News

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.

IMPORTANT UPCOMING DATES FOR MEDICAL GROUPS

The Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule earlier this year that included a 3.37% cut the Medicare conversion factor and other important policies for medical groups. MGMA has been and will continue to advocate that Congress avert the full cut in anticipation of the new year. Unfortunately, political issues related to legislation to fund the operations of the federal government and its agencies have prevented Congress from addressing critical end-of-year Medicare policies impacting medical groups. With Congress unlikely to intervene before the end of the year, here’s a timeline of upcoming key dates:

• Dec. 31:  3.5% APM incentive payment expires
• Jan. 1: Cut of 3.37% to the Medicare conversion factor takes effect
• Jan. 1: Medicare begins paying for G2211 complexity add-on code
• Jan. 1: Qualifying APM Participant threshold increases for the 2024 performance year
• Jan. 19: Partial federal government shutdown deadline
• Jan. 19: 1.0 work GPCI floor expires
• Feb. 2: Second federal government shutdown deadline

NO SURPRISES ACT UPDATES

On Dec. 15,the No Surprises Act independent dispute resolution (IDR) portal was reopened for all disputes after previously being closed to batched disputes. The Administration released an FAQ detailing extended timelines for the submission of batched disputes and guidance for IDR entities in determining eligibility. Additionally, earlier this week a new rule was finalized setting the IDR administrative fee at $115 per dispute. The proposed rule had set the administrative fee at $150.

MGMA submitted comments on Wednesday about a separate IDR operations proposed rule. We asked for increased flexibility for batched disputes and highlighted the need to streamline the IDR process.

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.

HOUSE COMMITTEE ADVANCES LEGISLATION TO REFORM PRIOR AUTHORIZATION

The House Committee on Ways and Means held a markup of healthcare legislation yesterday. One of the bills considered, the Health Care Price Transparency Act of 2023, included provisions that would make critical changes to the prior authorization process for Medicare Advantage plans. Specifically, the legislative text incorporates language from the the Improving Seniors’ Timely Access to Care Act which MGMA has long supported and has broad bipartisan support among Congress.

MGMA Government Affairs issued a statement before the markup in support of the inclusion of the prior authorization provisions. The Committee agreed on a 25-16 vote to report the "Transparency Act" to the House floor. We will continue to monitor this legislation and advocate for commonsense prior authorization reform.

SAVE THE DATE: GOVCHAT LIVE ON PROPOSED 2024 PHYSICIAN FEE SCHEDULE

MGMA Government Affairs is hosting a GovChat Live on 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. 

Registration information is available on the MGMA GovChat Community page. If you have questions, please email govaff@mgma.org.

REMINDER: MID-YEAR POLICY UPDATE WEBINAR AVAILABLE  ON-DEMAND

If you missed MGMA's mid-year policy update webinar earlier this month, it is now available to members on-demand. To learn about the current 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, the recording may be accessed here. 

For additional insights on the proposed cuts to Medicare reimbursement, prior authorization reform, Medicare site of service differentials, upcoming changes to health IT regulations, telehealth policies following the end of the COVID-19 public health emergency, and more, members are encouraged to read our latest article from the July 2023 issue of MGMA Connection magazine.

MGMA TO CONGRESS: CUT RED TAPE FOR MEDICAL GROUPS

MGMA submitted testimony to the House Committee on Small Business Subcommittee on Oversight, Investigations & Regulations ahead of its July 19 hearing, "Burdensome Red Tape: Overregulation in Health Care and the Impact on Small Businesses." The testimony highlights the ongoing challenges medical groups face related to MIPS, APM development and reporting, physician reimbursement, and prior authorization. 

Notably, Committee Chair Van Duyne referenced data points from MGMA's annual regulatory burden report in her opening statement, saying, “89% of [medical group practices surveyed] feel that regulatory burden has increased in the past year." In the testimony, MGMA raised concerns that increasing regulatory burdens further impede practices' ability to ensure high-quality, timely patient care. 

NOW ON-DEMAND: MID-YEAR POLICY UPDATE WEBINAR

If you missed MGMA's mid-year policy update webinar earlier this week, it is now available to members on-demand. To learn about the current 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, the recording may be accessed here. 

For additional insights on the proposed cuts to Medicare reimbursement, prior authorization reform, Medicare site of service differentials, upcoming changes to health IT regulations, telehealth policies following the end of the COVID-19 public health emergency, and more, members are encouraged to read our latest article from the July 2023 issue of MGMA Connection magazine.

TRANSITION OF COVID-19 VACCINE TO COMMERCIAL MARKET

The Department of Health and Human Services has released guidance for the transition of the COVID-19 vaccine to the commercial market. Effective Aug. 3, 2023, at 4 p.m. ET, the U.S. Government will end their regular vaccine and ancillary kit distribution processes. Providers are encouraged to place any necessary orders in advance of the Aug. 3, 2023, deadline. The Public Readiness and Emergency Preparedness Act's liability protections to providers administering COVID-19 vaccines will not be impacted by this transition.

It is important to note that this guide is intended for planning purposes and its details may change pending future recommendations from the Food and Drug Administration and Centers for Disease Control. MGMA Government Affairs will continue to monitor this transition process and keep members apprised any relevant changes.

Medicare proposes 2024 payment and quality reporting changes

The Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Physician Fee Schedule (PFS) proposed rule this afternoon, which includes proposed changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2024. Key proposals include:

• Setting 2024 Medicare payment rates for physician services. For 2024, CMS proposes a Conversion Factor of $32.7476 and $20.4370 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, over final 2023 rates);
• Extending flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time through at least 2024, following MGMA advocacy;
• Reimbursing telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
• Continuing to allow direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
• Continuing coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
• Pausing implementation and rescinding the Appropriate Use Criteria program regulations;
• Increasing the performance threshold from 75 points to 82 points for all three MIPS reporting options;
• Adding five new MIPS Value Pathways related to women's health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
• Making numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
• Ending the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitioning to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.

MGMA will submit detailed comments in response to these proposals to CMS and prepare a more detailed analysis of proposed changes in the coming weeks. Review the proposed rule, the PFS fact sheet, and the QPP fact sheet. The final 2024 PFS rule is expected by Nov. 1, 2023.

Next Tuesday: Join MGMA for our mid-year policy update webinar

Join MGMA Government Affairs 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 next Tuesday, 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. 

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.