Latest News

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.

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 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.

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.

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 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.

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.

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.

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.

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