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MGMA Washington Connection 10/08/20

10/08/2020 7:49 AM | Rebekah Francis (Administrator)

New round of Provider Relief Fund payments available

HHS announced that applications will be accepted from Oct. 5 through Nov. 6 for $20 billion in new funding under “Phase 3” of the Provider Relief Fund General Distribution. Under this new phase, providers that have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and changes in operating expenses due to COVID-19. HHS also expanded eligibility for payments in Phase 3, so groups that have not received Provider Relief Fund payments to date should check new eligibility criteria.

If an applicant has not yet received (and retained) a payment equal to approximately 2% of annual revenue from patient care as part of either Phase 1 or 2 of the General Distribution, then they should receive at least that amount in Phase 3. Groups that already received payments at or above 2% of annual revenue can also apply and potentially receive additional payments. However, HHS indicates it will determine final payment amounts for those applicants once all applications have been received and reviewed. For more information on Phase 3, including the application, instructions, and FAQs, visit the Provider Relief Fund website.

Member-benefit HIT webinar now available on-demand

The MGMA Government Affairs member-benefit webinar on the most critical health information technology (HIT) issues facing medical practices today and MGMA’s current HIT advocacy priorities is now available on-demand. Topics covered on the program included the information blocking and Application Programming Interface requirements included in the recently released interoperability regulations, cybersecurity concerns and solutions, updates to the Appropriate Use Criteria program, and the latest on administrative simplification efforts to improve practice revenue cycle operations.

MGMA urges adoption of operating rules to improve prior auth 

MGMA joined the American Hospital Association, the American Medical Association, and the Arthritis Foundation calling on the National Committee on Vital and Health Statistics (NCVHS) to endorse proposed operating rules to reduce burdens associated with prior authorization. NCVHS, a federal advisory body, is currently deliberating whether to recommend national adoption of operating rules that would set new data content and timing mandates on health plans, including a requirement that plans respond within two business days following an authorization request from a practice and respond with the additional documentation needed to complete the request. Under the proposal, plans would also have a maximum of two business days to send a final determination once they receive all requested information.

MGMA to CMS: Revise radiation oncology APM 

In a letter to CMS, MGMA along with radiation oncology and other physician groups asked for critical changes to the new radiation oncology (RO) alternative payment model (APM). In particular, we urged the agency to push back the mandatory payment model to January 2022, develop more appropriate opt out mechanisms, and revise the model’s payment cuts. While MGMA is very supportive of expanding opportunities to join APMs, we do not support requiring medical groups to participate in untested demonstrations, particularly at a time when COVID-19 is creating financial strain and uncertainty.

Under current model rules, CMS will require participation from providers in randomly selected locations across the country starting Jan. 1, 2020. The RO model tests episodic payments for certain radiotherapy providers and has the potential to be a promising APM, however MGMA is concerned that the potential for downside risk is too significant and is recommending that the model be voluntary.


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