• 12/05/2019 9:14 AM | Rebekah Francis (Administrator)

    MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the agency’s request for information on Medicare’s use of prior authorization. CMS is exploring the possibility of expanding the use of prior authorization for the Medicare program in an attempt to decrease cost. The Association highlighted the many administrative burdens physician practices face in meeting health plan prior authorization requirements and emphasized that these processes can delay or deny care to patients. MGMA recommended that Medicare limit any expansion of prior authorization, reduce the volume of prior authorization through exempting physicians who meet established clinical guidelines, and automate prior authorization in the limited situations when it is required.

  • 11/14/2019 9:33 AM | Rebekah Francis (Administrator)

    A small group of leading healthcare organizations, including MGMA, American Medical Association, American Hospital Association, America’s Health Insurance Plans, and Blue Cross Blue Shield Association were invited to meet with top officials of the Centers for Medicare & Medicaid Services (CMS), including Administrator Seema Verma, to discuss prior authorization challenges. With MGMA members ranking prior authorization as their leading administrative burden, Anders Gilberg, Senior Vice President of MGMA Government Affairs, took the opportunity to advocate for reducing the overall volume of authorization requirements through gold carding and eliminating authorizations for routine services with high health plan approval rates. He also emphasized to CMS the need to standardize health plan medical necessity requirements, called for transparency of health plan approval rates by service and provider, and encouraged automation of prior authorization processes by leveraging national standards for electronic transactions and electronic clinical documentation attachments.

  • 11/14/2019 9:33 AM | Rebekah Francis (Administrator)

    Medicare Open Enrollment ends on Dec. 7 and your Medicare patients may have questions about their benefits. The Department of Health and Human Services' Administration for Community Living has a resource for beneficiaries called the State Health Insurance Assistance Program. This free, federally-sponsored program serves to help beneficiaries understand their Medicare benefits and enrollment options.

  • 10/30/2019 7:30 PM | Rebekah Francis (Administrator)

    Members whose clinicians or practices submitted data for the MIPS Total Per Capita Costs for All Attributed Beneficiaries (TPCC) measure or the MIPS Medicare Spending per Beneficiary (MSPB) cost measure in 2018 can utilize a new resource from CMS.

    Individuals or groups can compare their costs for each measure with the benchmark provided in the performance user interface on the Quality Payment Program website to better understand their performance relative to their peers. MGMA has long called on CMS to provide better, actionable data to MIPS-participants related to the cost category. In response, the agency notes that this resource was created to help identify care coordination opportunities for patients and streamline resource use.
  • 10/30/2019 7:29 PM | Rebekah Francis (Administrator)

    MGMA submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) in response to the agency’s proposal to modify the privacy requirements for sharing substance use disorder (SUD) information. SAMHSA proposed a number of modifications to current regulations that could impact medical group practices. Patients would be required to designate a practice, as opposed to a specific individual as currently required, to receive their SUD information, which MGMA supports. While MGMA expressed support for practice access to SUD information in emergency situations and to all state Prescription Drug Monitoring Program (PDMP) information, we expressed concern that certain non-clinicians, including law enforcement officials, could be given access to SUD and other sensitive patient data via the PDMP. 

  • 10/30/2019 7:27 PM | Rebekah Francis (Administrator)

    Last week, the Centers for Medicare & Medicaid Services (CMS) opened the application period for the Primary Care First (PCF) advanced alternative payment model (APM) and also delayed the start date until Jan. 1, 2021. Practices applying to begin participation in 2021 will need to submit the application by Jan. 22, 2020. MGMA updated its member-resource outlining the PCF model to reflect these new details.

    CMS also opened the application period for the Kidney Care Choices model, which will close on Jan. 22, 2020. Applications for the Kidney Care First model have not yet been released. Stay tuned to the Washington Connection for further announcements. 

  • 10/10/2019 10:24 AM | Rebekah Francis (Administrator)

    The Department of Health and Human Services (HHS) released long-awaited proposals that modify the physician self-referral (Stark) and anti-kickback laws. The intent of the proposed rules is to create new exceptions that encourage value-based arrangements and allow for increased patient engagement.

    MGMA is evaluating these two proposed rules and will develop comments in the coming weeks. For more information, see HHS' press release.

  • 10/10/2019 10:23 AM | Rebekah Francis (Administrator)

    The 2019 MIPS performance year is in its final months and there are important steps participants can take to ensure successful data reporting. For participants utilizing EHR vendors to submit MIPS data, make time to check-in with those vendors to ensure they are on track to submit data during the submission period early next year. In the past, MGMA members have reported vendors experiencing glitches and computing issues when calculating scores. This is an issue MGMA Government Affairs tracks closely and members are encouraged to reach out to us if they encounter issues. As a reminder, Dec. 31 is the last day MIPS participants can apply for a Promoting Interoperability hardship exception and an extreme and uncontrollable circumstances application. Those that qualify will receive re-weighting of one or more MIPS performance categories.

  • 09/25/2019 4:18 PM | Rebekah Francis (Administrator)

    MGMA joined organizations representing clinicians, hospitals, health systems, and others in encouraging congressional leaders to ensure that the interoperability provisions of the 21st Century Cures Act of 2016 are implemented in a manner that best meets the needs of patients and those who deliver their care. The letter raised concerns that provisions of the recently-proposed Office of the National Coordinator for Health Information Technology interoperability rule, especially prohibitions against information blocking, could increase administrative burdens for practices and jeopardize the security of patient information. The letter called on the government to: 

    ·     Enhance the privacy and security of patient data being exchanged electronically; 

    ·     Ensure that appropriate implementation timelines are established, giving practices and their vendor partners sufficient time to deploy and test technology and take into account competing regulatory mandates; and

    ·     Use discretion in its initial enforcement of the data blocking provisions of the regulation, prioritizing education and corrective action plans over monetary penalties.

  • 09/25/2019 4:17 PM | Rebekah Francis (Administrator)

    The Department of Health and Human Services Office of the Inspector General (OIG) released a report finding that Medicare Part D beneficiaries face avoidable steps that can delay or prevent access to prescribed drugs. Based on 2017 data, the report found that Part D insurers rejected millions of prescriptions presented at pharmacies, yet overturned 73 percent of drug-coverage denials when beneficiaries appealed. The OIG signaled that some of these rejections could have been avoided if the prescribed drugs were on the approved lists, met requirements, or received any required preapprovals. OIG recommends that CMS:

    ·     Improve electronic communication between Part D insurers and prescribers to reduce avoidable pharmacy rejections and coverage denials; 

    ·     Reduce inappropriate pharmacy rejections; 

    ·     Reduce inappropriate coverage denials; and

    ·     Provide beneficiaries with clear, easily accessible information about Part D insurer performance problems, including those related to inappropriate pharmacy rejections and coverage denials.


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