• 01/12/2023 10:30 PM | Rebekah Francis (Administrator)


    U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) yesterday. This renewal extends the PHE through mid-April 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. HHS has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

    While many telehealth flexibilities are tied to the PHE, it is important to note that the recently passed Consolidated Appropriations Act, 2023, does ensure certain ones will remain in effect through Dec. 31, 2024, regardless of PHE status. More information may be found in MGMA Government Affairs’ newly updated telehealth resource.


    2023 is the first year clinicians may voluntarily report under a MIPS Value Pathway (MVP), with the Centers for Medicare & Medicaid Services (CMS) having finalized 12 MVPs for 2023. On Monday, as part of the “MVP Candidate Feedback Process,” CMS announced it is accepting comments on the following five draft MVPs under consideration for 2024:

    1.   Quality Care in Mental Health and Substance Use Disorder

    2.   Prevention and Treatment of Infectious Disorders Including Hepatitis C and HIV

    3.   Musculoskeletal Care and Rehabilitative Support

    4.   Quality Care for Otolaryngology

    5.   Focusing on Women’s Health

    Comments on these five draft MVPs will be accepted through Feb. 8, 2023. CMS will display feedback it received for each MVP on the Quality Payment Program website, but won’t respond to those submitting feedback directly. If you would like to provide feedback on any of the draft MVPs, additional information may be found here.

    For more information on MVPs, check out MGMA Government Affairs’ newly updated resource.


    The Provider Relief Fund (PRF) Reporting Portal is now open for reporting on use of funds in Reporting Period 4. Providers who received one or more PRF (General or Targeted) and/or American Rescue Plan Rural payments exceeding $10,000, in the aggregate, during the fourth Payment Received Period (July 1 to December 31, 2021) must report on their use of funds by March 31, 2023. First time reporters can get started by registering in the PRF Reporting Portal. If a reporting entity has previously reported, they do not need to register again and may log into the Portal with their username, TIN, and password. For more information visit the PRF Reporting webpage.

  • 01/06/2023 12:00 PM | Rebekah Francis (Administrator)


    On Dec. 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (CAA, 2023), into law, which contained a handful of provisions that impact medical group practices, including mitigating provider reimbursement cuts under Medicare for two years and extending certain telehealth flexibilities. To assist members, MGMA Government Affairs created a high-level resource outlining those provisions included within the CAA, 2023, likely to have an effect on practice operations.

    Interested in additional information on 2023 policies? Make sure to review MGMA’s 2023 Physician Fee Schedule Analysis and 2023 Medicare Outlook webinar recording!


    The Centers for Medicare and Medicaid Services (CMS) extended the deadline to file a 2022 MIPS Extreme and Uncontrollable Circumstances (EUC) hardship exception application for those citing COVID-19 as a triggering event until March 3, 2023 at 8 p.m. ET. The deadline originally was Jan. 3, 2023. CMS notes that applications received between Jan. 3, 2023 and March 3, 2023 will not override submitted data for individuals, groups, and virtual groups. Additionally, APM Entities participating in MIPS APMs can submit a MIPS EUC exception application, but should note the following differences:

    • APM Entities are required to request reweighting for all performance categories.
    • At least 75% of the MIPS eligible clinicians in the APM Entity will need to qualify for reweighting in the Promoting Interoperability performance category.

    Data submission for an APM Entity won't override performance category reweighting from an approved application.


    CMS has released additional guidance regarding the good faith estimates (GFE) for uninsured (or self-pay) individuals as established in the No Surprises Act. The FAQs cover how federally qualified health centers with sliding fee discounts can comply with GFE requirements, when an abbreviated GFE can be used, and what types of contact information providers should include in a GFE. CMS includes a sample template that group practices can utilize for abbreviated GFEs.

    For more information on the No Surprises Act, please review MGMA’s updated member-exclusive

  • 12/22/2022 8:00 AM | Rebekah Francis (Administrator)


    Earlier this week, Congress released the text of their year-end spending package, which contains a handful of healthcare provisions that will impact medical groups.

    Medicare physician payment: The legislation averts 6.5% of the scheduled 8.5% reduction to physician reimbursement in Medicare, resulting in an approximate 2% cut to the Medicare conversion factor for 2023. By way of background, in 2021, CMS shifted funds in the physician fee schedule to pay for an increase in work RVUs, which raised reimbursement for office visits. This shift resulted in a decrease to the conversion factor due to a statutorily mandated budget neutrality adjustment. Congress provided funds to offset the adjustment in 2021 and partially offset it again in 2022. Going into 2023, we expected a cut of 8.5%, resulting from both a decrease to the conversion factor (4.5%) and PAYGO cut (4%). For the third year in a row, we’ve urged Congress to address the de facto cuts
    this year in the form of adding 4.5% back into the fee schedule and waiving PAYGO. Unfortunately, despite 10,000 letters from MGMA members, Congress did not have the appetite to fully waive budget neutrality requirements to address the slated 4.5% cut. Instead, Congress will only partially mitigate it by allowing a 2% cut in 2023. This is in addition to legislation waiving the 4% PAYGO for 2023 and 2024. MGMA has voiced its disappointment that Congress is allowing a 2% cut to occur in 2023 and will continue working to find a more sustainable and comprehensive solution.

    Alternative Payment Models (APMs): The 5% incentive bonus is set to expire at the end of this year. The legislation would extend the bonus for an additional year, through 2023, at 3.5%.

    Telehealth: Many telehealth waivers, including being able to treat a patient in their home, were extended through 2024. This is positive development supported by MGMA to ensure continuity from pandemic-era telehealth policies.

    Lab cuts: Pending the passage of this legislation, practices will receive a one-year reprieve from the laboratory cuts of up to 15% that would have gone into effect in January 2023. This provision was also supported by #MGMAAdvocacy.

    We expect Congress to pass this legislation into law by Friday. We will let you know if Congress modifies the current text.


    The Health Resources & Services Administration (HRSA) began issuing Repayment Request Notices to Provider Relief Fund (PRF) recipients who must repay funds. If your practice receives a Repayment Request Notice based on a HRSA finding of non-compliance or the results of an audit, you can request a Decision Review. As a reminder, the Decision Review is not related to payment calculations and determinations. If you believe your payment was incorrectly calculated, visit the Payment Reconsideration page.

    More information about the repayment process can be found


    As we approach 2023, many new federal policies will take effect that will impact your medical group. MGMA Government Affairs has updated and created new resources to help your practice prepare! Take advantage of these member-exclusive resources today:

    MGMA members can reach out to with any questions regarding these new and updated resources.
  • 12/08/2022 9:57 AM | Rebekah Francis (Administrator)


    On Monday, MGMA and over 100 other healthcare stakeholder organizations sent a letter to congressional leadership urging action to avert the entire 4.5% reduction to Medicare payment rates scheduled to take effect Jan. 1, 2023. The letter illustrates the severity of this pending cut and the negative impact it will have on practices, especially in light of current inflationary pressures. As the Medicare physician fee schedule is the only Medicare payment system without an annual inflationary update, the pending 4.5% reduction will only exacerbate current financial concerns.

    MGMA is continuing to advocate against this harmful reduction and for permanent payment reforms. Join in #MGMAAdvocacy today by sending a letter to your members of Congress to pass legislation to stop the full 4.5% payment reduction from taking effect.


    Following months of #MGMAAdvocacy, CMS announced that they are extending enforcement discretion, pending future rulemaking, for the convening/co-provider good faith estimate (GFE) requirements. Therefore, CMS will  NOT begin enforcing these requirements on Jan. 1, 2023. If enforced, practices acting as “conveners” would be responsible for requesting and compiling estimates from each co-provider or co-facility expected to provide a service in connection with the convening provider or facility’s service. This is in addition to the convening provider’s other GFE responsibilities. MGMA previously urged CMS to continue to exercise enforcement discretion past Jan. 1, 2023, due to challenges associated with transferring this information and the tight timeframes.

    As a reminder, the advanced explanation of benefits (AEOB) requirements are similarly not being enforced pending further rulemaking.


    On Tuesday, CMS released its proposed rule on electronic prior authorization (ePA) after months of MGMA urging the agency to do so. If finalized, this rule would apply to Medicare Advantage (MA) organizations, state Medicaid and CHIP Fee-for-Service (FFS) programs, Medicaid managed care plans and Children's Health Insurance Program (CHIP) managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs). The rule proposes, in part, to require the aforementioned plans to: (1) Provide a clear reason for PA denials, (2) Publicly report on PA approvals, denials, and appeals, (3) Respond to PA requests within certain timeframes (72 hours for urgent, 7 days for non-urgent), and (4) Implement and maintain an API to support and streamline the PA process. 

    MGMA will comment on this proposed rule and work with CMS to further refine it. We are also hopeful that this rule will help get MGMA-supported PA legislation (the Improving Seniors' Timely Access to Care Act) across the finish line before the end of the year. Please continue to urge your members of Congress to support this legislation by sending a letter through our Contact Congress portal.


    Yesterday, MGMA’s Senior Vice President of Government Affairs Anders Gilberg was named one of The Hill’s 2022 Top Lobbyists — an award recognizing “the corporate lobbyists, hired guns, association leaders and grassroots activists who leveraged their expertise and connections to make a difference in the nation’s capital this year.” This prestigious recognition is reflective of the work Anders and MGMA have undertaken this past year representing the interests of our members and medical groups nationwide.

    The Government Affairs team would like to extend a huge ‘thank you’ to everyone who has participated in #MGMAAdvocacy this past year, as you all undoubtedly contributed to this win!
  • 11/22/2022 3:51 PM | Rebekah Francis (Administrator)

    Your guide to 2023 Medicare payment rules

    The Centers for Medicare & Medicaid Services released its final 2023 Physician Fee Schedule (PFS) rule, which includes payment and coding updates for Medicare services, modifications to telehealth, and changes to the Quality Payment Program.

    MGMA Government Affairs reviewed, analyzed, and distilled over 2,000 pages of the final rule to draft this member-benefit analysis. The resource breaks down significant payment and quality reporting changes for 2023 and offers practical takeaways for busy medical group practice executives. Key regulatory provisions include:

    • Setting the CY 2023 PFS conversion factor at $33.0607 (a reduction of 4.47%) and the CY 2023 national average anesthesia conversion factor at $20.6097. MGMA is advocating for a legislative fix to address the reimbursement cuts resulting from the lower conversion factor;
    • Delaying the split/shared E/M billing policy until CY 2024, permitting the billing clinician to bill for services based on history, exam, medical decision marking or time in 2023;
    • Continuing payment for Medicare telehealth services that are temporarily included on the telehealth list for 151 days following the conclusion of the COVID-19 public health emergency and maintains payment parity between in-person and telehealth visits through 2023;
    • Permitting auxiliary personnel to furnish behavioral health services incident to a physician or NPPs services under general instead of direct supervision;
    • Increasing Qualifying APM Participant (QP) and partial QP threshold in performance year 2023; and
    • Finalizing 5 new MIPS Value Pathways (MVPs), for a total of 12 MVPs available for voluntary reporting in 2023.

    Interested in learning more about the updates to Medicare physician payment and quality reporting that will be in effect come Jan. 1, 2023? Join MGMA Government Affairs on Dec. 13 at 1 p.m. ET for our member-exclusive 2023 Medicare Outlook webinar to gain insights about payment and policy changes outlined in the final 2023 PFS rule. Register here.
  • 11/17/2022 2:35 PM | Rebekah Francis (Administrator)

    MGMA sends Congress year-end legislative recommendations

    On Monday, MGMA sent a letter to congressional leadership urging them to address significant Medicare cuts and other important healthcare policies before the end of this year. The letter highlights current issues with Medicare reimbursement that projected payment cuts will exacerbate and asks Congress to act by:

    • Offsetting the 4.47% reduction to the Medicare physician conversion factor;
    • Waiving the 4% statutory Pay-As-You-Go sequester; and,
    • Extending the 5% alternative payment model (APM) incentive payment for six additional years.

    Further, MGMA encouraged Congress to pass additional commonsense legislation to address significant administrative burdens impacting group practices and improve the timeliness of clinical care delivery. These recommendations included passing the Improving Seniors’ Timely Access to Care Act, extending telehealth waivers for at least two years after the conclusion of the public health emergency, passing the Saving Access to Laboratory Services Act, and appropriating additional funds to continue rewarding high performing clinicians within the Merit-based Incentive Payment System (MIPS).

    Visit MGMA's
    Contact Congress portal to send a letter to your legislators on these important issues!

    MGMA submits feedback on AEOB requirements

    On Tuesday, MGMA submitted feedback to the Department of Health and Human Services about the upcoming advanced explanation of benefits (AEOB) requirements stemming from the No Surprises Act. The AEOB policies would require group practices to send good faith estimates to health plans, thereby allowing the plans to generate AEOBs to send to patients. As a reminder, these requirements are not being enforced until rulemaking is completed. MGMA encouraged HHS to not enforce the AEOB requirements until there are workable solutions that are developed, tested, and implemented as well as to continue soliciting input and working with medical groups to implement these solutions.


    Interested in learning more about the updates to Medicare physician payment and quality reporting that will be in effect come Jan. 1, 2023? Join MGMA Government Affairs on Dec. 13 at 1 p.m. ET for a for our member-exclusive 2023 Medicare Outlook webinar to gain insights about payment and policy changes outlined in the 2023 Medicare Physician Fee Schedule final rule. Additionally, we’ll provide details about MIPS reporting requirements, the MIPS Value Pathways implementation timeline, and APM participation and reporting options for 2023. The hour-long session will conclude with a discussion of MGMA’s advocacy initiatives and an interactive Q&A session with Government Affairs staff.

    For more information, or to register, please click here.
  • 11/10/2022 8:24 AM | Rebekah Francis (Administrator)


    On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model participation options and requirements for 2023. MGMA issued a statement expressing disappointment in the final rule and its negative impact to physician payment, urging Congress to take action to avert the cuts and waive the 4% PAYGO sequestration before the end of the year. 

    To assist others in their advocacy efforts surrounding the Medicare cuts, the Government Affairs team created a social media toolkit 
    which includes several resources for actions to take from now until Congress acts, motivating others to participate in our critical #MGMAAdvocacy grassroots efforts. Join the conversation online and encourage others to do the same by using the hashtag #AvertTheMedicareCuts!

    ICYMI: Updated PI requirements for 2023

    As a reminder, those reporting under MIPS and wishing to receive credit for Promoting Interoperability (PI) will be required to only use certified technology updated to the 2015 Edition Cures Update for an EHR reporting period or performance period in CY 2023. Group practices are not required to demonstrate they are using updated technology to meet the CEHRT definitions immediately participants must use technology meeting these requirements during a self-selected EHR reporting period or performance period of a minimum of any consecutive 90 days in 2023 (i.e. – October 1, 2023).


    Practices that spend a total of $750,000 or more in federal funds, including Provider Relief Fund (PRF) payments during their fiscal year, are subject to Single Audit requirements. The Health Resources & Services Administration (HRSA) recently announced the availability of a Commercial Audit Reporting Portal. Commercial (i.e., for-profit) entities may log into the portal with the same username and password as the PRF Reporting Portal. Non-profit organizations should continue to submit their Single Audits to the Federal Audit Clearinghouse (FAC).

  • 11/04/2022 11:58 AM | Rebekah Francis (Administrator)


    On Tuesday, the Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements for 2023.

    Immediately following, MGMA issued a statement expressing disappointment in the final rule and its negative impact to physician payment, urging Congress to take action to avert the cuts and waive the 4% PAYGO sequestration before the end of the year. Join in #MGMAAdvocacy today by sending a letter to your congressional members imploring them to act swiftly to avert these significant payment cuts!

    In the coming weeks, we will release a detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP). Until then, additional information about the final rule is available in the
    PFS fact sheet and the QPP fact sheet.

  • 10/20/2022 9:35 AM | Rebekah Francis (Administrator)

    COVID-19 public health emergency renewed

     The COVID-19 public health emergency (PHE) was renewed again, effective Oct. 13, 2022. This renewal extends the PHE through mid-January 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. The U.S. Department for Health and Human Services has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

    To understand what waivers will expire upon the eventual conclusion of the PHE, review MGMA’s Flexibilities and Policy Following the Expiration of the COVID-19 PHE member-exclusive resource.  

    Join in #MGMAAdvocacy to prevent Medicare payment cuts

     With just over two months left in 2022, MGMA needs your help urging Congress to take action to avert significant Medicare payment cuts set to take effect in 2023. Send a letter to your members of Congress today encouraging the passage of legislation to avert the 4.5% reduction to the Medicare conversion factor, waive the statutory 4% Pay-As-You-Go sequester, and provide an inflationary update based on the Medicare Economic Index. MGMA Government Affairs’ latest report on Medicare cuts showcases what medical groups around the country have to say about these proposed payment cuts, including how they would significantly disrupt patient access to care, practice operations, and overall investment throughout the healthcare industry.

    The time to act is now! Join in #MGMAAdvocacy today by sending a letter to your members of Congress urging for the swift passage of legislation to avert these significant payment cuts!

    Available now: MGMA's '22 Annual Regulatory Burden Report

     Last week, the MGMA Government Affairs team released its 2022 Annual Regulatory Burden Report. With responses from over 500 medical group practices, the survey findings demonstrate the impact that increasing regulatory burden has on practices. An overwhelming majority (89%) of respondents reported that the overall regulatory burden on their medical practice has increased over the past 12 months. And an even greater number of respondents (97%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

    Thank you again to all of our members who participated in this survey! For more information about how to engage in current advocacy efforts, please visit the MGMA Advocacy webpage.

  • 09/29/2022 8:47 AM | Rebekah Francis (Administrator)

    Next week: New information blocking requirements take effect

    Beginning on and after Oct. 6, 2022, a medical group must respond to a request to access, exchange, or use electronic health information (EHI) more broadly to the extent that EHI would be included in a designated record set that is defined in HIPAA, unless any of eight exceptions can be applied. The new definition of EHI includes medical records, billing records, payment and claims records, case management records, and other records used, in whole or in part, by a medical group to make decisions about individuals. Until Oct. 6, the definition of EHI remains narrower in scope.

    For more information on the information blocking requirements, download MGMA’s member-exclusive Information Blocking ToolkitMGMA is urging U.S. Department of Health and Human Services Secretary Becerra to postpone information blocking deadlines for one year and asking for additional clarity on requirements. 

    Reporting deadline Friday: Provider Relief Fund

    Medical practices that received Provider Relief Fund (PRF) assistance exceeding $10,000, in aggregate, from Jan. 1, 2021, through June 30, 2021 (RP3), must report on their use of funds by tomorrow, Sept. 30, 2022 at 11:59 p.m. ET. The next reporting period (RP4) opens Jan. 1, 2023.

    Those impacted by Hurricane Ian will be allowed the opportunity to submit a request to report late due to extenuating circumstances. For more information related to reporting requirements and auditing, visit the Health Resources & Services Administration (HRSA)’s FAQs. For all other questions related to reporting, call the Provider Support Line at 866-569-3522.

    Promoting interoperability deadline fast approaching 

    The last day to start a 90-day reporting period under the Promoting Interoperability (PI) performance category for the Merit-based Incentive Payment System (MIPS) is Oct. 3, 2022. The PI program requirements include a set of objectives and measures that focus on patient access to health information and electronic exchange of information that is worth 25% of an eligible clinician or group’s MIPS final score, and requires a minimum continuous 90-day reporting period during the calendar year. In addition to this, providers must use the appropriate edition of Certified Electronic Health Record Technology (CEHRT) and attest to required objectives and measures for the required EHR reporting period.

    To learn more about the 2022 MIPS PI performance category, please review this guide from the Centers for Medicare & Medicaid Services.


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