• 10/29/2020 7:26 AM | Rebekah Francis (Administrator)

    HHS updates Provider Relief Fund reporting guidance again

    The Department of Health and Human Services (HHS) again modified its guidance around Provider Relief Fund (PRF) post-payment reporting requirements. Among other changes, HHS updated its definition of “lost revenues,” now defined as the difference between the 2019 and 2020 actual revenues from patient care. Previous guidance from September articulated a more restrictive view of what constituted “lost revenues” and drew concern from MGMA and other groups that HHS was narrowing the range of permitted uses of PRF payments. While this October update is a welcomed change, MGMA will continue to engage with HHS on PRF-related issues and advocate for improvements and clarifications.

    Advanced APM participants: Review public notice for missing payments by Nov. 13

    Following reports of missing payments, MGMA is advising all members that participated in an advanced APM in 2018 and earned a 5% bonus in 2020 to review CMS files to confirm that none of their clinicians eligible for an incentive bonus failed to receive a payment. CMS listed the names of clinicians it was unable to disburse payment to because of missing billing information in an Excel document contained in this 2020 QP Notice for APM Incentive Payment zip file. In order to receive payments, these clinicians or someone on their behalf will need to verify their Medicare billing information by Nov. 13, 2020. The zip file contains additional instructions.

    Even group practices that have already received a 2020 APM bonus payment and believed it to be complete should check this file for their clinicians' names. Several MGMA members in APMs were missing payments for certain clinicians, despite receiving an earlier payment to their tax identification number (TIN). It appears that CMS could not locate updated billing information for many physician assistants, in particular. The agency has not conveyed why there were issues with this provider type, but they appear to be disproportionately represented in the list of clinicians with missing billing information.

    2019 QPP preliminary performance results released

    CMS released additional information about aggregate 2019 performance in the Quality Payment Program (QPP) for both the MIPS and APM track. Some highlights include:

    • 6.83% (65,237) of MIPS eligible clinicians had one or more MIPS categories re-weighted due to the COVID-19-related extreme and uncontrollable circumstances policy.
    • 1.79% is the maximum positive MIPS payment adjustment in 2021 (for those that earned a perfect MIPS score in 2019).
    • The number of QPs in advanced APMs increased slightly in 2019 to 195,564 (from 183,306 in 2018).
    CMS also released supplemental data from the 2018 performance year of MIPS that provides more detail at the TIN/national provider identifier level. This information is sortable by variables like clinician type, practice size, scores, and payment adjustments. This may be helpful for those interested in drilling down on performance results.
  • 10/29/2020 7:23 AM | Rebekah Francis (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) announced it will delay the start date of the Radiation Oncology alternative payment model (APM) from Jan. 1, 2021, until July 1, 2021, based on feedback from MGMA and other radiation oncology stakeholders. MGMA appreciates the leadership of the American Society for Radiation Oncology (ASTRO) on efforts to improve this model and push back its launch until group practices are better prepared.

    MGMA joined ASTRO and others in expressing concerns about the model. We are pleased that CMS is delaying participation, but there is still work to be done to improve the model, including urging CMS to make participation voluntary, rather than mandatory.

    In an Oct. 2020 Stat poll, 76% of respondents indicated they do not support the government requiring participation in APMs. MGMA has long championed voluntary APM opportunities for physician group practices of different types, sizes, and specialties, but does not agree with requiring groups to experiment in untested demonstrations that lack evidentiary support. 

  • 10/15/2020 8:18 AM | Rebekah Francis (Administrator)

    New, simpler PPP forgiveness application available for loans      under $50k

    The U.S. Small Business Administration (SBA) released a new loan forgiveness
    application (SBA Form 3508S) for Paycheck Protection Program (PPP) loans of $50,000 or less. This application is intended to simplify the loan forgiveness process for borrowers by requiring fewer calculations and less documentation. Additionally, borrowers who use SBA Form 3508S are exempt from reductions in loan forgiveness amounts based on reductions in FTE count or in salaries or wages. As a reminder, SBA began approving PPP forgiveness applications and remitting forgiveness payments to lenders on Oct. 2, 2020.

    Advance Payment Program loan payback delayed, details released

    Following MGMA advocacy, Congress revised and improved repayment terms for the Medicare Advance Payment Program (APP) for those that accepted loans earlier this year. In response to recent legislative changes, CMS issued guidance stating the claims recoupment process is automatically stayed for one year starting from when the APP loan was issued. After one year, Medicare payments will be recouped at a rate of 25% for 11 months and 50% for another six months. Once this 29-month timeframe expires, local Medicare Administrative Contractors (MACs) will issue a letter for payment of any remaining balance. Medical group practices that want to begin payments sooner or make lump sum payments should contact their MAC.

    MGMA encourages legislation to prevent Medicare payment cuts

    MGMA joined over 60 organizations to express appreciation for legislation that would prevent drastic payment cuts to various sections of the provider community by waiving Medicare’s budget neutrality requirement. The Centers for Medicare & Medicaid Services’ final Medicare Physician Fee Schedule for 2020 included welcomed changes to reduce administrative burden and improve payment rates for E/M services. However, adhering to existing budget neutrality requirements will result in sizable cuts to various specialties starting Jan. 1, 2021. MGMA appreciates Rep. Burgess and Rep. Rush’s leadership in introducing legislation (H.R. 8505) that would prevent pending Medicare payment cuts by waiving budget neutrality requirements for one year and looks forward to working with Congress on a viable legislative solution before the end of the year.

    OCR issues additional HIPAA right of action fines 

    The Office for Civil Rights (OCR), the agency that enforces HIPAA privacy and security, announced two new settlements with providers over separate HIPAA right of access violations. The HIPAA right of access establishes the right of patients to obtain access to their medical records in a timely fashion, for a reasonable fee, and in their requested format. The two organizations, a practice with offices in New York and Florida and an Arizona hospital system, failed to provide patients timely access to their health information. The practice paid OCR a settlement of $100,000 and the hospital system paid a settlement of $160,000, with each organization required to adopt a corrective action plan. To learn more about these HIPAA right of access issues, download the member-benefit resource The Patient Right to their Medical Record: Format, Fees and other Requirements

  • 10/08/2020 8:12 AM | Rebekah Francis (Administrator)

    Secretary of Health & Human Services (HHS) Alex Azar renewed the COVID-19 public health emergency, effective Oct. 23, 2020, which means that all current Medicare telehealth waivers and other flexibilities are also extended. The renewed pubic health emergency declaration will terminate 90 days thereafter, on Jan. 21, 2021, unless it is renewed again.

    MGMA has advocated for renewal of this declaration as practices continue to need regulatory flexibility and expanded reimbursement for virtual care. Previous renewals were issued at the last minute, so MGMA appreciates the advanced notice of the most recent announcement. For more information on regulatory waivers, visit our COVID-19 Action Center.

  • 10/08/2020 7:49 AM | Rebekah Francis (Administrator)

    New round of Provider Relief Fund payments available

    HHS announced that applications will be accepted from Oct. 5 through Nov. 6 for $20 billion in new funding under “Phase 3” of the Provider Relief Fund General Distribution. Under this new phase, providers that have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and changes in operating expenses due to COVID-19. HHS also expanded eligibility for payments in Phase 3, so groups that have not received Provider Relief Fund payments to date should check new eligibility criteria.

    If an applicant has not yet received (and retained) a payment equal to approximately 2% of annual revenue from patient care as part of either Phase 1 or 2 of the General Distribution, then they should receive at least that amount in Phase 3. Groups that already received payments at or above 2% of annual revenue can also apply and potentially receive additional payments. However, HHS indicates it will determine final payment amounts for those applicants once all applications have been received and reviewed. For more information on Phase 3, including the application, instructions, and FAQs, visit the Provider Relief Fund website.

    Member-benefit HIT webinar now available on-demand

    The MGMA Government Affairs member-benefit webinar on the most critical health information technology (HIT) issues facing medical practices today and MGMA’s current HIT advocacy priorities is now available on-demand. Topics covered on the program included the information blocking and Application Programming Interface requirements included in the recently released interoperability regulations, cybersecurity concerns and solutions, updates to the Appropriate Use Criteria program, and the latest on administrative simplification efforts to improve practice revenue cycle operations.

    MGMA urges adoption of operating rules to improve prior auth 

    MGMA joined the American Hospital Association, the American Medical Association, and the Arthritis Foundation calling on the National Committee on Vital and Health Statistics (NCVHS) to endorse proposed operating rules to reduce burdens associated with prior authorization. NCVHS, a federal advisory body, is currently deliberating whether to recommend national adoption of operating rules that would set new data content and timing mandates on health plans, including a requirement that plans respond within two business days following an authorization request from a practice and respond with the additional documentation needed to complete the request. Under the proposal, plans would also have a maximum of two business days to send a final determination once they receive all requested information.

    MGMA to CMS: Revise radiation oncology APM 

    In a letter to CMS, MGMA along with radiation oncology and other physician groups asked for critical changes to the new radiation oncology (RO) alternative payment model (APM). In particular, we urged the agency to push back the mandatory payment model to January 2022, develop more appropriate opt out mechanisms, and revise the model’s payment cuts. While MGMA is very supportive of expanding opportunities to join APMs, we do not support requiring medical groups to participate in untested demonstrations, particularly at a time when COVID-19 is creating financial strain and uncertainty.

    Under current model rules, CMS will require participation from providers in randomly selected locations across the country starting Jan. 1, 2020. The RO model tests episodic payments for certain radiotherapy providers and has the potential to be a promising APM, however MGMA is concerned that the potential for downside risk is too significant and is recommending that the model be voluntary.

  • 10/02/2020 5:25 PM | Rebekah Francis (Administrator)

    MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the proposed 2021 Medicare Physician Fee Schedule (PFS). Our comprehensive comments address the direct concerns and feedback we have heard from members, particularly as they continue to face challenges resulting from the COVID-19 pandemic. In our comments, MGMA recommends that CMS:

    • Continue to reimburse audio-only remote visits at a rate that adequately covers the cost of care.
    • Move forward with implementing improvements to Evaluation and Management office visits on Jan. 1, 2021, but take action to prevent physician payment cuts due to budget neutrality adjustments.
    • Delay proposed changes to Medicare Shared Savings Program ACO quality reporting.
    • Implement an automatic hardship exception for participants in the Merit-based Incentive Payment System for the 2020 and 2021 performance years, similar to the policy implemented for the 2019 performance year.
    The final PFS is typically released on or around Nov. 1 each year, but due to the pandemic, CMS stated that the final 2021 PFS may be released closer to Dec. 1
  • 10/01/2020 9:37 AM | Rebekah Francis (Administrator)

    MGMA-supported APP fixes signed into law

    This week, Congress passed a continuing resolution (CR) to fund the government through Dec. 11, 2020. The CR, which was signed into law early this morning, also contains important revisions to the Medicare Accelerated and Advance Payments program (APP), improving harsh repayment terms that could have resulted in loan recoupment at a time when groups are still experiencing cash flow issues. As a result of MGMA advocacy, the CR:

    • Postpones the recoupment of disbursed funds until 365 days after the advance payment has been issued to a physician practice;
    • Extends the repayment timeline so that the loan balance is not due until September 2022;
    • Reduces the per-claim recoupment amount from 100 percent to 25 percent for the first 11 months and then 50 percent of claims withheld for an additional six months; and 
    • Lowers the interest rate from 10.25 percent to 4 percent for loans not repaid in full by September 2022.

    MGMA calls for delay of information blocking enforcement

    MGMA joined seven leading healthcare organizations urging the Office of the National Coordinator for Health Information Technology (ONC) to delay enforcement of the information blocking regulations. Due to the impact of the COVID-19 pandemic, the coalition called on ONC to extend enforcement discretion by a minimum of one year to help ensure providers have adequate time to prepare their organizations for the new requirements. The coalition also called for any extension to be harmonized with information blocking attestation responsibilities under the Promoting Interoperability component of the Merit-based Incentive Payment System. To learn more about the information blocking final rule, download this member-benefit resource.
  • 10/01/2020 9:34 AM | Rebekah Francis (Administrator)

    President Trump signed an executive order (EO) on Sept. 24 outlining his America First Healthcare Plan, which addresses his Administration’s stance on surprise medical bills and preexisting conditions. The EO does not on its own create new substantive policies absent regulation or legislation and therefore is considered largely symbolic and a representation of Trump’s healthcare platform leading into the election. The major provisions of the EO are as follows:

    • Affordable Care Act (ACA): The EO reiterates the Administration’s support for repealing the ACA, but retaining protections for individuals against insurance discrimination based on preexisting conditions. Whether the Administration has authority to require private health insurers to offer coverage to individuals with preexisting conditions, absent legislative authority such as in the ACA, is unclear. While supporting repeal of the ACA, the EO conveys support for giving “Americans seeking healthcare more choice, lower costs, and better care.”
    • Surprise Billing: The EO pledges the Administration’s support for congressional action to protect individuals from surprise medical bills and sets a deadline of Jan. 1, 2021, for Congress to pass a legislative solution. If this timeline is not met, the EO calls on the Department of Health & Human Services (HHS) to “investigate regulatory action.” There have been no specifications provided as to what action HHS would take; Sec. Azar instead stated in a press meeting on the EO that he hopes stakeholder groups will work on a solution with Congress. While Congress has heavily debated surprise billing legislation, it has yet to pass any major legislation on this issue.
  • 09/17/2020 9:07 AM | Rebekah Francis (Administrator)

    CMS begins disbursing 2018 performance year advanced APM incentive payments

    Group practices that participated in an advanced alternative payment model (APM) in 2018 should be receiving their bonus payments this week if participating clinicians achieved qualifying participant (QP) status by meeting patient or payment thresholds in 2018. Bonuses may have been transmitted as early as Friday, Sept. 11, and electronic deposits may be labeled as “CMMI QPP MEDICARE.” Payments are generally made to the tax identification number (TIN) associated with the QP’s participation in the advanced APM. The Centers for Medicare & Medicaid Services (CMS) announced that it was unable to verify current Medicare billing information for some QPs and therefore was unable to issue payments. If you expected to receive a payment but have not, please take note of the CMS’ regulatory filing providing instructions for updating billing information. Updated information must be submitted by Nov. 13 (note that early versions of CMS’ instructional document list an incorrect deadline of Nov. 10; MGMA reached out to CMS and confirmed that the correct deadline is Nov. 13). The bonus is 5% of aggregate payments for covered professional services billed by QPs across all TINs associated with the QP in the calendar year immediately preceding the payment year (in this case, 2019).

    DOL issues new regulations modifying employee leave rules

    Following a New York federal court decision that vacated several aspects of the Department of Labor’s (DOL) regulations under the Families First Coronavirus Response Act (FFCRA), DOL issued new regulations addressing employee leave eligibility and entitlement. Specifically, DOL narrowed its definition of who a “healthcare provider” is for purposes of being excluded by their employer from receiving FFCRA paid leave. In a departure from its previous definition, DOL stated that a person is not a healthcare provider merely because his or her employer provides healthcare services. Therefore, IT professionals, HR personnel, billers, building maintenance staff, and others are not considered healthcare providers within the meaning of the regulations and therefore are not eligible for exclusion from FFCRA leave. For more information on the revised regulations, reference DOL’s updated FAQ and MGMA’s updated FFCRA resource.

    2019 MSSP ACO results announced

    The 541 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) generated nearly $1.2 billion in net savings in 2019, the highest number to date for the program. ACOs saved $739 million in 2018 and $313 million in 2017. CMS Administrator Seema Verma announced the results in a blog post on Health Affairs, which includes links to more comprehensive data files. MSSP ACOs share in any savings generated for Medicare if they meet certain spending and quality metrics. The MSSP is the largest Medicare APM and began in 2012.

  • 09/10/2020 8:54 AM | Rebekah Francis (Administrator)

    Deadline approaching: Sept. 13 is last day to apply for Provider Relief Fund

    Eligible Medicaid, Children’s Health Insurance Program, and certain Medicare providers have until Sept. 13 at 11:59 pm ET to apply for funding from the Phase 2 of the Provider Relief Fund (PRF) General Distribution. The application portal will allow eligible providers to submit their Tax ID Number and most recent federal income tax return to be considered for funding. For more information on the PRF, review MGMA’s resource.

    New CMS Care Compare tool now combines Medicare cost and quality data

    The Centers for Medicare & Medicaid Services (CMS) has announced the launch of Care Compare, a new comparison tool that incorporates the agency’s previously existing transparency tools, including Physician Compare. In one location, Medicare beneficiaries are able to review a variety of information including cost and quality data on providers and procedures. Providers and groups will continue to use PECOS to make updates to information such as group affiliation and address updates.


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