• 02/10/2022 8:19 PM | Rebekah Francis (Administrator)

    MIPS technical assistance program ends Feb. 15

    Funding for the Quality Payment Program Small, Underserved, and Rural (QPP-SURS) technical assistance program ends on Feb. 15, 2022. This program supports practices participating in the Merit-based Incentive Payment System (MIPS) by providing guidance in determining MIPS eligibility, submitting data, and transitioning to voluntary participation in alternative payment models (APMs).

    MGMA is urging Congress to provide funding for the QPP-SURS program through 2027 to ensure small and rural practices can continue to succeed in the MIPS program. Join #MGMAAdvocacy by sending a letter to your congressional representatives today!

    Reminder: Medicare telehealth changes

    The Centers for Medicare and Medicaid Services (CMS) recently published an article regarding changes to telehealth billing that were included in the 2022 Medicare Physician Fee Schedule (PFS). The changes mostly cover the expansion of mental telehealth services available following the conclusion of the COVID-19 public health emergency, including the ability to treat patients at home and via audio-only technology if certain conditions are met. The article also includes the two new mental telehealth modifiers – FQ and FR.

    For more information on the telehealth changes included in the final 2022 PFS rule, download MGMA’s member-benefit analysis.

    Join #MGMAAdvocacy on 2022 priority issues

    While the MGMA Government Affairs team works tirelessly in Washington, D.C., advocating on top issues impacting group practices, we need your help to amplify the message to Congress. In less than five minutes you can send a personalized email advocating for change on all of the issues listed below!

    Learn more about MGMA federal advocacy, access member-exclusive resources, and find out how you can be involved by visiting the MGMA advocacy webpage.  

  • 02/03/2022 4:17 PM | Rebekah Francis (Administrator)

    MGMA to Congress: Support practices in funding legislation

    Last Friday, MGMA sent a letter to Congress urging for the following priorities to be considered while they negotiate the upcoming February funding legislation:

    • Extend Medicare sequester relief beyond March 2022;
    • Continue telehealth flexibilities through at least CY 2024;
    • Extend the alternative payment model (APM) 5% bonus;
    • Update the Qualifying Participant (QP) threshold; and
    • Delay implementation of the good faith estimate (GFE) and advanced explanation of benefits (AEOB) requirements.

    2020 MIPS participation results now available

    The Centers for Medicare & Medicaid Services (CMS) has released participation results for the 2020 performance year of the Merit-based Incentive Payment System (MIPS). MIPS participation slightly decreased from 2019 to 2020 and 81% of clinicians received a final score at or above the exceptional performance threshold.  

    Throughout 2020, many clinicians were significantly impacted by the COVID-19 pandemic, and as a result, CMS provided clinicians with the option to apply for reweighting of all or some MIPS performance categories. In 2020, 26% of participants received reweighting of at least one performance category.   

    MGMA urges Congress to extend telehealth flexibilities

    MGMA and hundreds of other leading organizations wrote to Congress asking for a pathway to comprehensive permanent telehealth reform. At the beginning of the COVID-19 pandemic, Congress and the Administration acted quickly to expand Medicare telehealth, allowing millions of beneficiaries access to virtual care. These flexibilities hinge on whether the COVID-19 public health emergency (PHE) is in effect, leading to uncertainty surrounding how long these waivers will remain.

    The letter urges Congress to continue all current telehealth waivers through Dec. 31, 2024, allowing time to collect the necessary evidence needed to support permanent policy.

  • 01/27/2022 9:44 AM | Rebekah Francis (Administrator)

    MGMA to HHS: Delay good faith estimate mandate

    In a letter sent yesterday, MGMA urged the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to use their enforcement discretion and delay implementation of the uninsured or self-pay good faith estimate (GFE) requirements until practices have had appropriate time to understand and implement the requirements.

    Passed as part of the No Surprises Act, these GFE requirements took effect on Jan. 1, 2022. Additional information about the No Surprises Act and member-exclusive resources are available on the MGMA surprise billing landing page.

    OSHA withdraws COVID-19 vaccination and testing ETS

    Following a U.S. Supreme Court ruling, the Occupational Safety and Health Administration (OSHA) published an announcement that it is withdrawing its COVID-19 vaccination and testing emergency temporary standard (ETS).

    Although OSHA is withdrawing the ETS, the agency conveyed its intention to pursue future action on COVID-19 workplace safety down the road.

    HRSA announces $2 billion in Provider Relief Fund assistance

    On Tuesday, the HHS, through the Health Resources and Services Administration (HRSA), announced it will make $2 billion in Provider Relief Fund (PRF) Phase 4 payments this week. More than 7,600 providers nationwide should receive these funds, which are based on lost revenues and expenses due to COVID-19. Medical groups must have previously applied for relief funds.

    For more information on the PRF, visit HRSA’s PRF landing page.
  • 01/20/2022 8:46 AM | Rebekah Francis (Administrator)

    MGMA releases 2022 Advocacy Agenda

    As we enter a new year, MGMA continues to ensure the voice of medical groups is heard in Washington. Our 2022 Advocacy Agenda outlines key federal issues we are tackling, such as protecting the financial viability for medical group practices, improving the implementation of surprise billing requirements, and advancing value-based care.

    Follow the MGMA Government Affairs team on Twitter for updates on the latest #MGMAAdvocacy efforts this year:

    @AndersGilberg, @ClaireErnstJD, @KelseyMHaag, and @EmilyRDowsett.

    HHS renews COVID-19 PHE

    The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective Jan. 16, 2022. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90-days. In a letter to HHS, MGMA called on the Department to expeditiously renew the PHE to ensure groups practices can continue to leverage existing critical flexibilities as they continue to respond on the frontlines of the pandemic.   

    Unless further extended, the current PHE will lapse on April 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide a 60-day notice prior to allowing the COVID-19 PHE to lapse.

    Provider Relief Fund portal open for 'Period 2' reporting

    Medical groups who received Provider Relief Fund (PRF) payments exceeding $10,000 in the aggregate from July 1, 2020 to Dec. 31, 2020 (‘Period 2’) can now report on the use of those funds. Providers have until March 31 to complete the reporting.

    Additionally, the Health Resources and Services Administration released new reporting resources specific to ‘Period 2,' which can be accessed here.
  • 01/13/2022 3:35 PM | Rebekah Francis (Administrator)

    Today, the U.S. Supreme Court ruled on both the Occupational Safety and Health Administration (OSHA) vaccination and testing emergency temporary standard (ETS) and the Centers for Medicare & Medicaid Services (CMS) facilities rule. The Supreme Court blocked the OSHA ETS, which would have required workers of large employers (100+ employees) to get vaccinated or tested weekly for COVID-19. The CMS facilities rule, which would require vaccination of healthcare employees in facilities that receive Medicare and Medicaid payments, is allowed to move forward nationally. The CMS facilities rule generally does not apply to physician practices, although some might be subjected to it based on how they are structured.

    The OSHA ETS opinion can be viewed here.

    The CMS facilities rule opinion can be viewed here.

    The CMS facilities rule FAQs can be viewed here.

  • 01/06/2022 9:11 AM | Rebekah Francis (Administrator)

    MGMA successfully advocates for sunsetting of healthcare ETS

    On Dec. 27, 2021, the Occupational Safety and Health Administration (OSHA) issued a statement on the status of its COVID-19 healthcare emergency temporary standard (ETS), confirming that it is withdrawing the ETS with the exception of the recordkeeping portions.

    Last August, MGMA urged OSHA to not make this standard permanent, due to it disrupting ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. Although OSHA is letting this ETS sunset, it expressed its intentions to revisit the issue of protecting healthcare workers from COVID-19 in the future by issuing another standard. MGMA will urge the Agency to solicit input from stakeholders, such as medical groups, when developing such a standard.

    Updated member resources to navigate surprise billing

    On Jan. 1, 2022, the No Surprises Act requirements prohibiting certain out-of-network balance billing and new uninsured (or self-pay) good faith estimate price transparency requirements took effect. Throughout 2021, the Biden Administration released several rules implementing these newly effective requirements. The Administration will continue to release additional rules throughout 2022 outlining the remaining patient protections that have not yet been implemented.

    The MGMA Government Affairs team has updated member-exclusive resources to help group practices better understand the requirements in place. Check out the most up-to-date resources on the MGMA Surprise Billing landing page.

    MIPS 2021 data submission window open

    Clinicians can now submit and review data for the 2021 performance year for the Merit-based Incentive Payment System (MIPS). The data submission window closes on March 31, 2022 at 8 p.m. (ET). The Centers for Medicare and Medicaid Services provided several flexibilities for clinicians due to the COVID-19 public health emergency, including applying an automatic reweighting of performance scores for individual clinicians.

    In other MIPS updates: on Jan 1. 2022, the 2022 payment adjustment, based on clinician 2020 MIPS performance scores took effect and will be applied to Part B covered services. Additionally, looking ahead to the 2022 performance year, clinicians can now review their preliminary MIPS eligibility by signing into the Quality Payment Program website
  • 12/17/2021 9:58 AM | Rebekah Francis (Administrator)

    MGMA to HHS: Provide flexibilities for surprise billing requirements

    In a letter to the U.S. Department of Health and Human Services (HHS), MGMA called for additional flexibilities for group practices as new surprise billing requirements are implemented on Jan. 1, 2022. The final rules implementing requirements related to surprise billing were released less than three months before their effective date, not allowing practices sufficient time to understand and implement new workflows in compliance with these new requirements.

    MGMA recently published a surprise billing FAQ and launched a new surprise billing landing page containing member-exclusive resources, advocacy materials, and federal resources to help guide practices as they begin complying with the new requirements in the new year.

    Dec. 31: Upcoming MIPS deadlines

    As 2021 comes to a close, clinicians must prepare for the upcoming deadlines for the Merit-based Incentive Payment System (MIPS) program. There are two key deadlines on Dec. 31, 2021:

    • EUC Application deadline for groups, virtual groups and APM entities, and
    • Virtual group election for PY 2022

    While the automatic and extreme and uncontrollable circumstances (EUC) policy applies to individual MIPS clinicians due to the COVID-19 pandemic, groups, virtual groups, and APM entities must apply to have performance categories reweighted for PY 2021. Virtual group election must be made before the start of PY 2022. More information about both of these deadlines may be found on the Quality Payment Program website.


  • 12/02/2021 4:43 PM | Rebekah Francis (Administrator)

    MGMA to Congress: Prevent cuts to Medicare in CY 2022

    On Monday, MGMA and hundreds of other healthcare organizations sent a letter to congressional leadership urging them to address the cuts to Medicare reimbursement slated to take effect Jan. 1, 2022. More specifically, the groups asked Congress to extend the 3.75% payment adjustment through at least CY 2022. Last year, Congress appropriated funds to the Medicare physician fee schedule (PFS) to mitigate cuts stemming from payment policy changes that went into effect in CY 2021. That 3.75% increase to the PFS expires at the end of this year. MGMA will soon share resources and grassroots letters addressing these impending cuts for members to engage in #MGMAAdvocacy! The letter may be viewed here.

    MGMA to Congress: Prevent cuts to labs in CY 2022

    This week, MGMA and two dozen other leading healthcare organizations wrote to Congress asking to extend the hold on laboratory payment cuts and the private payer data reporting period under the Clinical Laboratory Fee Schedule (CLFS) for a year. In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) with the goal of giving Medicare beneficiaries access to critical health services, such as laboratory tests. The way that the U.S. Department of Health and Human Services implemented PAMA led to severe cuts to laboratories under Medicare. The CARES Act, passed in 2020, delayed the implementation of the CLFS cuts in 2021. Without congressional intervention, physician office laboratories could see cuts up to 15% for tests. The letter may be viewed here.

  • 11/11/2021 9:12 AM | Rebekah Francis (Administrator)

    New MGMA vaccine mandate resource

    Last week, the Biden administration published new rules pertaining to COVID-19 vaccination and testing. To assist medical groups in navigating these complex mandates, MGMA Government Affairs created a new member-exclusive resource covering both mandates: (1) the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) published an emergency temporary standard (ETS) requiring employers with 100 or more employees to implement a COVID-19 vaccination and testing policy; and (2) the Centers for Medicare & Medicaid Services (CMS) issued an Interim Final Rule (IFR) requiring healthcare workers at facilities participating in Medicare and Medicaid to be fully vaccinated. Both mandates are slated to go into full effect on Jan. 4, 2022, although have already been challenged in court.

    Additional information:

    New MGMA surprise billing resource

    Several federal requirements related to surprise billing and related patient transparency requirements take effect on Jan. 1, 2022. To assist members in implementing these new requirements, MGMA Government Affairs created a member-exclusive resource outlining critical surprise billing policies impacting group practices.

    While the federal regulation of balance billing generally only applies to clinicians providing care at in-network facilities, other patient transparency requirements may impact clinicians providing care in group practice settings. MGMA will also be hosting a member-exclusive informational session and answering questions about the new surprise billing requirements later this month. More information will be posted in the member-exclusive Government Affairs Communities page in the coming weeks.

    Additional information:

  • 11/09/2021 3:09 PM | Rebekah Francis (Administrator)

    CMS finalizes 2022 Physician Fee Schedule

    On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) released the final 2022 Medicare Physician Fee Schedule rule, finalizing changes to physician payment policies, including changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements. Most of the final policies will take effect Jan. 1, 2022. MGMA submitted detailed comments in response to the proposed rule and thanks CMS for incorporating MGMA’s feedback into the final rule.

    CY 2022 CF:

    - Physician: $33.5983
    - Anesthesia: $20.9343

    Additional information:
    PFS fact sheet
    QPP fact sheet
    MGMA comments

    CMS finalizes 2022 outpatient facility and ambulatory surgical center rule

    On Nov. 2, CMS released the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. This rule finalizes CY 2022 OPPS and ASC payment rates and policies, including updates to improve transparency and quality reporting.

    Additionally, CMS is finalizing, as proposed, to use CY 2019 claims data for payment rate setting due to the impact of the COVID-19 public health emergency.

    Additional information:
    OPPS/ASC fact sheet
    CMS press release


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