News

New CMS FAQ on 2026 Telehealth

CMS released an updated Telehealth FAQ on November 20, 2025, with information regarding the CY 2026 Medicare Physician Fee Schedule Final Rule and telehealth flexibility extensions through January 30, 2026. The FAQ includes clarifications that respond to concerns raised by MGMA members, including:

• Retroactive Billing During Government Shutdown: CMS clarified that telehealth services provided during the recent government shutdown will be paid as if there had been no lapse in telehealth flexibilities. Telehealth flexibilities apply retroactively through January 30, 2026, and claims will continue to be processed in the same manner as before October 1, 2025.
• Home Enrollment for Telehealth Services: CMS confirmed that distant site practitioners can provide telehealth services from their home and, in many cases, do not need to report their home address on their Medicare enrollment application.
  • Practitioners who furnish telehealth services from home but maintain a physical practice location are not required to list their home address. They may enroll and bill from their physical practice location as if the telehealth service were furnished in person.
  • Virtual-only telehealth practitioners whose only physical practice location is their home must enroll their home address as a practice location. CMS instructs these practitioners to mark the address as a “Home office for administrative/telehealth use only” in their enrollment application to suppress street address details on the CMS Care Compare website. Practitioners may also email QPP@cms.hhs.gov to suppress the street address and/or phone number.

See more information on Medicare Telehealth Coverage here. 

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.

CHANGE HEALTHCARE CYBERSECURITY ATTACK

MGMA Government Affairs is closely monitoring the cybersecurity attack against Change Healthcare and its impact on medical groups. We have been hearing from MGMA members about the wide-ranging effects they are experiencing. MGMA sent a letter to the Department of Health and Human Services (HHS) asking for guidance, financial resources, enforcement discretion, and more to support group practices and patient access to care. 

We will continue update members as information becomes available.

CONGRESS REACHES SHORT-TERM AGREEMENT TO AVOID SHUTDOWN

Congress has reached an agreement on a short-term deal to fund the federal government before the March 1 deadline for a partial government shutdown. Congress has taken a tiered approach to attempting to fund the federal government for 2024 and passed numerous short-term funding bills over the last few months. This agreement is similar as it extends funding for some government agencies to March 8, and funding for the rest to March 22.

As part of these funding packages, Congress has been discussing numerous healthcare policies and potentially addressing the Medicare conversion factor cut that went into effect on Jan. 1, 2024. MGMA is continuing to advocate to reverse the full 3.37% cut, which remains our top priority. If you have not already, please send a pre-populated letter to your representatives through MGMA’s Contact Congress portal urging them to address the full cut in the 2024 appropriations package.

NIST RELEASES UPDATED CYBERSECURITY GUIDANCE

The National Institute of Standards and Technology (NIST) has updated its Cybersecurity Framework (CSF) for the first time since 2014. This guidance document is meant for all industry sectors to help reduce cybersecurity risk; NIST has developed resources to help users navigate the framework.

This follows additional recent actions from NIST and HHS meant to strengthen cybersecurity. NIST and HHS Office of Civil Rights (OCR) released an updated resource that reviews the HIPAA Security Rule and includes suggestions for medical groups to manage risk.

“WASHINGTON POLICY OUTLOOK” SESSION AT MGMA SUMMIT

Attending MGMA Summit next month? You won't want to miss MGMA Government Affairs' "Washington Policy Outlook" on Tuesday, March 12, from 12:55 p.m. to 1:45 p.m. ET. Discussions will center around the latest legislative and regulatory developments impacting group practices such as Medicare reimbursement, telehealth, quality reporting, and more.

For more information on MGMA Summit, including how to register, please click here. 

NO SURPRISES ACT UPDATES

The Centers for Medicare & Medicaid Services (CMS) released new data on the implementation of the No Surprises Act (NSA). The number of disputes received by the Departments in the first half of 2023 was 13 times higher than the amount projected for the entire year.

CMS also confirmed that all applicable extensions for IDR dispute submissions following temporary closures of the IDR portal will end on March 14, 2024. The agency clarified that, effective March 14, “initiating parties who submitted a batched dispute before August 3, 2023, and received notification from a certified IDR entity that the dispute was improperly batched will have the standard 4-business-day period to resubmit, instead of the existing 10-business days.”

An updated version of MGMA’s 'Implementing the No Surprises Act' resource is now available to members containing new information following court decisions and various rulemaking.

MIPS 2023 DATA SUBMISSION WINDOW

The MIPS data submission window is open for the 2023 performance year for MIPS eligible clinicians. You can submit and update your data until 8 p.m. ET on April 1, 2024; you can’t correct errors after the submission period is over.

Preliminary scoring is no longer available. Previews of your 2023 final score will be available in June 2024 and your 2025 MIPS payment adjustment information will be available in Aug. 2024. Visit CMS' QPP Resource Library page for helpful tools such as the 2023 Traditional MIPS Data Submission User Guide.

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.

MGMA SEEKS REBILLING CLARIFICATION SHOULD MEDICARE CUT BE RETROACTIVELY ADDRESSED

MGMA sent a letter to the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) asking for rebilling clarification should Congress retroactively address the 3.37% Medicare conversion factor cut. Specifically, the letter requests guidance to ensure medical groups do not violate the beneficiary inducement statute if they choose to waive small patient balances that could result from a retroactive payment increase.

Congress has returned from its holiday recess with only a few weeks before a partial government shutdown on Jan. 19 if funding for certain government agencies is not extended. Addressing the 3.37% cut to the conversion factor remains MGMA’s top priority.

ONC PUBLISHES FINAL HTI-1 RULE

The Office of the National Coordinator for Health Information Technology (ONC) published its final rule to advance health information technology (IT) and algorithm transparency (HTI-1) in the Federal Register after announcing it at the end of last year. The rule touches on many topics related to health IT such as updating the ONC health IT certification program, establishing transparency requirements for artificial intelligence and predictive algorithms included in certified health IT, revising certain information blocking definitions and exceptions, and more. MGMA provided comments on the proposed version of the rule last year.

HAVE YOUR PHYSICIANS RECEIVED A REQUEST FOR PATIENT-CARE HOURS INFORMATION FROM AMA/MATHEMATICA?

The physicians in your practice may have received a request from Mathematica to participate in a short patient-care hours study. If they have, please encourage them to participate. The Medicare physician payment schedule, which is used by many other payers, relies on 2006 cost information to develop practice expense relative values, the Medicare Economic Index and resulting physician payments. Mathematica is collecting the data needed to calculate updated practice expenses per hour of patient care by physician specialty. More information may be found here.

UPDATE: IDR PROCESS RESUMES FOR CERTAIN DISPUTES

Following the Texas court's ruling in favor of the Texas Medical Association to rescind several No Surprises Act (NSA) regulations related to the independent dispute resolution (IDR) process, the Centers for Medicare & Medicaid Services (CMS) has issued guidance directing certified IDR entities to proceed with eligibility determinations submitted on or before Aug, 3, 2023, effective Sep. 5, 2023. Disputing parties with eligibility determinations submitted on or before Aug. 3, 2023, may continue to engage in open negotiation and should respond to requests for information from a certified IDR entity. All other aspects of the Federal IDR process remain suspended.

The agency is reviewing the court's decision and will update directions for the IDR process in concordance with the court's order. MGMA Government Affairs will continue to monitor for this future guidance and provide updates to membership.

CMS ANNOUNCES NEW AHEAD MODEL

CMS announced the introduction of the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. This new voluntary state total cost of care model is intended to improve population health, curb healthcare cost growth, and advance health equity. Participating states will receive support to increase investment in primary care, provide financial stability for hospitals, and support connection for beneficiaries to community resources.

The AHEAD model is scheduled to operate for eleven years starting in 2024, and CMS will issue awards of up to $12 million to support implementation for up to eight states. The first Notice of Funding Opportunity for states to apply will be released in late fall 2023. CMS will host a webinar on Sep. 18 from 3 p.m. – 4:30 p.m. ET.

NEW PRIORITY BILL TRACKER RESOURCE FOR MEMBERS

To assist members in their advocacy efforts, MGMA Government Affairs created a priority bill tracker resource outlining legislative efforts that have been introduced during the 118th Congress impacting medical groups. This pending federal legislation reflects several of MGMA’s key advocacy priorities. We need your support to get these bills passed into law. Please visit MGMA’s Contact Congress portal to send a letter to your legislators on these important issues.

NEXT MONDAY: GOVCHAT LIVE ON PROPOSED 2024 PHYSICIAN FEE SCHEDULE

MGMA Government Affairs is hosting a GovChat Live next Monday, August 7, at 2 p.m. ET. During this member-exclusive discussion, the team will provide a high-level overview of policies included in the proposed 2024 Medicare Physician Fee Schedule (PFS), including changes to the conversion factor/reimbursement, telehealth, behavioral health, E/M visits, the Medicare Shared Savings Program, and the Quality Payment Program. 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. 

For registration information, please visit the MGMA Member Community, log in, and navigate to the GovChat Community page where you will find details in the pinned post! Haven't checked out the GovChat Community yet? You can find it by utilizing the search bar at the top of the Member Community home page! If you have questions, please email govaff@mgma.org.

MGMA ENDORSES POLICIES TO REFORM PRIOR AUTHORIZATION

Congress continues to examine potential solutions to the prior authorization burden facing medical groups. The GOLD CARD Act was recently reintroduced by Representatives Michael Burgess and Vicente Gonzalez of Texas.

If enacted, the legislation would exempt qualifying physicians from prior authorization requirements if they had at least 90% of prior authorization claims approved in the previous year. Medicare Advantage organizations would be required to notify each provider who qualifies no later than 30 days prior to the first day of the plan year, and reviews for a Gold Card would be limited to no more than one per year. MGMA issued a statement in support of the legislation.

VALUE-BASED CARE LEGISLATION REINTRODUCED IN HOUSE

The Value in Health Care Act was reintroduced last week. This bipartisan legislation would make changes to alternative payment models (APMs) and provide support for practices transitioning from fee-for-service to value-based care. If enacted, the bill would extend the APM incentive bonus at 5%, allow the Centers for Medicare & Medicaid Services to adjust qualifying participant thresholds through rulemaking, and make changes to the Medicare Shared Savings Program to encourage participation. MGMA joined 16 partner healthcare organizations in a letter of support to the bill’s cosponsors.

NEW REQUIREMENT FOR DEA-REGISTERED PRACTICIONERS

All practitioners registered with the Drug Enforcement Agency (DEA) will be responsible for fulfilling a one-time, eight-hour training requirement on the treatment or management of patients with opioid or other substance use disorders. Practitioners need to satisfy this requirement before their initial or next scheduled DEA registration submission on or after June 27, 2023.

There are multiple ways that a practitioner may satisfy this new requirement — the DEA sent a letter outlining these options and providing a list of accredited groups that may provide trainings. The Substance Abuse and Mental Health Services Administration (SAMSHA) has additional information about frequently asked questions. MGMA Government Affairs will discuss this policy in more detail during our upcoming mid-year policy update webinar.

JOIN MGMA FOR OUR MID-YEAR POLICY UPDATE WEBINAR

Join MGMA Government Affairs staff for our member-exclusive, mid-year policy update to review current federal policies and their impact on group practices. Attendees will learn about the congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement. There will be time for Q&A at the end of the presentation, so come ready with your questions!

This webinar will be held on July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here. 

NOW OPEN: PRF REPORTING PERIOD 5

Effective July 1, 2023, the Provider Relief Fund (PRF) Reporting Period 5 is open. Any American Rescue Plan Rural and/or PRF payment in excess of $10,000.00 received between Jan. 1, 2022, and June 30, 2022, should be included in this period's report. All reports must be submitted through the PRF Reporting Portal. The deadline to submit a report for this period is Sept. 30, 2023, at 11:59 p.m. ET.

Additional resources concerning the PRF can be found here. MGMA Government Affairs will continue to keep members apprised of relevant developments.

MGMA SHARES MEDICARE PAYMENT REFORM RECOMMENDATIONS WITH CONGRESS

MGMA submitted a letter for the record to the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations ahead of their hearing, “MACRA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.” The Subcommittee examined the Quality Payment Program (QPP) that was instituted under the Medicare Access and CHIP Reauthorizations Act of 2015 (MACRA) and discussed challenges practices face related to the legislation.

Our comments included recommendations on how to reform the program such as providing an annual inflationary-based physician payment update based on the Medicare Economic Index (MEI), providing positive financial incentives to support practices transitioning to value-based care, and opposing efforts to offset unrelated congressional spending to the detriment of Medicare providers. MGMA expects Congress to continue reviewing potential options for MACRA reform in the coming months and we will engage with policymakers to advocate for solutions that provide for sustainable reimbursement to medical groups.

MGMA ADVOCATES FOR BEHAVIORAL TELEHEALTH CARE

The House Committee on Energy and Commerce Subcommittee on Health held a hearing on the reauthorization of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) for Patients and Communities Act. The Subcommittee discussed numerous provisions of the SUPPORT Act with witnesses from several federal agencies tasked with enforcing the law.

MGMA sent a letter recommending policies to the Subcommittee that would support medical groups’ ability to offer high-quality mental health and behavioral telehealth care. The letter advocated for instituting an appropriate process for the administration of controlled substances via telehealth and to remove the in-person requirement for behavioral telehealth visits.

JOIN MGMA FOR OUR MID-YEAR POLICY UPDATE WEBINAR

Join MGMA Government Affairs staff for our member-exclusive, mid-year policy update to review current federal policies and their impact on group practices. Attendees will learn about the congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement. There will be time for Q&A at the end of the presentation, so come ready with your questions!

This webinar will be held on July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here.