News

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  • 11/22/2022 3:51 PM | Rebekah Francis (Administrator)

    Your guide to 2023 Medicare payment rules

    The Centers for Medicare & Medicaid Services released its final 2023 Physician Fee Schedule (PFS) rule, which includes payment and coding updates for Medicare services, modifications to telehealth, and changes to the Quality Payment Program.

    MGMA Government Affairs reviewed, analyzed, and distilled over 2,000 pages of the final rule to draft this member-benefit analysis. The resource breaks down significant payment and quality reporting changes for 2023 and offers practical takeaways for busy medical group practice executives. Key regulatory provisions include:

    • Setting the CY 2023 PFS conversion factor at $33.0607 (a reduction of 4.47%) and the CY 2023 national average anesthesia conversion factor at $20.6097. MGMA is advocating for a legislative fix to address the reimbursement cuts resulting from the lower conversion factor;
    • Delaying the split/shared E/M billing policy until CY 2024, permitting the billing clinician to bill for services based on history, exam, medical decision marking or time in 2023;
    • Continuing payment for Medicare telehealth services that are temporarily included on the telehealth list for 151 days following the conclusion of the COVID-19 public health emergency and maintains payment parity between in-person and telehealth visits through 2023;
    • Permitting auxiliary personnel to furnish behavioral health services incident to a physician or NPPs services under general instead of direct supervision;
    • Increasing Qualifying APM Participant (QP) and partial QP threshold in performance year 2023; and
    • Finalizing 5 new MIPS Value Pathways (MVPs), for a total of 12 MVPs available for voluntary reporting in 2023.
    DOWNLOAD THE ANALYSIS!

    Interested in learning more about the updates to Medicare physician payment and quality reporting that will be in effect come Jan. 1, 2023? Join MGMA Government Affairs on Dec. 13 at 1 p.m. ET for our member-exclusive 2023 Medicare Outlook webinar to gain insights about payment and policy changes outlined in the final 2023 PFS rule. Register here.
  • 11/17/2022 2:35 PM | Rebekah Francis (Administrator)

    MGMA sends Congress year-end legislative recommendations

    On Monday, MGMA sent a letter to congressional leadership urging them to address significant Medicare cuts and other important healthcare policies before the end of this year. The letter highlights current issues with Medicare reimbursement that projected payment cuts will exacerbate and asks Congress to act by:

    • Offsetting the 4.47% reduction to the Medicare physician conversion factor;
    • Waiving the 4% statutory Pay-As-You-Go sequester; and,
    • Extending the 5% alternative payment model (APM) incentive payment for six additional years.

    Further, MGMA encouraged Congress to pass additional commonsense legislation to address significant administrative burdens impacting group practices and improve the timeliness of clinical care delivery. These recommendations included passing the Improving Seniors’ Timely Access to Care Act, extending telehealth waivers for at least two years after the conclusion of the public health emergency, passing the Saving Access to Laboratory Services Act, and appropriating additional funds to continue rewarding high performing clinicians within the Merit-based Incentive Payment System (MIPS).

    Visit MGMA's
    Contact Congress portal to send a letter to your legislators on these important issues!

    MGMA submits feedback on AEOB requirements

    On Tuesday, MGMA submitted feedback to the Department of Health and Human Services about the upcoming advanced explanation of benefits (AEOB) requirements stemming from the No Surprises Act. The AEOB policies would require group practices to send good faith estimates to health plans, thereby allowing the plans to generate AEOBs to send to patients. As a reminder, these requirements are not being enforced until rulemaking is completed. MGMA encouraged HHS to not enforce the AEOB requirements until there are workable solutions that are developed, tested, and implemented as well as to continue soliciting input and working with medical groups to implement these solutions.

    JOIN MGMA FOR OUR 2023 MEDICARE OUTLOOK WEBINAR

    Interested in learning more about the updates to Medicare physician payment and quality reporting that will be in effect come Jan. 1, 2023? Join MGMA Government Affairs on Dec. 13 at 1 p.m. ET for a for our member-exclusive 2023 Medicare Outlook webinar to gain insights about payment and policy changes outlined in the 2023 Medicare Physician Fee Schedule final rule. Additionally, we’ll provide details about MIPS reporting requirements, the MIPS Value Pathways implementation timeline, and APM participation and reporting options for 2023. The hour-long session will conclude with a discussion of MGMA’s advocacy initiatives and an interactive Q&A session with Government Affairs staff.

    For more information, or to register, please click here.
  • 11/10/2022 8:24 AM | Rebekah Francis (Administrator)

    AVAILABLE NOW: MEDICARE CUTS ADVOCACY
    SOCIAL MEDIA TOOLKIT

    On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model participation options and requirements for 2023. MGMA issued a statement expressing disappointment in the final rule and its negative impact to physician payment, urging Congress to take action to avert the cuts and waive the 4% PAYGO sequestration before the end of the year. 

    To assist others in their advocacy efforts surrounding the Medicare cuts, the Government Affairs team created a social media toolkit 
    which includes several resources for actions to take from now until Congress acts, motivating others to participate in our critical #MGMAAdvocacy grassroots efforts. Join the conversation online and encourage others to do the same by using the hashtag #AvertTheMedicareCuts!

    ICYMI: Updated PI requirements for 2023

    As a reminder, those reporting under MIPS and wishing to receive credit for Promoting Interoperability (PI) will be required to only use certified technology updated to the 2015 Edition Cures Update for an EHR reporting period or performance period in CY 2023. Group practices are not required to demonstrate they are using updated technology to meet the CEHRT definitions immediately participants must use technology meeting these requirements during a self-selected EHR reporting period or performance period of a minimum of any consecutive 90 days in 2023 (i.e. – October 1, 2023).

    PROVIDER RELIEF FUND UPDATE:  AUDIT PORTAL

    Practices that spend a total of $750,000 or more in federal funds, including Provider Relief Fund (PRF) payments during their fiscal year, are subject to Single Audit requirements. The Health Resources & Services Administration (HRSA) recently announced the availability of a Commercial Audit Reporting Portal. Commercial (i.e., for-profit) entities may log into the portal with the same username and password as the PRF Reporting Portal. Non-profit organizations should continue to submit their Single Audits to the Federal Audit Clearinghouse (FAC).

  • 11/04/2022 11:58 AM | Rebekah Francis (Administrator)

    FINAL 2023 MEDICARE PHYSICIAN FEE SCHEDULE

    On Tuesday, the Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements for 2023.

    Immediately following, MGMA issued a statement expressing disappointment in the final rule and its negative impact to physician payment, urging Congress to take action to avert the cuts and waive the 4% PAYGO sequestration before the end of the year. Join in #MGMAAdvocacy today by sending a letter to your congressional members imploring them to act swiftly to avert these significant payment cuts!

    In the coming weeks, we will release a detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP). Until then, additional information about the final rule is available in the
    PFS fact sheet and the QPP fact sheet.

  • 10/20/2022 9:35 AM | Rebekah Francis (Administrator)

    COVID-19 public health emergency renewed

     The COVID-19 public health emergency (PHE) was renewed again, effective Oct. 13, 2022. This renewal extends the PHE through mid-January 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. The U.S. Department for Health and Human Services has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

    To understand what waivers will expire upon the eventual conclusion of the PHE, review MGMA’s Flexibilities and Policy Following the Expiration of the COVID-19 PHE member-exclusive resource.  

    Join in #MGMAAdvocacy to prevent Medicare payment cuts

     With just over two months left in 2022, MGMA needs your help urging Congress to take action to avert significant Medicare payment cuts set to take effect in 2023. Send a letter to your members of Congress today encouraging the passage of legislation to avert the 4.5% reduction to the Medicare conversion factor, waive the statutory 4% Pay-As-You-Go sequester, and provide an inflationary update based on the Medicare Economic Index. MGMA Government Affairs’ latest report on Medicare cuts showcases what medical groups around the country have to say about these proposed payment cuts, including how they would significantly disrupt patient access to care, practice operations, and overall investment throughout the healthcare industry.

    The time to act is now! Join in #MGMAAdvocacy today by sending a letter to your members of Congress urging for the swift passage of legislation to avert these significant payment cuts!

    Available now: MGMA's '22 Annual Regulatory Burden Report

     Last week, the MGMA Government Affairs team released its 2022 Annual Regulatory Burden Report. With responses from over 500 medical group practices, the survey findings demonstrate the impact that increasing regulatory burden has on practices. An overwhelming majority (89%) 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 (97%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

    Thank you again to all of our members who participated in this survey! For more information about how to engage in current advocacy efforts, please visit the MGMA Advocacy webpage.

  • 09/29/2022 8:47 AM | Rebekah Francis (Administrator)

    Next week: New information blocking requirements take effect

    Beginning on and after Oct. 6, 2022, a medical group must respond to a request to access, exchange, or use electronic health information (EHI) more broadly to the extent that EHI would be included in a designated record set that is defined in HIPAA, unless any of eight exceptions can be applied. The new definition of EHI includes medical records, billing records, payment and claims records, case management records, and other records used, in whole or in part, by a medical group to make decisions about individuals. Until Oct. 6, the definition of EHI remains narrower in scope.

    For more information on the information blocking requirements, download MGMA’s member-exclusive Information Blocking ToolkitMGMA is urging U.S. Department of Health and Human Services Secretary Becerra to postpone information blocking deadlines for one year and asking for additional clarity on requirements. 

    Reporting deadline Friday: Provider Relief Fund

    Medical practices that received Provider Relief Fund (PRF) assistance exceeding $10,000, in aggregate, from Jan. 1, 2021, through June 30, 2021 (RP3), must report on their use of funds by tomorrow, Sept. 30, 2022 at 11:59 p.m. ET. The next reporting period (RP4) opens Jan. 1, 2023.

    Those impacted by Hurricane Ian will be allowed the opportunity to submit a request to report late due to extenuating circumstances. For more information related to reporting requirements and auditing, visit the Health Resources & Services Administration (HRSA)’s FAQs. For all other questions related to reporting, call the Provider Support Line at 866-569-3522.

    Promoting interoperability deadline fast approaching 

    The last day to start a 90-day reporting period under the Promoting Interoperability (PI) performance category for the Merit-based Incentive Payment System (MIPS) is Oct. 3, 2022. The PI program requirements include a set of objectives and measures that focus on patient access to health information and electronic exchange of information that is worth 25% of an eligible clinician or group’s MIPS final score, and requires a minimum continuous 90-day reporting period during the calendar year. In addition to this, providers must use the appropriate edition of Certified Electronic Health Record Technology (CEHRT) and attest to required objectives and measures for the required EHR reporting period.

    To learn more about the 2022 MIPS PI performance category, please review this guide from the Centers for Medicare & Medicaid Services.

  • 09/15/2022 7:57 AM | Rebekah Francis (Administrator)

    House passes MGMA-supported prior authorization legislation

    Yesterday, the House of Representatives passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). This MGMA-supported bill is a step forward in reforming prior authorization practices within the Medicare Advantage (MA) program. In part, the legislation would increase transparency around MA prior authorization, establish an electronic prior authorization program, and streamline the prior authorization process for routinely approved items and services.

    Keep the momentum going by contacting your senators and urging the swift passage of S. 3018. Medical practices can use MGMA’s Contact Congress portal to send letters today!

    MGMA sends year-end legislative priorities to Congress

    On Monday, MGMA sent a letter to congressional leadership outlining the legislative priorities that we would like addressed before the end of the year. Before 2023, MGMA urges Congress to mitigate cuts to Medicare reimbursement slated to take effect on January 1, extend telehealth flexibilities, reform prior authorization practices, and support value-based care.

    Congress has since taken steps to address the Medicare cuts
    the House of Representatives introduced the Supporting Medicare Providers Act of 2022 on Tuesday, which would avert almost 4.5% of the projected 8.5% cuts. MGMA supports this legislation, but calls on Congress to fully avert cuts to Medicare stemming from the 4% statutory Pay-As-You-Go (PAYGO) sequester and provide an inflationary updated based on the Medicare Economic Index. 

    MGMA Government Affairs at MPE: Leaders Conference

    MGMA’s annual Medical Practice Excellence (MPE): Leaders Conference is less than a month away. Register now to join us in Boston and attend one of our "Washington Update" sessions, during which the Government Affairs team will share insights on current federal policy developments impacting medical practice operations. We'll delve into upcoming Medicare payment and quality rules, the status of surprise billing and transparency requirements, information blocking, and other key regulatory changes to come in 2023.

    Mark your calendars today for either of the below sessions and be sure to compare prepared with your questions!

    • Monday, Oct. 10 at 9:15 - 10:15 a.m. ET
    • Tuesday, Oct. 11 at 2:45 - 3:45 p.m. ET

  • 09/08/2022 10:05 PM | Rebekah Francis (Administrator)

    MGMA provides feedback to CMS in response to the 2023 Medicare PFS

    On Tuesday, Sept. 6, MGMA provided comprehensive feedback to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed 2023 Medicare Physician Fee Schedule (PFS). MGMA urges CMS to make important adjustments to the proposed policies to support medical group practices going into 2023, including updating the Medicare conversion factor to avert a 4.5% reduction in payment and adjusting certain reporting requirements under the Merit-based Incentive Payment System. In the coming weeks, MGMA will launch an advocacy campaign to avert these cuts.

    The agency will review comments submitted by stakeholders before issuing the final rule in November. Following the release of the final rule, MGMA will provide an in-depth analysis of the 2023 Medicare policies.

    Support prior authorization reform

    With only a few months left in the 117th Congress, it is time to voice your support for prior authorization reform! MGMA Government Affairs drafted a template letter that you can send directly to your members of Congress today. The letter urges Congress to pass the Improving Seniors’ Timely Access to Care Act, which puts commonsense guardrails around prior authorization processes in the Medicare Advantage program. With your help, MGMA hopes to see this legislation pass into law by the end of the year!

    Final Reminder: Regulatory burden questionnaire closes Sept. 9

    MGMA needs your feedback - complete the Annual Regulatory Burden Questionnaire by tomorrow, Friday, Sept. 9!

    This annual research project is your opportunity to provide critical feedback on the impact that federal programs have on your practice. The findings of this research will guide MGMA's advocacy efforts in Washington, D.C., to improve the regulatory landscape in which group practices operate, including critical policies related to prior authorization, surprise billing, and the Quality Payment Program.

  • 08/18/2022 8:58 AM | Rebekah Francis (Administrator)

    HHS expected to renew COVID-19 PHE in October

    MGMA expects the U.S. Department of Health and Human Services (HHS) to renew the COVID-19 public health emergency (PHE) in October, since the 60-day notice period passed with no word from the Department. Recently, the Administration reiterated its promise to provide a 60-day notice prior to ending the PHE. If HHS does renew the PHE for an 11th time, it is expected to be in effect through at least mid-January.

    Last week, MGMA wrote to HHS Secretary Becerra, asking him to renew the PHE and provide medical groups at least a 90-days’ notice prior to ending it so they may sufficiently wind down flexibilities that have been in effect for over two years.

    MIPS facility-based scoring unavailable in PY 2022

    Due to the continued impact of COVID-19 on measure performance under the Hospital Value-Based Purchasing (VBP) program, the Centers for Medicare and Medicaid Services (CMS) announced that facility-based scoring will be unavailable in performance year (PY) 2022 under the Merit-based Incentive Payment System (MIPS). CMS utilizes performance under the Hospital VBP to calculate quality and cost scores under MIPS for facility-based clinicians and groups.

    In 2022, affected clinicians must report MIPS quality measures; there are no reporting requirements under the cost performance category. However, CMS notes, that if facility-based clinicians or groups do not have available measures to report, they can submit a MIPS Extreme and Uncontrollable Circumstances Exception application to reweight selected performance categories. Additional information is available in the Quality Payment Program Resource Library.

    CMS releases new IDR resources

    Yesterday, CMS released new resources related to the federal Independent Dispute Resolution (IDR) process under the No Surprises Act. CMS launched a new page on the surprise billing website, linking helpful IDR resources and common mistakes when submitting a dispute resolution claim. Additionally, the agency published a new technical guidance document for IDR entities which includes additional information about eligibility for the federal IDR process, batching claims, and submission of supplemental information to IDR entities. 

    While the resources will help practices better understand the IDR claim submission process, MGMA continues to advocate for critical improvements to be made to the IDR portal to streamline the dispute resolution process. Additional resources related to the requirements under the No Surprises Act are available on the MGMA surprise billing issue page.

  • 08/11/2022 10:58 AM | Rebekah Francis (Administrator)

    Inflation Reduction Act slated to pass tomorrow

    On Sunday, the U.S. Senate passed the Inflation Reduction Act of 2022 (IRA) by a 51-50 vote, with the Vice President breaking the tie. This legislation would, for the first time, provide the U.S. Department of Health and Human Services (HHS) Secretary the authority to negotiate the cost of certain drugs in the Medicare program and establish an annual out-of-pocket cap of $2,000 for Medicare beneficiaries. Price negotiation would first apply to 10 high-cost drugs under Medicare Part D in 2026, later expanding to certain high-cost physician administered drugs under Medicare Part B in 2028. In addition to updates to prescription drug policy, the IRA would also extend expiring tax subsidies under the Affordable Care Act and invest over $400 billion to address climate change.

    The bill heads to the House tomorrow, Friday, August 12; pending its passage, the legislation is expected to then be immediately signed into law by the President. 

    Join MGMA in a GovChat Live on August 23

    The MGMA Government Affairs team is hosting a GovChat live on Tuesday, August 23, from 2:00 – 3:00 p.m. (ET). During this member-exclusive discussion, the team will provide a high-level overview of policies included in the 2023 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) proposed rule. MGMA will be seeking feedback from members to help inform our comments in response to the policy proposals and will answer questions during the interactive discussion. 

    Registration information is available on the MGMA GovChat Community page. Additionally, we encourage you to review our member-exclusive key takeaway analysis of the 2023 PFS and QPP proposed rule if you haven't done so yet. Please reach out to the Government Affairs team at govaff@mgma.org with any questions.  

    Post-pandemic flexibilities resource available now

    Since January 2020, the HHS Secretary has determined that a public health emergency (PHE) has been in effect due to the COVID-19 pandemic. Under the declared PHE, HHS has the authority to waive certain program requirements, however, following the termination of the PHE, many of these flexibilities will expire. MGMA has published a member-exclusive resource highlighting key flexibilities that will expire after the end of the COVID-19 PHE to help practices prepare for policy changes post-pandemic.

    The COVID-19 PHE is currently in effect through October 13, 2022, and MGMA anticipates HHS will again renew the PHE at that time.

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