Latest News

CMS announces new oncology payment model

On June 27, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced the Enhancing Oncology Model (EOM), a new oncology payment model. Building off of lessons learned in previous oncology models, the EOM will be a nation-wide, episode-based payment model focused on patient-centered care delivery. Expected to launch in July 2023, the EOM request for applications is now open through September 30, 2022.

Updated resource highlights language access requirements

MGMA recently updated a key member resource outlining language access requirements for group practices. This resource reflects updates made in a 2020 final rule making changes to patient protections against discrimination in health programs and activities under Section 1557 of the Affordable Care Act. Please note, no changes to the language access requirements have been made since the 2020 final rule.

Final Reminder: Avert projected 7-10% Medicare payment cuts

The Medicare member research questionnaire to support #MGMAAdvocacy in averting potential significant payment cuts to Medicare in 2023 closes on Friday, June 24.

In 2023, group practices are facing potential 7-10% cuts to Medicare payment rates, compared to Jan. 1, 2022, reimbursement amounts. After two years of financial uncertainty caused by the COVID-19 pandemic, the projected payment cuts will have long-term resounding impacts on practice financial sustainability. MGMA needs to hear from you! If you haven't done so already, complete the questionnaire today!

Full Medicare sequester phase-in begins July 1

On July 1, 2022, the full 2% Medicare sequester is set to phase-in. The Medicare sequester, which has been in effect since 2013, was suspended at the beginning of the pandemic through March 31, 2022. On April 1, 1% of the full 2% sequestration was reintroduced, and on July 1, an additional 1% will phase-in, signaling the complete reintroduction of the Medicare sequestration. The 2% sequester will apply to care with dates of service on or after July 1.

Deadline to register for CAHPS for MIPS survey is June 30

The deadline for groups and virtual groups to register for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey closes on June 30, 2022, at 8 p.m. (ET). The CAHPS for MIPS survey is an optional quality measure that groups, virtual groups, and alternative payment model (APM) entities can report. The CAHPS for MIPS survey is a required measure for groups and APM entities reporting via the APM Performance Pathway.

New telehealth guidance from HHS in preparation for PHE expiration

The U.S. Department of Health and Human Services (HHS) released new guidance this week surrounding telehealth and HIPAA compliance following the eventual conclusion of the COVID-19 public health emergency (PHE). Throughout the pandemic, the Department instituted various flexibilities tied to the PHE that waive many of the generally applicable rules governing Medicare telehealth services. While largely not new information, HHS’ guidance does provide helpful clarifications surrounding when the Office for Civil Rights will stop utilizing enforcement discretion, as well as important clarifications on audio-only telehealth visits which were not reimbursable under Medicare prior to the pandemic.

Of note, HIPAA enforcement discretion was not one of the waivers extended by Congress for five months following the conclusion of the PHE. In an effort to ensure medical groups are aware of their obligations immediately following the expiration of the PHE, MGMA Government Affairs will soon release a member-exclusive resource outlining the reintroduction of HIPAA requirements for audio-visual and audio-only telehealth services.

MGMA provides recommendations to HHS on provisions of the HITECH Act

Last week, MGMA provided feedback to HHS Secretary Becerra in response to the Department’s request for information on certain provisions from the Health Information Technology for Economic and Clinical Health (HITECH) Act. With cybersecurity attacks on healthcare organizations escalating in recent years, medical groups have had to become more vigilant and take increased precautions to protect themselves and the patients they treat.

MGMA applauds HHS for engaging with stakeholders to better understand what recognized and effective cybersecurity practices medical groups have voluntarily implemented and offers the following recommendations as the Department considers future cybersecurity regulations:

• Offer flexibility to medical groups surrounding which security programs they implement;

• Provide best practices and frameworks to help medical groups as they implement acknowledged cybersecurity policies into their practices; and

• Take steps to prevent unnecessary confusion and burden by considering other rules and policies impacting medical groups while developing additional regulations.

CMS to launch MIPS final score preview

The Centers for Medicare and Medicaid Services (CMS) announced a new performance feedback process for the Merit-based Incentive Payment System (MIPS). MIPS clinicians will now be able to preview final 2021 MIPS scores in June prior to the publication of final MIPS scores and payment adjustments. During the preview period, clinicians will be able to review the data used to calculate their highest attributed final score and the data used to calculate the scores. The final score preview period will not include payment adjustment information.

With the introduction and review of MIPS scores, CMS hopes to address any potential scoring issues prior to calculating payment adjustments. More information about the MIPS performance, scoring, and payment adjustment can be found on the Quality Payment Program website.

Real-world examples needed on information blocking

MGMA is soliciting feedback from medical groups experiencing information blocking and encountering challenges when requesting patient health information from other actors such as electronic health record (EHR) vendors. Questions to consider: (1) What issues have you experienced when requesting patients’ electronic health information from an EHR vendor? (2) Any functions or features your EHR vendor does not provide to comply with information blocking regulations? (3) Does your practice release lab, diagnostic, or any medical information immediately to patients? If not, what’s the typical timeframe? (4) Any additional concerns or challenges while complying with information blocking regulations?

If you have examples, please email MGMA Associate Director of Government Affairs Swapna Pachauri at spachauri@mgma.org by Thursday, June 16. Any information you provide will be kept confidential and will be deidentified as MGMA continues to engage with the Department of Health and Human Services to advocate for more flexibility and clarity regarding the rules.

MGMA to Congress: Refine LDT legislation

MGMA and 70 leading health organizations wrote to Congress this week urging for more time to refine the VALID Act before passing it into law. The VALID Act, as written, contains language that would change the way laboratory developed tests (LDTs) are regulated.

MGMA is concerned that the legislation as drafted could potentially unduly restrict access to tests that medical groups deem necessary to care for patients.

MGMA to Congress: Repeal Patient ID prohibition

MGMA joined with more than 120 healthcare organizationsto urge Congress to repeal Section 510 in the Labor, Health and Human Services, and Education and Related Agencies (Labor-HHS) appropriations bill, which would prohibit the Department of Health and Human Services from spending federal dollars to accept a national unique patient health identifier standard. Patient misidentification is one of the top threats to patient safety and MGMA is requesting that Congress find solutions and identify a national strategy that protects patient privacy in a cost-effective way.

Open Payments pre-publication review ends May 15

The deadline for covered recipients under the Open Payments program to review 2021 data is quickly approaching. Providers covered under the Open Payments program have the opportunity to review and dispute any attributed data until May 15, 2022, prior to its publication in June 2022. The Centers for Medicare and Medicaid Services (CMS) have published additional resources to assist providers in reviewing Open Payments data.

Update: If missed deadline, complete PRF reporting by April 22

Due in large part to #MGMAAdvocacy, the Health Resources & Services Administration (HRSA) will allow medical groups who missed the Provider Relief Fund (PRF) reporting deadline to submit a “Request to Report Late Due to Extenuating Circumstances for Reporting Period 1” between April 11 and April 22, 2022, at 11:59 p.m. ET. Physician practices should receive information about how to submit a request directly from HRSA via email. Recipients must attest to an extenuating circumstance, examples of which are listed in the linked guidance above. 

If HRSA approves the extenuated circumstances form, you will receive a notification to proceed with completing PRF Period 1 reporting shortly thereafter. Providers will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal.

New surprise billing FAQ released

The Centers for Medicare and Medicaid Services (CMS) released a new FAQ document providing additional information about the uninsured and self-pay good faith estimate (GFE) requirements. These new policies went into effect on Jan. 1, 2022, and were implemented under the No Surprises Act.

MGMA is encouraged by the continued engagement from CMS to provide necessary clarifications; however, we are continuing to advocate for additional guidance and education to ensure all practices have the information necessary to comply with the requirements. 

Open Payments pre-publication review deadline May 15

Covered recipients under the Open Payments program can now review 2021 data through May 15, 2022. Providers covered under the Open Payment program have the opportunity to review and dispute any attributed data prior to its publication in June 2022.

The goal of the Open Payments program is to increase transparency and accountability. Additional information about Open Payments and to understand providers that qualify as covered recipients is available on the CMS Open Payments website.

MGMA submits comments on prior authorization automation

Last week, MGMA submitted comments to the Office of the National Coordinator (ONC) on electronic prior authorization (ePA).  Within the comments, MGMA outlines key recommendations and considerations including its primary goal of reducing the number and frequency of PA, noting that without addressing broader PA, automation could simply increase PA.

While reiterating support for ONC's goal to advance ePA, MGMA also encourages ONC, as well as the Centers for Medicare & Medicaid Services (CMS), to identify and consider other areas of reform. MGMA believes that the burden associated with PA could be reduced through automation, but only if implemented appropriately. Proper implementation includes robust piloting and testing, as well as ensuring an appropriate timeline for implementation. It also includes ensuring there are adequate guardrails in place.

PA requirements continue to increase year after year. To get involved in #MGMAAdvocacy on the matter, send a template letter to Congress advocating for commonsense PA reforms in the Medicare Advantage program!

President Biden releases FY 2023 budget request

On Monday, President Biden released his $5.8 trillion budget proposal for fiscal year (FY) 2023, which included several healthcare related policies that would support the temporary expansion of telehealth, bolster access to behavioral health, and make investments for future pandemic preparedness. The FY 2023 budget also includes a proposal to cut the nation’s deficit by $1.3 trillion from last year.

Presidential budgets do not have the force of law and are intended to serve as statements of administrative priorities, while Congress negotiates the budget. MGMA will continue to advocate on behalf of our members throughout the budget negotiation process.

MGMA to CMS: Improving health equity within value-based care

Yesterday, MGMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) providing feedback to the agency on how to support practices in value-based care arrangements and improve health equity. CMS recently hosted a roundtable discussion with leaders across the healthcare industry to identify how CMS can support safety net providers participating in payment models.

Within the comments, MGMA recommended CMS expand the definition of safety net to include small and rural practices, as they similarly provide critical care to sicker, poorer, and disadvantaged patient populations. Extending support within value-based care to these practice types will help CMS achieve their goal to improve health equity within the healthcare system.

COVID-19-era Uninsured Program runs out of funds

The Health Resources & Services Administration (HRSA) is no longer accepting COVID-19 testing and treatment claims — and will soon stop accepting vaccination claims — made under the Uninsured Program due to lack of sufficient funds. The Uninsured Program was established during the pandemic to provide claims reimbursement to healthcare providers generally at Medicare rates for testing uninsured individuals for COVID-19, treating uninsured individuals with a positive COVID-19 diagnosis, as well as administering COVID-19 vaccines to uninsured individuals.

Claims submitted prior to the below deadlines will be paid subject to the availability of funds:

• On March 22, 2022 at 11:59 p.m. ET, the Uninsured Program stopped accepting claims for testing and treatment

On April 5, 2022 at 11:59 p.m. ET, the Uninsured Program will also stop accepting vaccination claims

2021 MIPS data reporting period ends March 31

The data reporting period for the Merit-based Incentive Payment System (MIPS) 2021 performance year closes on March 31, 2022. Eligible clinicians must submit all data through the Quality Payment Program (QPP) website prior to the deadline. The Centers for Medicare and Medicaid Services (CMS) will calculate final scores that will be used to apply the appropriate MIPS payment adjustment in CY 2023.

For the 2021 performance year, CMS is applying the automatic Extreme and Uncontrollable Circumstances (EUC) policy to individual MIPS clinicians and has reopened the EUC application for groups, virtual groups, and Alternative Payment Model entities through March 31. Under the EUC policy, clinicians that have all performance categories reweighted will receive a neutral payment adjustment in CY 2023. More information is available on the QPP website.

Telehealth waivers extended 5 months past PHE conclusion

On March 15, 2022, President Biden signed the $1.5 trillion omnibus spending package into law, which extended certain telehealth flexibilities related to the COVID-19 public health emergency (PHE). A handful of PHE-related waivers will be in effect for an additional 151 days following the conclusion of the PHE, including the ability to treat patients virtually in their homes.

An overview of the PHE-related telehealth waivers — including those extended by the omnibus — may be found in MGMA’s updated Medicare Telehealth Waivers resource.

MGMA to Congress: Extend Medicare sequester moratorium

Last Friday, MGMA and 50 other leading healthcare organizations sent a letter to Congress urging for an extension of the 2% Medicare sequester moratorium that has been in effect since 2020. Specifically, the letter asks that they extend the full moratorium for the duration of the COVID-19 public health emergency (PHE).

Without this extension, the Medicare sequester will phase in at 1% this April and return to the full 2% this July. Prior to the COVID-19 pandemic, the 2% Medicare sequester was in effect for almost a decade. It is unlikely that the moratorium will last indefinitely — instead, it will most likely require greater reform.

Court rules against HHS in surprise billing case

On Feb. 23, 2022, a federal court in Texas issued a ruling in one of the surprise billing cases filed against the U.S. Department of Health and Human Services (HHS). In this ruling, the court invalidated certain aspects of the federal independent dispute resolution (IDR) process — specifically, the requirement that the median in-network rate would be the assumed out-of-network rate for all payment disputes.

Additionally, while the federal protections against surprise billing took effect on Jan. 1, 2022, the federal IDR portal where providers can initiate an IDR dispute has not been yet been launched. HHS announced that for all disputes for which the negotiation period has expired, providers will have 15 business days following the opening of the federal IDR portal to submit a dispute. More information about surprise billing is available on the MGMA surprise billing page.

CMS reopens MIPS EUC application

The Centers for Medicare & Medicaid Services (CMS) has reopened the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) policy for providers impacted by the COVID-19 pandemic until March 31, 2022.

CMS publishes surprise billing state enforcement letters

The Centers for Medicare and Medicaid Services (CMS) has published a comprehensive list of state enforcement letters for the requirements under the No Surprises Act. These state letters, including letters to the District of Columbia and U.S. territories, outline CMS’ current understanding of which surprise billing requirements each state is enforcing and what requirements CMS will enforce.

The letters also outline whether the federal independent dispute resolution and patient-provider dispute resolution processes apply in each state, and under what circumstances. These state-specific letters will help providers determine what governing body oversees their surprise billing requirements. More information about surprise billing is available on the MGMA surprise billing landing page.

Biden administration renews national emergency

President Biden recently announced that the U.S. national emergency declared in March 2020 related to the COVID-19 pandemic will be extended beyond March 1, when it was set to expire. This emergency declaration is separate from the COVID-19 public health emergency (PHE), which was extended through April 16 by U.S. Department of Health and Human Services (HHS) Secretary Becerra. However, the extension of the president’s national emergency declaration is necessary for the HHS Secretary to temporarily waive certain Medicare and Health Insurance Portability And Accountability Act (HIPAA) privacy requirements, such as the telehealth waivers currently in effect.

Join CMS March 9 for webinar on Open Payments

On Wednesday, March 9, from 1:00-1:30 p.m. (ET), CMS is hosting a webinar on the Open Payments program to provide an overview of the data review, dispute, and correction period, and to answer stakeholder questions. Covered recipients will have the opportunity to review data between April 1 and May 15, prior to the publication of 2021 Open Payments data by June 30, 2022.

The goal of the Open Payments program is to increase transparency and accountability. Additional information about Open Payments, including how to understand which providers qualify as covered recipients, is available on the CMS Open Payments website.