past years, clinicians participating in MIPS APMs were scored under the “MIPS APM” scoring standard. Starting in 2021, the MIPS APM scoring standard has been eliminated and replaced with the APP. The APP consists of a single, pre-determined set of quality measures that MIPS APM participants must report at the individual, group, or APM Entity levels. While the APP is optional for most MIPS APMs, it is required for all Medicare Shared Savings Program ACOs. MIPS APMs that forgo reporting via the APP will be subject to generally applicable MIPS scoring policies, which include being measured on cost and reporting for improvement activities. Download MGMA’s new resource to learn more.

Upcoming MIPS Deadlines

MGMA members that participate in the Quality Payment Program (QPP) should note the following upcoming deadlines:

Feb. 1: Last day to submit a 2020 MIPS extreme and uncontrollable circumstances application to request re-weighting of one or more MIPS categories due to COVID-19. Submit applications here.
March 25: Preview period for clinician “Care Compare” closes. Care Compare is a transparency initiative that displays MIPS performance data on a public website; clinicians and groups may use the currently open preview period to ensure the accuracy of 2019 MIPS performance information and submit a targeted review of any inaccuracies before the data goes live in 2021.
March 31: Deadline to report 2020 MIPS data through the QPP portal. Sign into your account on the QPP webpage.

MGMA Washington Connection 01/21/2021

Thu, 21 Jan 2021 14:32:49 GMT

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.

MGMA Washington Connection 01/08/2021

Fri, 08 Jan 2021 15:05:33 GMT

CMS confirms new, increased 2021 conversion factor following year-end legislation

Following legislation signed into law in December, Congress added $3 billion to the Medicare Physician Fee Schedule (PFS) and delayed implementation of HCPCS add-on code G2211 for three years. As a result, the Centers for Medicare & Medicaid Services (CMS) has confirmed that the new 2021 PFS conversion factor will be $34.8931 instead of $32.4085, as previously finalized in the PFS final rule. CMS also updated the 2021 RVU file. We expect to see a formal announcement regarding these developments in the near future. CMS is also expected to communicate the new conversion factor and payment rates to local Medicare Administrative Contractors (MACs), who will update their schedules accordingly. For accurate rates based on your geographic area, we recommend checking with your local MAC.

MGMA submits comments on CMS prior authorization proposed rule

MGMA offered comments on the CMS proposed rule requiring a limited number of federal payers to support application programming interface (API) standards. CMS proposed that covered payers provide patients access to their claims information via APIs and support API standards for prior authorization transactions with physician practices. The rule would also require payers to support automated approaches to coverage determinations and transmit to practice EHRs the clinical documentation template for the authorization. CMS also proposed that payers would be given 72 hours to respond to an urgent prior authorization and seven days for all others. MGMA strongly urged CMS to include Medicare Advantage and other payers in the regulation and significantly shorten the time payers would have to respond to practices.

2020 MIPS data submission portal open; report by March 31

CMS opened the data submission portal for MIPS clinicians and groups who participated in the 2020 performance year. Data can be submitted until March 31, and you must sign into the Quality Payment Program (QPP) website to report.

CMS has a variety of resources dedicated to assisting participants with their 2020 data submission in its QPP resource library. In addition, MGMA recommends that groups that expect to participate in MIPS for 2021 review recently added guidance that pertains to the 2021 performance period, such as quality measure benchmark files, cost measure information, promoting interoperability measure specifications, and more.

MGMA to ONC: Delay enforcement of information blocking until after PHE

In a comment letter to the Office of the National Coordinator for Health Information Technology (ONC), MGMA called on the agency to tie the start of enforcement of the information blocking requirements to the end of the COVID-19 Public Health Emergency (PHE). The association argued that physician practices are focused on meeting the challenges related to the COVID-19 pandemic and need additional time to prepare for the complex new regulatory requirements. MGMA also called on ONC to develop additional guidance to help practices comply with the law.

MGMA Washington Connection 01/04/21

Tue, 05 Jan 2021 15:25:35 GMT

Year-end legislation summary: What medical groups need to know

On Dec. 21, Congress passed massive year-end legislation that includes $1.4 trillion in funding for the federal government in FY 2021, an additional $900 billion in COVID-19 stimulus funds, and various other provisions that impact medical groups. President Trump signed the bill into law on Dec. 27.

In the coming weeks, MGMA expects the Administration will issue guidance on certain provisions of the new law. This guidance is expected to provide more detail into how these provisions will be implemented and the impact on medical groups. As this information becomes available, MGMA will keep medical group practices updated and will be revising resources, such as those published in MGMA’s COVID-19 Recovery Center.

Key provisions of the law include the following:

Medicare payment

Increases Medicare payments across the board for CY 2021 from what was finalized in the 2021 Physician Fee Schedule (PFS) by adding $3 billion into the PFS and delaying payment of HCPCS add-on code G2211 for three years. MGMA expects that the Centers for Medicare & Medicaid Services (CMS) will release information regarding the updated payments for 2021 once it factors in the 3.75% increase to the PFS and calculates the impact of delaying G2211. We expect CMS to communicate the new conversion factor and new payment rates to local Medicare Administrative Contractors, who will update their schedules accordingly. These payment increases follow significant MGMA advocacy and will serve to offset cuts previously slated for Jan. 1, 2021.
Temporarily suspends the 2% Medicare sequester from Jan. 1 through March 31, 2021. MGMA advocated for an extension of the current moratorium on Medicare sequestration authorized in the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Extends the work geographic index floor under the Medicare program through Dec. 31, 2023.
Expands access to mental health services furnished through telehealth past the expiration of the COVID-19 public health emergency. MGMA expects to see further guidance from CMS on this policy change.

Paycheck Protection Program (PPP)

Extends and modifies the PPP to provide further flexibilities, such as:
- A simplified loan forgiveness application process for loans under $150,000;
- Clarification that loan recipients may deduct forgiven PPP loans;
- The creation of a “PPP second draw” loan for businesses that meet certain criteria;
- The allowance of additional eligible and forgivable covered expenses;
- The ability for certain 501(c)(6) organizations to qualify for a PPP loan; and
- The ability to elect a covered period ending between 8 and 24 weeks after loan origination.
MGMA expects the U.S. Department of the Treasury to issue and update guidance to reflect the modifications made to the PPP in the coming days.

Provider Relief Fund (PRF)

Adds $3 billion to the $175 billion PRF and clarifies how recipients can use funds to cover “lost revenue” attributable to COVID-19. The new law allows providers to calculate lost revenues using a budgeted-to-actual revenue comparison, rather than actual year-over-year comparisons as currently required by Department of Health & Human Services (HHS) guidance.
This change, as well as the addition of funds, is welcome news; however, it remains to be seen how HHS will implement new clarification. Group practices should continue to monitor the PRF website for updates based on the new legislation in the coming days or weeks.

FFCRA paid sick and family leave

Extends the refundable payroll tax credits for paid sick and family leave enacted in the Families First Coronavirus Reponses Act (FFCRA) through March 31, 2021, so employers may choose to continue offering paid leave to their employees. It does not, however, require employers to extend FFCRA paid sick and family leave past Dec. 31, 2020.

Surprise billing

Provides patient protections from out-of-network medical bills. Nonparticipating providers at emergency facilities (or a participating provider at a nonparticipating emergency facility) will not be permitted to bill a patient beyond the allowed cost-sharing amount. Instead, the patient’s health plan will make an initial payment directly to the provider or issue a notice of denial. If the provider or plan is not satisfied with the payment, either party may initiate an Independent Dispute Resolution (IDR) process, which is overseen by a third party entity who has no affiliation with the provider or payer. Each party then submits a payment offer for consideration by the IDR entity, who selects one prevailing offer as the final payment amount.
This provision is set to go into effect in 2022 and will involve rulemaking from the Administration to provide certain implementation details. Following MGMA advocacy, at the last minute lawmakers included improvements to the IDR process.

Alternative Payment Models (APMs)

Freezes the 2020 qualifying participant thresholds required to achieve APM benefits, such as the 5% lump sum bonus. These thresholds were set to increase in 2021 to unrealistic levels, however pursuant to this legislation, will remain at the 2020 thresholds (at least 50% of Medicare Part B payments or at least 35% of Medicare patients through an advanced APM entity) through 2023. MGMA strongly supported maintaining 2020 thresholds in 2021 and beyond to allow more group practices to realize the benefits of APM participation.

MGMA Washington Connection 12/17/2020

Thu, 17 Dec 2020 14:10:26 GMT

HHS begins issuing Phase 3 Provider Relief Fund payments

The Department of Health & Human Services (HHS) announced it is beginning distribution of Phase 3 Provider Relief Fund (PRF) payments on Dec. 16, which will continue through January. The Phase 3 distribution considers actual revenue losses and expenses attributable to COVID-19 and follows two earlier General Distributions to group practices and other healthcare entities.

While HHS has not published a formula for how it calculated Phase 3 payments, yesterday’s announcement indicated that this funding will meet “up to 88 percent of [a provider’s] reported losses” from COVID-19 in the first half of the year. Previous General Distributions endeavored to provide entities with a baseline payment of 2% of annual revenue from patient care. Practices that applied for Phase 3 should watch for payments and not be alarmed if payments result in amounts that exceed this 2% figure. MGMA will share updates with members as they are released. Additional information about Phase 3 includes:

Phase 3 funds are being distributed pursuant to applications submitted between Oct. 5 and Nov. 6. Payments are based in part on how many providers applied, which explains the delay in issuing funding.
HHS increased the amount of available Phase 3 funding from $20 billion to $24.5 billion.

Payments are being distributed to over 70,000 providers. Of these, it is estimated that 35,000 applicants will not receive an additional payment either because they experienced no change in revenues or net expenses or because they already received funds that equal or exceed reimbursement of 88% of reported losses.

MIPS hardship applications available for 2020 performance year

Group practices experiencing issues with meeting 2020 MIPS reporting requirements can apply for a hardship exception that, if approved, will re-weight any or all performance categories and hold clinicians harmless for non-reporting. There are two separate applications available:

The Extreme and Uncontrollable Circumstances Exception application allows a clinician, group practice, or APM entity to request reweighting for any or all performance categories if they experience circumstances beyond their control, such as the COVID-19 public health emergency. The deadline to apply for this exception is Feb. 1, 2021.
The MIPS Promoting Interoperability Performance Category Hardship Exception application is available to request reweighting for this category only. MIPS clinicians or group practices can submit an application by Dec. 31, 2020, citing one of the following reasons:
- The group is a small practice
- EHR technology is decertified
- Insufficient internet connectivity
- Lack control over the availability of CEHRT

Extreme and uncontrollable circumstances

MGMA calls on Congress to mitigate HIPAA fines for medical groups

MGMA joined six other leading healthcare organizations, including the American Medical Association and American Hospital Association, urging Senate leaders to support H.R. 7898. Specifically, this legislation would require the HHS Office for Civil Rights (OCR) to consider use of recognized security best practices by a medical group when assessing fines and audits related to HIPAA. The legislation gives much-needed protection to medical groups who follow recognized security practices to fend off cyberattacks by acknowledging that organizations who have been acting in good faith should not be penalized by OCR. Earlier this month, the House of Representatives passed the legislation on a voice vote. Access MGMA cybersecurity resources here.

MGMA Washington Connection 12/10/20

Mon, 14 Dec 2020 17:49:46 GMT

Tell Congress to support medical groups in year-end legislation!

As Congress continues to negotiate an end-of-year legislative package, it is essential for lawmakers to hear from medical group practices on two issues that could impact the financial viability of your organization. Help #MGMAAdvocacy by sending your congressional representatives letters urging them to:

Prevent Medicare cuts: Due to budget neutrality requirements, the finalized payment increases to office/outpatient E/M services and other payment policies will result in a 10.2% reduction to the 2021 Medicare physician fee schedule conversion factor. While MGMA is supportive of streamlined documentation policies and payment increases to office visits, we strongly oppose the resulting payment cuts to many specialties. Urge Congress to pass legislation that would prevent Medicare reimbursement cuts before they begin.

Suspend Medicare sequestration: The CARES Act, signed into law in March, offered much-needed relief to medical groups by placing a temporary moratorium on the 2% Medicare sequestration cut. Unfortunately, the Medicare sequestration cuts are scheduled to return Jan. 1, 2021. Urge Congress to pass legislation before the end of the year to delay reinstatement of the MGMA-opposed sequestration cuts until the end of the COVID-19 public health emergency.

Advanced APMs: Check for missing 2018 payments by Dec. 13

Group practices that participated in an advanced alternative payment model (APM) in 2018 and earned the 5% bonus payment should review CMS' list of qualifying participants (QPs) who remain unpaid and follow instructions on how to claim payments if their QPs are listed. More information can be found in this zip file. CMS distributed 2018 APM incentive payments in September, but the agency indicated there are many QPs it has been unable to locate in order to issue the incentive payments.

Following MGMA advocacy, CMS extended the deadline to provide updated information from Nov. 13 to Dec. 13. While we urged the agency to eliminate the deadline altogether and pursue more extensive outreach, we are pleased the agency is giving unpaid clinicians more time to claim the payments they earned. Even group practices that have already received an APM bonus payment should check the file for their clinicians' names, as the payments received earlier may have omitted certain clinicians' payments.

Regulatory alert: Medicare finalizes 2021 payment and quality reporting changes

Wed, 02 Dec 2020 16:06:25 GMT

The Centers for Medicare & Medicaid Services (CMS) released the final 2021 Medicare physician fee schedule (PFS) rule this evening, which includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2021. The final rule:

Sets the CY 2021 PFS conversion factor at $32.41 and the CY 2021 national average anesthesia conversion factor at $20.0547. MGMA is advocating for a legislative fix to address the reimbursement cuts resulting from the lower conversion factor;
Generally confirms E/M office visit documentation guidelines and payment changes finalized in the 2020 PFS;
Modestly expands telehealth coverage; and
Establishes MIPS reporting requirements for 2021 and sets the performance threshold at 60 points.

For more information, review the physician payment fact sheet and QPP zip file associated with the 2021 final PFS. MGMA will analyze the final rule and provide a detailed analysis as a member benefit. MGMA will also provide further education on this complex regulation during our 2021 Medicare Outlook member-benefit webinar on Thursday, Dec. 10 at 1 pm ET.

Introduction of new mandatory Part B drug pricing model

Tue, 24 Nov 2020 16:29:55 GMT

On Friday, the Trump Administration issued an interim final rule implementing a new mandatory, nationwide model for Medicare suppliers, including group practices. The Most Favored Nation (MFN) Model will operate for seven years, beginning on Jan. 1, 2021, and will include the following elements:

Instead of paying providers that administer drugs based on the average sales price (ASP) in the U.S., Medicare will pay for Medicare Part B drugs based on a blended formula that includes the lowest adjusted international price (the “MFN Price”) and the ASP as well as a flat add-on amount per dose. The MFN Price will be phased in over the span of four years, but is subject to an accelerated timeline if U.S. prices rise faster than the MFN Price and inflation.
The MFN Model will focus on a list of 50 drugs that encompass a high percentage of Medicare Part B spending.

Due to the way in which the Administration circumvented the typical rulemaking process in issuing this regulation, it is possible that it will face legal challenges. MGMA is assessing the impact on medical group practices and will monitor future developments.

Regulatory alert: Trump Administration releases final rules on Stark Law changes and new mandatory Part B drug pricing model

Tue, 24 Nov 2020 16:29:07 GMT

Changes to the physician self-referral “Stark” law

On Friday, Nov. 20, the Centers for Medicare & Medicaid Services announced changes to the Physician Self-Referral Law, also known as the “Stark Law,” as well as revisions under the Anti-Kickback Statute. Historically, the Stark Law has prohibited physicians from making referrals to entities for certain healthcare services paid by Medicare if the physician has a financial relationship with the entity. MGMA and other stakeholder groups have long argued these rules impede the nation’s transition to value-based reimbursement. The new Stark Law rule finalizes many of the proposed policies from the notice of proposed rulemaking issued in October 2019, including:

Creating exceptions for value-based arrangements that permit physicians and other providers to design and enter into value-based arrangements without violating the physician self-referral law;
Offering additional guidance on key requirements of existing exceptions to the physician self-referral law; and
Providing protection for non-abusive, beneficial arrangements that apply regardless of whether the parties operate in a fee-for-service or value-based payment system, such as donations of cybersecurity technology that safeguard the integrity of the healthcare ecosystem.

In response to these changes, MGMA released a statement and will be closely evaluating the impacts these changes might have on medical group practices

MGMA to payers: Reimburse additional COVID-19 related costs

Thu, 19 Nov 2020 16:54:29 GMT

MGMA joined over 100 other organizations in urging the Centers for Medicare & Medicaid Services (CMS) and major commercial health plans to immediately implement and pay for CPT code 99072 with no patient cost-sharing during the COVID-19 public health emergency (PHE). The CPT Editorial Panel recently approved CPT code 99072 to cover additional supplies, materials, and clinical staff time above the typical practice expenses included in an office visit when performed during the COVID-19 PHE. Reimbursement for this code is intended to help compensate practices for these additional expenses and provide financial support so that practices can continue to focus on caring for their patients during the pandemic.

MGMA Washington Connection 11/19/20

Thu, 19 Nov 2020 16:53:48 GMT

MGMA to Congress: Extend moratorium on sequestration

MGMA sent a letter to Congress urging an extension to the current moratorium on the Medicare sequester through the end of the COVID-19 PHE. Sequestration is a budget enforcement tool that uses the automatic reduction of federal spending to encourage certain budget objectives or goals. Since 2013, it has resulted in a 2% across-the-board cut in Medicare provider payments. The CARES Act, signed into law in March, temporarily suspended sequestration through the end of this year. MGMA has long opposed applying the sequester to Medicare reimbursement and encourages extending the CARES Act moratorium beyond its current expiration date.

MGMA urges delay and reevaluation of AUC program

MGMA joined more than 20 physician organizations in a letter calling on Congress to statutorily delay the Appropriate Use Criteria (AUC) program. The AUC program requires professionals ordering certain advanced imaging tests for Medicare patients to consult a qualified Clinical Decision Support Mechanism to establish if the test is appropriate for the patient’s condition. The rendering professional will be required to include the AUC consultation code on their Medicare claim. Although CMS announced it has extended the educational and operations testing period for the AUC program through 2021, the letter calls on Congress to delay the program indefinitely and find a more feasible, less burdensome approach to reward Medicare clinicians who provide high-quality, clinically appropriate care. Access the MGMA member-benefit AUC Toolkit for more information on the program.

MGMA Washington Connection 11/12/20

Thu, 12 Nov 2020 22:08:03 GMT

U.S. Supreme Court hears ACA challenge

On Nov. 10, the U.S. Supreme Court heard oral arguments in a case challenging the Affordable Care Act (ACA). MGMA prepared a summary of the case for members on our ACA landing page, which we will continue to update as developments occur. A decision is not expected until 2021.

The case, captioned California v. Texas, centers on the ACA’s individual mandate to maintain minimum health coverage and its tax penalty. Following legislation that set the tax penalty to zero dollars starting in 2019, plaintiffs challenged the validity of the ACA and argued that, if the individual mandate is unconstitutional, the rest of the law is as well. Statements made by several justices during oral arguments implied the Court is unlikely to overturn the entire law, but the actual outcome of the case remains unknown until an opinion is issued.

Last chance: Tell your lawmakers to pass COVID-19 relief legislation this year

Following the 2020 election, Congress is returning to Washington, D.C. for one final “lame duck” session of the 116th Congress. There are limited legislative working days left in the year, making it imperative that physician practices reach out to their lawmakers to urge them to pass COVID-19 relief legislation.

Send a letter to your senators and representatives urging them to include the following in any final legislation:

direct financial support to medical groups,
continue telehealth flexibilities past the COVID-19 public health emergency,
address Medicare payment cuts to certain specialties; and

reopen and amend aspects of the Paycheck Protection Program.

Don’t miss these important MIPS deadlines

With the end of the year approaching, MIPS-participating clinicians and groups need to be aware of these upcoming MIPS deadlines.

Dec. 31 – 2020 Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances Exception applications are due for clinicians and groups who believe they are eligible for a re-weighting of one or more performance categories.
Dec. 31 – 2021 virtual group election period closes.
Jan. 4 – 2020 MIPS performance year data submission window opens.
March 1 - Deadline for CMS to receive 2020 claims data for the Quality performance category. Claims must be received by CMS within 60 days of the end of the performance period. Deadline dates vary to submit claims. Check with your MAC for specific instructions.
March 31 - 2020 MIPS performance year data submission window closes.

Nov. 6 is last day to apply for Phase 3 of Provider Relief Fund

Fri, 06 Nov 2020 14:43:41 GMT

Eligible providers have until Nov. 6 at 11:59 pm ET to apply for $20 billion in funding from Phase 3 of the Provider Relief Fund (PRF) General Distribution. Under the current phase, providers that have already applied for or received PRF payments are invited to apply for additional funding that considers financial losses and changes in operating expenses due to COVID-19. The Department of Health & Human Services also expanded eligibility for payments in Phase 3 to include certain behavioral health providers and new healthcare providers that began practicing between Jan. 1 and March 31 of this year.

If an applicant has not yet received (and retained) a payment equal to approximately 2% of annual revenue from patient care as part of either Phase 1 or 2 of the General Distribution, then they should receive at least that amount in Phase 3. Groups that already received payments at or above 2% of annual patient care revenue can also apply and have the potential to receive an additional payment amount higher than 2%. The exact formula for these add-on payments is not yet known; the additional percentage paid to providers will depend in part on how many providers apply in Phase 3 and will therefore be determined after the application deadline.

MGMA Washington Connection 10/29/20

Thu, 29 Oct 2020 12:30:40 GMT

HHS updates Provider Relief Fund reporting guidance again

The Department of Health and Human Services (HHS) again modified its guidance around Provider Relief Fund (PRF) post-payment reporting requirements. Among other changes, HHS updated its definition of “lost revenues,” now defined as the difference between the 2019 and 2020 actual revenues from patient care. Previous guidance from September articulated a more restrictive view of what constituted “lost revenues” and drew concern from MGMA and other groups that HHS was narrowing the range of permitted uses of PRF payments. While this October update is a welcomed change, MGMA will continue to engage with HHS on PRF-related issues and advocate for improvements and clarifications.

Advanced APM participants: Review public notice for missing payments by Nov. 13

Following reports of missing payments, MGMA is advising all members that participated in an advanced APM in 2018 and earned a 5% bonus in 2020 to review CMS files to confirm that none of their clinicians eligible for an incentive bonus failed to receive a payment. CMS listed the names of clinicians it was unable to disburse payment to because of missing billing information in an Excel document contained in this 2020 QP Notice for APM Incentive Payment zip file. In order to receive payments, these clinicians or someone on their behalf will need to verify their Medicare billing information by Nov. 13, 2020. The zip file contains additional instructions.

Even group practices that have already received a 2020 APM bonus payment and believed it to be complete should check this file for their clinicians' names. Several MGMA members in APMs were missing payments for certain clinicians, despite receiving an earlier payment to their tax identification number (TIN). It appears that CMS could not locate updated billing information for many physician assistants, in particular. The agency has not conveyed why there were issues with this provider type, but they appear to be disproportionately represented in the list of clinicians with missing billing information.

2019 QPP preliminary performance results released

CMS released additional information about aggregate 2019 performance in the Quality Payment Program (QPP) for both the MIPS and APM track. Some highlights include:

6.83% (65,237) of MIPS eligible clinicians had one or more MIPS categories re-weighted due to the COVID-19-related extreme and uncontrollable circumstances policy.
1.79% is the maximum positive MIPS payment adjustment in 2021 (for those that earned a perfect MIPS score in 2019).
The number of QPs in advanced APMs increased slightly in 2019 to 195,564 (from 183,306 in 2018).

CMS also released supplemental data from the 2018 performance year of MIPS that provides more detail at the TIN/national provider identifier level. This information is sortable by variables like clinician type, practice size, scores, and payment adjustments. This may be helpful for those interested in drilling down on performance results.

MGMA Advocacy: CMS delays mandatory radiation oncology APM

Thu, 29 Oct 2020 12:25:47 GMT

The Centers for Medicare & Medicaid Services (CMS) announced it will delay the start date of the Radiation Oncology alternative payment model (APM) from Jan. 1, 2021, until July 1, 2021, based on feedback from MGMA and other radiation oncology stakeholders. MGMA appreciates the leadership of the American Society for Radiation Oncology (ASTRO) on efforts to improve this model and push back its launch until group practices are better prepared.

MGMA joined ASTRO and others in expressing concerns about the model. We are pleased that CMS is delaying participation, but there is still work to be done to improve the model, including urging CMS to make participation voluntary, rather than mandatory.

In an Oct. 2020 Stat poll, 76% of respondents indicated they do not support the government requiring participation in APMs. MGMA has long championed voluntary APM opportunities for physician group practices of different types, sizes, and specialties, but does not agree with requiring groups to experiment in untested demonstrations that lack evidentiary support.

MGMA Washington Connection 10/15/20

Thu, 15 Oct 2020 13:29:25 GMT

New, simpler PPP forgiveness application available for loans under $50k

The U.S. Small Business Administration (SBA) released a new loan forgiveness application (SBA Form 3508S) for Paycheck Protection Program (PPP) loans of $50,000 or less. This application is intended to simplify the loan forgiveness process for borrowers by requiring fewer calculations and less documentation. Additionally, borrowers who use SBA Form 3508S are exempt from reductions in loan forgiveness amounts based on reductions in FTE count or in salaries or wages. As a reminder, SBA began approving PPP forgiveness applications and remitting forgiveness payments to lenders on Oct. 2, 2020.

Advance Payment Program loan payback delayed, details released

Following MGMA advocacy, Congress revised and improved repayment terms for the Medicare Advance Payment Program (APP) for those that accepted loans earlier this year. In response to recent legislative changes, CMS issued guidance stating the claims recoupment process is automatically stayed for one year starting from when the APP loan was issued. After one year, Medicare payments will be recouped at a rate of 25% for 11 months and 50% for another six months. Once this 29-month timeframe expires, local Medicare Administrative Contractors (MACs) will issue a letter for payment of any remaining balance. Medical group practices that want to begin payments sooner or make lump sum payments should contact their MAC.

MGMA encourages legislation to prevent Medicare payment cuts

MGMA joined over 60 organizations to express appreciation for legislation that would prevent drastic payment cuts to various sections of the provider community by waiving Medicare’s budget neutrality requirement. The Centers for Medicare & Medicaid Services’ final Medicare Physician Fee Schedule for 2020 included welcomed changes to reduce administrative burden and improve payment rates for E/M services. However, adhering to existing budget neutrality requirements will result in sizable cuts to various specialties starting Jan. 1, 2021. MGMA appreciates Rep. Burgess and Rep. Rush’s leadership in introducing legislation (H.R. 8505) that would prevent pending Medicare payment cuts by waiving budget neutrality requirements for one year and looks forward to working with Congress on a viable legislative solution before the end of the year.

OCR issues additional HIPAA right of action fines

The Office for Civil Rights (OCR), the agency that enforces HIPAA privacy and security, announced two new settlements with providers over separate HIPAA right of access violations. The HIPAA right of access establishes the right of patients to obtain access to their medical records in a timely fashion, for a reasonable fee, and in their requested format. The two organizations, a practice with offices in New York and Florida and an Arizona hospital system, failed to provide patients timely access to their health information. The practice paid OCR a settlement of $100,000 and the hospital system paid a settlement of $160,000, with each organization required to adopt a corrective action plan. To learn more about these HIPAA right of access issues, download the member-benefit resource The Patient Right to their Medical Record: Format, Fees and other Requirements

HHS renews public health emergency declaration

Thu, 08 Oct 2020 13:09:00 GMT

Secretary of Health & Human Services (HHS) Alex Azar renewed the COVID-19 public health emergency, effective Oct. 23, 2020, which means that all current Medicare telehealth waivers and other flexibilities are also extended. The renewed pubic health emergency declaration will terminate 90 days thereafter, on Jan. 21, 2021, unless it is renewed again.

MGMA has advocated for renewal of this declaration as practices continue to need regulatory flexibility and expanded reimbursement for virtual care. Previous renewals were issued at the last minute, so MGMA appreciates the advanced notice of the most recent announcement. For more information on regulatory waivers, visit our COVID-19 Action Center.

MGMA Washington Connection 10/08/20

Thu, 08 Oct 2020 13:07:48 GMT

New round of Provider Relief Fund payments available

HHS announced that applications will be accepted from Oct. 5 through Nov. 6 for $20 billion in new funding under “Phase 3” of the Provider Relief Fund General Distribution. Under this new phase, providers that have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and changes in operating expenses due to COVID-19. HHS also expanded eligibility for payments in Phase 3, so groups that have not received Provider Relief Fund payments to date should check new eligibility criteria.

If an applicant has not yet received (and retained) a payment equal to approximately 2% of annual revenue from patient care as part of either Phase 1 or 2 of the General Distribution, then they should receive at least that amount in Phase 3. Groups that already received payments at or above 2% of annual revenue can also apply and potentially receive additional payments. However, HHS indicates it will determine final payment amounts for those applicants once all applications have been received and reviewed. For more information on Phase 3, including the application, instructions, and FAQs, visit the Provider Relief Fund website.

Member-benefit HIT webinar now available on-demand

The MGMA Government Affairs member-benefit webinar on the most critical health information technology (HIT) issues facing medical practices today and MGMA’s current HIT advocacy priorities is now available on-demand. Topics covered on the program included the information blocking and Application Programming Interface requirements included in the recently released interoperability regulations, cybersecurity concerns and solutions, updates to the Appropriate Use Criteria program, and the latest on administrative simplification efforts to improve practice revenue cycle operations.

MGMA urges adoption of operating rules to improve prior auth

MGMA joined the American Hospital Association, the American Medical Association, and the Arthritis Foundation calling on the National Committee on Vital and Health Statistics (NCVHS) to endorse proposed operating rules to reduce burdens associated with prior authorization. NCVHS, a federal advisory body, is currently deliberating whether to recommend national adoption of operating rules that would set new data content and timing mandates on health plans, including a requirement that plans respond within two business days following an authorization request from a practice and respond with the additional documentation needed to complete the request. Under the proposal, plans would also have a maximum of two business days to send a final determination once they receive all requested information.

MGMA to CMS: Revise radiation oncology APM

In a letter to CMS, MGMA along with radiation oncology and other physician groups asked for critical changes to the new radiation oncology (RO) alternative payment model (APM). In particular, we urged the agency to push back the mandatory payment model to January 2022, develop more appropriate opt out mechanisms, and revise the model’s payment cuts. While MGMA is very supportive of expanding opportunities to join APMs, we do not support requiring medical groups to participate in untested demonstrations, particularly at a time when COVID-19 is creating financial strain and uncertainty.

Under current model rules, CMS will require participation from providers in randomly selected locations across the country starting Jan. 1, 2020. The RO model tests episodic payments for certain radiotherapy providers and has the potential to be a promising APM, however MGMA is concerned that the potential for downside risk is too significant and is recommending that the model be voluntary.

Regulatory alert: MGMA comments on 2021 Medicare Physician Fee Schedule

Fri, 02 Oct 2020 22:24:55 GMT

MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the proposed 2021 Medicare Physician Fee Schedule (PFS). Our comprehensive comments address the direct concerns and feedback we have heard from members, particularly as they continue to face challenges resulting from the COVID-19 pandemic. In our comments, MGMA recommends that CMS:

Continue to reimburse audio-only remote visits at a rate that adequately covers the cost of care.
Move forward with implementing improvements to Evaluation and Management office visits on Jan. 1, 2021, but take action to prevent physician payment cuts due to budget neutrality adjustments.
Delay proposed changes to Medicare Shared Savings Program ACO quality reporting.
Implement an automatic hardship exception for participants in the Merit-based Incentive Payment System for the 2020 and 2021 performance years, similar to the policy implemented for the 2019 performance year.

The final PFS is typically released on or around Nov. 1 each year, but due to the pandemic, CMS stated that the final 2021 PFS may be released closer to Dec. 1

Trump issues executive order on healthcare

Thu, 01 Oct 2020 14:33:36 GMT

President Trump signed an executive order (EO) on Sept. 24 outlining his America First Healthcare Plan, which addresses his Administration’s stance on surprise medical bills and preexisting conditions. The EO does not on its own create new substantive policies absent regulation or legislation and therefore is considered largely symbolic and a representation of Trump’s healthcare platform leading into the election. The major provisions of the EO are as follows:

Affordable Care Act (ACA): The EO reiterates the Administration’s support for repealing the ACA, but retaining protections for individuals against insurance discrimination based on preexisting conditions. Whether the Administration has authority to require private health insurers to offer coverage to individuals with preexisting conditions, absent legislative authority such as in the ACA, is unclear. While supporting repeal of the ACA, the EO conveys support for giving “Americans seeking healthcare more choice, lower costs, and better care.”

Surprise Billing: The EO pledges the Administration’s support for congressional action to protect individuals from surprise medical bills and sets a deadline of Jan. 1, 2021, for Congress to pass a legislative solution. If this timeline is not met, the EO calls on the Department of Health & Human Services (HHS) to “investigate regulatory action.” There have been no specifications provided as to what action HHS would take; Sec. Azar instead stated in a press meeting on the EO that he hopes stakeholder groups will work on a solution with Congress. While Congress has heavily debated surprise billing legislation, it has yet to pass any major legislation on this issue.

MGMA Washington Connection 10/01/20

Thu, 01 Oct 2020 14:31:26 GMT

MGMA-supported APP fixes signed into law

This week, Congress passed a continuing resolution (CR) to fund the government through Dec. 11, 2020. The CR, which was signed into law early this morning, also contains important revisions to the Medicare Accelerated and Advance Payments program (APP), improving harsh repayment terms that could have resulted in loan recoupment at a time when groups are still experiencing cash flow issues. As a result of MGMA advocacy, the CR:

Postpones the recoupment of disbursed funds until 365 days after the advance payment has been issued to a physician practice;
Extends the repayment timeline so that the loan balance is not due until September 2022;
Reduces the per-claim recoupment amount from 100 percent to 25 percent for the first 11 months and then 50 percent of claims withheld for an additional six months; and
Lowers the interest rate from 10.25 percent to 4 percent for loans not repaid in full by September 2022.

MGMA calls for delay of information blocking enforcement

MGMA joined seven leading healthcare organizations urging the Office of the National Coordinator for Health Information Technology (ONC) to delay enforcement of the information blocking regulations. Due to the impact of the COVID-19 pandemic, the coalition called on ONC to extend enforcement discretion by a minimum of one year to help ensure providers have adequate time to prepare their organizations for the new requirements. The coalition also called for any extension to be harmonized with information blocking attestation responsibilities under the Promoting Interoperability component of the Merit-based Incentive Payment System. To learn more about the information blocking final rule, download this member-benefit resource.

MGMA Washington Connection 09/17/20

Thu, 17 Sep 2020 14:10:18 GMT

CMS begins disbursing 2018 performance year advanced APM incentive payments

Group practices that participated in an advanced alternative payment model (APM) in 2018 should be receiving their bonus payments this week if participating clinicians achieved qualifying participant (QP) status by meeting patient or payment thresholds in 2018. Bonuses may have been transmitted as early as Friday, Sept. 11, and electronic deposits may be labeled as “CMMI QPP MEDICARE.” Payments are generally made to the tax identification number (TIN) associated with the QP’s participation in the advanced APM. The Centers for Medicare & Medicaid Services (CMS) announced that it was unable to verify current Medicare billing information for some QPs and therefore was unable to issue payments. If you expected to receive a payment but have not, please take note of the CMS’ regulatory filing providing instructions for updating billing information. Updated information must be submitted by Nov. 13 (note that early versions of CMS’ instructional document list an incorrect deadline of Nov. 10; MGMA reached out to CMS and confirmed that the correct deadline is Nov. 13). The bonus is 5% of aggregate payments for covered professional services billed by QPs across all TINs associated with the QP in the calendar year immediately preceding the payment year (in this case, 2019).

DOL issues new regulations modifying employee leave rules

Following a New York federal court decision that vacated several aspects of the Department of Labor’s (DOL) regulations under the Families First Coronavirus Response Act (FFCRA), DOL issued new regulations addressing employee leave eligibility and entitlement. Specifically, DOL narrowed its definition of who a “healthcare provider” is for purposes of being excluded by their employer from receiving FFCRA paid leave. In a departure from its previous definition, DOL stated that a person is not a healthcare provider merely because his or her employer provides healthcare services. Therefore, IT professionals, HR personnel, billers, building maintenance staff, and others are not considered healthcare providers within the meaning of the regulations and therefore are not eligible for exclusion from FFCRA leave. For more information on the revised regulations, reference DOL’s updated FAQ and MGMA’s updated FFCRA resource.

2019 MSSP ACO results announced

The 541 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) generated nearly $1.2 billion in net savings in 2019, the highest number to date for the program. ACOs saved $739 million in 2018 and $313 million in 2017. CMS Administrator Seema Verma announced the results in a blog post on Health Affairs, which includes links to more comprehensive data files. MSSP ACOs share in any savings generated for Medicare if they meet certain spending and quality metrics. The MSSP is the largest Medicare APM and began in 2012.

MGMA Washington Connection

Thu, 10 Sep 2020 13:49:52 GMT

Deadline approaching: Sept. 13 is last day to apply for Provider Relief Fund

Eligible Medicaid, Children’s Health Insurance Program, and certain Medicare providers have until Sept. 13 at 11:59 pm ET to apply for funding from the Phase 2 of the Provider Relief Fund (PRF) General Distribution. The application portal will allow eligible providers to submit their Tax ID Number and most recent federal income tax return to be considered for funding. For more information on the PRF, review MGMA’s resource.

New CMS Care Compare tool now combines Medicare cost and quality data

The Centers for Medicare & Medicaid Services (CMS) has announced the launch of Care Compare, a new comparison tool that incorporates the agency’s previously existing transparency tools, including Physician Compare. In one location, Medicare beneficiaries are able to review a variety of information including cost and quality data on providers and procedures. Providers and groups will continue to use PECOS to make updates to information such as group affiliation and address updates.

Oct. 5 last day to request MIPS targeted review

Thu, 03 Sep 2020 13:56:11 GMT

Clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2019 can review their performance feedback, MIPS final score, and 2021 payment adjustment factor on the Quality Payment Program (QPP) website. If you believe there is an error in your group practice or clinician's 2021 MIPS payment adjustment calculation, you can request a targeted review via the QPP site until Oct. 5, 2020, at 8:00 PM ET. Some examples of potential issues where MIPS participants may want to request a targeted review include:

Errors or data quality issues for the measures or activities you submitted;
Eligibility and special status issues (e.g., the participant falls below the low-volume threshold and should not receive a payment adjustment); or
Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard.

MGMA Washington Connection

Thu, 03 Sep 2020 13:53:14 GMT

QPP eCQM scoring issue

The Centers for Medicare & Medicaid Services (CMS) is alerting group practices to a calculation issue that impacts electronic clinical quality measure (eCQM) scoring during the 2020 quality performance year. eCQMs are used in several programs, including the Quality Payment Program. This issue has the potential to impact scoring for three specific measures when certain time values are not present in the input data. The erroneous calculation may result in an increase or decrease of cases that fall in the measure population.

Impacted measures:

CMS128v8 Anti-depressant Medication Management
CMS146v8 Appropriate Testing for Children with Pharyngitis
CMS56v8 Functional Status Assessment for Total Hip Replacement

CMS has published updated measure packages to correct the issue for all three impacted eCQMs here. Physician practices that are reporting on the measure(s) should contact their EHR vendors to determine if updates are warranted.

Congress set to return to DC next week

When Congress returns to Washington next week, they will face two major hurdles—government funding and COVID-19 relief. Congress has until Sept. 30 to fund the government or face a potential government shutdown. It is possible that COVID-19 relief measures will get wrapped into a final package that includes government funding. To that end, MGMA members are encouraged to send a letter to their congressional representatives urging their support of physician practices during COVID-19 using our Contact Congress portal.

MGMA Washington Connection 08/06/20

Thu, 06 Aug 2020 13:49:55 GMT

Help #MGMAAdvocacy: Urge Congress to support physician practices during COVID-19 pandemic

As Congress continues to negotiate the next COVID-19 package, it is imperative that they hear from physician practices. Use MGMA’s template letter to tell Congress that any final legislation must:

· Include direct financial support to medical groups experiencing an adverse economic impact from COVID-19;

· Continue telehealth flexibilities past the expiration of the public health emergency;

· Add flexibilities for Medicare accelerated and advance payments, such as eliminating interest rates and lowering recoupment amounts; and

· Amend the Paycheck Protection Program (PPP) to provide a more simplified process for borrowers seeking PPP loan forgiveness, include personal protective equipment as an eligible covered cost, and allow for 501(c)(6) nonprofit organizations to be eligible for PPP loans.

Thank you for joining our advocacy effort and supporting medical practices during the COVID-19 pandemic!

SBA releases new PPP forgiveness information

The Small Business Administration (SBA) released new PPP FAQs that address eligible payroll and nonpayroll costs as well as loan forgiveness reductions. More specifically, SBA provides new information regarding costs incurred before the Covered Period and further details how to determine the amount of owner compensation eligible for loan forgiveness. As a reminder, absent further congressional action, the last day to apply for a PPP loan is Aug. 8, 2020.

MGMA calls on CMS to delay and modify Advance Payment Program loan repayment

MGMA is urging the Centers for Medicare & Medicaid Services (CMS) to delay repayment of Medicare Accelerated and Advance Payment Program (APP) loans. In addition to suspending repayment for one year, the Association is calling on policymakers to extend the repayment period to two years and waive interest during the extended period.

Congress expanded the APP earlier this year to give providers access to cash flow. CMS opened applications for the program in late March but ceased accepting applications by April 26. Under current program rules, repayment begins 120 days after the advance payment was issued, which is as early as the first week of August. Loans that are not repaid in full within 210 days from the date the payment was received will be subject to interest rates of 10.25%.

MGMA to Congress: Expand Medicare telehealth beyond COVID-19 pandemic

MGMA joined over 200 organizations in support of the Protecting Access to Post-COVID-19 Telehealth Act of 2020. If signed into law, this legislation would remove geographic restrictions on where a patient must be located to utilize telehealth services, enable patients to receive telehealth services in their homes, allow federally qualified health centers and rural health centers to furnish telehealth, and give the Secretary of Health & Human Services (HHS) permanent waiver authority for future emergency periods and for 90 days past the expiration of the current public health emergency. Absent congressional action, the ability for patients to utilize telehealth in nonrural settings and in their homes is only in effect during the public health emergency. MGMA urges Congress to act before the public health emergency ends to avoid a scenario where providers are abruptly unable to treat most Medicare beneficiaries via telehealth.

HHS to reopen Provider Relief Fund applications for certain Medicare providers

HHS announced it will allow a second opportunity for Medicare providers to access payments from the CARES Act Provider Relief Fund (PRF). Starting the week of Aug. 10, HHS will permit Medicare providers that missed the opportunity to apply for additional funding from the $20 billion second tranche of the $50 billion Medicare General Distribution. This opportunity will also be opened to Medicare providers that experienced a change in ownership in 2020 and therefore failed to receive a PRF payment based on 2019 CMS claims data. Both groups of providers will have until Aug. 28 to submit their revenue information to be considered for additional funding. Additional information on this second funding opportunity is expected via the PRF webpage next week.

Regulatory alert: Medicare proposes 2021 payment and quality reporting changes

Tue, 04 Aug 2020 17:21:31 GMT

The Centers for Medicare & Medicaid Services (CMS) released the proposed 2021 Medicare physician fee schedule (PFS) rule late this evening, which includes proposed changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2021. Key proposals include:

· Setting 2021 Medicare payment rates for physician services;

· Generally confirming E/M documentation guidelines and payment changes finalized in the 2020 PFS;

· Expanding telehealth coverage; and

· Establishing MIPS reporting requirements for 2021.

MGMA will submit detailed comments in response to these proposals to CMS and prepare a more detailed analysis of proposed changes in the coming weeks. Review the proposed rule, the PFS fact sheet, and the QPP fact sheet. The final 2021 PFS rule is expected by Nov. 1, 2020.

MGMA Washington Connection 07/30/20

Thu, 30 Jul 2020 12:45:55 GMT

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.

MGMA Washington Connection 07/23/20

Thu, 23 Jul 2020 14:08:31 GMT

Participate in the latest #MGMAAdvocacy poll on practice financial sustainability

Help MGMA learn how COVID-19 has financially impacted your medical group so far by taking this 3-minute survey. The information collected will be used to inform MGMA’s advocacy efforts, educate policymakers, and develop new resources to assist your practice. All responses will remain anonymous. The MGMA COVID-19 Financial Impact Survey will close tomorrow, July 24 at midnight ET.

HHS publishes timeline for Provider Relief Fund reporting requirements

The Department of Health and Human Services (HHS) released an overview of future reporting requirements for providers that received payments under the Provider Relief Fund. HHS outlined the timing of future reporting requirements for providers that receive payments exceeding $10,000 in the aggregate from any Provider Relief Fund distribution (i.e., any payment under the $50 billion general distribution; Medicaid distribution; or a targeted distribution). The overview does not indicate whether providers that received $10,000 or less will be subject to any reporting obligations and does not provide detail as to the form or content of reports. However, the following timeline is provided:

· August 17, 2020: Release of detailed instructions

· October 1, 2020: Reporting system is available

· February 15, 2021: Report due for calendar year 2020 expenditures

· July 31, 2021: Second report due for those who expended funds in 2021

2020 APM participation: Check qualifying participant status now

The Centers for Medicare & Medicaid Services (CMS) updated the Quality Payment Program (QPP) participation tool to include the first snapshot of 2020 performance year data from alternative payment model (APM) participants. Group practice leaders can now use the tool to see if clinicians achieved qualifying participant (QP) status through an advanced APM based on the first snapshot period, which includes payment and patient data from dates of service between Jan 1, 2020 and March 31, 2020. There are three snapshots in a given performance year and clinicians participating in an advanced APM only need to achieve QP status during one snapshot period to qualify for advanced APM incentives (e.g., a 5% bonus and exemption from MIPS). At this time, you may also use the tool to see if clinicians within your group are affiliated with a MIPS APM.

New recommendations on anti-discrimination rules during COVID-19

HHS’ Office for Civil Rights released guidelines for healthcare providers aimed at preventing discrimination based on race, color, and national origin during the COVID-19 pandemic. The guidance is applicable to group practices and providers that receive federal funding and suggests that these entities create proactive policies preventing discrimination, including:

· Adopting policies to prevent harassment and discrimination;

· Confirming existing policies and procedures with respect to COVID-19 related care does not exclude individuals on the basis of race, color, or national origin; and

· Making available information available to individuals and patients on how the practice complies with anti-discrimination laws and regulations.

MGMA recommends members review these guidelines and use this as an opportunity to ensure compliance with existing federal laws.

Deadline extended to apply for Medicaid/CHIP Provider Relief Fund payment

HHS announced an extension to the application deadline for Medicaid and Children’s Health Insurance Program (CHIP) providers seeking a payment from the Provider Relief Fund. Eligible Medicaid and CHIP providers now have until Aug. 3 to complete an application for this distribution. A new fact sheet from HHS reflects the updated deadline, along with additional information on eligibility and the application process.

MGMA Washington Connection 07/16/20

Thu, 16 Jul 2020 15:21:14 GMT

Practices see rise in cyberattacks during COVID-19 pandemic

Healthcare entities, including medical practices and hospitals, are seeing an increase in the number of cyberattacks since the start of the COVID-19 pandemic. In particular, practices are vulnerable to ransomware, a type of malware that locks valuable digital files and then demand a ransom in order for these files to be unlocked. As well, stealing electronic health records can be more valuable than getting access to credit card numbers alone, allowing thieves to file fraudulent insurance claims, obtain prescription medication, and steal identities. To assist in protecting your practice against cyberattacks, members are encouraged to visit the MGMA HIPAA Resource Center to access resources such as the Cybersecurity Action Steps for Medical Practices tool and the Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients resource developed by the federal government.

MGMA advocates for changes to tax treatment of Provider Relief Funds

The Internal Revenue Service clarified on July 6 that for-profit healthcare providers must pay taxes on any grant payments received from the Provider Relief Fund. In response to this announcement, MGMA urged Congress to change this policy to ensure these funds are not taxed. The CARES Act established both the Provider Relief Fund and the Paycheck Protection Program (PPP) and specifically addressed the taxability of the PPP by stating any PPP loan payments that are forgiven are not counted as taxable income. However, the Act did not address the tax treatment of the Provider Relief Fund. MGMA believes this was an oversight and is advocating for change.

Apply for Medicaid/CHIP Provider Relief Fund payment by July 20

July 20 is the deadline for eligible Medicaid and Children’s Health Insurance Program (CHIP) providers to apply for funding via the Enhanced Provider Relief Fund Payment Portal. The Department of Health & Human Services (HHS) expects to distribute $15 billion to eligible providers that did not previously receive a payment from the $50 billion General Distribution. The portal will allow such providers to report their annual revenue data to HHS and apply to receive a payment equal to at least two percent of reported gross revenues from patient care. For additional information on eligibility and the application process, providers can refer to the program’s application instructions.

HHS modifies substance use disorder privacy regulations

The Substance Abuse and Mental Health Services Administration, an agency within HHS, released a final rule modifying the 42 CFR Part 2 regulation governing the confidentiality of records for patients with substance use disorder (SUD). While HIPAA permits the sharing of patient data for treatment, payment, and healthcare operations without patient consent, Part 2 creates a separate standard for the sharing of SUD information that requires patient consent. Key modifications include:

· Treatment records created by non-Part 2 providers are explicitly not covered by Part 2, unless any SUD records previously received from a Part 2 program are incorporated into such records;

· SUD patients may consent to disclosure of Part 2 treatment records to a practice without naming an individual (previously, they would have had to identify a specific person in the practice); and

Non-opioid treatment program and non-central registry treating providers are now eligible to query a central registry in order to determine whether their patients are already receiving opioid treatment.

MGMA Washington Connection

Thu, 09 Jul 2020 12:40:39 GMT

New CMS report details 2018 MIPS, APM performance results

The Centers for Medicare & Medicaid Services (CMS) released its 2018 performance results from the Quality Payment Program's Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). 2018 was the second year of the program and informs 2020 payment adjustments. Highlights include:

98% of MIPS eligible clinicians avoided a negative payment adjustment by scoring at least 15 points. 84% received an exceptional performance bonus by scoring 70 points or higher. The maximum positive payment adjustment, inclusive of the bonus, was just 1.68% due to the small pool of payment penalty money.
The average MIPS score was 86 points. MIPS APM participants had the highest average score at 98 points, followed by groups at 82 points, and individuals at 52 points.
Individual reporting is down to just 6% overall.
More clinicians are participating in Advanced APMs. The number of qualifying participants nearly doubled in 2018 (183,306) from 2017 (99,076).

The report contains more information including the most commonly reported measures, average scores, and more.

Congress advances HHS spending bill

On July 7, a House Appropriations subcommittee approved the FY 2021 Labor-Health and Human Services (HHS)-Education funding bill, which would raise the HHS annual budget to $96.4 billion. The proposal includes billions of dollars in emergency supplemental funding in addition to regular, discretionary funding. The bill also includes a handful of Democratic priorities, such as money directed towards ACA outreach and enrollment as well as gun violence research. The subcommittee voted along party lines to advance the proposal to the full Appropriations committee for debate next Monday the 13th. Any package must be approved by the full House and Senate before going to the President’s desk for signature and becoming law.

Optimizing Telehealth During COVID-19 and Beyond

Wed, 08 Jul 2020 18:12:28 GMT

The "new normal" of the COVID-19 environment is so dynamic that it can be hard to prepare for the next day. One constant we have found in an ocean of variables is the practicality of telehealth in this environment. Understanding how to optimize telehealth technology and the workflows around it is essential for your practice's success, during COVID-19 and beyond.

Our new in-depth report, Optimizing Telehealth During COVID-19 and Beyond, details strategies, insights and best practices from practice leaders that are essential in moving forward in this unpredictable environment. Get your free report today.

MGMA Washington Connection

Thu, 25 Jun 2020 13:16:38 GMT

2020 MIPS: Hardship exception available due to COVID-19

The Centers for Medicare & Medicaid Services (CMS) announced flexibilities for clinicians participating in the Merit-based Incentive Payment System (MIPS) in 2020. Clinicians significantly impacted by the COVID-19 public health emergency may submit an Extreme & Uncontrollable Circumstances application to reweight any or all of the MIPS performance categories by logging into their HARP account at qpp.cms.gov. If a group practice or individual clinician submits 2020 MIPS data for one or more performance categories, that data submission will override an approved application on a category-by-category basis.

Updated PPP forgiveness guidance released

The Small Business Administration (SBA) released further guidance on Paycheck Protection Program (PPP) loan forgiveness. The Interim Final Rule updates previous loan forgiveness guidance to reflect the changes made under the recently enacted Paycheck Protection Program Flexibility Act. In the guidance, SBA clarifies that a borrower may submit a loan forgiveness application before the end of the covered period if he or she has used all the loan proceeds for which he or she is requesting forgiveness. For more information on the PPP, you can access MGMA’s recently updated resource.

CMS updates COVID-19 coverage FAQ

CMS released new FAQs regarding COVID-19 coverage issues included in the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act. FFCRA requires insurers to cover COVID-19 tests without patient cost-sharing, but this new guidance clarifies that the requirement for coverage does not extend to tests conducted for general workplace health and safety (such as screening for employees to come back to work) or for any purposes not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition.

New Medicare prior authorization requirements go into effect July 1

The Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule issued by CMS established nationwide prior authorization requirements for certain hospital outpatient department services. The following Medicare services will require prior authorization when provided on or after July 1, 2020:

· Blepharoplasty

· Botulinum toxin injections

· Panniculectomy

· Rhinoplasty

· Vein ablation

CMS is, however, removing HCPCS code 21235 (Obtaining ear cartilage for grafting) from the list of codes that require prior authorization as a condition of payment, as it is more commonly associated with procedures unrelated to rhinoplasty that are not likely to be cosmetic in nature. The full list of HCPCS codes requiring prior authorization is available here.

MGMA Washington Connection

Thu, 18 Jun 2020 13:26:28 GMT

New PPP loan forgiveness applications released

The Small Business Administration released two Paycheck Protection Program (PPP) loan forgiveness applications: (1) A new, abbreviated application (Form EZ) and (2) a revised version of the original application. Form EZ is intended to be simpler to complete and is available to borrowers who meet one of three conditions. Both forms reflect the changes made to the PPP earlier this month, such as the extended covered period, the 60% payroll cost threshold, and the new safe harbor.

Changes to Section 1557 nondiscrimination rule

On June 12, the Department of Health & Human Services (HHS) issued a final rule revising Affordable Care Act Section 1557’s nondiscrimination regulations. The final rule, which goes into effect on August 18, 2020, modifies certain policies and also eliminates the following requirements that existed under 2016 regulations:

· The requirement for group practices and other covered entities to issue nondiscrimination notices and non-English taglines in the top-15 languages spoken by individuals with limited English proficiency in their state;

· The requirement that each covered entity appoint a compliance director and adopt grievance procedures to handle complaints; and

· Nondiscrimination protections based on sex stereotyping and gender identity.

MGMA frequently receives questions about language access requirements to provide translation/interpretation services and prepared an overview of changes under the 2020 rule. In our comments on the proposed version of the rule, MGMA urged HHS to establish a reimbursement mechanism for practices that care for individuals that require language assistance services. Although HHS responded that this recommendation was outside the scope of the 2020 rule, MGMA will continue to recommend that practices receive financial assistance or reimbursement to assist with these costs.

MedPAC releases June 2020 report

MedPAC, an independent board that advises Congress on how to improve Medicare, released its biannual report this week. The report focuses primarily on strategies to accelerate the move away from fee-for-service and toward a value-based payment system that offers incentives to providers to control costs while maintaining quality. Accountable care organizations (ACOs) and Medicare Advantage plans could serve as vehicles to speed up payment reform, the report states, if existing structures are improved upon. MedPAC acknowledged ACO savings are greater than other models Medicare has tested but suggested technical changes to ACOs to increase potential savings. MGMA agrees with the MedPAC recommendation that the federal government should do more to support group practices in the move toward value-based payment.

MGMA Washington Connection

Mon, 15 Jun 2020 16:45:17 GMT

Take action now: Tell Congress to extend Medicare telehealth waivers

Once the Secretary of Health & Human Services (HHS) lifts the COVID-19 public health emergency (PHE) declaration, many of the telehealth flexibilities allowed during the PHE will end. Since declaring the end of a PHE is at the sole discretion of the Secretary, it is difficult to predict when he will exercise that authority. It is possible that he could end it before patients feel comfortable or safe seeking treatment in an office. To avoid a situation where providers can no longer treat patients via telehealth regardless of their location, Congress must act soon. MGMA drafted a template letter that members can send to their congressional representatives urging them to extend the Medicare telehealth flexibilities beyond the conclusion of the PHE. Since the letter is editable, we encourage members to include anecdotes on how telehealth flexibilities during the COVID-19 PHE have benefited their practices and their ability to treat patients. You can access the letter here or through our Contact Congress portal.

HHS announces $15 billion in Provider Relief Fund payments for Medicaid and CHIP providers

This week, HHS announced it will be distributing $15 billion to Medicaid and Children’s Health Insurance Program (CHIP) providers via a new Targeted Distribution Provider Relief Fund Payment Portal. This portal will allow providers that did not previously receive a payment from the Provider Relief Fund General Distribution to report their annual revenue data and apply to receive a payment equal to at least two percent of reported gross revenues from patient care.

To be eligible for this funding, healthcare providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and must have directly billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019. The deadline to submit an application for the Medicaid Targeted Distribution is July 20, and providers that have been allocated a payment must sign an attestation confirming receipt of the funds and agree to the Terms and Conditions within 90 days of receiving payment. HHS has published a set of instructions to assist providers in the completion of the application form.

CMS accepting applications for Direct Contracting model through July 6

Group practices can apply through July 6 to participate in the Medicare Direct Contracting model starting in April 2021. This model builds on the Next Generation ACO model and features higher risk and reward than the Medicare Shared Savings Program.

The Direct Contracting model is a Centers for Medicare & Medicaid Services (CMS) advanced alternative payment model that includes capitated payments. There are two payment tracks: The Professional option is lower risk for participating physicians (50% shared savings/losses) and the Global option is full risk (100% shared savings/losses).

More information and future updates are available on the Direct Contracting website.

MGMA asks Congress to offer providers liability protections

This week, MGMA joined almost 100 other organizations in urging Congress to include liability protections for providers in the next COVID-19 relief package. More specifically, the sign-on letter asks congressional leadership to include the targeted and limited liability protections for healthcare professionals that are in the bipartisan “Coronavirus Provider Protection Act.” These liability protections would extend to those who provide care in good faith during and 60 days after the COVID-19 PHE.

MGMA Washington Connection

Thu, 04 Jun 2020 13:12:42 GMT

Congress passes critical PPP legislation

On Wednesday, the Senate succeeded in passing the House of Representatives' bill that makes significant changes to the Paycheck Protection Program (PPP). The legislation would lower the Small Business Administration’s requirement that 75% of the loan be spent on payroll costs to qualify for forgiveness to 60%, extend the Covered Period to 24 weeks (up until Dec. 31, 2020), allow PPP borrowers to defer payroll tax payments, establish a minimum maturity term of five years for the balance remaining after forgiveness, and provide greater flexibility for borrowers to rehire employees that would otherwise reduce the amount forgiven. Once the President signs this legislation, the Paycheck Protection Program Flexibility Act of 2020 will become law.

MGMA to HHS: Disburse remaining Provider Relief Funds

MGMA is urging the Department of Health & Human Services (HHS) to expeditiously provide financial relief to group practices by disbursing the remaining Provider Relief Funds. Congress appropriated $175 billion to HHS to deliver financial relief to healthcare providers in order to cover expenses and lost revenue attributable to COVID-19. HHS is making disbursements through a $50 billion General Distribution, however some providers that submitted applications for additional funding have yet to receive payments, despite applying over a month ago. MGMA is encouraging HHS to quickly deliver funds pursuant to those applications.

After accounting for disbursements to date, HHS still has approximately $95 billion in unallocated Provider Relief Funds. Since eligibility for payments under the $50 billion General Distribution was contingent upon Medicare enrollment, MGMA is urging HHS to support group practices underrepresented in this distribution, such as providers that do not accept Medicare.

Save the date: 2020 Washington Update and Policy Outlook webinar

MGMA Government Affairs invites you to join us for a member-exclusive webinar on Thursday, June 25 at 1:00 p.m. ET. With legislative and regulatory changes reshaping the healthcare landscape in response to the COVID-19 pandemic, this timely program will present a mid-year update on the current state of federal healthcare policy impacting medical groups. The session’s forward-looking agenda will also provide considerations for the future of medical group practices and potential new actions Congress and the Administration could take in response to the pandemic. In addition, attendees will learn about ongoing MGMA advocacy in support of medical groups. Attendees will also have a chance to ask their most pressing questions during a question and answer session. Don’t delay - register now to secure your place!

New APM flexibilities for COVID-19

The Centers for Medicare & Medicaid Services (CMS) announced new flexibilities to current and future Innovation Center alternative payment models (APMs) to address the public health emergency, as detailed in a new chart. The agency previously made changes to the Medicare Shared Savings Program, summarized in the MGMA COVID-19 Action Center, but did not address other APM policies until this announcement.

Adjustments include:

Extending the Next Generation accountable care organization (ACO) model through December 2021 and reducing 2020 downside risk.
Delaying the start of new Direct Contracting and Kidney Care Choices models until April 1, 2021, and creating a new application cycle for 2022. The new Primary Care First model will still begin Jan. 1, 2021, but the Serious Illness component is delayed until April 1.
Allowing participants in the Bundled Payments for Care Improvement (BPCI) model the option to eliminate upside and downside risk for 2020.
Additional changes to these and other models are further detailed in the chart.

MGMA advocated for CMS to extend the Next Gen ACO program as it was previously set to end this year and also called on the agency to make adjustments to APM policies in response to COVID-19. We are pleased to see that CMS heeded our advice and is in the process of evaluating individual model changes.

MGMA to Congress: Lift the ban on unique patient identifier

MGMA joined 68 leading healthcare organizations calling on Congress to reject the inclusion of outdated language in Fiscal Year 2021 Appropriations legislation that prohibits HHS from spending any federal dollars to adopt a national unique patient identifier (UPI). Last year, the US House of Representatives voted to remove the ban but the Senate opposed the measure. Removing the prohibition will permit HHS to evaluate a range of solutions that protects patient privacy and is cost-effective, scalable, and secure. Deployment of a UPI would allow practices to more effectively match patient records, decrease medical errors, and facilitate EHR interoperability.

MGMA Washington Connection

Thu, 28 May 2020 14:51:38 GMT

HHS extends deadline for acceptance of terms and conditions for Provider Relief Fund payments

HHS announced another extension to the deadline to accept the Terms and Conditions for Provider Relief Fund payments from the $50 billion general distribution. Providers now have 90 days from the date they received a Provider Relief Fund payment to accept the Terms and Conditions or return the funds. For example, providers that received funds on April 10 will have a new deadline for attestation of July 9. Furthermore, providers that do not accept the Terms and Conditions after 90 days of receipt will be deemed to have accepted the funds and associated Terms and Conditions.

MGMA will continue to track and report developments pertaining to the HHS Provider Relief Funds, including the nearly $100 billion in appropriated funding that has yet to be allocated.

Newly updated MGMA resource: Commercial health plan COVID-19 policies

MGMA developed and recently updated the Commercial Health Plan COVID-19 Policies resource to help groups better understand key COVID-19 related health plan policies that impact medical practices. The resource incorporates information from large commercial plans such as Aetna, Cigna, Humana, UnitedHealthcare, and others. The resource outlines each plan’s policies on advanced payments, telehealth, prior authorization, billing/coding, and other relevant COVID-19 changes.

SBA releases long-awaited PPP loan forgiveness guidance

The Small Business Administration (SBA) released new interim final rules on Paycheck Protection Program (PPP) loan forgiveness and loan review process. The loan forgiveness guidance mostly clarifies information already published in the PPP loan forgiveness application, such as FTE reduction exceptions, how to calculate employee salary/wage reductions, and when payroll/nonpayroll costs must be incurred and/or paid to be eligible for forgiveness. The SBA loan review procedure guidance describes the process by which SBA plans to undertake PPP loan reviews, and reiterates that a lender must issue a decision to SBA on loan forgiveness within 60 days. That decision can take the form of an approval (in whole or in part), a denial, or a denial without prejudice due to a pending SBA review of the loan.

New draft legislation to amend PPP loans

After hearing from constituents, Congress identified several issues with the PPP as currently implemented. As a result, a number of bills were introduced to amend the PPP to provide borrowers with more flexibility. One of these bills, the Paycheck Protection Flexibility Act, is scheduled for a vote in the House of Representatives today. MGMA supports this legislation, which would allow loan forgiveness for expenses beyond the eight-week covered period, eliminate the restriction that limits nonpayroll expenses to 25% of the loan amount, extend the two-year maximum loan term requirement, and allow PPP borrowers to utilize the payroll tax deferment incentive established in the Coronavirus Aid, Relief, and Economic Security Act.

MGMA Washington Connection

Thu, 21 May 2020 14:24:34 GMT

Provider Relief Fund attestation deadline approaching

Group practices who received a payment from the Department of Health and Human Services (HHS) under the Provider Relief Fund must sign an attestation confirming receipt of funds and agreeing to conditions of payment within 45 days of payment. That means groups who received funding from the initial distribution on April 10 have until May 24 to attest. Notably, not returning the payment within 45 days of receipt will be viewed as acceptance of the funds and associated terms and conditions.

HHS also announced this week that providers have until June 3 to submit revenue information to be considered for an additional payment from the $50 billion general distribution. While HHS automatically disbursed payments from the first tranche ($30 billion) starting on April 10, most group practices must submit a request to receive additional funds from the second tranche ($20 billion).

Finally, HHS updated and clarified FAQs on the Provider Relief Fund general distribution. With the Department updating their FAQs and website periodically without any formal announcement or notification, MGMA recommends that group practices review this new guidance. See MGMA’s resource on financial relief programs for more information.

SBA releases PPP loan forgiveness application

The Small Business Administration (SBA) released an application for Paycheck Protection Program (PPP) borrowers to submit to their lenders when seeking loan forgiveness. The application includes:

Instructions on how to perform calculations for loan forgiveness;
A list of documents borrowers must submit with the PPP loan forgiveness application;
Confirmation that eligible nonpayroll costs still cannot exceed 25% of the total forgiveness amount;
A newly created “Alternative Payroll Covered Period” for borrowers with biweekly (or more frequent) pay periods, which would allow the eight-week Covered Period to begin on the first day of the first pay period following PPP loan disbursement;
Clarification that borrowers are generally eligible for forgiveness for payroll/nonpayroll costs paid and payroll costs incurred during the eight-week Covered Period (or Alternative Payroll Covered Period); and
Additional FTE reduction exceptions.

While the application is helpful, it does not resolve all outstanding questions. MGMA hopes to see additional loan forgiveness guidance from SBA and will update membership on future developments. working from home, and other recommendations. In addition, the toolkit outlines the recently-released guidance from the Office for Civil Rights on HIPAA enforcement discretion for telehealth.

MGMA advocates for additional relief for physician practices, ACOs

Last week, Democratic leadership in the U.S. House of Representatives introduced the ‘‘Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act,” which includes several provisions that directly pertain to medical practices. The legislation would make further amendments to the PPP, Medicare’s Advance Payment Program, and the Provider Relief Fund. While this bill is not expected to pass due to lack of bipartisan support, MGMA offered several key recommendations for consideration as Congress works to come to a bipartisan agreement.

Additionally, MGMA and other industry-leading associations have urged the Centers for Medicare & Medicaid Services (CMS) to provide flexibility for practices participating in a Medicare accountable care organization (ACO) and to protect them from potentially harmful losses created by the COVID-19 pandemic. Specifically, MGMA called on CMS to:

New COVID-19 resource: Maintaining cyber security while working remotely To assist members in ensuring the security of their patient’s information when working outside their medical practice, MGMA has developed the new Maintaining Cyber Security while Working Remotely Toolkit. Home offices are increasingly being used during the COVID-19 pandemic, and they are generally more vulnerable to cyber attacks than systems located in medical offices. The resource offers action steps to ensure the physical security of devices, improve the security of your network, practical tips when

Adopt a policy to give ACOs an option to be protected from losses in exchange for a reduced shared savings rate, no less than 40%;
Extend the current June 1 Medicare Shared Savings Program (MSSP) deadline to voluntarily terminate to avoid financial losses to no earlier than Oct. 31;
Reverse its decision to cancel the 2021 MSSP application cycle; and
Pay ACO shared savings payments and advanced alternative payment model bonuses as soon as possible.

MGMA Washington Connection

Thu, 30 Apr 2020 20:52:17 GMT

Regulatory alert: CMS increases telehealth payments and makes ACO changes

Today, the Centers for Medicare & Medicaid Services (CMS) issued another round of regulatory waivers through an interim final rule intended to expand care to Medicare beneficiaries and provide more flexibilities to the providers that treat them. The changes outlined below will be effective for the duration of the COVID-19 public health emergency (PHE).

Changes to telehealth policy:

Following MGMA advocacy, CMS is increasing payment for audio-only telephone E/M services (CPT codes 99441-99443) such that they are paid at the same rate as similar office and outpatient E/M visits, resulting in increased payments from $14-$41 to $46-$110. CMS believes that the resources required to furnish these services during the PHE are better captured by RVUs associated with level 2-4 established office/outpatient E/M visits. CMS is not increasing payment for CPT codes 98966-98968, which are intended for practitioners that cannot separately bill for E/M. This policy is retroactive to March 1, 2020.
For telehealth services other than CPT codes 99441-99443 and 98966-98968 (now added to the list of covered telehealth services), Medicare continues to require modalities that have both audio and video capabilities.
CMS is forgoing its typical rulemaking process to add new services to the list of Medicare services that may be furnished via telehealth. Instead, CMS will add new telehealth services on a sub-regulatory basis to speed up the process of adding codes to the list.

Changes to Medicare Shared Savings Program (MSSP):

There will be no application cycle for a Jan. 1, 2021 start date, and ACOs in the last performance year of their current agreement period (mainly Track 1 ACOs and Track 1+ Model ACOs) will be allowed to voluntarily extend their agreement period by an additional performance year in 2021.
ACOs participating in the BASIC track glide path will be permitted to maintain their current risk level under the BASIC track for PY 2021 and freeze progression to higher risk.
CMS is removing all Part A and B payment amounts for episodes of care involving the treatment of COVID-19 for the purposes of determining benchmark year and performance year expenditures.
The list of primary care services used for beneficiary attribution will be expanded to include additional telemedicine services.

MGMA Government Affairs will continue to inform medical groups as the Administration releases additional waivers and further guidance on COVID-19 related regulatory changes. CMS’ press release on the changes can be found here and a fact sheet on MSSP changes can be found here.

CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

Mon, 27 Apr 2020 15:31:07 GMT

On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund. The Accelerated and Advance Payment (AAP) Programs are typically used to give providers emergency funding and address cash flow issues for providers and suppliers when there is disruption in claims submission or claims processing, including during a public health emergency or Presidentially-declared disaster.

Since expanding the AAP programs on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. For Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP programs are not a grant, and providers and suppliers are typically required to pay back the funding within one year, or less, depending on provider or supplier type. Beginning today, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.

Significant additional funding will continue to be available to hospitals and other health care providers through other programs. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for health care providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid.

The CARES Act Provider Relief Fund is being administered through HHS and has already released $30 billion to providers and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support health care-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19.

For more information on the CARES Act Provider Relief Fund and how to apply, visit: hhs.gov/providerrelief.

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.

MGMA Washington Connection

Fri, 24 Apr 2020 15:31:30 GMT

Congress passes aid package to assist healthcare providers and small businesses

Today, Congress passed an economic aid package to assist healthcare providers and small businesses. The Paycheck Protection Program and Health Care Enhancement Act (H.R. 266) includes $321 billion for the recently depleted Paycheck Protection Program (PPP), $60 billion for Economic Injury Disaster Loans (EIDL) loans and grants, $75 billion for hospitals and healthcare providers, and $25 billion for COVID-19 testing. If signed into law, the Small Business Administration can once again begin accepting PPP applications. The $75 billion for healthcare providers would be in addition to the original $100 billion in relief funds allocated under the CARES Act and distributed in the future by the Department of Health and Human Services (HHS). President Trump has signaled support and is expected to sign the bill into law.

MGMA advocates for CARES Act Provider Relief fund distribution and clarifications

MGMA urged HHS to clarify certain terms and conditions associated with accepting Provider Relief grant funds under the CARES Act. HHS distributed $30 billion in funds to Medicare providers starting April 10 and requires all recipients to sign an agreement form and attestation confirming receipt of the funds within 30 days. Medical group practices that do not wish to agree to the terms and conditions may return the payment, but any practice that does not return the funds or attest within 30 days will be deemed to have accepted the funds and associated conditions. Following numerous member questions and concerns about ambiguous or unclear attestation conditions, MGMA recommended HHS expeditiously release additional guidance so that group practices can make informed decisions before submitting attestations.

On April 22, HHS announced it is distributing another $20 billion which, together with the initial $30 billion, is described as a $50 billion “general allocation.” The $20 billion will be disbursed based on 2018 net patient revenue, not just Medicare fee-for-service. MGMA is seeking clarification on this announcement. Visit the Provider Relief landing page for more information.

CMS releases guidelines for reopening facilities to provide non-emergent, non-COVID care

This week, CMS announced phase 1 criteria to guide health systems and facilities as they consider resuming in-person care of non-COVID-19 patients in regions with low incidence of COVID-19 disease. The agency explains that careful planning is required to resume in-person care of patients requiring non-COVID-19

care, and all aspects of care must be considered, including:

Adequate facilities, workforce, testing, and supplies; and
Adequate workforce across phases of care (such as availability of clinicians, nurses, anesthesia, pharmacy, imaging, pathology support, and post-acute care).

MGMA will update members as CMS releases additional recommendations.

HHS announces delay of major parts of its interoperability rules

Due to the impact of the COVID-19 pandemic, HHS announced a delay in its implementation and enforcement of a number of important provisions of recently-released interoperability regulations. For example, the requirement that hospitals provide practices patient data on admissions, discharge and transfer is delayed six additional months, going into effect one year after implementation of the final rule. In addition, the EHR vendors have an additional three months to comply with the requirement to support patient access to their data via third-party apps. The clock for implementation of the final rules does not start until they are published in the Federal Register, expected to occur early next month. HHS' Office of Inspector General also unveiled its proposed rule to impose financial penalties on certain entities that violate the information-blocking rules.

Extended 2019 MIPS data submission ends April 30, plus new 2020 COVID-19 improvement activity

The 2019 Merit-based Incentive Payment System (MIPS) data submission extension will end on April 30, 2020, at 8 pm. Individual MIPS eligible clinicians (ECs) who have not submitted any data, and who do not submit their MIPS data by the submission deadline will qualify for the 2019 automatic extreme and uncontrollable circumstances policy. MIPS ECs, groups, and virtual groups that submitted some data, but not able to complete their 2019 MIPS submission can now apply for a 2019 extreme and uncontrollable circumstances exception due to the COVID-19 pandemic.

The Centers for Medicare & Medicaid Services (CMS) also announced that ECs may now earn 2020 MIPS credit for participation in a clinical trial and reporting clinical information by attesting to the new COVID-19 Clinical Trials improvement activity. In order to receive credit for the new improvement activity, ECs must attest that they participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry for the duration of their study. Click here for additional information on 2019 MIPS data submission and this new improvement activity.

Regulatory alert: HHS distributing initial $30 billion in grant funds for provider relief under CARES Act

Fri, 10 Apr 2020 14:05:46 GMT

The Department of Health & Human Services (HHS) announced today it is beginning distribution of $30 billion in grants to hospitals and providers as part of the $100 billion fund authorized by the CARES Act; more information on the initial disbursement can be found here. These are payments, not loans, that have no repayment obligations and could be delivered via direct deposit as early as today.

This announcement follows MGMA advocacy urging HHS to provide immediate financial support to group practices in order for them to sustain operations and continue treating patients. We will continue to press HHS to disburse remaining funds directly to medical group practices in an expeditious, efficient manner.

Healthcare entities eligible for the initial $30 billion include all facilities and providers that received Medicare fee-for-service (FFS) payments in CY 2019. Importantly, this is only the first wave of funds under the $100 billion, and MGMA expects forthcoming distributions will focus on providers with lower shares of Medicare FFS reimbursement or who predominantly serve the Medicaid population.

Payment distribution amounts are determined by the eligible provider’s share of 2019 Medicare FFS reimbursements. HHS is partnering with UnitedHealth Group and Optum Bank to assist in the delivery of the initial $30 billion; funds will be distributed to the eligible provider’s billing tax identification number (TIN) using direct deposit information on file with United, Optum, or Medicare (with “HHSPAYMENT” or “HHS Stimulus” as the payment descriptor), or via paper check for those that normally receive reimbursement this way. Within 30 days of payment, HHS requires providers to attest to receipt of the funds and agree to certain terms via a portal opening on April 13.

The $30 billion being distributed was authorized under the CARES Act, which was the third COVID-19 economic stimulus bill passed by Congress. The CARES Act designates $100 billion in funding through the Public Health and Social Services Emergency Fund and requires HHS to distribute capital through grants or “other mechanisms” to eligible healthcare entities, which include hospitals and group practices that are experiencing financial losses due to COVID19. Unlike the small business loans authorized under CARES, there are no employer size limitations.

Regulatory alert: New MGMA resources on federal financial assistance

Mon, 06 Apr 2020 14:36:17 GMT

MGMA Government Affairs developed two new resources to inform medical groups of available financial assistance opportunities set forth in the CARES Act, which was signed into law on March 27, 2020. The resources are organized by medical group size because the U.S. Small Business Administration (SBA)’s Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL) are only available to businesses with 500 employees or less. Please note that financial lenders should start accepting applications for PPP loans today, although it has been reported that not all lenders are prepared. In the meantime, SBA has supplied a sample application form for applicants to understand what will be requested of them.

Resource for medical groups with less than 500 employees: The CARES Act allocated money to fund the PPP loans and EIDLs. Loans under the PPP can be forgiven if the employer keeps their employees on the payroll for eight weeks after the loan origination date. EIDL loans are available to businesses who have suffered substantial economic injury. Small businesses who have applied for EIDL loans can receive an advance of $10,000 ("emergency EIDL grants") within three days after the SBA receives their application. Please review MGMA’s resource for more details on both programs.

Resource for medical groups of all sizes: CMS’s Accelerated and Advance Payment Program (APP) and funds distributed from the “Public Health and Social Services Emergency Fund” are two available financial assistance options. The APP provides a quick mechanism for healthcare entities to obtain an accelerated cash flow, which is subject to repayment – funding through this mechanism can be accessed now. Little is known yet on how the $100 billion from the emergency fund will be distributed, but these funds are intended to reimburse eligible healthcare entities for healthcare related expenses and lost revenue stemming from COVID-19.

Regulatory alert: CMS announces new flexibilities

Tue, 31 Mar 2020 16:26:10 GMT

Last night, the Centers for Medicare & Medicaid Services (CMS) issued a series of temporary regulatory waivers to further support the ability of the nation’s healthcare system to respond to COVID-19. The changes outlined below will take effect immediately across the entire country:

New telehealth codes. CMS will pay for 80 additional telehealth codes, including home visits, emergency department visits, and therapy services. Providers can waive copayments for all telehealth services for Original Medicare beneficiaries.
Virtual check-ins. Clinicians can provide virtual check-in services (HCPCS G2012, G2010) to both new and established patients. Previously, these services were limited to established patients only.
Telephone codes. CMS will reimburse for telephone evaluation and management services provided by a physician (CPT 99441-99443) and telephone assessment and management services provided by a qualified nonphysician healthcare professional (CPT 98966-98968). These codes are only available to established patients but may be furnished using audio-only devices.
E-visits. Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists can provide e-visits (HCPCS G2061-G2063). These codes are only available to established patients and must be initiated by the patient.
Removal of frequency limitations on Medicare telehealth. Subsequent inpatient visits (CPT 99231-99233), subsequent skilled nursing visits (CPT 99307-99310), and critical care consult codes (CPT G0508-G0509) no longer have limitations on the number of times they can be billed.
Medicare physician supervision requirements. Physician supervision can be provided virtually using real-time audio/visual technology for services requiring direct supervision by a physician or other practitioner.
“Stark Law” waivers. CMS is implementing waivers that exempt providers from sanctions for noncompliance of certain Stark Law rules, permitting certain referrals and the submission of related claims that would otherwise violate the Stark Law.
MIPS flexibilities. CMS will allow clinicians adversely affected by COVID-19 to submit an application to request reweighting of the MIPS performance categories for the 2019 performance year.

MGMA Government Affairs will continue to educate medical groups as the Administration releases additional waivers and further guidance on COVID-19 related regulatory changes. For a comprehensive list of Medicare telehealth waivers and regulatory developments, please click here.

COVID-19 regulatory alert: CMS announces expanded Advance Payment Program to provide accelerated loans to healthcare providers

Mon, 30 Mar 2020 18:11:21 GMT

On Saturday, the Centers for Medicare & Medicaid Services (CMS) announced nationwide expansion of the existing accelerated Advance Payment Program (APP), making the program available for most Medicare physicians and group practices. The APP provides a quick mechanism for healthcare entities to obtain accelerated, interest-free cash flow. Specifically, the APP fact sheet outlines that:

Physician practices can request an advanced payment of up to 100% of the Medicare payment amount based on a three-month lookback period. Hospitals can request up to 100% (125% for critical access hospitals) based on a six-month lookback period. The guidance does not specify how the lookback period is determined.
Healthcare entities must make a request for an accelerated payment under the APP by submitting a form to their Medicare Administrative Contractor (MAC).
Once requested, CMS anticipates MACs will issue payment within seven calendar days from the request.
The criteria for applying for the APP are:
Having billed Medicare for claims within 180 days immediately prior to the date of request;
Not in bankruptcy;
Not under active medical review or program integrity investigation; and
No outstanding delinquent Medicare overpayments.
APP payments are subject to repayment, which for most healthcare entities begins 120 days after the payment is received.
During the 120-day period, the healthcare entity will continue to be paid like normal for claims submitted to Medicare.
After the 120 days, the recoupment process starts and every claim submitted will be offset to repay the advanced payment.

This announcement is a step in the right direction; however, MGMA is advocating that the Administration make available funding that is not subject to repayment or recoupment. Recently passed legislation (the CARES Act) creates several financial assistance programs, including $100 billion in grants for Medicare physicians and hospitals. Although the APP fact sheet states that the APP reflects the passage of the CARES Act, which did expand the APP, this program is not part of the $100 billion in funding authorized under that law.

Following MGMA advocacy, CMS extends 2019 MIPS reporting deadline, creates automatic exemptions

Thu, 26 Mar 2020 17:23:20 GMT

In response to MGMA calling on the Centers for Medicare & Medicaid Services (CMS) to ease quality reporting and other regulatory requirements, the deadline to submit 2019 MIPS performance data is extended from March 31 to April 30, 2020. MIPS eligible clinicians who have not submitted any MIPS data by April 30 will qualify for an automatic exemption from reporting responsibilities for “extreme and uncontrollable circumstances” and will receive a neutral payment adjustment for the 2021 MIPS payment year. Various other quality reporting programs, such as those applicable to hospitals and post-acute providers, have new flexibilities as well. CMS is also evaluating options for providing relief around participation and data submission for the 2020 performance year. Read more here.

MGMA to Congress: Leverage health IT in the fight against COVID-19

Thu, 26 Mar 2020 17:21:36 GMT

MGMA joined 21 healthcare organizations on a lettercalling on congressional leaders to fully leverage health IT to detect, treat, and prevent the spread of COVID-19. Specifically, the letter urges Congress to address issues including: telehealth and remote patient monitoring, funding to expand rural broadband capabilities, improve the matching of patient medical records, funding for and rapid testing of emerging technologies, and expanded hardship exceptions to protect practices against unfair penalties associated with the Quality Payment Program and other reporting programs.

Senate passes third stimulus package

Thu, 26 Mar 2020 17:20:54 GMT

Late Wednesday night, the Senate passed a much anticipated third emergency funding bill to help combat the spread of the virus and the negative economic impact its having on the country. The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act:

Provides $100 billion to hospitals and healthcare providers to ensure they continue to receive the support they need for COVID-19 related expenses and lost revenue;
creates a “paycheck protection program” that would provide 8 weeks of cash-flow assistance to small employers;
Gives the Secretary more flexibility to waive additional Medicare telehealth requirements; and
Temporarily suspends the 2% Medicare sequestration.

The House of Representatives is expected to vote on the bill as soon as tomorrow. MGMA Government Affairs will continue to monitor these legislative developments and provide updates via the COVID-19 Action Center.

COVID-19 regulatory alert: Medicare telehealth restrictions lifted

Tue, 17 Mar 2020 18:36:48 GMT

Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Secretary Azar’s waiver authority that broadens access to Medicare telehealth services. Effective March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, CMS will:

· Waive geographic restrictions, meaning patients can receive telehealth services in non-rural areas;

· Waive originating site restrictions, meaning patients can receive telehealth services in their home;

· Allow use of telephones that have audio and video capabilities;

· Allow reimbursement for any telehealth covered code, even if unrelated to COVID-19 diagnosis, screening, or treatment; and

· Not enforce the established relationship requirement that a patient see a provider within the last three years.

The Medicare telemedicine healthcare provider fact sheet can be found here. The Medicare FAQ on these telehealth waivers can be found here. The Enforcement Discretion for telehealth remote communications during the COVID-19 notice can be found here.

This announcement follows MGMA efforts to encourage CMS to expeditiously expand telehealth coverage in response to the public health emergency.

Visit the MGMA COVID-19 Action Center for the latest developments impacting medical practices.

Questions?

Contact MGMA Government Affairs by emailing govaff@mgma.org or calling 202.293.3450, 877.275.6462 toll-free

COVID-19 regulatory alert: New waiver protections for healthcare community

Mon, 16 Mar 2020 20:31:31 GMT

Due to the spread of COVID-19, President Trump last Friday declared a national emergency, which expands the Administration’s ability to implement regulatory flexibilities through “blanket waivers” of generally applicable Medicare, Medicaid, and CHIP program requirements. When a blanket waiver is issued, it applies broadly and clinicians do not need to apply for individual waiver protection. The Department of Health and Human Services (HHS), together with the Centers for Medicare & Medicaid Services (CMS), has already acted under this authority to implement a number of waivers including:

· Allowing licensed providers to render services outside their state of enrollment for purposes of billing Medicare and Medicaid.

· Temporarily suspending certain enrollment requirements under Medicare, postponing revalidation actions, and expediting pending or new applications.

· Removing the requirement for a 3-day prior hospitalization prior to coverage of a SNF stay and adding flexibility for obtaining renewed coverage for certain beneficiaries who have recently exhausted SNF benefits.

· Extending certain timelines for filing Medicare Parts B, C, and D appeals.

These waivers generally have retroactive effect as of March 1. Notably, no waiver around Medicare telehealth coverage and billing has yet been issued. MGMA is closely monitoring this situation and will continue to make updates to our COVID-19 Action Center as they become available. We encourage you to bookmark the COVID-19 Action Center today and check back routinely, as we will be updating it consistently throughout the coming days and weeks.

New HIPAA Breach Toolkit now available

Thu, 20 Feb 2020 21:04:28 GMT

With physician practices increasingly vulnerable to cyber attacks and other incidents that could lead to patient information being inappropriately revealed, MGMA has developed a new member-exclusive resource to help practice leaders better understand and implement the HIPAA breach requirements. The MGMA HIPAA Breach Toolkit outlines how practices can determine if the disclosure is a reportable breach under the law and what steps the practice must take to inform patients, the federal government, and potentially even local media outlets of the disclosure. In addition, the toolkit discusses the role of business associates in the event of a data breach and offers suggestions on effectively documenting how the breach occurred and the steps practices took following identification of the breach.

Changes to Physician Compare tool coming

Thu, 20 Feb 2020 21:03:13 GMT

In a recent blog post, CMS announced changes to its various public quality performance tools, such as Physician and Hospital Compare. The goal of these tools is to help beneficiaries make informed healthcare decisions, find physicians, and view certain performance data collected from quality reporting programs like MIPS.

While there are currently eight independent tools, this spring CMS plans to combine and standardize these existing Compare tools. CMS claims this will permit users to access the same information through a single point of entry and simplify navigation to find the information that is currently divided. This new version will be called Medicare Care Compare.

In the past, CMS has established review and dispute periods to correct preliminary datasets. MGMA encourages members to access Physician Compare to ensure the accuracy of data during such periods and will keep members informed about future review opportunities, as well as any further developments about the new Care Compare website.

Reminder: 2020 only a testing year for AUC

Fri, 17 Jan 2020 02:31:36 GMT

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.

MGMA asks Congress for social determinants hearing

Fri, 17 Jan 2020 02:30:37 GMT

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.

Application period for Primary Care First and Kidney Care Choices ends Jan. 22

Fri, 17 Jan 2020 02:29:16 GMT

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.

Don't forget: 2018 Open Payments data available for review and dispute through Dec. 31

Fri, 13 Dec 2019 20:30:39 GMT

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.

Reminder: Medicare claims without an MBI will be rejected Jan. 1

Fri, 13 Dec 2019 20:29:47 GMT

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.

MGMA to CMS: Improve patient record matching

Fri, 13 Dec 2019 20:28:48 GMT

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.

CMS releases new Advanced APM applications

Thu, 05 Dec 2019 15:15:39 GMT

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.

Need an exception for MIPS promoting interoperability or other reporting requirements? Apply by Dec. 31

Thu, 05 Dec 2019 15:14:51 GMT

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.

MGMA to CMS: Address prior authorization challenges

Thu, 05 Dec 2019 15:13:34 GMT

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.

MGMA meets with CMS Administrator on prior authorization

Thu, 14 Nov 2019 15:33:36 GMT

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.

Medicare open enrollment assistance is available to your practice’s patients

Thu, 14 Nov 2019 15:32:32 GMT

Medicare Open Enrollment ends on Dec. 7 and your Medicare patients may have questions about their benefits. The Department of Health and Human Services' Administration for Community Living has a resource for beneficiaries called the State Health Insurance Assistance Program. This free, federally-sponsored program serves to help beneficiaries understand their Medicare benefits and enrollment options.

New beneficiary-level data from CMS for 2018 MIPS cost performance category

Thu, 31 Oct 2019 00:29:52 GMT

Members whose clinicians or practices submitted data for the MIPS Total Per Capita Costs for All Attributed Beneficiaries (TPCC) measure or the MIPS Medicare Spending per Beneficiary (MSPB) cost measure in 2018 can utilize a new resource from CMS.

Individuals or groups can compare their costs for each measure with the benchmark provided in the performance user interface on the Quality Payment Program website to better understand their performance relative to their peers. MGMA has long called on CMS to provide better, actionable data to MIPS-participants related to the cost category. In response, the agency notes that this resource was created to help identify care coordination opportunities for patients and streamline resource use.

MGMA offers recommendations on patient privacy changes

Thu, 31 Oct 2019 00:28:42 GMT

MGMA submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) in response to the agency’s proposal to modify the privacy requirements for sharing substance use disorder (SUD) information. SAMHSA proposed a number of modifications to current regulations that could impact medical group practices. Patients would be required to designate a practice, as opposed to a specific individual as currently required, to receive their SUD information, which MGMA supports. While MGMA expressed support for practice access to SUD information in emergency situations and to all state Prescription Drug Monitoring Program (PDMP) information, we expressed concern that certain non-clinicians, including law enforcement officials, could be given access to SUD and other sensitive patient data via the PDMP.

CMS releases new Advanced APM applications

Thu, 31 Oct 2019 00:27:03 GMT

Last week, the Centers for Medicare & Medicaid Services (CMS) opened the application period for the Primary Care First (PCF) advanced alternative payment model (APM) and also delayed the start date until Jan. 1, 2021. Practices applying to begin participation in 2021 will need to submit the application by Jan. 22, 2020. MGMA updated its member-resource outlining the PCF model to reflect these new details.

CMS also opened the application period for the Kidney Care Choices model, which will close on Jan. 22, 2020. Applications for the Kidney Care First model have not yet been released. Stay tuned to the Washington Connection for further announcements.

HHS proposes Stark and anti-kickback law changes

Thu, 10 Oct 2019 15:24:57 GMT

The Department of Health and Human Services (HHS) released long-awaited proposals that modify the physician self-referral (Stark) and anti-kickback laws. The intent of the proposed rules is to create new exceptions that encourage value-based arrangements and allow for increased patient engagement.

MGMA is evaluating these two proposed rules and will develop comments in the coming weeks. For more information, see HHS' press release.

MIPS reminder: Check-in with data submission vendors

Thu, 10 Oct 2019 15:23:57 GMT

The 2019 MIPS performance year is in its final months and there are important steps participants can take to ensure successful data reporting. For participants utilizing EHR vendors to submit MIPS data, make time to check-in with those vendors to ensure they are on track to submit data during the submission period early next year. In the past, MGMA members have reported vendors experiencing glitches and computing issues when calculating scores. This is an issue MGMA Government Affairs tracks closely and members are encouraged to reach out to us if they encounter issues. As a reminder, Dec. 31 is the last day MIPS participants can apply for a Promoting Interoperability hardship exception and an extreme and uncontrollable circumstances application. Those that qualify will receive re-weighting of one or more MIPS performance categories.

MGMA to Congress: Ensure interoperability regulations address needs of practices

Wed, 25 Sep 2019 21:18:09 GMT

MGMA joined organizations representing clinicians, hospitals, health systems, and others in encouraging congressional leaders to ensure that the interoperability provisions of the 21st Century Cures Act of 2016 are implemented in a manner that best meets the needs of patients and those who deliver their care. The letter raised concerns that provisions of the recently-proposed Office of the National Coordinator for Health Information Technology interoperability rule, especially prohibitions against information blocking, could increase administrative burdens for practices and jeopardize the security of patient information. The letter called on the government to:

· Enhance the privacy and security of patient data being exchanged electronically;

· Ensure that appropriate implementation timelines are established, giving practices and their vendor partners sufficient time to deploy and test technology and take into account competing regulatory mandates; and

· Use discretion in its initial enforcement of the data blocking provisions of the regulation, prioritizing education and corrective action plans over monetary penalties.

OIG finds Part D drug rejections delay or deny care

Wed, 25 Sep 2019 21:17:46 GMT

The Department of Health and Human Services Office of the Inspector General (OIG) released a report finding that Medicare Part D beneficiaries face avoidable steps that can delay or prevent access to prescribed drugs. Based on 2017 data, the report found that Part D insurers rejected millions of prescriptions presented at pharmacies, yet overturned 73 percent of drug-coverage denials when beneficiaries appealed. The OIG signaled that some of these rejections could have been avoided if the prescribed drugs were on the approved lists, met requirements, or received any required preapprovals. OIG recommends that CMS:

· Improve electronic communication between Part D insurers and prescribers to reduce avoidable pharmacy rejections and coverage denials;

· Reduce inappropriate pharmacy rejections;

· Reduce inappropriate coverage denials; and

· Provide beneficiaries with clear, easily accessible information about Part D insurer performance problems, including those related to inappropriate pharmacy rejections and coverage denials.

Regulatory Burden Survey closing soon: Act now!

Wed, 25 Sep 2019 21:16:51 GMT

MGMA's Annual Regulatory Burden Survey is closing soon. This is your opportunity to provide critical feedback on the impact that federal programs have on your practice. The findings of this research will greatly assist MGMA's advocacy efforts in Washington to reduce burdensome regulations on group practices. Click here to participate in this 5-7 minute survey!

MGMA recommends improvements to Medicare payment policy, QPP for 2020

Wed, 25 Sep 2019 21:14:19 GMT

MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed 2020 Medicare Physician Fee Schedule. MGMA recommended that CMS:

· Finalize the proposal to maintain separate payment rates for E/M visit levels;

· Develop the Merit-based Incentive Payment System (MIPS) Value Pathways proposal through continued stakeholder input;

· Stabilize the MIPS quality performance category by maintaining current data completeness thresholds for longer than a single performance year;

· Prioritize improvements to the MIPS cost performance category before increasing its weight; and

· Increase opportunities to participate in Advanced Alternative Payment Models.

Call to action: Tell Congress to hold health plans accountable for surprise billing

Wed, 17 Jul 2019 21:07:05 GMT

In recent months, Congress introduced a number of bills that address the issue of surprise billing. There is widespread agreement that patients should be protected from surprise medical bills and taken out of the middle of payment disputes. However, the current legislative “solutions” give too much power to health plans. Instead of the discounted in-network benchmark rate solution proposed by many of these bills, MGMA advocates for out-of-network payments to be set by leveraging commercial data from independent sources. When this payment rate is insufficient, an independent dispute resolution process should be utilized to determine fair payment for the physician.

Please take a moment to submit a letter to Congress through our Contact Congress portal and ask your representatives to hold health plans accountable.

MIPS report cards now on Physician Compare

Wed, 17 Jul 2019 21:06:06 GMT

As part of CMS’s continued phased-in approach to public reporting on Physician Compare, the agency recently published a subset of 2017 QPP information submitted under MIPS and APMs. The information added on profile pages for MIPS eligible clinicians and groups includes select quality measure and CAHPS survey data.

To learn more about Physician Compare and the 2017 QPP data publication, review CMS’s fact sheet. MGMA Government Affairs encourages members to share feedback with us regarding their experiences with Physician Compare.

New Medicare APMs announced

Wed, 17 Jul 2019 21:04:37 GMT

CMS announced the creation of two voluntary and two mandatory Medicare APMs for CY2020. The voluntary models are Kidney Care First and Comprehensive Kidney Care Contracting. CMS also proposed a regulation that would create two mandatory models – End-Stage Renal Disease Treatment Choices (ETC) and Radiation Oncology.

CMS anticipates that all models will open for participation in CY 2020 and that each model, except for the proposed ETC model, will qualify as an Advanced APM starting in performance year CY 2021. While MGMA strongly supports the creation of new voluntary APM opportunities, we oppose mandatory models that subject group practices to untested payment structures that lack evidentiary support. To learn more about these new opportunities, visit MGMA’s APM landing page.

2018 QPP performance results released

Wed, 17 Jul 2019 21:03:08 GMT

CMS has released data outlining preliminary, high-level results of participation data in the 2018 Quality Payment Program (QPP). A key takeaway from 2018 performance is that a higher percentage of participants in MIPS avoided a negative adjustment compared to 2017 performance (almost 98% versus 93%). Additional details of 2018 QPP participation include:

· The total number of clinicians who participated in MIPS in 2018 was 559,230, down from 716,603 in 2017;

· Small practice participation in MIPS increased to 89.2% in 2018, up from 81% in 2017; and

· The number of Advanced Payment Model Qualifying Participants (QPs) rose to 183,306 in 2018, up from 99,076 in 2017.

MGMA members who believe an error has been made to their 2018 performance final scores can request a targeted review through the QPP website until September 30, 2019.

Upcoming CMS webinar on Primary Care First model option for Seriously Ill Populations

Wed, 10 Jul 2019 23:15:14 GMT

CMS is hosting a webinar on Wednesday, July 24, 2019 at 12 p.m. ET on the Primary Care First Model option for Seriously Ill Populations (SIP). Topics to be discussed include how eligible practices can participate in the SIP payment track of Primary Care First, eligibility requirements, quality measures, and payment. Click here to register for this webinar.

For more information about the new Primary Care First model, please refer to the "Top Member Resources" section of the Washington Connection.

Now available: 2018 MIPS final scores impacting 2020 payments

Wed, 10 Jul 2019 23:14:15 GMT

If your group practice submitted 2018 Merit-based Incentive Payment System (MIPS) data, you can now view performance feedback, final scores, and 2020 payment adjustments by logging into the Quality Payment Program (QPP) website. MIPS participants that feel there is an error in their 2020 payment adjustment may submit a “targeted review” request by Sept. 30. More information on the targeted review process and FAQs on 2018 performance feedback/2020 payment adjustments can be found on the QPP website in the Resource Library.

The Centers for Medicare & Medicaid Services (CMS) estimates that 98% of MIPS eligible clinicians avoided a negative payment adjustment based on 2018 performance. Because MIPS is a budget neutral program, positive payment adjustments will be low even for very high scores. For example, based on inaugural performance year data from 2017, 95% of eligible clinicians avoided a payment penalty and the maximum payment adjustment in 2019 was 1.88% for a perfect score. By statute, the maximum payment adjustment is 4% for 2017 reporting and 5% for 2018 reporting, plus an additional 10% for exceptional performance.

CMS reports MBI usage now at 75%

Wed, 10 Jul 2019 23:11:09 GMT

CMS reports that as of June 14, practices have submitted 75% of Medicare fee-for-service claims with the new Medicare Beneficiary Identifier (MBI). Practices are urged to remind Medicare patients to present their new card and to collect MBIs at the time of service. As a reminder, starting Jan. 1, 2020, Medicare will only accept the MBI on claims. MBIs are accessible via your Medicare Administrative Contractor web portal.

Download the MGMA member-benefit New Medicare Card Toolkit for additional information on this transition to MBIs and downloadable posters you can post in your practice to educate your patients on the new card.

New CMS resource on MIPS Cost category

Wed, 12 Jun 2019 21:50:37 GMT

CMS has released a new Merit-based Incentive Payment System (MIPS) resource on the Cost performance category. The resource outlines details on the different Cost measures, reporting requirements, and scoring methodology. As a reminder, in additional to the historic Total Per Capita Cost and Medicare Spending Per Beneficiary MIPS Cost measures, CMS added eight new episode-based measures that cover five different procedures and three acute inpatient medical conditions. MGMA has heard from members that this category unfairly penalizes group practices that treat sicker patients and has significant concerns about the way CMS evaluates clinicians on certain measures. A top advocacy priority for MGMA is supporting efforts that more accurately measure the Cost component of MIPS and only hold clinicians accountable for resource use within their control.

VA launches new private care system

Wed, 12 Jun 2019 21:49:40 GMT

The Department of Veterans Affairs (VA) launched its new Veterans Community Care Program (VCCP) on June 6, which consolidates several programs that pay for veterans' care outside the VA system, including Veterans Choice, into one. With community care, veterans can receive care from a private practitioner in their community depending on specific eligibility requirements. TriWest will continue as interim third-party administrator for the VCCP while the new contractors ramp up networks and processes over the coming year. These changes were required by the VA MISSION Act of 2018, which MGMA supported. For more information, review the VA’s announcement.

MGMA to Congress: Hold insurers accountable for surprise medical bills

Wed, 12 Jun 2019 21:48:07 GMT

MGMA submitted feedback last week on the Lower Health Care Costs Act, a legislative draft proposed by the U.S. Senate Health, Education, Labor and Pensions Committee. The draft bill outlined potential solutions for addressing unexpected or “surprise” medical bills, improving transparency, and lowering drug costs.

The Association recommended an approach to unexpected medical bills that holds insurers accountable for narrow and inflexible networks and protects patients from unexpected healthcare costs that their insurance will not cover.

Deadline: Application for 2020 Medicare Shared Savings Program

Thu, 30 May 2019 13:34:49 GMT

For practices seeking to participate in the Medicare Shared Savings Program (MSSP) beginning Jan. 1, 2020, the Notice for Intent to Apply (NOIA) will become available on June 11 and must be submitted by June 28 at 12 p.m. ET. Practices must submit a NOIA if they intend to apply to the BASIC or ENHANCED track of the MSSP, apply for a Skilled Nursing Facility 3-Day Rule Waiver, and/or establish and operate a Beneficiary Incentive Program.

While a NOIA submission is not binding, it is required to submit a formal application, which will be available for submission from July 1-29. For more information on the application process, please visit the MSSP website. For resources and guidance on Accountable Care Organizations and the MSSP, visit MGMA.com/ACO.

CMS rule enables MA plans ability to use step therapy

Thu, 30 May 2019 13:33:28 GMT

The Centers for Medicare & Medicaid Services (CMS) issued a final rule enabling Medicare Advantage (MA) plans to implement step therapy for Part B drugs as a recognized utilization management tool. CMS did however, put some parameters on how step therapy may be implemented by these plans. Starting Jan. 1, 2020, MA step therapy programs:

· Only apply to new starts of medication;

· Must be reviewed and approved by the plan’s pharmacy and therapeutics committee; and

· Must have a shorter decision-making time frame when patients request coverage of or appeal a denial of a Part B drug.

The rule also codified the longstanding policy that Part D sponsors are permitted to implement prior authorization and step therapy requirements for beneficiaries starting treatment for five of the six Part D drug classes.

ET3 Model RFA FAQs now available

Thu, 30 May 2019 13:32:53 GMT

MGMA members interested in learning more about the new Emergency Triage, Treat and Transport (ET3) care model from the CMS Innovation Center are encouraged to review these FAQs. The FAQs are intended to help potential applicants ahead of the official request for applications (RFA), which is expected to be released later this summer. The goals of the ET3 model are to offer alternative interventions following a 911 call. Specifically, the model will offer reimbursement to participating ambulance care teams to:

1. Transport an individual to a hospital emergency department;

2. Transport to an alternative destination such as a doctor’s office or clinic; or

3. Provide treatment in place.

MGMA will notify members when the official RFA is released this summer.

CMS to host calls on new prior authorization initiative

Thu, 09 May 2019 15:06:57 GMT

The Centers for Medicare & Medicaid Services (CMS) will host a series of open-door forum calls outlining a new initiative to develop a Medicare Fee for Service (FFS) Documentation Requirement Lookup Service (DRLS) prototype. MGMA serves on the DRLS workgroup. The first call will be held Tuesday, May 14, 2019 from 2:00 - 3:00 p.m. ET and will permit physician practices and others to provide feedback on this initiative. The goal of the DRLS is to improve "provider to payer" information exchange and thereby reduce provider burden. The prototype will allow practices to discover at the time of the patient encounter and within their EHR or practice management system:

· If Medicare FFS requires prior authorization for a given item or service; and

Documentation requirements for Oxygen and Continuous Positive Airway Pressure (CPAP) Devices.

MGMA Statement on Improving MACRA

Thu, 09 May 2019 15:05:42 GMT

MGMA's statement to the Senate Committee on Finance articulates the association’s priorities related to the MACRA statute and its two payment pathways: The Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). While supporting MACRA’s overall framework, MGMA makes a number of recommendations aimed at improving MACRA, including:

· Simplify MIPS scoring and reduce reporting burdens;

· Extend the availability of the APM incentive bonus; and

· Continue to provide stable, positive updates to the Physician Fee Schedule for all services.

Urge Congress to support new step therapy bill

Thu, 09 May 2019 15:04:12 GMT

Congress introduced the Safe Step Act (H.R. 2279), which requires group health plans to adhere to common-sense parameters and reasonable timelines around the practice of step therapy. MGMA supports this bipartisan bill as it aims to improve step therapy protocols to ensure that patients have timely access to appropriate care while reducing physician practice burden associated with step therapy. Members are encouraged to contact their congressional representatives through MGMA’s “Contact Congress” portal and urge them to support the Safe Step Act.

MGMA working to reduce unnecessary prior authorization

Thu, 14 Mar 2019 00:18:23 GMT

MGMA joined a broad industry coalition including the American Academy of Family Physicians, American College of Cardiology, American College of Radiology, America’s Health Insurance Plans, UnitedHealthcare, and more than 20 other organizations to develop a set of four considerations focused on improving, reforming, and streamlining the prior authorization (PA) process. The considerations include:

Increasing transparency;
Reducing PA volume;
Increasing use of existing electronic standards; and
Exploring bundled authorizations.

The coalition is exploring pilot programs based on these considerations.

Medicare takes center stage in President's 2020 budget priorities

Thu, 14 Mar 2019 00:17:59 GMT

President Trump released his $4.7 trillion fiscal year (FY) 2020 budget request, which includes several Medicare proposals relevant to medical practices, such as expanding prior authorization. Presidential budgets do not have the force of law and are intended to serve as statements of administrative priorities, while Congress negotiates the budget. MGMA will continue to advocate on behalf of our members throughout the budget negotiation process.

Deadline approaching: Submit MIPS 2018 performance data

Thu, 14 Mar 2019 00:16:31 GMT

MGMA reminds members that the deadline for submission of 2018 performance year data for the Merit-based Incentive Payment System (MIPS) is April 2, 2019 at 8:00 p.m. ET. MIPS participants must submit data and receive a minimum of 15 points in order to avoid a negative payment adjustment in 2020.

MGMA encourages all members to log into their HCQIS Access Roles and Profile (HARP) accounts as soon as possible and make sure they are on track to complete all data submissions by this deadline. Reach out to MGMA’s Government Affairs team with any questions or concerns about submitting your MIPS performance data.

In letter to HHS, NCVHS underscores MGMA’s HIPAA testimony

Thu, 28 Feb 2019 16:20:01 GMT

In a letter to the Secretary of the Department of Health and Human Services (HHS), the National Committee on Vital and Health Statistics (NCVHS) recommended new approaches to improve the adoption of national healthcare standards. The NCVHS, a federal body named in HIPAA as an HHS advisor, issued a number of recommendations: (i) remove the regulatory mandate for modifications to adopted standards and move towards industry-driven upgrades; (ii) promote and facilitate voluntary testing and use of new standards or emerging versions of transactions or operating rules; (iii) improve the visibility and impact of the administrative simplification enforcement program; and (iv) provide policy-related guidance from HHS regarding administrative standards adoption and enforcement. MGMA testified before the NCVHS in December and the letter closely aligns with the Association’s recommendations. HHS is expected to act on the NCVHS recommendations later this year.

New Medicare cards: It’s zero not O

Thu, 28 Feb 2019 16:19:27 GMT

In response to MGMA member concerns whether new Medicare Beneficiary Identifiers (MBIs) contain the number “0” or the letter “O” on new Medicare cards, CMS clarified that the MBI uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. As a reminder, starting Jan. 1, 2020, Medicare will only accept the MBI on claims, and practices can access their MBIs via your Medicare Administrative Contractor web portal. Download the member-benefit New Medicare Card Toolkit for additional information on the transition to the new cards and numbers.

Broad set of Health IT proposed rules released

Wed, 13 Feb 2019 22:31:20 GMT

The Office of the National Coordinator for Health Information Technology (ONC) released its proposed rule implementing provisions of the 21st Century Cures Act. Issues covered in the rulemaking include prohibitions against the blocking of data by providers or EHR vendors, the development and deployment of Application Programming Interface (API) standards, EHR developer certification, development of pediatric health information technology, practice ability to export patient data from one EHR to another, and other topics. Concurrently, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on patient access to data using APIs, health information exchange across health plans, and other topics. Both agencies also included an RFI on the issue of accurately matching patient records. ONC and CMS will accept comments on these proposals until mid-April. MGMA will comment on each of these rules and the RFI.

MGMA voices concerns on surprise billing

Wed, 13 Feb 2019 22:30:21 GMT

MGMA joined over 100 medical societies and associations to voice concern to Congress regarding the impact unexpected medical bills have on patient out-of-pocket costs. In the letter, we argue that the issue is complex and requires a balanced approach to resolve. Included in the letter is a list of policies for Congress to consider, including insurer accountability, limits on patient responsibility, and promoting transparency.

MGMA advocates for HIPAA reform

Wed, 13 Feb 2019 22:29:28 GMT

MGMA submitted comments in response to an Office for Civil Rights (OCR) Request for Information (RFI) on modifying HIPAA to facilitate care coordination and support value-based care. MGMA identified opportunities to reduce administrative burden, particularly with regards to patient acknowledgement of practice privacy policies. The Association pushed back on forcing practices to disclose patient records when requested by other providers or business associates, arguing clinicians should be permitted to use professional judgement to determine when a disclosure is appropriate. Also, MGMA strongly opposed the expansion of the current accounting of disclosures report to include disclosures made for purposes of treatment, payment, or healthcare operations. OCR is expected to publish regulations later this year.

Medical Practice Issues to Watch in 2019

Thu, 10 Jan 2019 15:57:09 GMT

2019 promises to be another busy year in healthcare. The 2018 midterm elections shifted the balance of power in Washington as Democrats now hold the gavel in the U.S. House of Representatives, creating a divided Congress with the Republican-held Senate. MGMA has identified the following legislative and regulatory issues critical for medical practices in the coming year. We will keep members apprised of key developments in these areas and their impact on medical practices and will continue to advocate for policies that enable practices to thrive in their mission to furnish high-quality, cost-effective patient care.

1. HHS doubles down on risk

Despite an anemic pipeline of new voluntary Medicare alternative payment models (APMs) trickling out of the Department of Health and Human Services (HHS), Secretary Alex Azar is planning a new approach to accelerate participation in risk-based APMs. Forgoing incremental implementation, the Secretary is expected to unveil new mandatory models in 2019 and to emphasize performance-based risk as a necessary component of any new APM.

MGMA strongly supports voluntary participation in APMs when it makes financial sense for individual practices and disagrees with the Secretary that the way to expedite the move to value-based care is to mandate participation. We will continue to advocate for new opportunities for practices to participate in voluntary APMs and for development of more physician-led models.

2. Regulatory relief from government burdens

It is expected that Congress and the Administration will continue to work toward reducing the regulatory burden on medical practices participating in government healthcare programs. The Centers for Medicare & Medicaid Services’ (CMS’) “Patients Over Paperwork” initiative is one such example. However, this has translated into only modest relief for practices thus far, as 88% of MGMA members polled reported an increase in overall regulatory burden last year. MGMA will continue to make regulatory relief a top advocacy priority in 2019. Keep up with our efforts at mgma.com/regrelief.

3. Kicking back the Stark Law

As part of the effort to accelerate payment innovation, HHS leaders pledge to revisit antiquated fraud and abuse rules such as the Stark Law and Anti-Kickback Statute. In 2019, watch for proposed rules that expand exceptions and safe harbors to protect value-based arrangements and benefit providers willing to take on performance-based risk.

While a push to simplify Medicare compliance rules is welcomed, it is likely that congressional intervention will be necessary to achieve meaningful reform. It remains to be seen if Congress will also prioritize this issue in 2019.

4. Surprise! Here is a medical bill you didn’t expect

Medical practices can expect to see a push to curb surprise medical bills, including efforts to empower patients and consumers through improved access to healthcare cost information. The sticker shock of surprise hospital bills continues to make headlines and draw bipartisan attention in Congress, making this issue ripe for legislative action in 2019.

5. A spoonful of new regulations to help drug prices go down

With a new Congress and support from the Administration, reducing Medicare drug prices is on the action list for 2019. For physician-administered drugs, one proposal seeks to curb the price of drugs in Part B by tying prices to a new International Price Index, create new private-sector vendors to supply practices with drugs, and set drug administration cost as a flat fee. CMS is also looking to give Part D drug plans greater flexibility to negotiate drug prices in protected classes.

6. The stakes are higher in MIPS

Implementation of the Merit-based Incentive Payment System (MIPS) continues to ramp up. In 2019, MIPS performance will determine whether clinicians receive a positive or negative payment adjustment of up to 7% on 2021 Medicare reimbursement. Medicare is accelerating cost accountability for MIPS clinicians by increasing the cost component to 15% of the overall MIPS score and introducing episode-based measures. The performance threshold required to avoid a payment penalty also doubles from 15 to 30 points in 2019. With more on the line this year, it is critical that MGMA members prepare their practices for success. Visit mgma.com/macra for helpful resources.

7. Data interoperability a priority for feds

The Office of the National Coordinator for Health Information Technology (ONC) is expected to release regulations to meet requirements of the 21st Century Cures Act and facilitate improved data sharing between healthcare entities. ONC will define and seek to discourage “information blocking,” develop a framework to facilitate data movement between heath information exchange entities, and release specifications for the use of apps to foster data exchange between different providers and between providers and patients. The goal of using apps, a component of MIPS and Stage 3 Meaningful Use, is to permit practices to efficiently and securely move administrative and clinical data via their EHR.

8. Cybersecurity continues to be a top practice concern

Medical practices can be a prime target for phishing and other cybersecurity attacks because they possess valuable information assets (patient clinical and financial data) and often have inadequate cybersecurity protections. HHS’ HIPAA enforcement arm is expected to ramp up audits and fines in 2019. Medical practices should protect both their data and business continuity by completing a comprehensive risk assessment, identifying vulnerable areas of the organization, and taking the steps necessary to mitigate risk. Check out MGMA security resources to prepare your practice this year.

9. Site-of-service payment differentials remain a target

Policymakers will continue the trend toward site-neutral payments with the goal of equalizing Medicare payments for the same services across clinical sites. Medicare expanded this policy through 2018 rulemaking by phasing-in payment reductions for clinic visits at hospital outpatient departments (HOPDs), including HOPDs excpeted from previous site-neutral payment rules. In addition to saving money for patients and the government, site-neutral payments are viewed as a policy lever for increasing market competition, eliminating the incentive for hospitals to purchase freestanding clinics and leveling the playing field.

10. “Repeal and replace” is out, “Medicare for all” is in

This shift in power within Congress will recast the role the federal government plays in healthcare in 2019. With “Medicare for all” a key platform for many progressives during the 2018 primaries, the politicized debate over a single-payer health system shows no signs of slowing down and will likely gain steam ahead of 2020 elections.

Passage of any major health reform bill is highly unlikely anytime soon. However, as presidential contenders begin campaigning for the 2020 primaries, universal healthcare will almost certainly become a point of debate.

MGMA 2018 Regulatory Burden Survey results

Wed, 03 Oct 2018 21:26:08 GMT

After receiving responses from 426 medical practices, MGMA released the findings of the 2018 Regulatory Burden Survey on Tuesday at MGMA18 | The Annual Conference. An overwhelming 86% of respondents reported an increase in regulatory burden over the past 12 months. An even larger percentage (94%) said a reduction in regulatory burden would allow more resources to be allocated toward patient care.

The Quality Payment Program (QPP) ranked as the most burdensome issue with 88% of respondents finding the QPP to be very or extremely burdensome with little clinical benefit. Furthermore, the percentage of medical practices citing the lack of EHR interoperability as very or extremely burdensome increased 12% since last year.

MGMA will use data from the survey to continue to educate the Administration and Congress and advocate for reduced regulatory burden on medical group practices. Click here for the full survey results.

Medicare now covers remote patient monitoring

Wed, 25 Apr 2018 21:39:44 GMT

Effective January 2018, CMS began recognizing medical group practices that use digital health tools to monitor and analyze patient physiological data. CMS opened the door to reimbursement for remote patient monitoring (RPM) services by unbundling CPT code 99091, which is described as the collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored or transmitted by the patient to a qualified healthcare professional. To be reimbursed for RPM services, practices must meet certain billing requirements, such as obtaining and documenting patient consent and spending a minimum of 30 minutes of time on RPM. Additionally, for patients who are new or have not been seen within one year, providers must initiate RPM services in a face-to-face visit.

To learn more about RPM services and additional Medicare service updates for the 2018 payment year, download MGMA’s analysis of the 2018 Physician Fee Schedule.

2018 MIPS: Are you in or out?

Wed, 25 Apr 2018 21:36:27 GMT

To determine 2018 MIPS eligibility, physician practice leaders must check the participation status for each clinician by inputting his or her national provider identified (NPI) in the MIPS look-up tool. Previously, CMS mailed letters to practices to inform them of their eligibility status, but the agency does not plan to notify medical groups about their eligibility in 2018. Practices should not rely on historic eligibility determinations, as many physicians and medical groups who were required to participate in MIPS in 2017 will be exempt in 2018 under the expanded low-volume threshold.

MGMA is engaged in discussions with CMS officials about the limitations of the look-up tool and asked the agency to enhance the tool’s functionality by making available eligibility data for all NPIs who have reassigned their billing rights to the group practice, rather than requiring eligibility data to be accessed on an NPI-by-NPI basis.

MGMA to CMS: Shorten 2018 MIPS reporting period

Wed, 25 Apr 2018 21:35:12 GMT

MGMA authored a letter to the Centers for Medicare & Medicaid Services (CMS), which was signed by more than 40 physician organizations, urging the agency to shorten the 2018 Merit-based Incentive Payment System (MIPS) quality data reporting period from 365 to 90 days. Despite being held accountable for data tracking and collection as of Jan. 1, 2018, physicians were not informed of basic eligibility information until early April, and the MIPS website has yet to be updated with key 2018 program information, including final quality measures. MGMA and the coalition also recommended CMS maintain a shorter reporting period in future years to reduce administrative burden and ensure physicians have sufficient time to report after receiving MIPS feedback. MGMA has long championed a 90-day reporting period to give group practices greater flexibility to focus their attention on improving patient care, as opposed to reporting for reporting’s sake.

CMS seeks participants for MIPS burden study

Thu, 19 Apr 2018 00:39:14 GMT

Participants in the 2018 CMS study on quality reporting burdens will receive full improvement activity credit for the Merit-based Incentive Payment System (MIPS). The study, which will run from April 2018 to March 2019, will examine challenges group practices and clinicians face when collecting and reporting quality data and make recommendations to eliminate burden and improve quality data collection. Study participants must complete surveys, attend a virtual focus group session, and submit at least three MIPS quality measures in 2018. If you are interested in receiving full MIPS improvement activity credit for helping CMS understand quality reporting burdens, submit a study application by April 30.

Medicare faces scrutiny for improper telehealth payments

Thu, 19 Apr 2018 00:37:43 GMT

A new report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) concluded that nearly one-third of claims did not meet Medicare requirements for telehealth services, resulting in improper payments of around $3.7 million in 2014-2015. Most sampled claims were deemed improper because patients were not located at a rural geographic originating site. OIG recommended the Centers for Medicare & Medicaid Services (CMS) conduct periodic post-payment reviews on telehealth claims, underscoring the importance of billing compliance, particularly with respect to originating site rules. MGMA recommends practices use the Medicare telehealth eligibility analyzer to determine payment eligibility based on location and urges groups who bill Medicare for telehealth services to ensure their claims comply with Medicare requirements.

Legislative Alert: Congress passes budget bill with wins for medical groups

Fri, 09 Feb 2018 18:03:58 GMT

Overnight, Congress passed a sweeping two-year budget deal signed into law by President Trump today. The Bipartisan Budget Act of 2018 (H.R. 1892) is largely a win for physician practices. The law addresses top MGMA priorities, including reducing burden in the MIPS program, eliminating the unelected Medicare cost-cutting board known as the IPAB, and averting a flawed misvalued-code policy that would have resulted in drastic across-the-board payment cuts in 2019 and 2020. MGMA opposed Congress’ use of a .25 reduction to the Medicare physician payment conversion factor next year as a budgetary offset. Its inclusion is a disappointment in an otherwise favorable bill.

Important to medical groups, the bill will:

Increase flexibility and reduce burden in the Quality Payment Program;
Eliminate the unelected Medicare cost-cutting board known as the IPAB;
Extend the work Geographic Practice Cost Index (GPCI) floor for two years through 2019;
Permanently repeal the Medicare therapy payment cap;
Incorporate new flexibility for Accountable Care Organizations;
Expand coverage for telehealth services;
Decrease requirements in the Meaningful Use Program; and
Extend Children's Health Insurance Program funding for an additional four years through fiscal year 2027.

MGMA will continue to advocate for Medical Group Practices, and we thank you for your continued grassroots efforts.

MGMA comments on proposed 2019 Medicare Advantage, Part D plan changes

Wed, 24 Jan 2018 21:57:47 GMT

MGMA recently commented on proposed policy changes to the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs. The Association applauded a proposal to publish a list of precluded providers rather than proceeding with burdensome new requirements, opposed by MGMA, that eligible professionals enroll in or validly opt out of Medicare by Jan. 1, 2019 to have their Part D drugs and MA services covered by Medicare. The Association also underscored the growing burden imposed by patient records requests from MA plans, which MGMA members report can be several thousand records annually. Read the full letter.

Spending deal reopens government, funds CHIP, omits Medicare extenders

Wed, 24 Jan 2018 21:56:53 GMT

A short-term spending deal reached late Monday reopened the federal government and provides temporary funding through Feb. 8. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for six years and delays several Affordable Care Act-related taxes, including the so-called “Cadillac tax,” which imposes a fee on high-cost employer health insurance plans. Notably absent were extensions of several expired Medicare provisions, including the 1.0 work GPCI floor and therapy caps exceptions. Both provisions have bipartisan support in Congress but have been put on hold for other legislative priorities. The Centers for Medicare & Medicaid Services (CMS) is temporarily holding claims affected by therapy caps but if Congress does not act soon, will “release and process claims accordingly.”

Breaking: Alex Azar confirmed as new HHS Secretary

Wed, 24 Jan 2018 21:56:28 GMT

Today, the Senate voted to confirm Alex Azar as the new Secretary of the Department Health and Human Services (HHS) by a vote of 55-43. Azar previously served as HHS deputy secretary and chief counsel during the George W. Bush administration and most recently as president of the pharmaceutical company Lilly USA. During his confirmation hearings, Azar testified that he intends to continue the transformation to value-based payment in Medicare

MGMA supports introduction of ACO reform bill

Wed, 13 Dec 2017 23:01:29 GMT

MGMA joined a coalition of other healthcare groups to support the introduction of the ACO Improvement Act of 2017 (H.R. 4580). The legislation would provide common sense reforms to the Medicare Shared Savings Program, including waivers for several types of services, bonus payments for quality achievement and improvement, and allowing for growth of risk scores, among other changes. The operational changes would remove regulatory barriers and improve the overall design of the program to help it achieve its goal of reducing costs while improving quality and patient outcomes. Read the press release at our ACO Resource Center.

MGMA reiterates opposition to sequestration in letter to Congress

Wed, 13 Dec 2017 23:00:33 GMT

MGMA wrote Congressional leadership reiterating the Association’s opposition to the use of budget sequestration to offset the cost of end-of-year legislative initiatives. MGMA continues to strongly oppose the sequestration provisions of the Budget Control Act of 2011, which resulted in 2% cuts to Medicare physician payments.

2018 Medicare RVU files now available

Wed, 13 Dec 2017 22:59:22 GMT

The Centers for Medicare & Medicaid Services (CMS) recently provided the RVU files related to the 2018 Physician Fee Schedule (PFS). The RVU files can be accessed in spreadsheet and other formats here. The PFS contains a number of updates impacting Medicare payment and policies, including expanded coverage of telehealth services and retroactive reductions to PQRS reporting requirements and associated penalties. MGMA Government Affairs staff developed a detailed analysis of key provisions of the 2018 Medicare PFS, as well as changes to the Merit-based Incentive Payment System and alternative payment models. Download this member-exclusive resource and more at MGMA’s MACRA Resource Center.

Repayment delay triggers False Claims Act settlement for double damages

Fri, 10 Nov 2017 01:16:44 GMT

A cardiovascular group recently agreed to pay over $440,000 to settle false claims allegations that they failed to timely report and return $175,000 in overpayments owed to federal healthcare programs. Under the 60-Day Repayment Rule, healthcare providers must repay credit balances owed to federal payers within 60 days of identifying the overpayment. The government intervened following a whistleblower lawsuit filed by a former employee of the medical group.

This is only the second reported settlement under the 60-Day Repayment Rule; the first resulted in treble damages. These settlements confirm the Department of Justice’s commitment to using the False Claims Act to enforce the rule and underscores the importance for practices to implement policies to identify and report overpayments. For more information, MGMA has a member-benefit analysis on the rule prepared by MGMA’s Washington Counsel.

Not too late to avoid a MIPS penalty for 2019

Fri, 10 Nov 2017 01:15:12 GMT

The final 90-day Merit-based Incentive Payment System (MIPS) reporting period of 2017 is closing fast and what you do or do not report will influence the payment you receive in 2019. MGMA has outlined three potential options clinicians or groups can take before the end of the year to avoid a 2019 MIPS penalty based on their 2017 reporting.

As a reminder, for the 2017 reporting year clinicians and groups with less than $30,000 in Medicare allowed charges or fewer than 100 Medicare patients, those who are new to Medicare in 2017, and those who participate in advanced alternative payment models are exempt from the MIPS program. Use the CMS eligibility lookup tool to check your MIPS participation status.

Regulatory alert: Medicare finalizes 2018 payment and quality reporting changes

Thu, 02 Nov 2017 21:10:58 GMT

The Centers for Medicare & Medicaid Services (CMS) released two final rules impacting Medicare physician payment policies and quality reporting requirements beginning Jan. 1, 2018. First, CMS finalized modifications to the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs) participation options and requirements for 2018. CMS estimates the vast majority of eligible clinicians and groups will participate in MIPS, making it the default track again in 2018. The final rule changes MIPS in the following ways:

Quadruples the reporting period for the quality component of MIPS from 90 days to one calendar year;
Delays the mandate to move to 2015 Edition Certified EHR Technology;
Increases the low-volume threshold exclusion to $90,000 in Medicare Part B allowed charges or 200 Medicare Part B patients;
Counts the criticized cost component as 10% of the MIPS final score;
Provides additional flexibility for small group practices; and
Offers a virtual group option for solo practitioner and small practices to aggregate their data for shared MIPS evaluation.

Additionally, CMS released the 2018 Medicare Physician Fee Schedule (PFS) final rule. Among other changes, the final rule:

Sets the CY 2018 PFS conversion factor at $35.9996 and the CY 2018 national average anesthesia conversion factor at $22.1887, both of which reflect a modest payment increase under the Medicare Access and CHIP Reauthorization Act (MACRA).
Delays mandatory appropriate use criteria consultation until Jan. 1, 2020;
Retroactively lowers PQRS reporting requirements to six measures;
Reduces Value-Based Payment Modifier penalties and holds groups harmless if they met minimum quality reporting requirements; and
Establishes the new Medicare Diabetes Prevention Program, which begins April 1.

MGMA will analyze both final rules and provide a detailed analysis as a member benefit. Contact MGMA government affairs with questions by emailing govaff@mgma.org or calling 202.293.3450, 877.275.6462 toll-free.

Tell Congress to repeal IPAB before it's too late

Thu, 12 Oct 2017 22:00:02 GMT

The Independent Payment Advisory Board (IPAB) could finally be coming to an end. Last week, the House Ways and Means Committee approved bipartisan legislation (H.R. 849) to repeal the IPAB, a cost containment tool mandated by the Affordable Care Act to convene if Medicare spending exceeds a specified limit. The IPAB has significant power to make changes to Medicare spending, leaving little-to-no room for recourse if IPAB-mandated payment cuts are triggered.

It is paramount that Congress act now and pass this important legislation before future actuary reports trigger the IPAB and activate payment reductions to Medicare providers. Contact your member of Congress now via MGMA's Advocacy Center and urge lawmakers to support this important legislation.

New 2017 APM participant status look-up tool

Thu, 12 Oct 2017 21:58:15 GMT

CMS released a new tool that allows clinicians and practices to look up whether they achieved qualified participant (QP) status in an Advanced APM for the 2017 performance year based on claims data with dates of service from January through March. As a reminder, those who achieve QP status in 2017 are eligible for a 5% lump sum bonus and exempt from MIPS in 2019. Clinicians who did not qualify during the first claims analysis will have two more opportunities to achieve QP status this year based on claims data from April through June and July through August. For more information visit MGMA's APM resource center.

CMS to health plans: no fees for EFT payments

Thu, 05 Oct 2017 15:42:32 GMT

After an aggressive advocacy effort by MGMA, CMS released guidance on the issues of Electronic Funds Transfer (EFT) payments and the use of “virtual” credit cards (VCCs). Health plans sending VCCs must stop if a provider requests to receive payments via EFT. Most importantly, health plans (or their payment vendors) must not charge providers unsanctioned fees for the use of EFT. Permissible fees are limited to banking fees, typically around $.034 per transaction. In addition, practices are not required to contract for additional “value added” payment services from vendors and signing up for EFT does not automatically allow the plan to deduct funds from a provider’s account unless contractually authorized by the provider to do so. Access the MGMA member-benefit EFT/ERA Guide for more information and our sample letter to request payment via EFT.

MGMA to Congress: Extend MACRA transition period

Thu, 05 Oct 2017 15:41:34 GMT

MGMA joined the American Medical Association and more than 100 physician specialty and state medical organizations in a letter urging Congress to ensure smooth implementation of Medicare payment policies under the Medicare Access and CHIP Reauthorization Act (MACRA). In particular, MGMA and the medical community call for a three-year extension of program flexibility to ensure physician practices are able to successfully participate in the new Merit-Based Incentive Payment System (MIPS) while CMS finalizes cost measures, improves data feedback, and provides tools to improve performance. Among other refinements, the letter requested clarification that Medicare Part B drugs are outside the scope of MIPS payment adjustments.

MGMA advocates for regulatory relief at HHS “Cut the Red Tape” Summit

Thu, 05 Oct 2017 15:40:12 GMT

MGMA offered recommendations to reduce unnecessary government regulations at the U.S. Department of Health and Human Services (HHS) “Cut the Red Tape” Summit this week. During their opening remarks, HHS Acting Secretary, Dr. Don Wright, CMS Administrator, Seema Verma, and other HHS officials reiterated the Department’s commitment to reducing excessive regulatory burdens on medical group practices. During the panel discussion, Anders Gilberg, MGMA’s Senior Vice President of Government Affairs, shared results from MGMA’s 2017 Regulatory Burdens survey that highlighted the considerable time and resources required to comply with federal mandates and identified key areas of concern for medical group practices, such as the lack of clinical relevance in Medicare’s Quality Payment Program. MGMA will continue to call on HHS to support innovative, high-quality, and cost-effective care delivery untethered from excessive, one-size-fits-all regulations.

Medicare cancels Part B drug payment model in response to MGMA advocacy

Thu, 05 Oct 2017 15:38:30 GMT

The Centers for Medicare & Medicaid Services (CMS) withdrew its proposal to change the way Medicare pays for drugs administered in physician offices. MGMA raised significant concerns regarding the proposed payment model, which would have reduced Medicare reimbursement without addressing the root cause of drug price increases set by the manufacturer. The Association also took issue with the fact that this mandatory model would establish a precedent under which the CMS Innovation Center could expand its limited legislative authority to circumvent the usual channels for changing physician payment. MGMA continues to recommend the agency seek physician practice input in developing payment models to support innovative approaches to improve quality and affordability without restricting patient access to life-saving treatments.

MIPS 90-day reporting period deadline: Oct. 2

Wed, 27 Sep 2017 20:58:24 GMT

Group practices and eligible clinicians (ECs) seeking to earn a bonus in the Merit-Based Incentive Payment System (MIPS) in 2019 have until Oct. 2 to begin reporting one or more quality measures, improvement activities, or Advancing Care Information measures for the minimum 90 consecutive days. Conversely, group practices and ECs have through the end of the calendar year to avoid a 4% MIPS penalty in 2019 by reporting at least one quality measure on one patient. MGMA encourages practice executives to protect their practice from a Medicare payment cut by reporting more than one measure as an insurance policy in case the group encounters any data submission issues or inaccuracies. For resources to help your practice successfully participate in MIPS, visit MGMA.org/MACRA.

Healthcare Reform on Hold

Wed, 27 Sep 2017 20:57:29 GMT

The latest Affordable Care Act (ACA) replacement proposal will not be brought to a vote in the Senate, after Susan Collins, R-ME, became the third Republican to publicly come out against it. MGMA expressed concerns over this latest proposed Senate bill based on our healthcare reform principles. The Senate appears willing to resume its own bipartisan efforts to stabilize the exchanges for next year.

CMS to narrow scope of claims documentation audits

Mon, 18 Sep 2017 20:20:07 GMT

CMS announced last month it will launch a new audit strategy, called Targeted Probe and Educate (TPE), after pilot programs with four Medicare Administrative Contractors (MACs) demonstrated success. Under the TPE approach, MACs will perform reviews on claims that pose the greatest financial risk to the Medicare trust fund or have a high national error rate. Unlike the previous policy where reviews were initiated on all providers of a particular service, MACs are now instructed to focus only on those providers, identified through data analysis, who have the highest claims error rates or billing practices that vary significantly from their peers. The TPE program includes up to three rounds of review, coupled with individualized education based on review results, and is expected to be expanded to all MAC jurisdictions - later this year.

HHS issues first response to PTAC recommendations

Mon, 18 Sep 2017 20:19:24 GMT

Department of Health and Human Services (HHS) Secretary Tom Price, MD issued responses to the first physician focused payment models (PFPMs) reviewed by the PFPM Technical Advisory Committee (PTAC) in April. The Secretary asked that design concerns be addressed before making a final decision on the American College of Surgeons-Brandeis Model. HHS also indicated it would not be moving forward with the COPD and Asthma Monitoring Project and Project Sonar models, but would consider elements of those proposals when developing its own future models. Despite not proceeding with any of the proposals at this time, Price provided valuable insights to guide development of future PFPMs. He explained models that are broad in scope and feature enhanced patient monitoring to reduce complications and hospital admissions hold promise but that HHS is not interested in models that would not be implemented beyond the submitter or use proprietary technology.

MGMA survey: 1 out of 6 practices forced to pay fees for receiving electronic payments

Mon, 18 Sep 2017 20:18:26 GMT

A Sept. 5 MGMA Stat poll found that about 1 out of 6 practices report that their health plans charge transaction fees, typically ranging from 2-5%, to receive payments for medical services via Electronic Funds Transfer (EFT). As part of an effort in the Affordable Care Act to decrease healthcare administrative inefficiencies, CMS mandated a standardized EFT transaction and since 2014 health plans are required to offer EFT should providers request it. Contrary to the intent of the law, and despite the fact that health plans themselves save on printing and mailing costs, many practices are required to pay these EFT tolls. MGMA continues to strongly advocate that CMS issue guidance preventing health plans and payment vendors from charging these fees. Review the MGMA member-benefit EFT and ERA Guide.

MGMA comments on proposed 2018 Medicare physician fee schedule

Mon, 18 Sep 2017 20:17:42 GMT

MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed 2018 Medicare physician fee schedule. The proposed rule includes a number of policies that, if finalized, would affect medical group practices in 2018.

Among its recommendations, MGMA advocates for CMS to:

Finalize the proposed delay in requiring appropriate use criteria consultation and documentation;
Hold medical groups harmless from 2018 penalties in the obsolete PQRS, Meaningful Use, and Value Modifier programs if they reported some data in 2016; and
Reduce unnecessary regulations and improve the quality and efficiency of healthcare delivery using the results of MGMAâ€™s 2017 Regulatory Burdens survey as a compass.

Gain insight about the impact of Medicare payment policies on your practice at MGMA17 in Anaheim. MGMA government affairs presentations will highlight legislative and regulatory issues critical to your groupâ€™s success, feature exclusive office hours with CMSâ€™ Director of the Center for Clinical Standards and Quality, Dr. Kate Goodrich, and culminate in the popular â€œView from Washingtonâ€ general session with MGMAâ€™s Senior Vice President of Government Affairs. Register today to secure your spot.

MGMA to CMS: Add Medicare Advantage value-based payment contracts to Advanced APM list

Mon, 12 Jun 2017 15:06:07 GMT

MGMA joined several provider organizations in a letter urging the Centers for Medicare & Medicaid Services (CMS) to include group practices in value-based arrangements with Medicare Advantage (MA) plans in the Advanced alternative payment model (APM) track of MACRA. Last week, CMS announced nearly 100% of participants in designated Advanced APMs are expected to qualify for a 5% bonus and exemption from the Merit-Based Incentive Payment System (MIPS) based on historical claims data. However, even if 100% of current Advanced APM participants qualify, this is estimated to amount to just 10% of all eligible clinicians in 2017 due to the limited number of existing Advanced APMs. MGMA has repeatedly called for expanded opportunities for group practices to move away from MIPS into the APM track, and we believe adding qualifying MA risk-based arrangements to the Advanced APM list is an important step in this direction.

TMGMA offers a FREE Webinar Series as a benefit of membership!

Sat, 07 Jan 2017 16:03:22 GMT

TMGMA offers a FREE Webinar Series as a benefit of membership.

TMGMA offers webinars focusing on the domains of the ACMPE Body of Knowledge. These webinars are free to ALL members. To register as a non-member for a fee, please contact Rebekah Francis or Join TMGMA.

Webinars will be eligible for one ACMPE Credit Hour. Recordings of webinars will be available online in the Members' Only section of our website.

Invitations to sign up for the webinars will be sent directly to members.

The TMGMA Executive Council

Thu, 05 Jan 2017 16:00:05 GMT

Our Executive Council is composed of the President, President-Elect, Vice-President, Immediate Past President, and Secretary/Treasurer. The Executive Council shall include the Chair of the Council of Past Presidents and the Executive Director as non-voting, ex officio members. The Executive Council shall be responsible for the planning and implementation of member meetings of TMGMA, the fiscal and management affairs of the association between such meetings, and the acceptance of new members. The Executive Council shall appoint committee and work area chairs as needed to make up the TMGMA Leadership Committee.