• 08/12/2021 7:55 AM | Rebekah Francis (Administrator)

    Biden administration proposes to rescind MFN model

    After pushback from MGMA and other industry stakeholders, the U.S. Department of Heath and Human Services (HHS) proposed to withdraw the Trump administration’s Most Favored Nation (MFN) model. The mandatory model would have tied reimbursement for Medicare Part B drugs to prices paid in other countries, resulting in lower reimbursement rates to physician practices. The model and corresponding rule was finalized in late 2020, but blocked by federal judges and subsequently frozen by President Biden. Although HHS proposes to rescind the MFN model, it is clear that the Biden administration and Congress will look for other avenues to curb rising drug prices.

    Support advocacy to remove patient cost sharing for CCM services

    Join #MGMAAdvocay efforts by sending a template letter to your congressional representative urging for support of the recently introduced legislation to improve patient access to chronic care management (CCM) services. MGMA sent a letter alongside numerous other national stakeholder groups supporting the reintroduction of the Seniors’ Chronic Care Management Improvement Act of 2021. This important legislation would remove the 20% patient co-insurance amount for CCM services, reducing administrative burdens and enabling group practices to utilize these services to better manage the chronic conditions of their patients. Send a letter to your representative today!

    Can't miss resource: 2022 Medicare Physician Fee Schedule analysis

    The CY 2022 Physician Fee Schedule proposed rule includes many complex policy proposals, and the MGMA member exclusive key takeaway analysis highlights the top policy proposals impacting group practices. This can’t miss resource will help you and your practice understand and anticipate proposed changes to physician payment in CY 2022. The proposed rule includes policy proposals that would update the annual conversion factor, make changes to telehealth covered services, modify the definition of an E/M split (or shared) visit, and introduce the Merit-based Incentive Payment System Value Pathways as a voluntary reporting option for the 2023 performance year. This resource is only the first opportunity to engage with MGMA to understand the changes to physician payment in 2022, so be on the lookout for other key insights and resources from MGMA.

  • 07/29/2021 10:23 AM | Rebekah Francis (Administrator)

    MGMA to Congress: Prevent Medicare cuts in 2022

    MGMA and other leading health organizations wrote to Congress urging for a legislative solution to avoid Medicare reimbursement cuts in CY 2022. Specifically, the letter calls for Congress to maintain the 3.75% increase to the Medicare conversion factor through at least CYs 2022 and 2023. Following #MGMAAdvocacy, Congress mitigated the significant cuts slated for CY 2021 by injecting $3 billion into the physician fee schedule, which resulted in a 3.75% increase to the conversion factor. MGMA will continue to work with Congress to avoid further cuts in CY 2022.

    Hundreds of stakeholders ask Congress to make telehealth flexibilities permanent

    MGMA and hundreds of other stakeholders sent a letter to congressional leadership this week highlighting shared Medicare telehealth reform priorities and voicing concern over the “telehealth cliff,” which would occur once the COVID-19 public health emergency (PHE) ends. In part, the groups asked to permanently remove geographic and originating site restrictions, remove the in-person visit requirement for mental telehealth services, and allow for audio-only reimbursement when clinically appropriate. Currently, most telehealth flexibilities are only in effect through the duration of the COVID-19 PHE. MGMA will continue to engage with Congress and the Administration to craft policies that allow medical practices to leverage telehealth to reach vulnerable patients while maintaining continuity of care.

    Tell Congress to support improvements to APMs

    Join #MGMAAdvocacy efforts to support recently reintroduced legislation that will make improvements to accountable care organizations (ACOs) and other alternative payment models (APMs) by sending a template letter to your congressional representatives. MGMA worked in tandem with the bill’s cosponsors and other national stakeholder groups to ensure that the Value in Health Care Act would be reintroduced. In addition to modifying and extending the advanced APM bonuses through 2030, the bill would make important modifications to risk adjustment rules and fix the “rural glitch” for ACOs in the Medicare Shared Savings Program. Send a letter to your representatives today!

  • 07/22/2021 8:37 AM | Rebekah Francis (Administrator)

    MGMA joined 13 other national health stakeholder groups in supporting the reintroduction of the Value in Health Care Act, a bipartisan House bill that would help to accelerate the move to value-based care models in the Medicare program. Specifically, the bill would strengthen Medicare accountable care organizations (ACOs) and other alternative payment models (APMs) by:

    • Providing a mechanism to receive advanced funding when joining or advancing in an ACO;

    • Extending the advanced APM incentive payments for an additional six years through 2030;

    • Increasing shared savings rates for ACOs in the Medicare Shared Savings Program (MSSP); and

    • Making other technical improvements to MSSP by modifying benchmarks and risk adjustment methodologies.

  • 07/22/2021 8:36 AM | Rebekah Francis (Administrator)

    Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective July 20, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to this determination. As with previous determinations, the renewed PHE will end 90 days after its effective date on Monday, Oct. 18, 2021, unless it is extended further. The Biden Administration has indicated that it intends to continue renewing the COVID-19 PHE at least for the remainder of 2021 and to provide the healthcare community with 60 days' notice prior to allowing the PHE to lapse.

  • 07/08/2021 12:20 PM | Rebekah Francis (Administrator)

    Last week, the Department of Health and Human Services (HHS) released its first regulation implementing parts of the No Surprises Act, which was passed late last year. This interim final rule is the first of several rules in the surprise billing area that HHS plans to issue over the coming months. The law goes into effect on Jan. 1, 2022.

    For more information, review HHS’ fact sheet and the interim final rule. MGMA will release a comprehensive analysis of the rule to members in the coming weeks.

  • 07/08/2021 12:19 PM | Rebekah Francis (Administrator)

    As a reminder, the Provider Relief Fund (PRF) Reporting Portal is open for recipients to report on funds (exceeding $10,000 in aggregate) received from April 10, 2020 to June 30, 2020. Providers who received one or more payments exceeding $10,000 in the aggregate during one of the four Payment Received Periods are required to report in each applicable reporting period. Following #MGMAAdvocacy efforts, providers now have 90 days, instead of 30, to report their use of funds. For more information, see MGMA’s updated PRF resource.

  • 07/01/2021 4:38 PM | Rebekah Francis (Administrator)

    This afternoon, the Department of Health and Human Services (HHS) released its first regulation implementing provisions of the No Surprises Act. On Dec. 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021, with the goal of protecting patients from receiving surprise medical bills. The law, in part, allows providers and insurers to use an independent dispute resolution (IDR) process when disagreements arise over reimbursement. MGMA was successful in advocating that Congress forbid arbitrators from considering public payer reimbursement rates during the IDR process. The law goes into effect on Jan. 1, 2022.

    For more information, review HHS’ fact sheet and the interim final rule. MGMA will release a comprehensive analysis of the rule to members in the coming weeks.

  • 07/01/2021 8:47 AM | Rebekah Francis (Administrator)

    Staff Contact: Daniel Landon or Rob Monsees

    The Missouri House of Representatives approved legislation to reauthorize the hospital Federal Reimbursement Allowance and the other state provider taxes. The reauthorization extends for three years through Sept. 30, 2024. Senate Bill 1 also bans Medicaid coverage of abortifacient drugs and devices used for the purpose of inducing an abortion. As with the current Medicaid abortion coverage ban generally, the abortifacient ban does not apply when a physician certifies that a continued pregnancy would endanger the life of the mother. The legislation also states that if one of its components is held invalid, the remainder of the legislation will remain in force.

    The state Senate developed and passed the legislation last week, and Gov. Parson is expected to sign it into law. The governor previously released a list of $722 million in spending cuts throughout the state budget, announcing that they could be averted only if state legislators reauthorized the provider taxes in a legislative special session before the start of the state fiscal year on Thursday, July 1. 

    With the enactment of the provider tax reauthorization legislation, the governor is expected to proceed with approving the legislation creating the state’s budget for the next fiscal year.

  • 07/01/2021 8:46 AM | Rebekah Francis (Administrator)

    Earlier this week, MGMA sent a letter to the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) asking it to rescind or delay its emergency temporary standard (ETS) aimed at protecting workers facing the highest coronavirus hazards — those working in healthcare settings where suspected or confirmed coronavirus patients are treated. MGMA believes the ETS was issued much too late and will disrupt the ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. MGMA hopes that OSHA will rescind the ETS, or at a minimum, delay its effective date until stakeholders have adequate opportunity to provide input on the standard.

  • 07/01/2021 8:46 AM | Rebekah Francis (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) announced that 2021 alternative payment model (APM) incentive payment details are now available on the QPP website. After logging in, organizations will be able to see the amount paid for eligible clinicians that achieved qualifying participant (QP) status during the 2019 performance year. Clinicians who were QPs in an advanced APM entity in 2019 should begin receiving a 5% APM incentive payment this month.

    No action is required to receive these payments unless CMS is unable to verify a clinician's Medicare billing information. If payment is not received, check the CMS public notice, which indicates the names of clinicians whose billing information could not be verified. Such clinicians will need to verify their Medicare billing information by November 1, 2021, in order to receive their APM incentive payment. For additional information, download CMS' 2021 Learning Resources for QP Status and APM Incentive Payment zip file.


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