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  • 04/08/2021 8:42 AM | Rebekah Francis (Administrator)

    MGMA to Congress: Repeal prohibition on a national patient identifier

    MGMA, with over 100 other leading healthcare organizations, is urging Congress to reject legislative language that would continue to prohibit the Department of Health and Human Services (HHS) from spending any federal dollars to adopt a national patient identifier. The U.S. House of Representatives passed bipartisan legislation in the past two fiscal years that would repeal this prohibition. The absence of a consistent approach to accurately identify patient results is a significant cost to practices and hinders efforts to facilitate health information exchange, particularly during the COVID-19 pandemic. Inaccurate patient identification can lead to patient safety concerns when health data is either matched to the wrong patient or when a patient's data is not matched and is left out of the record. Lifting the prohibition will permit HHS to evaluate a range of patient identification solutions that are cost-effective, scalable, and secure.

    CMS begins recouping Accelerated and Advance Payments

    The Centers for Medicare & Medicaid Services (CMS) announced that the recoupment of Medicare Accelerated and Advance Payment (AAP) loans began for some providers as early as March 31, 2021. Following congressional action last year, repayment of AAP loans is set to begin one year from the date the payment was originally issued in the form of automatic withholds on Medicare claims. Medicare Administrative Contractors (MACs) will show the recoupment on the remittance advices issued for Medicare Part A and B claims processed after the one-year anniversary of when the first loan payment was issued. The recoupment will appear as an adjustment in the Provider-Level Balance section of the remittance advice. Providers with questions about the recoupment process or who would like to repay their AAP loan as a lump sum should contact their MAC directly.

  • 04/01/2021 8:07 AM | Rebekah Francis (Administrator)

    Senate clears legislation to extend 2% Medicare sequester moratorium

    On March 25, the Senate voted 90-2 to pass MGMA-supported legislation that would extend the 2% Medicare sequester moratorium through Dec. 31, 2021. Without further congressional action, the current moratorium was slated to expire on March 31, 2021. The House is expected to pass this legislation when it returns from recess in mid-April. The Centers for Medicare & Medicaid Services (CMS) instructed Medicare Administrative Contractors to hold all claims with dates of service on or after April 1 for a short period of time until the legislation passes the House and is signed into law. CMS does not expect this hold to affect providers’ cash flow and wants to minimize the number of claims that would need to be reprocessed if this legislation is passed. MGMA thanks our members who participated in #MGMAAdvocacy and sent letters to congressional members in support of an extension of the moratorium.

    Legislation to extend PPP signed into law

    Congress passed legislation to extend the Paycheck Protection Program (PPP) through May 31, 2021. The bill passed both chambers with overwhelming bipartisan support and was signed into law by President Biden earlier this week. Without the passage of this legislation, the PPP would have expired on March 31, 2021. This extension will give medical groups an additional two months to apply for either a first or second draw PPP loan.

    MGMA voices support for legislation to expand physician workforce

    MGMA and other leading health organizations sent a letter of support to the Senate and House sponsors of the Resident Physician Shortage Reduction Act. This bipartisan, bicameral legislation would gradually increase the number of Medicare-supported Graduate Medical Education positions by 2,000 per year for seven years, totaling 14,000 new slots. MGMA supports this legislation, which is critical to combat the impending physician shortage over the next decade.

  • 03/25/2021 9:14 AM | Rebekah Francis (Administrator)

    Prepare for upcoming information blocking compliance date

    The compliance date for the federal government’s information blocking provisions of the 21st Century Cures Act final rule is currently set for April 5, 2021. This multifaceted regulation, released by the Office of the National Coordinator for Health Information Technology (ONC), generally prohibits physician practices from interfering with the access, exchange, and use of electronic health information. MGMA’s information blocking toolkit outlines key provisions of the information blocking rule, summarizes the eight permitted exceptions to the rule, and provides actionable steps to help medical groups comply with the rule. Medical groups should also reference ONC’s information blocking FAQ for the most up-to-date guidance.

     

    Medicare loan repayment to begin as early as next week

    On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the Medicare Accelerated and Advance Payment Program (AAP), making the program available for most Medicare physicians and group practices. The AAP provided loans to applicants facing financial disruption due to COVID-19 based on historic Medicare billing. Repayment of AAP loans begins one year from the date the payment was issued, which means repayment could begin as early as next week. Group practices that accepted AAP loans should note the following repayment options:

    • Automatic claims recoupment (default mechanism): Starting one year from loan disbursement, Medicare Administrative Contractors (MACs) will recoup outstanding AAP loans by automatically reducing Medicare payments owed to the provider by 25% for 11 months (e.g., a claims withhold). Following the initial 11-month repayment period, if the loan has not been repaid in full, Medicare payments will be recouped at 50% for another six months. Thereafter, any remaining balance must be paid within 30 days or it will accrue interest at a rate of 4% until repaid in full (there is no interest assessed on loans repaid before this time).
    • Repayment in lump sum amounts: Providers may repay AAP loans by making a lump sum payment or payments to their MAC. Group practices interested in this repayment option should consult with their MAC for details, including any forms that should accompany repayments.

    CMS has not provided further details on the repayment process, such as when exactly claims recoupment will begin, so groups should direct questions to their MACs. For more information about the AAP and other financial relief programs, review MGMA’s COVID-19-related financial relief resources.

  • 03/18/2021 9:07 AM | Rebekah Francis (Administrator)

    MGMA to Congress: Act now to prevent Medicare cuts

    MGMA and leading health organizations wrote to Congress expressing concern over the impending Medicare sequester cuts. Specifically, the letter asks Congress to act before April 1, 2021, to extend the 2% Medicare sequester moratorium and prevent the projected 4% Medicare spending cut scheduled to begin next year due to "Pay-As-You-Go," or PAYGO, statute reductions. Without further congressional action, the 2% Medicare sequester moratorium will end after March 31, and an additional 4% cut could be triggered due to the cost associated with the American Rescue Plan and its effect on government spending.

    MedPAC recommends no payment update for physician services in 2022

    On Monday, MedPAC released its March report on Medicare payment policy, which recommended no payment update for physician services in 2022. MedPAC serves as an advisor to Congress, however its recommendations are not binding. MGMA issued a statement expressing disappointment with the recommendation. Physician practices are subject to annual increases in staff salaries, rent, and supplies. Without a modest annual payment update to keep up with the cost of inflation, practices will ultimately be forced to make difficult decisions about Medicare participation.

    MedPAC said it does not anticipate any long-term effects related to the public health emergency that would warrant changing the annual update to Medicare’s fee schedule for 2022. MGMA believes it is too early to assume that medical practices will not continue to experience financial challenges stemming from the COVID-19 pandemic next year, or an acceleration in post-pandemic practice-cost inflation.

    Medicare increases payment for COVID-19 vaccine administration

    This week, the Biden administration announced that Medicare will be increasing reimbursement for administering the COVID-19 vaccine. Effective for vaccines administered on or after March 15, 2021, the national average payment rate will be $40 to administer each dose of a vaccine. This represents an increase from approximately $28 to $40 for the administration of a single-dose vaccine and an increase from approximately $45 to $80 for the administration of two-dose vaccines. The final payment rate will also vary depending on the furnishing entity and geographic adjustments. 

    Even with the news of increased Medicare reimbursement for COVID-19 vaccine administration, MGMA has heard from many practices about difficulty obtaining vaccine doses for their patients. MGMA has
    called on the administration to include medical group practices in COVID-19 vaccine distribution strategies.

    Apply now for Primary Care First Model 2022 participation

    CMS released a request for applications for Cohort 2 of the Primary Care First (PCF) Model. Primary care practices in eligible regions may apply. PCF Cohort 2 will have five performance years and is scheduled to begin Jan. 1, 2022. The deadline for practice applications is April 30, 2021.

    PCF is based on the Comprehensive Primary Care Plus Model and qualifies as an advanced alternative payment model.

  • 03/04/2021 7:29 AM | Rebekah Francis (Administrator)

    MGMA submits telehealth policy recommendations to Congress

    This week, MGMA submitted written testimony to the Subcommittee on Health of the House Committee on Energy and Commerce’s hearing on “The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care” for consideration as they begin discussing policies that would expand telehealth flexibilities beyond the COVID-19 pandemic. MGMA's testimony outlined certain policy recommendations to consider while drafting legislation. MGMA believes any future legislation expanding Medicare telehealth should:

    • Preserve the patient-physician relationship to promote high-quality care,
    • Remove geographic and originating site restrictions,
    • Allow permanent coverage of audio-only services, and 
    • Reimburse telehealth visits equally to in-person visits.

    CMS applies automatic MIPS hardship policy for 2020

    Following MGMA advocacy, the Centers for Medicare & Medicaid Services (CMS) announced it will automatically apply the MIPS extreme and uncontrollable circumstances exception policy to all MIPS eligible clinicians for the 2020 performance period due to the COVID-19 public health emergency (PHE). This policy applies to individuals and groups that are unable to submit sufficient 2020 MIPS data during the submission period.

    Additionally, the agency is reopening the 2020 hardship application portal through March 31, 2021. Physicians, groups, and alternative payment model (APM) entities may submit an application to reweight one or all MIPS performance categories due to the COVID-19 PHE. Submitting MIPS data in two or more categories, such as quality and improvement activities, will override a hardship exception on a category-by-category basis.

    2020 MIPS hardship exceptions: Consider the COVID-19 impact on cost measures

    Some physician practices may be able to and wish to report 2020 MIPS data, for example, to earn an exceptional performance bonus by reaching the 85 point threshold. In light of CMS’ announcement to reopen the MIPS hardship application portal, MGMA encourages groups, including those who have submitted or plan to submit MIPS data, to consider submitting an application to reweight the cost category to zero. The deadline to submit data and hardship applications is March 31.

    MIPS cost measures are calculated automatically based on claims data and have no reporting requirement. However, we have concerns that cost measures will be significantly impacted by the COVID-19 PHE. Those approved for reweighting of the cost performance category pursuant to an application will never be scored on cost measures and the category will be reweighted to zero. Our concerns about cost measures include:

    • Because cost measures rely on national average benchmarks, physicians and practices in hot spots may have higher costs than the national average.
    • Postponing preventive and routine care may skew patient attribution toward the sickest patients.
    • Inadequate risk adjustment methodologies during a pandemic may severely affect patients who face economic hardships and social risk factors.

    Lack of transparency into cost measure scoring, attribution, and benchmarks.

    MGMA and ASTRO urge refinements to radiation oncology APM

    MGMA partnered with the American Society for Radiation Oncology (ASTRO) in a letter voicing concerns about the radiation oncology (RO) APM. The letter sent to the Biden administration highlights that the RO model is overly focused on achieving cost savings at the risk of jeopardizing access to care and quality. MGMA will work with the new Administration to achieve shared goals of value-based care and encourages transparency and an open dialogue in model development going forward.

  • 02/25/2021 9:31 AM | Rebekah Francis (Administrator)

    SBA modifies PPP to support smaller businesses

    On Feb. 22, the U.S. Small Business Administration (SBA) announced modifications to the Paycheck Protection Program (PPP). These reforms are meant to target smaller businesses and businesses that have been left out of previous relief efforts. To that effect, SBA instituted a 14-day period beginning on Feb. 24 during which only businesses with fewer than 20 employees can apply for PPP loans. Other changes, set to be implemented by the first week of March, include a revised funding formula for sole proprietors, independent contractors, and self-employed individuals, as well as the elimination of certain eligibility restrictions for those who are delinquent on their federal student loans and those who have non-fraud felony convictions.

    Provider Relief Fund: Registration now open for Reporting Portal

    The Department of Health & Human Services (HHS) delayed the Provider Relief Fund (PRF) reporting deadline in January and has yet to provide updates as to when reporting will begin for certain recipients of PRF payments. The Department is encouraging providers to register via its Reporting Portal, even though data cannot be submitted through the portal for reporting purposes at this time.

    According to the most recent data available, about $26 billion remains in the PRF. HHS has not announced plans on how it intends to distribute remaining funds and is not currently accepting applications for payments. However, group practices can
    file claims for reimbursement from the PRF for COVID-19 testing, treatment, and vaccination of uninsured individuals.

  • 02/18/2021 8:54 AM | Rebekah Francis (Administrator)

    Medicare loan repayment to begin as soon as next month

    The Medicare Accelerated and Advance Payment (AAP) program was expanded at the outset of the pandemic to provide upfront loans for Medicare providers experiencing cash flow disruptions. Following MGMA advocacy, loan repayment terms were improved and recoupment was delayed until one year following loan disbursement. MGMA updated its AAP loan resource so groups that received these loans can understand the revised repayment terms.

    Urge Congress to delay Medicare sequester cuts!

    Last year, two pieces of legislation were signed into law that provided a reprieve from the 2% Medicare payment sequester. Unfortunately, the current Medicare sequester moratorium is set to end on March 31, 2021 and physicians continue to face financial challenges associated with the COVID-19 pandemic. MGMA, along with over 100 other organizations, is urging Congress to pass legislation that would continue the current Medicare sequester moratorium for the duration of the COVID-19 public health emergency. You can help #MGMAAdvocacy by using MGMA’s Contact Congress portal to send template letters to your congressional members urging them to further delay the cuts.

  • 01/29/2021 5:04 PM | Rebekah Francis (Administrator)

    MGMA's 2021 Advocacy Agenda

    With a new Congress and Administration now in place, MGMA is working diligently to ensure your voice is heard. MGMA’s 2021 Advocacy Agenda outlines key issues we are tackling in Washington, such as prior authorization, maintaining access to care through telehealth, and advancing value-based care. Ensuring the sustainability of medical group practices is the foundation of our advocacy priorities, and we will continue to work with policymakers to shape legislation and regulations on behalf of our member group practices. Help MGMA advocate for physician practices by using #MGMAAdvocacy on social media.

    Results are in: Many medical groups left out of COVID-19 vaccine rollout

    A new MGMA poll reveals a staggering 85 percent of independent practices and 45 percent of hospital- or health system-owned practices actively seeking the COVID-19 vaccine for their patients report having obtained none to date. The majority of practices that have obtained the vaccine report only receiving enough to vaccinate one percent or less of their patients. The MGMA survey reflects responses from over 400 medical group practices that are already administering or planning to administer the COVID-19 vaccine to their patients. MGMA strongly urged the Biden Administration to include group practices in COVID-19 vaccine distribution strategies moving forward.

    MIPS APMs: Learn about 2021 reporting changes in new MGMA resource

    In response to new changes to performance requirements starting this year, MGMA created a member-benefit resource outlining the new APM Performance Pathway (APP), which applies to group practices that report for MIPS through an APM Entity.

    In past years, clinicians participating in MIPS APMs were scored under the “MIPS APM” scoring standard. Starting in 2021, the MIPS APM scoring standard has been eliminated and replaced with the APP. The APP consists of a single, pre-determined set of quality measures that MIPS APM participants must report at the individual, group, or APM Entity levels. While the APP is optional for most MIPS APMs, it is required for all Medicare Shared Savings Program ACOs. MIPS APMs that forgo reporting via the APP will be subject to generally applicable MIPS scoring policies, which include being measured on cost and reporting for improvement activities. Download MGMA’s new resource to learn more.

    Upcoming MIPS Deadlines

    MGMA members that participate in the Quality Payment Program (QPP) should note the following upcoming deadlines:

    • Feb. 1: Last day to submit a 2020 MIPS extreme and uncontrollable circumstances application to request re-weighting of one or more MIPS categories due to COVID-19. Submit applications here.
    • March 25: Preview period for clinician “Care Compare” closes. Care Compare is a transparency initiative that displays MIPS performance data on a public website; clinicians and groups may use the currently open preview period to ensure the accuracy of 2019 MIPS performance information and submit a targeted review of any inaccuracies before the data goes live in 2021.
    • March 31: Deadline to report 2020 MIPS data through the QPP portal. Sign into your account on the QPP webpage.
  • 01/21/2021 8:24 AM | Rebekah Francis (Administrator)

    MGMA 2021 policy outlook: What group practices need to know

    A new chapter has begun in Washington, DC, with President Biden’s inauguration yesterday and Democrats taking control of the Senate. MGMA Government Affairs has offered its unique perspective on what medical groups should expect this year from our nation’s capital. We outline what's on the horizon for healthcare policy and how these trends will impact your practice. Read our 2021 Policy Outlook to find out and share your thoughts on social media with #MGMAAdvocacy.

    Let your voice be heard: Take MGMA’s health policy poll before it closes!

    As a new Administration and Congress are poised to address a number of healthcare policies, MGMA asks that you complete a brief survey to better understand where medical group practice leaders stand on a variety of issues. MGMA will use the information collected to inform our advocacy efforts and educate policymakers. Your submission will remain anonymous. MGMA’s Medical Group Leaders Health Policy Poll will close this Friday, Jan. 22 at 11:59 pm ET. Don’t miss this opportunity for your voice to be heard!

    Provider Relief Fund reporting delayed

    Following changes made by Congress to Provider Relief Fund (PRF) reporting requirements, the Department of Health and Human Services (HHS) is delaying the reporting deadline for providers that received over $10,000 in PRF payments. Previously, the reporting period was set for Jan. 15 to Feb. 15, 2021; however, HHS has removed this deadline altogether for the time being. 

    As of Jan. 15, HHS is encouraging providers who received PRF payments exceeding $10,000 in the aggregate to register through the PRF Reporting Portal. The Portal is currently open for registration only and cannot be used to report data elements yet. MGMA has updated its PRF resource to reflect the latest HHS and congressional changes and encourages members to review this guidance and reach out with questions. 

    CMS issues final rule on prior authorization

    The Centers for Medicare & Medicaid Services (CMS) hastily released a final rule requiring a limited number of federally-controlled payers to support application programming interface (API) standards. Covered payers are mandated to provide patients and other payers access to their claims information via APIs and support APIs for prior authorization transactions with physician practices. The rule also requires payers to support automated approaches to coverage determinations and transmit to practice EHRs the clinical documentation template for the authorization. Payers are permitted 72 hours to respond to an urgent prior authorization and seven days for all others. MGMA is concerned that with CMS not requiring Medicare Advantage or commercial payers to comply with the rule, practices will be forced to continue using multiple, manual approaches to prior authorization. 

    The Stark Law is never easy: Attempts to clarify may fuel confusion

    MGMA, together with our Washington counsel’s office, drafted an article for members highlighting changes to group practice compensation arrangements under the final Physician Self-referral (Stark) Law regulations. On Dec. 2, 2020, CMS finalized massive rulemaking to modernize and clarify the Stark Law. The new rule has a number of benefits, including new exceptions for certain value-based payment arrangements and modest relaxation of certain terms that underlie the law’s existing exceptions for compensation relationships between physicians and outside entities to which they refer their patients. Buried in the final rule is one “clarification” that may complicate compensation planning for practice leaders, particularly large and mid-sized multispecialty groups using different compensation practices for different specialties or departments. Review MGMA’s article to learn more.

  • 01/08/2021 9:02 AM | Rebekah Francis (Administrator)

    CMS confirms new, increased 2021 conversion factor following year-end legislation

    Following legislation signed into law in December, Congress added $3 billion to the Medicare Physician Fee Schedule (PFS) and delayed implementation of HCPCS add-on code G2211 for three years. As a result, the Centers for Medicare & Medicaid Services (CMS) has confirmed that the new 2021 PFS conversion factor will be $34.8931 instead of $32.4085, as previously finalized in the PFS final rule. CMS also updated the 2021 RVU file. We expect to see a formal announcement regarding these developments in the near future. CMS is also expected to communicate the new conversion factor and payment rates to local Medicare Administrative Contractors (MACs), who will update their schedules accordingly. For accurate rates based on your geographic area, we recommend checking with your local MAC.

    MGMA submits comments on CMS prior authorization proposed rule

    MGMA offered comments on the CMS proposed rule requiring a limited number of federal payers to support application programming interface (API) standards. CMS proposed that covered payers provide patients access to their claims information via APIs and support API standards for prior authorization transactions with physician practices. The rule would also require payers to support automated approaches to coverage determinations and transmit to practice EHRs the clinical documentation template for the authorization. CMS also proposed that payers would be given 72 hours to respond to an urgent prior authorization and seven days for all others. MGMA strongly urged CMS to include Medicare Advantage and other payers in the regulation and significantly shorten the time payers would have to respond to practices.

    2020 MIPS data submission portal open; report by March 31

    CMS opened the data submission portal for MIPS clinicians and groups who participated in the 2020 performance year. Data can be submitted until March 31, and you must sign into the Quality Payment Program (QPP) website to report.

    CMS has a variety of resources dedicated to assisting participants with their 2020 data submission in its QPP
    resource library. In addition, MGMA recommends that groups that expect to participate in MIPS for 2021 review recently added guidance that pertains to the 2021 performance period, such as quality measure benchmark files, cost measure information, promoting interoperability measure specifications, and more.

    MGMA to ONC: Delay enforcement of information blocking until after PHE

    In a comment letter to the Office of the National Coordinator for Health Information Technology (ONC), MGMA called on the agency to tie the start of enforcement of the information blocking requirements to the end of the COVID-19 Public Health Emergency (PHE). The association argued that physician practices are focused on meeting the challenges related to the COVID-19 pandemic and need additional time to prepare for the complex new regulatory requirements. MGMA also called on ONC to develop additional guidance to help practices comply with the law.

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