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FINAL 2023 MEDICARE PHYSICIAN FEE SCHEDULE

On Tuesday, the Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements for 2023.

Immediately following, MGMA issued a statement expressing disappointment in the final rule and its negative impact to physician payment, urging Congress to take action to avert the cuts and waive the 4% PAYGO sequestration before the end of the year. Join in #MGMAAdvocacy today by sending a letter to your congressional members imploring them to act swiftly to avert these significant payment cuts!

In the coming weeks, we will release a detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP). Until then, additional information about the final rule is available in the PFS fact sheet and the QPP fact sheet.

COVID-19 public health emergency renewed

 The COVID-19 public health emergency (PHE) was renewed again, effective Oct. 13, 2022. This renewal extends the PHE through mid-January 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. The U.S. Department for Health and Human Services has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

To understand what waivers will expire upon the eventual conclusion of the PHE, review MGMA’s Flexibilities and Policy Following the Expiration of the COVID-19 PHE member-exclusive resource.  

Join in #MGMAAdvocacy to prevent Medicare payment cuts

 With just over two months left in 2022, MGMA needs your help urging Congress to take action to avert significant Medicare payment cuts set to take effect in 2023. Send a letter to your members of Congress today encouraging the passage of legislation to avert the 4.5% reduction to the Medicare conversion factor, waive the statutory 4% Pay-As-You-Go sequester, and provide an inflationary update based on the Medicare Economic Index. MGMA Government Affairs’ latest report on Medicare cuts showcases what medical groups around the country have to say about these proposed payment cuts, including how they would significantly disrupt patient access to care, practice operations, and overall investment throughout the healthcare industry.

The time to act is now! Join in #MGMAAdvocacy today by sending a letter to your members of Congress urging for the swift passage of legislation to avert these significant payment cuts!

Available now: MGMA's '22 Annual Regulatory Burden Report

 Last week, the MGMA Government Affairs team released its 2022 Annual Regulatory Burden Report. With responses from over 500 medical group practices, the survey findings demonstrate the impact that increasing regulatory burden has on practices. An overwhelming majority (89%) of respondents reported that the overall regulatory burden on their medical practice has increased over the past 12 months. And an even greater number of respondents (97%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

Thank you again to all of our members who participated in this survey! For more information about how to engage in current advocacy efforts, please visit the MGMA Advocacy webpage.

Next week: New information blocking requirements take effect

Beginning on and after Oct. 6, 2022, a medical group must respond to a request to access, exchange, or use electronic health information (EHI) more broadly to the extent that EHI would be included in a designated record set that is defined in HIPAA, unless any of eight exceptions can be applied. The new definition of EHI includes medical records, billing records, payment and claims records, case management records, and other records used, in whole or in part, by a medical group to make decisions about individuals. Until Oct. 6, the definition of EHI remains narrower in scope.

For more information on the information blocking requirements, download MGMA’s member-exclusive Information Blocking Toolkit. MGMA is urging U.S. Department of Health and Human Services Secretary Becerra to postpone information blocking deadlines for one year and asking for additional clarity on requirements. 

Reporting deadline Friday: Provider Relief Fund

Medical practices that received Provider Relief Fund (PRF) assistance exceeding $10,000, in aggregate, from Jan. 1, 2021, through June 30, 2021 (RP3), must report on their use of funds by tomorrow, Sept. 30, 2022 at 11:59 p.m. ET. The next reporting period (RP4) opens Jan. 1, 2023.

Those impacted by Hurricane Ian will be allowed the opportunity to submit a request to report late due to extenuating circumstances. For more information related to reporting requirements and auditing, visit the Health Resources & Services Administration (HRSA)’s FAQs. For all other questions related to reporting, call the Provider Support Line at 866-569-3522.

Promoting interoperability deadline fast approaching 

The last day to start a 90-day reporting period under the Promoting Interoperability (PI) performance category for the Merit-based Incentive Payment System (MIPS) is Oct. 3, 2022. The PI program requirements include a set of objectives and measures that focus on patient access to health information and electronic exchange of information that is worth 25% of an eligible clinician or group’s MIPS final score, and requires a minimum continuous 90-day reporting period during the calendar year. In addition to this, providers must use the appropriate edition of Certified Electronic Health Record Technology (CEHRT) and attest to required objectives and measures for the required EHR reporting period.

The National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience will soon publish a National Plan for Health Workforce Well-Being on October 3. The imminent launch of the National Plan will allow leaders in health care and public health, government, payers, health IT, education, professional societies, and health workers to use the National Plan to cultivate a health system to better support our care providers and patient care.

Register to attend the launch event in person in Washington, DC, or virtually on Monday, October 3, 10:00 am-12:00 pm ET: bit.ly/NationalPlanLaunchEvent.

The free event, co-hosted by the NAM, Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges, will describe how the newly published Plan will address the needs of the health workforce, and share leaders’ commitments to building momentum for a health workforce well-being movement.

Note the complete written plan will be accessible on 10/3 at nam.edu/NationalPlan.

For more information on the Clinician Well-Being Collaborative, visit nam.edu/CW. Join our listserv to receive updates: bit.ly/NAMListserv.

House passes MGMA-supported prior authorization legislation

Yesterday, the House of Representatives passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). This MGMA-supported bill is a step forward in reforming prior authorization practices within the Medicare Advantage (MA) program. In part, the legislation would increase transparency around MA prior authorization, establish an electronic prior authorization program, and streamline the prior authorization process for routinely approved items and services.

Keep the momentum going by contacting your senators and urging the swift passage of S. 3018. Medical practices can use MGMA’s Contact Congress portal to send letters today!

MGMA sends year-end legislative priorities to Congress

On Monday, MGMA sent a letter to congressional leadership outlining the legislative priorities that we would like addressed before the end of the year. Before 2023, MGMA urges Congress to mitigate cuts to Medicare reimbursement slated to take effect on January 1, extend telehealth flexibilities, reform prior authorization practices, and support value-based care.

Congress has since taken steps to address the Medicare cuts — the House of Representatives introduced the Supporting Medicare Providers Act of 2022 on Tuesday, which would avert almost 4.5% of the projected 8.5% cuts. MGMA supports this legislation, but calls on Congress to fully avert cuts to Medicare stemming from the 4% statutory Pay-As-You-Go (PAYGO) sequester and provide an inflationary updated based on the Medicare Economic Index. 

MGMA Government Affairs at MPE: Leaders Conference

MGMA’s annual Medical Practice Excellence (MPE): Leaders Conference is less than a month away. Register now to join us in Boston and attend one of our "Washington Update" sessions, during which the Government Affairs team will share insights on current federal policy developments impacting medical practice operations. We'll delve into upcoming Medicare payment and quality rules, the status of surprise billing and transparency requirements, information blocking, and other key regulatory changes to come in 2023.

Mark your calendars today for either of the below sessions and be sure to compare prepared with your questions!

• Monday, Oct. 10 at 9:15 - 10:15 a.m. ET
• Tuesday, Oct. 11 at 2:45 - 3:45 p.m. ET

MGMA provides feedback to CMS in response to the 2023 Medicare PFS

On Tuesday, Sept. 6, MGMA provided comprehensive feedback to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed 2023 Medicare Physician Fee Schedule (PFS). MGMA urges CMS to make important adjustments to the proposed policies to support medical group practices going into 2023, including updating the Medicare conversion factor to avert a 4.5% reduction in payment and adjusting certain reporting requirements under the Merit-based Incentive Payment System. In the coming weeks, MGMA will launch an advocacy campaign to avert these cuts.

The agency will review comments submitted by stakeholders before issuing the final rule in November. Following the release of the final rule, MGMA will provide an in-depth analysis of the 2023 Medicare policies.

Support prior authorization reform

With only a few months left in the 117^th Congress, it is time to voice your support for prior authorization reform! MGMA Government Affairs drafted a template letter that you can send directly to your members of Congress today. The letter urges Congress to pass the Improving Seniors’ Timely Access to Care Act, which puts commonsense guardrails around prior authorization processes in the Medicare Advantage program. With your help, MGMA hopes to see this legislation pass into law by the end of the year!

Final Reminder: Regulatory burden questionnaire closes Sept. 9

MGMA needs your feedback - complete the Annual Regulatory Burden Questionnaire by tomorrow, Friday, Sept. 9!

This annual research project is your opportunity to provide critical feedback on the impact that federal programs have on your practice. The findings of this research will guide MGMA's advocacy efforts in Washington, D.C., to improve the regulatory landscape in which group practices operate, including critical policies related to prior authorization, surprise billing, and the Quality Payment Program.

HHS expected to renew COVID-19 PHE in October

MGMA expects the U.S. Department of Health and Human Services (HHS) to renew the COVID-19 public health emergency (PHE) in October, since the 60-day notice period passed with no word from the Department. Recently, the Administration reiterated its promise to provide a 60-day notice prior to ending the PHE. If HHS does renew the PHE for an 11^th time, it is expected to be in effect through at least mid-January.

Last week, MGMA wrote to HHS Secretary Becerra, asking him to renew the PHE and provide medical groups at least a 90-days’ notice prior to ending it so they may sufficiently wind down flexibilities that have been in effect for over two years.

MIPS facility-based scoring unavailable in PY 2022

Due to the continued impact of COVID-19 on measure performance under the Hospital Value-Based Purchasing (VBP) program, the Centers for Medicare and Medicaid Services (CMS) announced that facility-based scoring will be unavailable in performance year (PY) 2022 under the Merit-based Incentive Payment System (MIPS). CMS utilizes performance under the Hospital VBP to calculate quality and cost scores under MIPS for facility-based clinicians and groups.

In 2022, affected clinicians must report MIPS quality measures; there are no reporting requirements under the cost performance category. However, CMS notes, that if facility-based clinicians or groups do not have available measures to report, they can submit a MIPS Extreme and Uncontrollable Circumstances Exception application to reweight selected performance categories. Additional information is available in the Quality Payment Program Resource Library.

CMS releases new IDR resources

Yesterday, CMS released new resources related to the federal Independent Dispute Resolution (IDR) process under the No Surprises Act. CMS launched a new page on the surprise billing website, linking helpful IDR resources and common mistakes when submitting a dispute resolution claim. Additionally, the agency published a new technical guidance document for IDR entities which includes additional information about eligibility for the federal IDR process, batching claims, and submission of supplemental information to IDR entities. 

While the resources will help practices better understand the IDR claim submission process, MGMA continues to advocate for critical improvements to be made to the IDR portal to streamline the dispute resolution process. Additional resources related to the requirements under the No Surprises Act are available on the MGMA surprise billing issue page.

Has a Health Plan Kicked You Out of its Network?
TMA Wants to Know About It as Well as Your IDR Experience

Several TMA members recently reported that health insurance plans issued network termination letters to several practices and physicians. It appears that hospital-based physicians are the primary targets of these actions. Some members received follow-up letters from the health plans offering to reinstate them into the networks only if they agree to deep cuts in reimbursement for their services.

If this is happening to TMA members, TMA would like a copy of the termination letter. TMA plans to share the letters with the Centers for Medicare and Medicaid Services (CMS). The Secretary of Health and Human Services has authority under the No Surprises Act to study the effect of the Act on access to medical services. Additionally, the Government Accountability Office (GAO) is tasked with submitting a report on the effects of the Act with respect to provider networks, fee schedules, contracted rates, and amounts of health care services. Let us know as well the impact in terms of reduction in reimbursement the health plans’ actions have on your practice.

TMA is also interested in submitting member feedback from physicians or practices which have participated in the independent dispute resolution process pursuant to the No Surprises Act. Please share your experiences with us.

Please submit letters and feedback to Tabitha Lara, TMA’s Director of Insurance Affairs, by email Tabitha.Lara@tnmed.org, or by mail to Tennessee Medical Association, Attention: Tabitha Lara, 701 Bradford Avenue, Nashville, TN 37204, as soon as possible. Any information submitted will be first be redacted so that no practice or physician identifying information will be shared with any agency of the federal government. 

Inflation Reduction Act slated to pass tomorrow

On Sunday, the U.S. Senate passed the Inflation Reduction Act of 2022 (IRA) by a 51-50 vote, with the Vice President breaking the tie. This legislation would, for the first time, provide the U.S. Department of Health and Human Services (HHS) Secretary the authority to negotiate the cost of certain drugs in the Medicare program and establish an annual out-of-pocket cap of $2,000 for Medicare beneficiaries. Price negotiation would first apply to 10 high-cost drugs under Medicare Part D in 2026, later expanding to certain high-cost physician administered drugs under Medicare Part B in 2028. In addition to updates to prescription drug policy, the IRA would also extend expiring tax subsidies under the Affordable Care Act and invest over $400 billion to address climate change.

The bill heads to the House tomorrow, Friday, August 12; pending its passage, the legislation is expected to then be immediately signed into law by the President. 

Join MGMA in a GovChat Live on August 23

The MGMA Government Affairs team is hosting a GovChat live on Tuesday, August 23, from 2:00 – 3:00 p.m. (ET). During this member-exclusive discussion, the team will provide a high-level overview of policies included in the 2023 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) proposed rule. MGMA will be seeking feedback from members to help inform our comments in response to the policy proposals and will answer questions during the interactive discussion. 

Registration information is available on the MGMA GovChat Community page. Additionally, we encourage you to review our member-exclusive key takeaway analysis of the 2023 PFS and QPP proposed rule if you haven't done so yet. Please reach out to the Government Affairs team at govaff@mgma.org with any questions.  

Post-pandemic flexibilities resource available now

Since January 2020, the HHS Secretary has determined that a public health emergency (PHE) has been in effect due to the COVID-19 pandemic. Under the declared PHE, HHS has the authority to waive certain program requirements, however, following the termination of the PHE, many of these flexibilities will expire. MGMA has published a member-exclusive resource highlighting key flexibilities that will expire after the end of the COVID-19 PHE to help practices prepare for policy changes post-pandemic.

The COVID-19 PHE is currently in effect through October 13, 2022, and MGMA anticipates HHS will again renew the PHE at that time.