• 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.
  • 09/03/2020 8:56 AM | Rebekah Francis (Administrator)

    Clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2019 can review their performance feedback, MIPS final score, and 2021 payment adjustment factor on the Quality Payment Program (QPP) website. If you believe there is an error in your group practice or clinician's 2021 MIPS payment adjustment calculation, you can request a targeted review via the QPP site until Oct. 5, 2020, at 8:00 PM ET. Some examples of potential issues where MIPS participants may want to request a targeted review include:

    • Errors or data quality issues for the measures or activities you submitted;
    • Eligibility and special status issues (e.g., the participant falls below the low-volume threshold and should not receive a payment adjustment); or
    • Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard.
  • 09/03/2020 8:41 AM | Rebekah Francis (Administrator)

    QPP eCQM scoring issue 

    The Centers for Medicare & Medicaid Services (CMS) is alerting group practices to a calculation issue that impacts electronic clinical quality measure (eCQM) scoring during the 2020 quality performance year. eCQMs are used in several programs, including the Quality Payment Program. This issue has the potential to impact scoring for three specific measures when certain time values are not present in the input data. The erroneous calculation may result in an increase or decrease of cases that fall in the measure population.

    Impacted measures:

    • CMS128v8 Anti-depressant Medication Management
    • CMS146v8 Appropriate Testing for Children with Pharyngitis
    • CMS56v8 Functional Status Assessment for Total Hip Replacement

    CMS has published updated measure packages to correct the issue for all three impacted eCQMs here. Physician practices that are reporting on the measure(s) should contact their EHR vendors to determine if updates are warranted.

    Congress set to return to DC next week

    When Congress returns to Washington next week, they will face two major hurdles—government funding and COVID-19 relief. Congress has until Sept. 30 to fund the government or face a potential government shutdown. It is possible that COVID-19 relief measures will get wrapped into a final package that includes government funding. To that end, MGMA members are encouraged to send a letter to their congressional representatives urging their support of physician practices during COVID-19 using our Contact Congress portal.

  • 08/06/2020 8:51 AM | Rebekah Francis (Administrator)

    Help #MGMAAdvocacy: Urge Congress to support physician practices during COVID-19 pandemic

    As Congress continues to negotiate the next COVID-19 package, it is imperative that they hear from physician practices. Use MGMA’s template letter to tell Congress that any final legislation must:

    ·     Include direct financial support to medical groups experiencing an adverse economic impact from COVID-19;

    ·     Continue telehealth flexibilities past the expiration of the public health emergency;

    ·     Add flexibilities for Medicare accelerated and advance payments, such as eliminating interest rates and lowering recoupment amounts; and

    ·     Amend the Paycheck Protection Program (PPP) to provide a more simplified process for borrowers seeking PPP loan forgiveness, include personal protective equipment as an eligible covered cost, and allow for 501(c)(6) nonprofit organizations to be eligible for PPP loans.

    Thank you for joining our advocacy effort and supporting medical practices during the COVID-19 pandemic! 

    SBA releases new PPP forgiveness information

    The Small Business Administration (SBA) released new PPP FAQs that address eligible payroll and nonpayroll costs as well as loan forgiveness reductions. More specifically, SBA provides new information regarding costs incurred before the Covered Period and further details how to determine the amount of owner compensation eligible for loan forgiveness. As a reminder, absent further congressional action, the last day to apply for a PPP loan is Aug. 8, 2020. 

    MGMA calls on CMS to delay and modify Advance Payment Program loan repayment

    MGMA is urging the Centers for Medicare & Medicaid Services (CMS) to delay repayment of Medicare Accelerated and Advance Payment Program (APP) loans. In addition to suspending repayment for one year, the Association is calling on policymakers to extend the repayment period to two years and waive interest during the extended period. 

    Congress expanded the APP earlier this year to give providers access to cash flow. CMS opened applications for the program in late March but ceased accepting applications by April 26. Under current program rules, repayment begins 120 days after the advance payment was issued, which is as early as the first week of August. Loans that are not repaid in full within 210 days from the date the payment was received will be subject to interest rates of 10.25%.

    MGMA to Congress: Expand Medicare telehealth beyond COVID-19 pandemic 

    MGMA joined over 200 organizations in support of the Protecting Access to Post-COVID-19 Telehealth Act of 2020. If signed into law, this legislation would remove geographic restrictions on where a patient must be located to utilize telehealth services, enable patients to receive telehealth services in their homes, allow federally qualified health centers and rural health centers to furnish telehealth, and give the Secretary of Health & Human Services (HHS) permanent waiver authority for future emergency periods and for 90 days past the expiration of the current public health emergency. Absent congressional action, the ability for patients to utilize telehealth in nonrural settings and in their homes is only in effect during the public health emergency. MGMA urges Congress to act before the public health emergency ends to avoid a scenario where providers are abruptly unable to treat most Medicare beneficiaries via telehealth.

    HHS to reopen Provider Relief Fund applications for certain Medicare providers

    HHS announced it will allow a second opportunity for Medicare providers to access payments from the CARES Act Provider Relief Fund (PRF). Starting the week of Aug. 10, HHS will permit Medicare providers that missed the opportunity to apply for additional funding from the $20 billion second tranche of the $50 billion Medicare General Distribution. This opportunity will also be opened to Medicare providers that experienced a change in ownership in 2020 and therefore failed to receive a PRF payment based on 2019 CMS claims data. Both groups of providers will have until Aug. 28 to submit their revenue information to be considered for additional funding. Additional information on this second funding opportunity is expected via the PRF webpage next week.

  • 08/04/2020 12:21 PM | Rebekah Francis (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) released the proposed 2021 Medicare physician fee schedule (PFS) rule late this evening, which includes proposed changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2021. Key proposals include:

    ·     Setting 2021 Medicare payment rates for physician services;

    ·     Generally confirming E/M documentation guidelines and payment changes finalized in the 2020 PFS;

    ·     Expanding telehealth coverage; and

    ·     Establishing MIPS reporting requirements for 2021.

    MGMA will submit detailed comments in response to these proposals to CMS and prepare a more detailed analysis of proposed changes in the coming weeks. Review the proposed rule, the PFS fact sheet, and the QPP fact sheet. The final 2021 PFS rule is expected by Nov. 1, 2020.
  • 07/30/2020 7:47 AM | Rebekah Francis (Administrator)

    MGMA advocacy update: New bill improves APMs, ACOs

    MGMA supports a recently introduced House of Representatives bill, the Value in Health Care Act, which makes important updates to Medicare alternative payment models (APMs). The Act would:

    ·     Extend the advanced APM bonus for an additional six years (from 2024 to 2030);

    ·     Provide a mechanism to receive advanced funding to join an accountable care organization (ACO);

    ·     Increase the shared savings rate for Medicare Shared Savings Program (MSSP) ACOs;

    ·     Make other technical updates to MSSP benchmarking and risk adjustment methodologies. 

    Secretary Azar renews public health emergency, continuing telehealth flexibilities

    Following MGMA advocacy, Department of Health & Human Services Secretary Alex Azar renewed the declaration that a national public health emergency exists due to COVID-19. The renewal is effective July 25, 2020 until October 23, 2020, unless the Secretary terminates it earlier. The public health emergency declaration must be renewed every 90 days to remain active. This renewed declaration authorizes HHS to continue implementing important telehealth and other flexibilities. To learn more about emergency declarations, review MGMA’s new resource. 

    CAQH seeks input on prior authorization burdens

    The 2020 CAQH Index survey is now open, and practice leaders are encouraged to share their perspectives and experiences. This year the Index will focus on prior authorization, assessing the resources needed to determine if a prior authorization is required, gathering information to populate the authorization, following up after the initial submission, and submitting additional clinical information. The survey will also measure practice use of manual versus automated administrative transactions, including insurance eligibility verification, claim payment, and remittance advice. The cost that practices incur to conduct these transactions with health plans will also be measured. The results of this research will help MGMA advocate for improved transactions and decreased administrative costs for practices. Respondents receive an honorarium and individualized reports. MGMA serves on the CAQH Index Advisory Board. 

    UnitedHealthcare to phase out paper checks

    UnitedHealthcare (UHC) announced a new claim payment policy that seeks to eliminate paper checks and requires practices move to electronic funds transfer (EFT) payments. Beginning next month for its commercial lines of business, UHC is starting a campaign of emails, letters, and phone calls to encourage practices that have not already enrolled in its EFT program to do so. UHC’s Medicare Advantage plans will start later in the fall and Community and Medicaid plans in 2021. Those practices who refuse to move to EFT will be paid using “virtual” credit cards and incur credit card merchant fees. Practices can sign up for the UHC EFT program and view the enrollment guides here. The MGMA member-benefit EFT-ERA Guide outlines the benefits of moving to automated payments.


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