MGMA Requests Guidance from CMS and OIG on Rebilling of Repriced Part B Claims Starting Oct. 1

MGMA requested guidance from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) on the reprocessing and rebilling of claims on or after October 1, 2025, in localities subject to the 1.0 work geographic practice cost index (GPCI) floor. Congress passed legislation last week that reopened the federal government and included extensions of healthcare policies, such as the 1.0 work GPCI floor, which expired at the end of September and was extended through January 30, 2026. We wrote to CMS and OIG seeking guidance on the reprocessing of claims that were paid at a lower rate than the 1.0 work GPCI floor in localities during the government shutdown. We requested regulatory flexibility to avoid unnecessary rebilling costs for medical groups.

MGMA Advocates for WISeR Model Reform

MGMA urged the House Committee on Appropriations to work with the Centers for Medicare and Medicaid (CMS) to prioritize reforming the Wasteful and Inappropriate Services Reduction (WISeR) Model. The WISeR Model is scheduled to begin in January 2026 in six states and would create new prior authorization processes for certain services. MGMA is advocating for delayed implementation, enhanced transparency, and gold carding exceptions to reduce administrative burdens on practices. If you expect your practice to be impacted by the WISeR Model, please contact govaff@mgma.org.

MGMA Urges Anthem to Rescind its Out-of-Network Hospital Policy

MGMA, along with dozens of national medical societies and state medical associations, urged Anthem Blue Cross and Blue Shield to rescind its policy of penalizing hospitals with a 10% reimbursement cut when using out-of-network physicians to provide care. This policy is set to start in 11 states on January 1, 2026, and the announcement indicates Anthem will consider terminating hospitals from Anthem networks should they continue to use nonparticipating physicians. The letter discusses how this policy attempts to circumvent the No Surprises Act and reviews the negative impact it would have on physician practices.