News

  • 09/18/2017 3:26 PM | Rebekah Francis (Administrator)

    MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed 2018 Medicare physician fee schedule. The proposed rule includes a number of policies that, if finalized, would affect medical group practices in 2018.

    Among its recommendations, MGMA advocates for CMS to: 

    • Finalize the proposed delay in requiring appropriate use criteria consultation and documentation; 
    • Hold medical groups harmless from 2018 penalties in the obsolete PQRS, Meaningful Use, and Value Modifier programs if they reported some data in 2016; and
    • Reduce unnecessary regulations and improve the quality and efficiency of healthcare delivery using the results of MGMA 2017 Regulatory Burdens survey as a compass. 

    Gain insight about the impact of Medicare payment policies on your practice at MGMA17 in Anaheim. MGMA government affairs presentations will highlight legislative and regulatory issues critical to your groups success, feature exclusive office hours with CMS Director of the Center for Clinical Standards and Quality, Dr. Kate Goodrich, and culminate in the popular View from Washington general session with MGMAs Senior Vice President of Government Affairs. Register today to secure your spot.

  • 09/18/2017 3:25 PM | Rebekah Francis (Administrator)

    A Sept. 5 MGMA Stat poll found that about 1 out of 6 practices report that their health plans charge transaction fees, typically ranging from 2-5%, to receive payments for medical services via Electronic Funds Transfer (EFT). As part of an effort in the Affordable Care Act to decrease healthcare administrative inefficiencies, CMS mandated a standardized EFT transaction and since 2014 health plans are required to offer EFT should providers request it. Contrary to the intent of the law, and despite the fact that health plans themselves save on printing and mailing costs, many practices are required to pay these EFT tolls. MGMA continues to strongly advocate that CMS issue guidance preventing health plans and payment vendors from charging these fees. Review the MGMA member-benefit EFT and ERA Guide.

  • 09/18/2017 3:24 PM | Rebekah Francis (Administrator)

    Last week, Department of Health and Human Services (HHS) Secretary Tom Price, MD issued responses to the first physician focused payment models (PFPMs) reviewed by the PFPM Technical Advisory Committee (PTAC) in April. The Secretary asked that design concerns be addressed before making a final decision on the American College of Surgeons-Brandeis Model. HHS also indicated it would not be moving forward with the COPD and Asthma Monitoring Project and Project Sonar models, but would consider elements of those proposals when developing its own future models. Despite not proceeding with any of the proposals at this time, Price provided valuable insights to guide development of future PFPMs. He explained models that are broad in scope and feature enhanced patient monitoring to reduce complications and hospital admissions hold promise but that HHS is not interested in models that would not be implemented beyond the submitter or use proprietary technology.

  • 09/18/2017 3:23 PM | Rebekah Francis (Administrator)

    CMS announced last month it will launch a new audit strategy, called Targeted Probe and Educate (TPE), after pilot programs with four Medicare Administrative Contractors (MACs) demonstrated success. Under the TPE approach, MACs will perform reviews on claims that pose the greatest financial risk to the Medicare trust fund or have a high national error rate. Unlike the previous policy where reviews were initiated on all providers of a particular service, MACs are now instructed to focus only on those providers, identified through data analysis, who have the highest claims error rates or billing practices that vary significantly from their peers. The TPE program includes up to three rounds of review, coupled with individualized education based on review results, and is expected to be expanded to all MAC jurisdictions - later this year.

  • 09/07/2017 10:44 AM | Rebekah Francis (Administrator)

    CMS is expected to release the 2016 PQRS Feedback Reports and Value Modifier Quality and Resource Use Reports within the next few weeks. These reports will provide details about group practice or individual clinician 2016 reporting results including any penalties or upward adjustments, which would impact Medicare Part B payments beginning Jan. 1, 2018. If there are concerns any penalties are unwarranted, a physician or designated practice official such as an administrator will have approximately 60 days from the release of the reports to appeal the penalty determination, after which point penalties cannot be reversed, even if they are found to be assessed in error. MGMA encourages practice leaders to avoid delays in accessing reports by verifying your Enterprise Identity Management account today. Learn more here

    CMS will host an educational call to review how to access the PQRS Feedback Reports and to answer questions from stakeholders on Tuesday, Sept. 26, from 1:30 to 3:00 PM ET. 

  • 09/07/2017 10:42 AM | Rebekah Francis (Administrator)
    Congress reconvened on Tuesday to face an ambitious agenda with numerous major deadlines that hit at month’s end. On the spending front, Congress must decide whether to raise the debt limit, whether to renew certain health programs including the Children’s Health Insurance Program, and draft a fiscal year 2018 budget before current funding expires Sept. 30. Meanwhile, the Senate Committee on Health, Education, Labor and Pensions led off today with one of a series of hearings to deliver a bipartisan plan to stabilize the 2018 exchanges by Sept. 27, the deadline for insurers to finalize participation agreements, and will continue hearing testimony from state insurance commissioners and governors to all week. Democrats look to guarantee the federal government funds cost sharing reduction subsidies, while Republicans seek more autonomy for states. There appears to be appetite on both sides for repealing taxes on medical devices and health insurance plans. 

    Make sure to attend MGMA17 and MGMA's view from Washington where Anders Gilberg, Senior Vice President, MGMA Government Affairs, will cover these important issues and more. Register and learn more about this and all of the sessions offered at MGMA17, by visiting our registration page.


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