Latest News

MGMA urges Congress to extend QPP-SURS program

The Quality Payment Program Small, Underserved, and Rural Support (QPP-SURS) program provides direct technical assistance to eligible clinicians required to participate in the Merit-based Incentive Payment System (MIPS). However, after five years of providing support to small practices, the program expired on Feb. 15, 2022.

MGMA is urging Congress to extend this critical program through the passage of the SURS Extension Act to ensure practices of all sizes have the resources available to succeed in the MIPS program. Join #MGMAAdvocacy by sending a letter to your congressional representatives today urging for the extension of the QPP-SURS program.

Register now for GovChat Live on good faith estimate mandates

Join MGMA Government Affairs in a GovChat Live on Tuesday, March 1 at 1 p.m. (ET), to have your questions answered and hear about MGMA advocacy related to the uninsured or self-pay good faith estimate (GFE) mandates, which took effect on Jan. 1, 2022 as part of the No Surprises Act. The team will discuss the types of providers required to issue uninsured or self-pay GFEs, what information is required to be communicated with patients, and provide an overview of the patient-provider dispute resolution process.

Registration information for the event can be found on MGMA Communities and additional information about the federal surprise billing requirements is available on the MGMA surprise billing landing page.

MGMA to CMS: Fix, don't end, Direct Contracting

MGMA, alongside 221 other leading healthcare organizations, sent a letter to the Centers for Medicare and Medicaid Services (CMS) Innovation Center urging the agency to provide improvements to the Direct Contracting model instead of ending it entirely.

The letter followed criticism from members of Congress of certain model participation tracks. However, MGMA and others maintain that with certain model improvements, Direct Contracting will remain a critical participation option for groups interested in advancing in value-based care arrangements.

MIPS technical assistance program ends Feb. 15

Funding for the Quality Payment Program Small, Underserved, and Rural (QPP-SURS) technical assistance program ends on Feb. 15, 2022. This program supports practices participating in the Merit-based Incentive Payment System (MIPS) by providing guidance in determining MIPS eligibility, submitting data, and transitioning to voluntary participation in alternative payment models (APMs).

MGMA is urging Congress to provide funding for the QPP-SURS program through 2027 to ensure small and rural practices can continue to succeed in the MIPS program. Join #MGMAAdvocacy by sending a letter to your congressional representatives today!

Reminder: Medicare telehealth changes

The Centers for Medicare and Medicaid Services (CMS) recently published an article regarding changes to telehealth billing that were included in the 2022 Medicare Physician Fee Schedule (PFS). The changes mostly cover the expansion of mental telehealth services available following the conclusion of the COVID-19 public health emergency, including the ability to treat patients at home and via audio-only technology if certain conditions are met. The article also includes the two new mental telehealth modifiers – FQ and FR.

For more information on the telehealth changes included in the final 2022 PFS rule, download MGMA’s member-benefit analysis.

Join #MGMAAdvocacy on 2022 priority issues

While the MGMA Government Affairs team works tirelessly in Washington, D.C., advocating on top issues impacting group practices, we need your help to amplify the message to Congress. In less than five minutes you can send a personalized email advocating for change on all of the issues listed below!

• Extend telehealth flexibilities
• Delay good faith estimate mandates
• Extend Medicare sequestration relief
• Support MIPS technical assistance
• Support necessary changes for APMs

Learn more about MGMA federal advocacy, access member-exclusive resources, and find out how you can be involved by visiting the MGMA advocacy webpage.  

MGMA to Congress: Support practices in funding legislation

Last Friday, MGMA sent a letter to Congress urging for the following priorities to be considered while they negotiate the upcoming February funding legislation:

• Extend Medicare sequester relief beyond March 2022;
• Continue telehealth flexibilities through at least CY 2024;
• Extend the alternative payment model (APM) 5% bonus;
• Update the Qualifying Participant (QP) threshold; and
• Delay implementation of the good faith estimate (GFE) and advanced explanation of benefits (AEOB) requirements.

2020 MIPS participation results now available

The Centers for Medicare & Medicaid Services (CMS) has released participation results for the 2020 performance year of the Merit-based Incentive Payment System (MIPS). MIPS participation slightly decreased from 2019 to 2020 and 81% of clinicians received a final score at or above the exceptional performance threshold.  

Throughout 2020, many clinicians were significantly impacted by the COVID-19 pandemic, and as a result, CMS provided clinicians with the option to apply for reweighting of all or some MIPS performance categories. In 2020, 26% of participants received reweighting of at least one performance category.   

MGMA urges Congress to extend telehealth flexibilities

MGMA and hundreds of other leading organizations wrote to Congress asking for a pathway to comprehensive permanent telehealth reform. At the beginning of the COVID-19 pandemic, Congress and the Administration acted quickly to expand Medicare telehealth, allowing millions of beneficiaries access to virtual care. These flexibilities hinge on whether the COVID-19 public health emergency (PHE) is in effect, leading to uncertainty surrounding how long these waivers will remain.

The letter urges Congress to continue all current telehealth waivers through Dec. 31, 2024, allowing time to collect the necessary evidence needed to support permanent policy.

MGMA to HHS: Delay good faith estimate mandate

In a letter sent yesterday, MGMA urged the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to use their enforcement discretion and delay implementation of the uninsured or self-pay good faith estimate (GFE) requirements until practices have had appropriate time to understand and implement the requirements.

Passed as part of the No Surprises Act, these GFE requirements took effect on Jan. 1, 2022. Additional information about the No Surprises Act and member-exclusive resources are available on the MGMA surprise billing landing page.

OSHA withdraws COVID-19 vaccination and testing ETS

Following a U.S. Supreme Court ruling, the Occupational Safety and Health Administration (OSHA) published an announcement that it is withdrawing its COVID-19 vaccination and testing emergency temporary standard (ETS).

Although OSHA is withdrawing the ETS, the agency conveyed its intention to pursue future action on COVID-19 workplace safety down the road.

HRSA announces $2 billion in Provider Relief Fund assistance

On Tuesday, the HHS, through the Health Resources and Services Administration (HRSA), announced it will make $2 billion in Provider Relief Fund (PRF) Phase 4 payments this week. More than 7,600 providers nationwide should receive these funds, which are based on lost revenues and expenses due to COVID-19. Medical groups must have previously applied for relief funds.

For more information on the PRF, visit HRSA’s PRF landing page.

MGMA releases 2022 Advocacy Agenda

As we enter a new year, MGMA continues to ensure the voice of medical groups is heard in Washington. Our 2022 Advocacy Agenda outlines key federal issues we are tackling, such as protecting the financial viability for medical group practices, improving the implementation of surprise billing requirements, and advancing value-based care.

Follow the MGMA Government Affairs team on Twitter for updates on the latest #MGMAAdvocacy efforts this year:

HHS renews COVID-19 PHE

The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective Jan. 16, 2022. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90-days. In a letter to HHS, MGMA called on the Department to expeditiously renew the PHE to ensure groups practices can continue to leverage existing critical flexibilities as they continue to respond on the frontlines of the pandemic.   

Unless further extended, the current PHE will lapse on April 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide a 60-day notice prior to allowing the COVID-19 PHE to lapse.

Provider Relief Fund portal open for 'Period 2' reporting

Today, the U.S. Supreme Court ruled on both the Occupational Safety and Health Administration (OSHA) vaccination and testing emergency temporary standard (ETS) and the Centers for Medicare & Medicaid Services (CMS) facilities rule. The Supreme Court blocked the OSHA ETS, which would have required workers of large employers (100+ employees) to get vaccinated or tested weekly for COVID-19. The CMS facilities rule, which would require vaccination of healthcare employees in facilities that receive Medicare and Medicaid payments, is allowed to move forward nationally. The CMS facilities rule generally does not apply to physician practices, although some might be subjected to it based on how they are structured.

The OSHA ETS opinion can be viewed here.

The CMS facilities rule opinion can be viewed here.

The CMS facilities rule FAQs can be viewed here.

On Dec. 27, 2021, the Occupational Safety and Health Administration (OSHA) issued a statement on the status of its COVID-19 healthcare emergency temporary standard (ETS), confirming that it is withdrawing the ETS with the exception of the recordkeeping portions.

Last August, MGMA urged OSHA to not make this standard permanent, due to it disrupting ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. Although OSHA is letting this ETS sunset, it expressed its intentions to revisit the issue of protecting healthcare workers from COVID-19 in the future by issuing another standard. MGMA will urge the Agency to solicit input from stakeholders, such as medical groups, when developing such a standard.

Updated member resources to navigate surprise billing

On Jan. 1, 2022, the No Surprises Act requirements prohibiting certain out-of-network balance billing and new uninsured (or self-pay) good faith estimate price transparency requirements took effect. Throughout 2021, the Biden Administration released several rules implementing these newly effective requirements. The Administration will continue to release additional rules throughout 2022 outlining the remaining patient protections that have not yet been implemented.

The MGMA Government Affairs team has updated member-exclusive resources to help group practices better understand the requirements in place. Check out the most up-to-date resources on the MGMA Surprise Billing landing page.

MIPS 2021 data submission window open

Clinicians can now submit and review data for the 2021 performance year for the Merit-based Incentive Payment System (MIPS). The data submission window closes on March 31, 2022 at 8 p.m. (ET). The Centers for Medicare and Medicaid Services provided several flexibilities for clinicians due to the COVID-19 public health emergency, including applying an automatic reweighting of performance scores for individual clinicians.

MGMA to HHS: Provide flexibilities for surprise billing requirements

In a letter to the U.S. Department of Health and Human Services (HHS), MGMA called for additional flexibilities for group practices as new surprise billing requirements are implemented on Jan. 1, 2022. The final rules implementing requirements related to surprise billing were released less than three months before their effective date, not allowing practices sufficient time to understand and implement new workflows in compliance with these new requirements.

MGMA recently published a surprise billing FAQ and launched a new surprise billing landing page containing member-exclusive resources, advocacy materials, and federal resources to help guide practices as they begin complying with the new requirements in the new year.

Dec. 31: Upcoming MIPS deadlines

As 2021 comes to a close, clinicians must prepare for the upcoming deadlines for the Merit-based Incentive Payment System (MIPS) program. There are two key deadlines on Dec. 31, 2021:

• EUC Application deadline for groups, virtual groups and APM entities, and
• Virtual group election for PY 2022

While the automatic and extreme and uncontrollable circumstances (EUC) policy applies to individual MIPS clinicians due to the COVID-19 pandemic, groups, virtual groups, and APM entities must apply to have performance categories reweighted for PY 2021. Virtual group election must be made before the start of PY 2022. More information about both of these deadlines may be found on the Quality Payment Program website.

MGMA to Congress: Prevent cuts to Medicare in CY 2022

On Monday, MGMA and hundreds of other healthcare organizations sent a letter to congressional leadership urging them to address the cuts to Medicare reimbursement slated to take effect Jan. 1, 2022. More specifically, the groups asked Congress to extend the 3.75% payment adjustment through at least CY 2022. Last year, Congress appropriated funds to the Medicare physician fee schedule (PFS) to mitigate cuts stemming from payment policy changes that went into effect in CY 2021. That 3.75% increase to the PFS expires at the end of this year. MGMA will soon share resources and grassroots letters addressing these impending cuts for members to engage in #MGMAAdvocacy! The letter may be viewed here.

MGMA to Congress: Prevent cuts to labs in CY 2022

This week, MGMA and two dozen other leading healthcare organizations wrote to Congress asking to extend the hold on laboratory payment cuts and the private payer data reporting period under the Clinical Laboratory Fee Schedule (CLFS) for a year. In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) with the goal of giving Medicare beneficiaries access to critical health services, such as laboratory tests. The way that the U.S. Department of Health and Human Services implemented PAMA led to severe cuts to laboratories under Medicare. The CARES Act, passed in 2020, delayed the implementation of the CLFS cuts in 2021. Without congressional intervention, physician office laboratories could see cuts up to 15% for tests. The letter may be viewed here.

New MGMA vaccine mandate resource

Last week, the Biden administration published new rules pertaining to COVID-19 vaccination and testing. To assist medical groups in navigating these complex mandates, MGMA Government Affairs created a new member-exclusive resource covering both mandates: (1) the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) published an emergency temporary standard (ETS) requiring employers with 100 or more employees to implement a COVID-19 vaccination and testing policy; and (2) the Centers for Medicare & Medicaid Services (CMS) issued an Interim Final Rule (IFR) requiring healthcare workers at facilities participating in Medicare and Medicaid to be fully vaccinated. Both mandates are slated to go into full effect on Jan. 4, 2022, although have already been challenged in court.

Additional information:

• MGMA Vaccine Mandate Resource
• White House Fact Sheet on Mandates

New MGMA surprise billing resource

Several federal requirements related to surprise billing and related patient transparency requirements take effect on Jan. 1, 2022. To assist members in implementing these new requirements, MGMA Government Affairs created a member-exclusive resource outlining critical surprise billing policies impacting group practices.

While the federal regulation of balance billing generally only applies to clinicians providing care at in-network facilities, other patient transparency requirements may impact clinicians providing care in group practice settings. MGMA will also be hosting a member-exclusive informational session and answering questions about the new surprise billing requirements later this month. More information will be posted in the member-exclusive Government Affairs Communities page in the coming weeks.

Additional information:

• MGMA No Surprises Act Resource
• Government Affairs Communities