Latest News

  • 10/30/2019 8:29 PM | Rebekah Francis (Administrator)

    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.
  • 10/30/2019 8:28 PM | Rebekah Francis (Administrator)

    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. 

  • 10/30/2019 8:27 PM | Rebekah Francis (Administrator)

    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. 

  • 10/10/2019 11:24 AM | Rebekah Francis (Administrator)

    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.

  • 10/10/2019 11:23 AM | Rebekah Francis (Administrator)

    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.

  • 09/25/2019 5:18 PM | Rebekah Francis (Administrator)

    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.

  • 09/25/2019 5:17 PM | Rebekah Francis (Administrator)

    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.

  • 09/25/2019 5:16 PM | Rebekah Francis (Administrator)

    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!

  • 09/25/2019 5:14 PM | Rebekah Francis (Administrator)

    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.

  • 07/17/2019 5:07 PM | Rebekah Francis (Administrator)

    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.


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