URGENT: TELL CONGRESS TO STOP THE 3.4% MEDICARE PAYMENT CUT

Congress is working on passing a continuing resolution (CR) to fund the federal government before the expiration of funding for certain federal agencies on Jan. 19. The current draft of the CR would fund the government until early March. Due to political factors related to this funding, a fix for the 3.37% Medicare physician payment cut that took effect on Jan. 1, 2024, is not currently included despite collective efforts from MGMA and other healthcare organizations.

A group of bipartisan representatives introduced the Preserving Seniors’ Access to Physicians Act of 2023 near the end of last year. This MGMA-supported bill would avert the full 3.37% cut to the Medicare conversion factor. Use MGMA’s Contact Congress portal to send a pre-populated letter to your congressional representatives urging them to address the full cut this week in the new CR. This letter is different than previous iterations as it is specific to the upcoming Jan. 19 deadline. 

CMS FINALIZES ITS PRIOR AUTHORIZATION AND INTEROPERABILITY RULE

The Centers for Medicare and Medicaid Services (CMS) finalized its Prior Authorization and Interoperability rule making numerous changes to the prior authorization process for Medicare Advantage and certain other health plans. Many of the provisions go into effect in 2026, such as reduced timeframes for payers to make prior authorization decisions, requiring payers post certain prior authorization metrics on their websites, and requiring payers to provide a specific reason for denying a prior authorization decision. Other sections of the final rule related to technological standards for transmitting prior authorization information must be implemented by Jan. 1, 2027.

MGMA commented on the proposed rule last year and will continue to analyze the final rule to provide additional information about upcoming changes. MGMA continues to support the Improving Seniors' Timely Access to Care Act which would provide additional relief for medical group practices.