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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 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.

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.

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'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 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.

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.

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.

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.

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.