Latest News

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  • 08/18/2022 9:55 AM | Rebekah Francis (Administrator)

    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 11th 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.

  • 08/15/2022 9:33 AM | Rebekah Francis (Administrator)

    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, 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. 

  • 08/11/2022 11:57 AM | Rebekah Francis (Administrator)

    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 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.

  • 06/30/2022 10:43 AM | Rebekah Francis (Administrator)

    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.”
  • 06/23/2022 9:42 AM | Rebekah Francis (Administrator)

    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 vendorsis available in the 2022 CAHPS for MIPS fact sheet.
  • 06/16/2022 6:06 PM | Rebekah Francis (Administrator)

    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
  • 05/26/2022 9:45 AM | Rebekah Francis (Administrator)

    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 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.

  • 05/12/2022 9:31 AM | Rebekah Francis (Administrator)

    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.

  • 04/07/2022 9:16 AM | Rebekah Francis (Administrator)

    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.

  • 03/31/2022 9:05 AM | Rebekah Francis (Administrator)

    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.

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