News

AVAILABLE NOW: MEDICARE CUTS ADVOCACY
SOCIAL MEDIA TOOLKIT

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).

PROVIDER RELIEF FUND UPDATE:  AUDIT PORTAL

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).

FINAL 2023 MEDICARE PHYSICIAN FEE SCHEDULE

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.

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.

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 Toolkit. MGMA 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.

House passes MGMA-supported prior authorization legislation

Yesterday, the House of Representatives passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). This MGMA-supported bill is a step forward in reforming prior authorization practices within the Medicare Advantage (MA) program. In part, the legislation would increase transparency around MA prior authorization, establish an electronic prior authorization program, and streamline the prior authorization process for routinely approved items and services.

Keep the momentum going by contacting your senators and urging the swift passage of S. 3018. Medical practices can use MGMA’s Contact Congress portal to send letters today!

MGMA sends year-end legislative priorities to Congress

On Monday, MGMA sent a letter to congressional leadership outlining the legislative priorities that we would like addressed before the end of the year. Before 2023, MGMA urges Congress to mitigate cuts to Medicare reimbursement slated to take effect on January 1, extend telehealth flexibilities, reform prior authorization practices, and support value-based care.

Congress has since taken steps to address the Medicare cuts — the House of Representatives introduced the Supporting Medicare Providers Act of 2022 on Tuesday, which would avert almost 4.5% of the projected 8.5% cuts. MGMA supports this legislation, but calls on Congress to fully avert cuts to Medicare stemming from the 4% statutory Pay-As-You-Go (PAYGO) sequester and provide an inflationary updated based on the Medicare Economic Index. 

MGMA Government Affairs at MPE: Leaders Conference

MGMA’s annual Medical Practice Excellence (MPE): Leaders Conference is less than a month away. Register now to join us in Boston and attend one of our "Washington Update" sessions, during which the Government Affairs team will share insights on current federal policy developments impacting medical practice operations. We'll delve into upcoming Medicare payment and quality rules, the status of surprise billing and transparency requirements, information blocking, and other key regulatory changes to come in 2023.

Mark your calendars today for either of the below sessions and be sure to compare prepared with your questions!

• Monday, Oct. 10 at 9:15 - 10:15 a.m. ET
• Tuesday, Oct. 11 at 2:45 - 3:45 p.m. ET

MGMA provides feedback to CMS in response to the 2023 Medicare PFS

On Tuesday, Sept. 6, MGMA provided comprehensive feedback to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed 2023 Medicare Physician Fee Schedule (PFS). MGMA urges CMS to make important adjustments to the proposed policies to support medical group practices going into 2023, including updating the Medicare conversion factor to avert a 4.5% reduction in payment and adjusting certain reporting requirements under the Merit-based Incentive Payment System. In the coming weeks, MGMA will launch an advocacy campaign to avert these cuts.

The agency will review comments submitted by stakeholders before issuing the final rule in November. Following the release of the final rule, MGMA will provide an in-depth analysis of the 2023 Medicare policies.

Support prior authorization reform

With only a few months left in the 117^th Congress, it is time to voice your support for prior authorization reform! MGMA Government Affairs drafted a template letter that you can send directly to your members of Congress today. The letter urges Congress to pass the Improving Seniors’ Timely Access to Care Act, which puts commonsense guardrails around prior authorization processes in the Medicare Advantage program. With your help, MGMA hopes to see this legislation pass into law by the end of the year!

Final Reminder: Regulatory burden questionnaire closes Sept. 9

MGMA needs your feedback - complete the Annual Regulatory Burden Questionnaire by tomorrow, Friday, Sept. 9!

This annual research project is your opportunity to provide critical feedback on the impact that federal programs have on your practice. The findings of this research will guide MGMA's advocacy efforts in Washington, D.C., to improve the regulatory landscape in which group practices operate, including critical policies related to prior authorization, surprise billing, and the Quality Payment Program.

HHS expected to renew COVID-19 PHE in October

MGMA expects the U.S. Department of Health and Human Services (HHS) to renew the COVID-19 public health emergency (PHE) in October, since the 60-day notice period passed with no word from the Department. Recently, the Administration reiterated its promise to provide a 60-day notice prior to ending the PHE. If HHS does renew the PHE for an 11^th time, it is expected to be in effect through at least mid-January.

Last week, MGMA wrote to HHS Secretary Becerra, asking him to renew the PHE and provide medical groups at least a 90-days’ notice prior to ending it so they may sufficiently wind down flexibilities that have been in effect for over two years.

MIPS facility-based scoring unavailable in PY 2022

Due to the continued impact of COVID-19 on measure performance under the Hospital Value-Based Purchasing (VBP) program, the Centers for Medicare and Medicaid Services (CMS) announced that facility-based scoring will be unavailable in performance year (PY) 2022 under the Merit-based Incentive Payment System (MIPS). CMS utilizes performance under the Hospital VBP to calculate quality and cost scores under MIPS for facility-based clinicians and groups.

In 2022, affected clinicians must report MIPS quality measures; there are no reporting requirements under the cost performance category. However, CMS notes, that if facility-based clinicians or groups do not have available measures to report, they can submit a MIPS Extreme and Uncontrollable Circumstances Exception application to reweight selected performance categories. Additional information is available in the Quality Payment Program Resource Library.

CMS releases new IDR resources

Yesterday, CMS released new resources related to the federal Independent Dispute Resolution (IDR) process under the No Surprises Act. CMS launched a new page on the surprise billing website, linking helpful IDR resources and common mistakes when submitting a dispute resolution claim. Additionally, the agency published a new technical guidance document for IDR entities which includes additional information about eligibility for the federal IDR process, batching claims, and submission of supplemental information to IDR entities. 

While the resources will help practices better understand the IDR claim submission process, MGMA continues to advocate for critical improvements to be made to the IDR portal to streamline the dispute resolution process. Additional resources related to the requirements under the No Surprises Act are available on the MGMA surprise billing issue page.

Inflation Reduction Act slated to pass tomorrow

On Sunday, the U.S. Senate passed the Inflation Reduction Act of 2022 (IRA) by a 51-50 vote, with the Vice President breaking the tie. This legislation would, for the first time, provide the U.S. Department of Health and Human Services (HHS) Secretary the authority to negotiate the cost of certain drugs in the Medicare program and establish an annual out-of-pocket cap of $2,000 for Medicare beneficiaries. Price negotiation would first apply to 10 high-cost drugs under Medicare Part D in 2026, later expanding to certain high-cost physician administered drugs under Medicare Part B in 2028. In addition to updates to prescription drug policy, the IRA would also extend expiring tax subsidies under the Affordable Care Act and invest over $400 billion to address climate change.

The bill heads to the House tomorrow, Friday, August 12; pending its passage, the legislation is expected to then be immediately signed into law by the President. 

Join MGMA in a GovChat Live on August 23

The MGMA Government Affairs team is hosting a GovChat live on Tuesday, August 23, from 2:00 – 3:00 p.m. (ET). During this member-exclusive discussion, the team will provide a high-level overview of policies included in the 2023 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) proposed rule. 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. Additionally, we encourage you to review our member-exclusive key takeaway analysis of the 2023 PFS and QPP proposed rule if you haven't done so yet. Please reach out to the Government Affairs team at govaff@mgma.org with any questions.  

Post-pandemic flexibilities resource available now

Since January 2020, the HHS Secretary has determined that a public health emergency (PHE) has been in effect due to the COVID-19 pandemic. Under the declared PHE, HHS has the authority to waive certain program requirements, however, following the termination of the PHE, many of these flexibilities will expire. MGMA has published a member-exclusive resource highlighting key flexibilities that will expire after the end of the COVID-19 PHE to help practices prepare for policy changes post-pandemic.

The COVID-19 PHE is currently in effect through October 13, 2022, and MGMA anticipates HHS will again renew the PHE at that time.

CMS announces new oncology payment model

On June 27, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced the Enhancing Oncology Model (EOM), a new oncology payment model. Building off of lessons learned in previous oncology models, the EOM will be a nation-wide, episode-based payment model focused on patient-centered care delivery. Expected to launch in July 2023, the EOM request for applications is now open through September 30, 2022.

Updated resource highlights language access requirements

MGMA recently updated a key member resource outlining language access requirements for group practices. This resource reflects updates made in a 2020 final rule making changes to patient protections against discrimination in health programs and activities under Section 1557 of the Affordable Care Act. Please note, no changes to the language access requirements have been made since the 2020 final rule.

Final Reminder: Avert projected 7-10% Medicare payment cuts

The Medicare member research questionnaire to support #MGMAAdvocacy in averting potential significant payment cuts to Medicare in 2023 closes on Friday, June 24.

In 2023, group practices are facing potential 7-10% cuts to Medicare payment rates, compared to Jan. 1, 2022, reimbursement amounts. After two years of financial uncertainty caused by the COVID-19 pandemic, the projected payment cuts will have long-term resounding impacts on practice financial sustainability. MGMA needs to hear from you! If you haven't done so already, complete the questionnaire today!

Full Medicare sequester phase-in begins July 1

On July 1, 2022, the full 2% Medicare sequester is set to phase-in. The Medicare sequester, which has been in effect since 2013, was suspended at the beginning of the pandemic through March 31, 2022. On April 1, 1% of the full 2% sequestration was reintroduced, and on July 1, an additional 1% will phase-in, signaling the complete reintroduction of the Medicare sequestration. The 2% sequester will apply to care with dates of service on or after July 1.

Deadline to register for CAHPS for MIPS survey is June 30

The deadline for groups and virtual groups to register for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey closes on June 30, 2022, at 8 p.m. (ET). The CAHPS for MIPS survey is an optional quality measure that groups, virtual groups, and alternative payment model (APM) entities can report. The CAHPS for MIPS survey is a required measure for groups and APM entities reporting via the APM Performance Pathway.