Latest News

  • 04/18/2018 8:37 PM | Rebekah Francis (Administrator)

    A new report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) concluded that nearly one-third of claims did not meet Medicare requirements for telehealth services, resulting in improper payments of around $3.7 million in 2014-2015. Most sampled claims were deemed improper because patients were not located at a rural geographic originating site. OIG recommended the Centers for Medicare & Medicaid Services (CMS) conduct periodic post-payment reviews on telehealth claims, underscoring the importance of billing compliance, particularly with respect to originating site rules. MGMA recommends practices use the Medicare telehealth eligibility analyzer to determine payment eligibility based on location and urges groups who bill Medicare for telehealth services to ensure their claims comply with Medicare requirements.

  • 02/09/2018 1:03 PM | Rebekah Francis (Administrator)

    Overnight, Congress passed a sweeping two-year budget deal signed into law by President Trump today. The Bipartisan Budget Act of 2018 (H.R. 1892) is largely a win for physician practices. The law addresses top MGMA priorities, including reducing burden in the MIPS program, eliminating the unelected Medicare cost-cutting board known as the IPAB, and averting a flawed misvalued-code policy that would have resulted in drastic across-the-board payment cuts in 2019 and 2020. MGMA opposed Congress’ use of a .25 reduction to the Medicare physician payment conversion factor next year as a budgetary offset. Its inclusion is a disappointment in an otherwise favorable bill.

    Important to medical groups, the bill will: 

    • Increase flexibility and reduce burden in the Quality Payment Program;
    • Eliminate the unelected Medicare cost-cutting board known as the IPAB;
    • Extend the work Geographic Practice Cost Index (GPCI) floor for two years through 2019;
    • Permanently repeal the Medicare therapy payment cap;
    • Incorporate new flexibility for Accountable Care Organizations;
    • Expand coverage for telehealth services; 
    • Decrease requirements in the Meaningful Use Program; and
    • Extend Children's Health Insurance Program funding for an additional four years through fiscal year 2027.

    MGMA will continue to advocate for Medical Group Practices, and we thank you for your continued grassroots efforts.

  • 01/24/2018 4:57 PM | Rebekah Francis (Administrator)

    MGMA recently commented on proposed policy changes to the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs. The Association applauded a proposal to publish a list of precluded providers rather than proceeding with burdensome new requirements, opposed by MGMA, that eligible professionals enroll in or validly opt out of Medicare by Jan. 1, 2019 to have their Part D drugs and MA services covered by Medicare. The Association also underscored the growing burden imposed by patient records requests from MA plans, which MGMA members report can be several thousand records annually. Read the full letter

  • 01/24/2018 4:56 PM | Rebekah Francis (Administrator)

    A short-term spending deal reached late Monday reopened the federal government and provides temporary funding through Feb. 8. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for six years and delays several Affordable Care Act-related taxes, including the so-called “Cadillac tax,” which imposes a fee on high-cost employer health insurance plans. Notably absent were extensions of several expired Medicare provisions, including the 1.0 work GPCI floor and therapy caps exceptions. Both provisions have bipartisan support in Congress but have been put on hold for other legislative priorities. The Centers for Medicare & Medicaid Services (CMS) is temporarily holding claims affected by therapy caps but if Congress does not act soon, will “release and process claims accordingly.” 

  • 01/24/2018 4:56 PM | Rebekah Francis (Administrator)

    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

  • 12/13/2017 6:01 PM | Rebekah Francis (Administrator)

    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

  • 12/13/2017 6:00 PM | Rebekah Francis (Administrator)

    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.

  • 12/13/2017 5:59 PM | Rebekah Francis (Administrator)

    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

  • 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.


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