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Today, the Senate voted to confirm Alex Azar as the new Secretary of the Department Health and Human Services (HHS) by a vote of 55-43. Azar previously served as HHS deputy secretary and chief counsel during the George W. Bush administration and most recently as president of the pharmaceutical company Lilly USA. During his confirmation hearings, Azar testified that he intends to continue the transformation to value-based payment in Medicare

MGMA joined a coalition of other healthcare groups to support the introduction of the ACO Improvement Act of 2017 (H.R. 4580). The legislation would provide common sense reforms to the Medicare Shared Savings Program, including waivers for several types of services, bonus payments for quality achievement and improvement, and allowing for growth of risk scores, among other changes. The operational changes would remove regulatory barriers and improve the overall design of the program to help it achieve its goal of reducing costs while improving quality and patient outcomes. Read the press release at our ACO Resource Center. 

MGMA wrote Congressional leadership reiterating the Association’s opposition to the use of budget sequestration to offset the cost of end-of-year legislative initiatives. MGMA continues to strongly oppose the sequestration provisions of the Budget Control Act of 2011, which resulted in 2% cuts to Medicare physician payments.

The Centers for Medicare & Medicaid Services (CMS) recently provided the RVU files related to the 2018 Physician Fee Schedule (PFS). The RVU files can be accessed in spreadsheet and other formats here. The PFS contains a number of updates impacting Medicare payment and policies, including expanded coverage of telehealth services and retroactive reductions to PQRS reporting requirements and associated penalties. MGMA Government Affairs staff developed a detailed analysis of key provisions of the 2018 Medicare PFS, as well as changes to the Merit-based Incentive Payment System and alternative payment models. Download this member-exclusive resource and more at MGMA’s MACRA Resource Center. 

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.

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.

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 govaff@mgma.org or calling 202.293.3450, 877.275.6462 toll-free.

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.

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.

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.