Latest News

  • 11/09/2017 8:16 PM | Rebekah Francis (Administrator)

    A cardiovascular group recently agreed to pay over $440,000 to settle false claims allegations that they failed to timely report and return $175,000 in overpayments owed to federal healthcare programs. Under the 60-Day Repayment Rule, healthcare providers must repay credit balances owed to federal payers within 60 days of identifying the overpayment. The government intervened following a whistleblower lawsuit filed by a former employee of the medical group. 

    This is only the second reported settlement under the 60-Day Repayment Rule; the first resulted in treble damages. These settlements confirm the Department of Justice’s commitment to using the False Claims Act to enforce the rule and underscores the importance for practices to implement policies to identify and report overpayments. For more information, MGMA has a member-benefit analysis on the rule prepared by MGMA’s Washington Counsel.

  • 11/09/2017 8:15 PM | Rebekah Francis (Administrator)

    The final 90-day Merit-based Incentive Payment System (MIPS) reporting period of 2017 is closing fast and what you do or do not report will influence the payment you receive in 2019. MGMA has outlined three potential options clinicians or groups can take before the end of the year to avoid a 2019 MIPS penalty based on their 2017 reporting.

    As a reminder, for the 2017 reporting year clinicians and groups with less than $30,000 in Medicare allowed charges or fewer than 100 Medicare patients, those who are new to Medicare in 2017, and those who participate in advanced alternative payment models are exempt from the MIPS program. Use the CMS eligibility lookup tool to check your MIPS participation status.

  • 11/02/2017 5:10 PM | Rebekah Francis (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) released two final rules impacting Medicare physician payment policies and quality reporting requirements beginning Jan. 1, 2018. First, CMS finalized modifications to the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs) participation options and requirements for 2018. CMS estimates the vast majority of eligible clinicians and groups will participate in MIPS, making it the default track again in 2018. The final rule changes MIPS in the following ways:


    • Quadruples the reporting period for the quality component of MIPS from 90 days to one calendar year;
    • Delays the mandate to move to 2015 Edition Certified EHR Technology;
    • Increases the low-volume threshold exclusion to $90,000 in Medicare Part B allowed charges or 200 Medicare Part B patients;
    • Counts the criticized cost component as 10% of the MIPS final score;
    • Provides additional flexibility for small group practices; and 
    • Offers a virtual group option for solo practitioner and small practices to aggregate their data for shared MIPS evaluation.

    Additionally, CMS released the 2018 Medicare Physician Fee Schedule (PFS) final rule. Among other changes, the final rule: 

    • Sets the CY 2018 PFS conversion factor at $35.9996 and the CY 2018 national average anesthesia conversion factor at $22.1887, both of which reflect a modest payment increase under the Medicare Access and CHIP Reauthorization Act (MACRA). 
    • Delays mandatory appropriate use criteria consultation until Jan. 1, 2020;
    • Retroactively lowers PQRS reporting requirements to six measures; 
    • Reduces Value-Based Payment Modifier penalties and holds groups harmless if they met minimum quality reporting requirements; and
    • Establishes the new Medicare Diabetes Prevention Program, which begins April 1.

    MGMA will analyze both final rules and provide a detailed analysis as a member benefit. Contact MGMA government affairs with questions by emailing or calling 202.293.3450, 877.275.6462 toll-free.

  • 10/12/2017 6:00 PM | Rebekah Francis (Administrator)

    The Independent Payment Advisory Board (IPAB) could finally be coming to an end. Last week, the House Ways and Means Committee approved bipartisan legislation (H.R. 849) to repeal the IPAB, a cost containment tool mandated by the Affordable Care Act to convene if Medicare spending exceeds a specified limit. The IPAB has significant power to make changes to Medicare spending, leaving little-to-no room for recourse if IPAB-mandated payment cuts are triggered.

    It is paramount that Congress act now and pass this important legislation before future actuary reports trigger the IPAB and activate payment reductions to Medicare providers. Contact your member of Congress now via MGMA's Advocacy Center and urge lawmakers to support this important legislation.

  • 10/12/2017 5:58 PM | Rebekah Francis (Administrator)

    CMS released a new tool that allows clinicians and practices to look up whether they achieved qualified participant (QP) status in an Advanced APM for the 2017 performance year based on claims data with dates of service from January through March. As a reminder, those who achieve QP status in 2017 are eligible for a 5% lump sum bonus and exempt from MIPS in 2019. Clinicians who did not qualify during the first claims analysis will have two more opportunities to achieve QP status this year based on claims data from April through June and July through August. For more information visit MGMA's APM resource center.

  • 10/05/2017 11:42 AM | Rebekah Francis (Administrator)

    After an aggressive advocacy effort by MGMA, CMS released guidance on the issues of Electronic Funds Transfer (EFT) payments and the use of “virtual” credit cards (VCCs). Health plans sending VCCs must stop if a provider requests to receive payments via EFT. Most importantly, health plans (or their payment vendors) must not charge providers unsanctioned fees for the use of EFT. Permissible fees are limited to banking fees, typically around $.034 per transaction. In addition, practices are not required to contract for additional “value added” payment services from vendors and signing up for EFT does not automatically allow the plan to deduct funds from a provider’s account unless contractually authorized by the provider to do so. Access the MGMA member-benefit EFT/ERA Guide for more information and our sample letter to request payment via EFT.

  • 10/05/2017 11:41 AM | Rebekah Francis (Administrator)

    MGMA joined the American Medical Association and more than 100 physician specialty and state medical organizations in a letter urging Congress to ensure smooth implementation of Medicare payment policies under the Medicare Access and CHIP Reauthorization Act (MACRA). In particular, MGMA and the medical community call for a three-year extension of program flexibility to ensure physician practices are able to successfully participate in the new Merit-Based Incentive Payment System (MIPS) while CMS finalizes cost measures, improves data feedback, and provides tools to improve performance. Among other refinements, the letter requested clarification that Medicare Part B drugs are outside the scope of MIPS payment adjustments.

  • 10/05/2017 11:40 AM | Rebekah Francis (Administrator)

    MGMA offered recommendations to reduce unnecessary government regulations at the U.S. Department of Health and Human Services (HHS) “Cut the Red Tape” Summit this week. During their opening remarks, HHS Acting Secretary, Dr. Don Wright, CMS Administrator, Seema Verma, and other HHS officials reiterated the Department’s commitment to reducing excessive regulatory burdens on medical group practices. During the panel discussion, Anders Gilberg, MGMA’s Senior Vice President of Government Affairs, shared results from MGMA’s 2017 Regulatory Burdens survey that highlighted the considerable time and resources required to comply with federal mandates and identified key areas of concern for medical group practices, such as the lack of clinical relevance in Medicare’s Quality Payment Program. MGMA will continue to call on HHS to support innovative, high-quality, and cost-effective care delivery untethered from excessive, one-size-fits-all regulations. 

  • 10/05/2017 11:38 AM | Rebekah Francis (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) withdrew its proposal to change the way Medicare pays for drugs administered in physician offices. MGMA raised significant concerns regarding the proposed payment model, which would have reduced Medicare reimbursement without addressing the root cause of drug price increases set by the manufacturer. The Association also took issue with the fact that this mandatory model would establish a precedent under which the CMS Innovation Center could expand its limited legislative authority to circumvent the usual channels for changing physician payment. MGMA continues to recommend the agency seek physician practice input in developing payment models to support innovative approaches to improve quality and affordability without restricting patient access to life-saving treatments.

  • 09/27/2017 4:58 PM | Rebekah Francis (Administrator)

    Group practices and eligible clinicians (ECs) seeking to earn a bonus in the Merit-Based Incentive Payment System (MIPS) in 2019 have until Oct. 2 to begin reporting one or more quality measures, improvement activities, or Advancing Care Information measures for the minimum 90 consecutive days. Conversely, group practices and ECs have through the end of the calendar year to avoid a 4% MIPS penalty in 2019 by reporting at least one quality measure on one patient. MGMA encourages practice executives to protect their practice from a Medicare payment cut by reporting more than one measure as an insurance policy in case the group encounters any data submission issues or inaccuracies. For resources to help your practice successfully participate in MIPS, visit


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