News

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  • 04/25/2018 4:39 PM | Rebekah Francis (Administrator)

    Effective January 2018, CMS began recognizing medical group practices that use digital health tools to monitor and analyze patient physiological data. CMS opened the door to reimbursement for remote patient monitoring (RPM) services by unbundling CPT code 99091, which is described as the collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored or transmitted by the patient to a qualified healthcare professional. To be reimbursed for RPM services, practices must meet certain billing requirements, such as obtaining and documenting patient consent and spending a minimum of 30 minutes of time on RPM. Additionally, for patients who are new or have not been seen within one year, providers must initiate RPM services in a face-to-face visit. 

    To learn more about RPM services and additional Medicare service updates for the 2018 payment year, download MGMA’s analysis of the 2018 Physician Fee Schedule. 

  • 04/25/2018 4:36 PM | Rebekah Francis (Administrator)

    To determine 2018 MIPS eligibility, physician practice leaders must check the participation status for each clinician by inputting his or her national provider identified (NPI) in the MIPS look-up tool. Previously, CMS mailed letters to practices to inform them of their eligibility status, but the agency does not plan to notify medical groups about their eligibility in 2018. Practices should not rely on historic eligibility determinations, as many physicians and medical groups who were required to participate in MIPS in 2017 will be exempt in 2018 under the expanded low-volume threshold. 

    MGMA is engaged in discussions with CMS officials about the limitations of the look-up tool and asked the agency to enhance the tool’s functionality by making available eligibility data for all NPIs who have reassigned their billing rights to the group practice, rather than requiring eligibility data to be accessed on an NPI-by-NPI basis.

  • 04/25/2018 4:34 PM | Rebekah Francis (Administrator)

    MGMA authored a letter to the Centers for Medicare & Medicaid Services (CMS), which was signed by more than 40 physician organizations, urging the agency to shorten the 2018 Merit-based Incentive Payment System (MIPS) quality data reporting period from 365 to 90 days. Despite being held accountable for data tracking and collection as of Jan. 1, 2018, physicians were not informed of basic eligibility information until early April, and the MIPS website has yet to be updated with key 2018 program information, including final quality measures. MGMA and the coalition also recommended CMS maintain a shorter reporting period in future years to reduce administrative burden and ensure physicians have sufficient time to report after receiving MIPS feedback. MGMA has long championed a 90-day reporting period to give group practices greater flexibility to focus their attention on improving patient care, as opposed to reporting for reporting’s sake. 

  • 04/18/2018 7:38 PM | Rebekah Francis (Administrator)

    Participants in the 2018 CMS study on quality reporting burdens will receive full improvement activity credit for the Merit-based Incentive Payment System (MIPS). The study, which will run from April 2018 to March 2019, will examine challenges group practices and clinicians face when collecting and reporting quality data and make recommendations to eliminate burden and improve quality data collection. Study participants must complete surveys, attend a virtual focus group session, and submit at least three MIPS quality measures in 2018. If you are interested in receiving full MIPS improvement activity credit for helping CMS understand quality reporting burdens, submit a study application by April 30.

  • 04/18/2018 7:37 PM | Rebekah Francis (Administrator)

    A new report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) concluded that nearly one-third of claims did not meet Medicare requirements for telehealth services, resulting in improper payments of around $3.7 million in 2014-2015. Most sampled claims were deemed improper because patients were not located at a rural geographic originating site. OIG recommended the Centers for Medicare & Medicaid Services (CMS) conduct periodic post-payment reviews on telehealth claims, underscoring the importance of billing compliance, particularly with respect to originating site rules. MGMA recommends practices use the Medicare telehealth eligibility analyzer to determine payment eligibility based on location and urges groups who bill Medicare for telehealth services to ensure their claims comply with Medicare requirements.

  • 02/09/2018 12:01 PM | Rebekah Francis (Administrator)

     

    Overnight, Congress passed a sweeping two-year budget deal signed into law by President Trump today. The Bipartisan Budget Act of 2018 (H.R. 1892) is largely a win for physician practices. The law addresses top MGMA priorities, including reducing burden in the MIPS program, eliminating the unelected Medicare cost-cutting board known as the IPAB, and averting a flawed misvalued-code policy that would have resulted in drastic across-the-board payment cuts in 2019 and 2020. MGMA opposed Congress’ use of a .25 reduction to the Medicare physician payment conversion factor next year as a budgetary offset. Its inclusion is a disappointment in an otherwise favorable bill.

     Important to medical groups, the bill will: 

    • Increase flexibility and reduce burden in the Quality Payment Program;
    • Eliminate the unelected Medicare cost-cutting board known as the IPAB;
    • Extend the work Geographic Practice Cost Index (GPCI) floor for two years through 2019;
    • Permanently repeal the Medicare therapy payment cap;
    • Incorporate new flexibility for Accountable Care Organizations;
    • Expand coverage for telehealth services; 
    • Decrease requirements in the Meaningful Use Program; and
    • Extend Children's Health Insurance Program funding for an additional four years through fiscal year 2027.

    MGMA will continue to advocate for Medical Group Practices, and we thank you for your continued grassroots efforts.

  • 01/24/2018 3:58 PM | Rebekah Francis (Administrator)

    MGMA recently commented on proposed policy changes to the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs. The Association applauded a proposal to publish a list of precluded providers rather than proceeding with burdensome new requirements, opposed by MGMA, that eligible professionals enroll in or validly opt out of Medicare by Jan. 1, 2019 to have their Part D drugs and MA services covered by Medicare. The Association also underscored the growing burden imposed by patient records requests from MA plans, which MGMA members report can be several thousand records annually. Read the full letter

  • 01/24/2018 3:57 PM | Rebekah Francis (Administrator)

    A short-term spending deal reached late Monday reopened the federal government and provides temporary funding through Feb. 8. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for six years and delays several Affordable Care Act-related taxes, including the so-called “Cadillac tax,” which imposes a fee on high-cost employer health insurance plans. Notably absent were extensions of several expired Medicare provisions, including the 1.0 work GPCI floor and therapy caps exceptions. Both provisions have bipartisan support in Congress but have been put on hold for other legislative priorities. The Centers for Medicare & Medicaid Services (CMS) is temporarily holding claims affected by therapy caps but if Congress does not act soon, will “release and process claims accordingly.” 

  • 01/24/2018 3:52 PM | Rebekah Francis (Administrator)
    Today, the Senate voted to confirm Alex Azar as the new Secretary of the Department Health and Human Services (HHS) by a vote of 55-43. Azar previously served as HHS deputy secretary and chief counsel during the George W. Bush administration and most recently as president of the pharmaceutical company Lilly USA. During his confirmation hearings, Azar testified that he intends to continue the transformation to value-based payment in Medicare
  • 12/13/2017 5:01 PM | Rebekah Francis (Administrator)

    MGMA joined a coalition of other healthcare groups to support the introduction of the ACO Improvement Act of 2017 (H.R. 4580). The legislation would provide common sense reforms to the Medicare Shared Savings Program, including waivers for several types of services, bonus payments for quality achievement and improvement, and allowing for growth of risk scores, among other changes. The operational changes would remove regulatory barriers and improve the overall design of the program to help it achieve its goal of reducing costs while improving quality and patient outcomes. Read the press release at our ACO Resource Center

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