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CMS finalizes 2022 Physician Fee Schedule

On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) released the final 2022 Medicare Physician Fee Schedule rule, finalizing changes to physician payment policies, including changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements. Most of the final policies will take effect Jan. 1, 2022. MGMA submitted detailed comments in response to the proposed rule and thanks CMS for incorporating MGMA’s feedback into the final rule.

CY 2022 CF:
- Physician: $33.5983
- Anesthesia: $20.9343

Additional information:
PFS fact sheet
QPP fact sheet
MGMA comments

CMS finalizes 2022 outpatient facility and ambulatory surgical center rule

This week, the MGMA Government Affairs team released the 2021 Annual Regulatory Burden Report. This annual report captures the impact of federal regulations on medical group practices, and these data points and stories will help drive #MGMAAdvocacy.

With responses from 420 medical group practices, the survey findings demonstrate the impact that increasing regulatory burden has on practices. An overwhelming majority (91%) 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 (95%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

Thank you to all of our members who participated in this survey! This is only one of many opportunities for members to partner with the Government Affairs team in #MGMAAdvocacy. For more information about how to engage in current advocacy efforts, please visit the MGMA Advocacy webpage.

Prior authorization reform bill introduced in the Senate

Yesterday, the Senate introduced an MGMA-supported bill which would deliver much-needed reform to prior authorization under the Medicare Advantage program. The bipartisan Improving Seniors’ Timely Access to Care Act of 2021 (S. 3018) is the companion bill to the House legislation introduced earlier this year.

As prior authorization continues to rank as one of the most burdensome issues for medical groups year over year, MGMA is committed to working with lawmakers to expedite the passage of this critical legislation.

MGMA engages in advocacy around electronic payments, value-based care, and vaccines

As the voice of medical practices in Washington, D.C., MGMA actively engages with other leading health organizations and coalitions to promote our advocacy agenda. This past week, MGMA joined in advocacy around a variety of pertinent issues, including the electronic funds transfer (EFT) transaction standard, the Medicare Shared Savings Program (MSSP), and COVID-19 vaccine access. Read more about these recent advocacy initiatives below:

• MGMA urged the Centers for Medicare & Medicaid Services (CMS) to affirm providers’ right to receive EFT payments without being forced to pay percentage-based fees for additional services.

• MGMA requested that CMS allow MSSP accountable care organizations to elect pre-pandemic years to set benchmarks for agreements beginning in performance year 2022.

• MGMA encouraged the White House COVID-19 Response Coordinator and U.S. Surgeon General to leverage office-based physicians, including primary care physicians and pediatricians, in the COVID-19 vaccine rollout.

HHS extends COVID-19 Public Health Emergency

The Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective Oct. 18, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90 days.

Unless it is further extended, the current PHE determination will lapse on Jan. 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide the healthcare community with 60 days' notice prior to allowing the PHE to lapse.

Help #MGMAAdvocacy prevent cuts to Medicare in 2022!

MGMA has prepared a template letter for members to send to their congressional representatives urging them to prevent Medicare cuts slated to go into effect on Jan. 1, 2022. In July, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the CY 2022 Medicare Physician Fee Schedule (PFS), which included a proposed conversion factor (CF) of 33.5848 (3.75% lower than the CY 2021 CF).

This decrease is attributed to the expiration of a short-term legislative fix that Congress passed at the end of last year to prevent cuts stemming from PFS payment policy updates and corresponding budget neutrality requirements. To prevent cuts to Medicare reimbursement in CY 2022, Congress must act again. Send a letter to your congressional representatives urging them to maintain the 3.75% increase to the conversion factor through at least CYs 2022 and 2023!

Deadline: Apply for Phase 4 Provider Relief funding by Oct. 26

Applications for Phase 4 of the Provider Relief Fund (PRF) General Distribution are due by Oct. 26. This new $17 billion round of funding will be similar to the previous round distributed in Phase 3, which covered up to 88% of reported losses and net changes in operating expenses from patient care from the first half of 2020. However, Phase 4 will focus on lost revenues and changes in operating expenses from July 1, 2020 - March 31, 2021.

Phase 4 will also include new elements specifically focused on equity, including reimbursing smaller providers for their lost revenues and COVID-19 related expenses at a higher rate compared to larger providers and "bonus" payments based on the number of services furnished to patients in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). An additional $8.5 billion Rural Distribution, intended for providers who furnish services to Medicare, Medicaid, and CHIP patients in defined rural areas, is also available for consideration via the same application. For additional details on the PRF, you can reference MGMA's member resource.

Surprise billing rule establishes dispute resolution process for patients, providers, and plans

The Office of Personnel Management and the Departments of Health and Human Services (HHS), Labor, and Treasury released the second interim final rule (IFR) implementing provisions of the No Surprises Act. This rule follows prior rulemaking outlining patient protections against surprise medical bills, establishing out-of-pocket limits, and notice and consent requirements.

This rule implements independent dispute resolution (IDR) processes for providers, patients, and health plans and takes effect Jan. 1, 2022. The rule also outlines the process the agencies will use to evaluate and certify IDR entities for the arbitration process.

More information is available on the associated Centers for Medicare & Medicaid Services (CMS) fact sheet and agency press release. As the agencies release additional information, it will be posted on the new CMS surprise billing landing page. Be on the lookout for MGMA’s analysis and comments in response to the second IFR.

New guidance from HHS on HIPAA and COVID-19 vaccination status

HHS, through its Office for Civil Rights, issued new guidance on the relationship between the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and COVID-19 vaccination status in the workplace. This practical guidance serves to help businesses and healthcare entities better understand when the HIPAA Privacy Rule applies to disclosures of vaccination status, particularly as it pertains to employees and patients.

Members may also wish to consult the MGMA HIPAA landing page for additional resources. 

MIPS virtual group election period for PY 2022 now open

The virtual group election process for the 2022 performance year for the Merit-based Incentive Payment System (MIPS) is now open. CMS has published a 2022 Virtual Group Toolkit providing detailed information about the virtual group election and participation process. Virtual group elections must be submitted via email to CMS by Dec. 31, 2021, at 11:59 PM (ET).

New Provider Relief funding available next week

The U.S. Department of Health and Human Services (HHS) plans to open applications for a new round of Provider Relief Fund payments totaling $25.5 billion in distributions beginning Sept. 29, 2021. This new funding includes $8.5 billion for providers furnishing services to Medicaid, Children's Health Insurance Program (CHIP), or Medicare patients in defined rural areas, and an additional $17 billion for a Phase 4 General Distribution for providers who can document lost revenue and changes in operating expenses between July 1, 2020, and March 31, 2021. Consideration for both distributions will be determined through a single application on the Health Resources & Services Administration (HRSA) website, and HRSA will use Medicaid, CHIP, and Medicare claims data in the calculation of payments.

As a reminder, HHS is allowing a 60-day grace period following the upcoming Sept. 30 reporting deadline for providers that received greater than $10,000 in Provider Relief funds between April 10 and June 30, 2020. HHS indicated it will not initiate any recoupment or enforcement actions for 60 days following the deadline, allowing for a period of enforcement discretion from Oct. 1 – Nov. 30, 2021. For additional information on the Provider Relief Fund, reference MGMA’s recently updated resource detailing program updates, requirements, and deadlines.

MIPS automatic neutral payment adjustment applies to clinicians impacted by Hurricane Ida

The Centers for Medicare & Medicaid Services announced that certain clinicians participating in the Merit-based Incentive Payment System (MIPS) will automatically receive a neutral payment adjustment for the 2021 performance year/2023 payment year due to the impact of Hurricane Ida. Clinicians located in declared disaster areas, including Louisiana, Mississippi, New York, New Jersey, and Missouri, will automatically have their performance scores across all four MIPS categories reweighted to 0% and receive a neutral payment adjustment in 2023.

However, impacted clinicians can still choose to submit MIPS performance data. If data is submitted for at least two performance categories, the clinician will be scored and have payment adjustments applied in 2023. While the automatic reweighting policy does not apply to groups or virtual groups, these MIPS participants can apply for reweighting of one or more MIPS performance categories.

MGMA urges HHS to delay enforcement of surprise billing requirements

MGMA wrote to the U.S. Department of Health and Human Services (HHS) urging the agency to delay the implementation and enforcement of the surprise medical billing requirements. Beginning Jan. 1, 2022, certain providers will be prohibited from balance billing for services provided to out-of-network patients, while other clinician types will be required to provide strict notice and consent documentation before services are rendered in order to seek payment from out-of-network patients. In the letter, MGMA expressed serious concerns regarding the arbitrary and overburdensome requirements for the notice and consent process and fears that it could disrupt clinical care and practice operations. HHS will be releasing additional regulations in the coming months further implementing the ban on surprise billing.

MGMA to Congress: Support the physician workforce

MGMA and other leading healthcare organizations sent a letter to congressional leadership asking to include policies in the budget reconciliation legislation that would increase Medicare support for graduate medical education (GME). These additional positions would alleviate the physician shortage by gradually providing new Medicare-supported GME positions. MGMA members can participate in #MGMAAdvocacy by sending a template letter to their congressional representatives.

Tax credits for paid leave set to expire at end of month

Eligible medical groups have until the end of September to take advantage of the tax credits available to employers to help fund paid FMLA and sick leave for reasons related to COVID-19. The Families First Coronavirus Response Act (FFCRA) provided funds in the form of refundable tax credits to businesses with fewer than 500 employees who offer employees paid FMLA and sick leave under the Act. Although the requirement to offer paid leave under the FFCRA is no longer mandatory, the refundable tax credits are only available to businesses that offer the paid leave. To learn more about the requirements to report qualified sick and family wages, see the updated guidance from the Internal Revenue Services issued this week.

MIPS Value Pathways demystified in member exclusive resource

The Centers for Medicare & Medicaid Services introduced seven new Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) for optional reporting beginning in the 2023 performance year. Check out this MGMA member exclusive resource that details the key MVP policy proposals and the proposed reporting pathways included in the CY 2022 Physician Fee Schedule. The goal of this new MIPS alternative is to provide clinicians with more meaningful reporting options through cohesive MVPs specific to physician specialties, patient populations, or clinical conditions. MIPS has caused many administrative challenges for MGMA members and has provided limited financial reward for high performance in the quality reporting program. MGMA will submit comments responding to these proposals and will provide an updated analysis highlighting key policies after the final rule is released in November.

MGMA to HHS: Extend Provider Relief Fund reporting deadline

In a letter to U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, MGMA urged HHS to extend the upcoming Sept. 30 reporting deadline for the Provider Relief Fund (PRF). Per current HHS guidance, recipients of more than $10,000 in the aggregate in PRF payments received between April 10 and June 30, 2020, are required to report their use of funds through the PRF Reporting Portal by Sept. 30, 2021. However, due to the sharp increase in COVID-19 cases across the country coupled with the complex and arduous reporting requirements of the program, MGMA has heard concerns from many practices struggling to complete reporting by the deadline. In addition to requesting an extension of the reporting deadline through 2023, MGMA urged HHS to clarify its existing reporting guidance to address outstanding confusion around acceptable uses of funds and to allow PRF recipients to use payments through the end of the COVID-19 public health emergency.

MGMA to OSHA: Exempt medical groups from new COVID-19 requirements

MGMA submitted written comments in response to the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) COVID-19 healthcare emergency temporary standard (ETS). The ETS places requirements, which are already in effect, on medical groups that are unable or choose not to avail themselves to relevant exemptions. In its comments, MGMA expressed concerns regarding the burdens associated with compliance and recommended that OSHA not make the ETS permanent. As MGMA continues to advocate on this issue, please send any examples of how compliance would be burdensome and/or difficult to MGMA Government Affairs.

MGMA to CMS: Prohibit insurers from charging EFT fees

MGMA sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure urging the Agency to use its authority under the Affordable Care Act to prohibit insurers and their payment processing vendors from imposing electronic funds transfer (EFT) fees on medical groups. A recent MGMA Stat poll indicated that 57% of medical groups report being charged fees by health insurers and payment processors to accept reimbursement through EFT direct deposit. This is a dramatic increase from the 26% who reported paying these fees only a year ago. The poll also showed that practices are typically charged 2-3% of the reimbursement amount with no clear value-add. MGMA believes EFT fees are prohibited under current law and will continue to strongly advocate against such predatory business tactics.

#MGMAAdvocacy opportunity: Urge Congress to prevent Medicare cuts in CY 2022!

With more than half of the congressional session behind us, now is the time to ask Congress to support physician practices by avoiding reimbursement cuts in CY 2022. In July, CMS released the proposed rule for the CY 2022 Medicare Physician Fee Schedule. The proposed CY 2022 conversion factor (CF) is 3.75% lower than the current CF because the funds that Congress allocated to the fee schedule to mitigate the projected CY 2021 reimbursement cuts were only for CY 2021. To prevent cuts to Medicare reimbursement in CY 2022, Congress must act before the end of the year. Send a letter to your congressional representatives urging them to maintain the 3.75% increase to the conversion factor through at least CYs 2022 and 2023!

Don’t miss it: CMS and OIG join MGMA in fraud series
part 2

In the second installment of the “Protect your Practice” webinar series, MGMA Government Affairs invites you to register for the second installment of the member-exclusive "Protect your Practice" webinar series on Tuesday, Aug. 31 at 1pm ET. During this session, MGMA will be joined by two of our national partners, the CMS Center for Program Integrity and the Department of Health and Human Services Office of Inspector General (OIG). Practice managers will be equipped with vital information necessary to avoid clinician-recruitment schemes from fraudsters, detect COVID-19-specific fraud and abuse, and will learn about the tools and programs the federal government uses to protect patients, medical practices, and federal healthcare programs.

Biden administration proposes to rescind MFN model

After pushback from MGMA and other industry stakeholders, the U.S. Department of Heath and Human Services (HHS) proposed to withdraw the Trump administration’s Most Favored Nation (MFN) model. The mandatory model would have tied reimbursement for Medicare Part B drugs to prices paid in other countries, resulting in lower reimbursement rates to physician practices. The model and corresponding rule was finalized in late 2020, but blocked by federal judges and subsequently frozen by President Biden. Although HHS proposes to rescind the MFN model, it is clear that the Biden administration and Congress will look for other avenues to curb rising drug prices.

Support advocacy to remove patient cost sharing for CCM services

Join #MGMAAdvocay efforts by sending a template letter to your congressional representative urging for support of the recently introduced legislation to improve patient access to chronic care management (CCM) services. MGMA sent a letter alongside numerous other national stakeholder groups supporting the reintroduction of the Seniors’ Chronic Care Management Improvement Act of 2021. This important legislation would remove the 20% patient co-insurance amount for CCM services, reducing administrative burdens and enabling group practices to utilize these services to better manage the chronic conditions of their patients. Send a letter to your representative today!

Can't miss resource: 2022 Medicare Physician Fee Schedule analysis

The CY 2022 Physician Fee Schedule proposed rule includes many complex policy proposals, and the MGMA member exclusive key takeaway analysis highlights the top policy proposals impacting group practices. This can’t miss resource will help you and your practice understand and anticipate proposed changes to physician payment in CY 2022. The proposed rule includes policy proposals that would update the annual conversion factor, make changes to telehealth covered services, modify the definition of an E/M split (or shared) visit, and introduce the Merit-based Incentive Payment System Value Pathways as a voluntary reporting option for the 2023 performance year. This resource is only the first opportunity to engage with MGMA to understand the changes to physician payment in 2022, so be on the lookout for other key insights and resources from MGMA.