Latest News

  • 05/30/2019 9:33 AM | Rebekah Francis (Administrator)

    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.

  • 05/30/2019 9:32 AM | Rebekah Francis (Administrator)

    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.
  • 05/09/2019 11:06 AM | Rebekah Francis (Administrator)

    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. 
  • 05/09/2019 11:05 AM | Rebekah Francis (Administrator)

    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.

  • 05/09/2019 11:04 AM | Rebekah Francis (Administrator)

    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.

  • 03/13/2019 8:18 PM | Rebekah Francis (Administrator)

    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.


  • 03/13/2019 8:17 PM | Rebekah Francis (Administrator)

    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. 

  • 03/13/2019 8:16 PM | Rebekah Francis (Administrator)

    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. 

  • 02/28/2019 11:20 AM | Rebekah Francis (Administrator)

    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. 

  • 02/28/2019 11:19 AM | Rebekah Francis (Administrator)

    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.  


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