• 03/31/2022 7:24 AM | Rebekah Francis (Administrator)

    MGMA submits comments on prior authorization automation

    Last week, MGMA submitted comments to the Office of the National Coordinator (ONC) on electronic prior authorization (ePA).  Within the comments, MGMA outlines key recommendations and considerations including its primary goal of reducing the number and frequency of PA, noting that without addressing broader PA, automation could simply increase PA.

    While reiterating support for ONC's goal to advance ePA, MGMA also encourages ONC, as well as the Centers for Medicare & Medicaid Services (CMS), to identify and consider other areas of reform. MGMA believes that the burden associated with PA could be reduced through automation, but only if implemented appropriately. Proper implementation includes robust piloting and testing, as well as ensuring an appropriate timeline for implementation. It also includes ensuring there are adequate guardrails in place.

    PA requirements continue to increase year after year. To get involved in #MGMAAdvocacy on the matter, send a template letter to Congress advocating for commonsense PA reforms in the Medicare Advantage program!

    President Biden releases FY 2023 budget request

    On Monday, President Biden released his $5.8 trillion budget proposal for fiscal year (FY) 2023, which included several healthcare related policies that would support the temporary expansion of telehealth, bolster access to behavioral health, and make investments for future pandemic preparedness. The FY 2023 budget also includes a proposal to cut the nation’s deficit by $1.3 trillion from last year.

    Presidential budgets do not have the force of law and are intended to serve as statements of administrative priorities, while Congress negotiates the budget. MGMA will continue to advocate on behalf of our members throughout the budget negotiation process.

     MGMA to CMS: Improving health equity within value-based care

    Yesterday, MGMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) providing feedback to the agency on how to support practices in value-based care arrangements and improve health equity. CMS recently hosted a roundtable discussion with leaders across the healthcare industry to identify how CMS can support safety net providers participating in payment models.

    Within the comments, MGMA recommended CMS expand the definition of safety net to include small and rural practices, as they similarly provide critical care to sicker, poorer, and disadvantaged patient populations. Extending support within value-based care to these practice types will help CMS achieve their goal to improve health equity within the healthcare system.

  • 03/24/2022 9:12 PM | Rebekah Francis (Administrator)

    COVID-19-era Uninsured Program runs out of funds

    The Health Resources & Services Administration (HRSA) is no longer accepting COVID-19 testing and treatment claims — and will soon stop accepting vaccination claims — made under the Uninsured Program due to lack of sufficient funds. The Uninsured Program was established during the pandemic to provide claims reimbursement to healthcare providers generally at Medicare rates for testing uninsured individuals for COVID-19, treating uninsured individuals with a positive COVID-19 diagnosis, as well as administering COVID-19 vaccines to uninsured individuals.

    Claims submitted prior to the below deadlines will be paid subject to the availability of funds:

    • On March 22, 2022 at 11:59 p.m. ET, the Uninsured Program stopped accepting claims for testing and treatment

    On April 5, 2022 at 11:59 p.m. ET, the Uninsured Program will also stop accepting vaccination claims

    2021 MIPS data reporting period ends March 31

    The data reporting period for the Merit-based Incentive Payment System (MIPS) 2021 performance year closes on March 31, 2022. Eligible clinicians must submit all data through the Quality Payment Program (QPP) website prior to the deadline. The Centers for Medicare and Medicaid Services (CMS) will calculate final scores that will be used to apply the appropriate MIPS payment adjustment in CY 2023.

    For the 2021 performance year, CMS is applying the automatic Extreme and Uncontrollable Circumstances (EUC) policy to individual MIPS clinicians and has reopened the EUC application for groups, virtual groups, and Alternative Payment Model entities through March 31. Under the EUC policy, clinicians that have all performance categories reweighted will receive a neutral payment adjustment in CY 2023. More information is available on the QPP website.

    Telehealth waivers extended 5 months past PHE conclusion

    On March 15, 2022, President Biden signed the $1.5 trillion omnibus spending package into law, which extended certain telehealth flexibilities related to the COVID-19 public health emergency (PHE). A handful of PHE-related waivers will be in effect for an additional 151 days following the conclusion of the PHE, including the ability to treat patients virtually in their homes.

    An overview of the PHE-related telehealth waivers — including those extended by the omnibus  may be found in MGMA’s updated Medicare Telehealth Waivers resource.

  • 03/03/2022 3:41 PM | Rebekah Francis (Administrator)

    MGMA to Congress: Extend Medicare sequester moratorium

    Last Friday, MGMA and 50 other leading healthcare organizations sent a letter to Congress urging for an extension of the 2% Medicare sequester moratorium that has been in effect since 2020. Specifically, the letter asks that they extend the full moratorium for the duration of the COVID-19 public health emergency (PHE).

    Without this extension, the Medicare sequester will phase in at 1% this April and return to the full 2% this July. Prior to the COVID-19 pandemic, the 2% Medicare sequester was in effect for almost a decade. It is unlikely that the moratorium will last indefinitely — instead, it will most likely require greater reform.

    Court rules against HHS in surprise billing case

    On Feb. 23, 2022, a federal court in Texas issued a ruling in one of the surprise billing cases filed against the U.S. Department of Health and Human Services (HHS). In this ruling, the court invalidated certain aspects of the federal independent dispute resolution (IDR) process — specifically, the requirement that the median in-network rate would be the assumed out-of-network rate for all payment disputes.

    Additionally, while the federal protections against surprise billing took effect on Jan. 1, 2022, the federal IDR portal where providers can initiate an IDR dispute has not been yet been launched. HHS announced that for all disputes for which the negotiation period has expired, providers will have 15 business days following the opening of the federal IDR portal to submit a dispute. More information about surprise billing is available on the MGMA surprise billing page.

    CMS reopens MIPS EUC application

    The Centers for Medicare & Medicaid Services (CMS) has reopened the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) policy for providers impacted by the COVID-19 pandemic until March 31, 2022.

    Eligible groups, virtual groups and APM Entities can request MIPS performance category reweighting for the 2021 performance year. Individual clinicians will still receive automatic reweighting and do not need to submit an EUC application. More information about the CMS MIPS EUC reweighting policy is available on the Quality Payment Program website.

  • 02/24/2022 10:55 AM | Rebekah Francis (Administrator)

    CMS publishes surprise billing state enforcement letters

    The Centers for Medicare and Medicaid Services (CMS) has published a comprehensive list of state enforcement letters for the requirements under the No Surprises Act. These state letters, including letters to the District of Columbia and U.S. territories, outline CMS’ current understanding of which surprise billing requirements each state is enforcing and what requirements CMS will enforce.

    The letters also outline whether the federal independent dispute resolution and patient-provider dispute resolution processes apply in each state, and under what circumstances. These state-specific letters will help providers determine what governing body oversees their surprise billing requirements. More information about surprise billing is available on the MGMA surprise billing landing page.

    Biden administration renews national emergency

    President Biden recently announced that the U.S. national emergency declared in March 2020 related to the COVID-19 pandemic will be extended beyond March 1, when it was set to expire. This emergency declaration is separate from the COVID-19 public health emergency (PHE), which was extended through April 16 by U.S. Department of Health and Human Services (HHS) Secretary Becerra. However, the extension of the president’s national emergency declaration is necessary for the HHS Secretary to temporarily waive certain Medicare and Health Insurance Portability And Accountability Act (HIPAA) privacy requirements, such as the telehealth waivers currently in effect.

    Join CMS March 9 for webinar on Open Payments

    On Wednesday, March 9, from 1:00-1:30 p.m. (ET), CMS is hosting a webinar on the Open Payments program to provide an overview of the data review, dispute, and correction period, and to answer stakeholder questions. Covered recipients will have the opportunity to review data between April 1 and May 15, prior to the publication of 2021 Open Payments data by June 30, 2022.

    The goal of the Open Payments program is to increase transparency and accountability. Additional information about Open Payments, including how to understand which providers qualify as covered recipients, is available on the CMS Open Payments website.

  • 02/17/2022 8:31 AM | Rebekah Francis (Administrator)

    MGMA urges Congress to extend QPP-SURS program

    The Quality Payment Program Small, Underserved, and Rural Support (QPP-SURS) program provides direct technical assistance to eligible clinicians required to participate in the Merit-based Incentive Payment System (MIPS). However, after five years of providing support to small practices, the program expired on Feb. 15, 2022.

    MGMA is urging Congress to extend this critical program through the passage of the SURS Extension Act to ensure practices of all sizes have the resources available to succeed in the MIPS program. Join #MGMAAdvocacy by sending a letter to your congressional representatives today urging for the extension of the QPP-SURS program.

    Register now for GovChat Live on good faith estimate mandates

    Join MGMA Government Affairs in a GovChat Live on Tuesday, March 1 at 1 p.m. (ET), to have your questions answered and hear about MGMA advocacy related to the uninsured or self-pay good faith estimate (GFE) mandates, which took effect on Jan. 1, 2022 as part of the No Surprises Act. The team will discuss the types of providers required to issue uninsured or self-pay GFEs, what information is required to be communicated with patients, and provide an overview of the patient-provider dispute resolution process.

    Registration information for the event can be found on MGMA Communities and additional information about the federal surprise billing requirements is available on the MGMA surprise billing landing page.

    MGMA to CMS: Fix, don't end, Direct Contracting

    MGMA, alongside 221 other leading healthcare organizations, sent a letter to the Centers for Medicare and Medicaid Services (CMS) Innovation Center urging the agency to provide improvements to the Direct Contracting model instead of ending it entirely.

    The letter followed criticism from members of Congress of certain model participation tracks. However, MGMA and others maintain that with certain model improvements, Direct Contracting will remain a critical participation option for groups interested in advancing in value-based care arrangements.

  • 02/10/2022 8:19 PM | Rebekah Francis (Administrator)

    MIPS technical assistance program ends Feb. 15

    Funding for the Quality Payment Program Small, Underserved, and Rural (QPP-SURS) technical assistance program ends on Feb. 15, 2022. This program supports practices participating in the Merit-based Incentive Payment System (MIPS) by providing guidance in determining MIPS eligibility, submitting data, and transitioning to voluntary participation in alternative payment models (APMs).

    MGMA is urging Congress to provide funding for the QPP-SURS program through 2027 to ensure small and rural practices can continue to succeed in the MIPS program. Join #MGMAAdvocacy by sending a letter to your congressional representatives today!

    Reminder: Medicare telehealth changes

    The Centers for Medicare and Medicaid Services (CMS) recently published an article regarding changes to telehealth billing that were included in the 2022 Medicare Physician Fee Schedule (PFS). The changes mostly cover the expansion of mental telehealth services available following the conclusion of the COVID-19 public health emergency, including the ability to treat patients at home and via audio-only technology if certain conditions are met. The article also includes the two new mental telehealth modifiers – FQ and FR.

    For more information on the telehealth changes included in the final 2022 PFS rule, download MGMA’s member-benefit analysis.

    Join #MGMAAdvocacy on 2022 priority issues

    While the MGMA Government Affairs team works tirelessly in Washington, D.C., advocating on top issues impacting group practices, we need your help to amplify the message to Congress. In less than five minutes you can send a personalized email advocating for change on all of the issues listed below!

    Learn more about MGMA federal advocacy, access member-exclusive resources, and find out how you can be involved by visiting the MGMA advocacy webpage.  

  • 02/03/2022 4:17 PM | Rebekah Francis (Administrator)

    MGMA to Congress: Support practices in funding legislation

    Last Friday, MGMA sent a letter to Congress urging for the following priorities to be considered while they negotiate the upcoming February funding legislation:

    • Extend Medicare sequester relief beyond March 2022;
    • Continue telehealth flexibilities through at least CY 2024;
    • Extend the alternative payment model (APM) 5% bonus;
    • Update the Qualifying Participant (QP) threshold; and
    • Delay implementation of the good faith estimate (GFE) and advanced explanation of benefits (AEOB) requirements.

    2020 MIPS participation results now available

    The Centers for Medicare & Medicaid Services (CMS) has released participation results for the 2020 performance year of the Merit-based Incentive Payment System (MIPS). MIPS participation slightly decreased from 2019 to 2020 and 81% of clinicians received a final score at or above the exceptional performance threshold.  

    Throughout 2020, many clinicians were significantly impacted by the COVID-19 pandemic, and as a result, CMS provided clinicians with the option to apply for reweighting of all or some MIPS performance categories. In 2020, 26% of participants received reweighting of at least one performance category.   

    MGMA urges Congress to extend telehealth flexibilities

    MGMA and hundreds of other leading organizations wrote to Congress asking for a pathway to comprehensive permanent telehealth reform. At the beginning of the COVID-19 pandemic, Congress and the Administration acted quickly to expand Medicare telehealth, allowing millions of beneficiaries access to virtual care. These flexibilities hinge on whether the COVID-19 public health emergency (PHE) is in effect, leading to uncertainty surrounding how long these waivers will remain.

    The letter urges Congress to continue all current telehealth waivers through Dec. 31, 2024, allowing time to collect the necessary evidence needed to support permanent policy.

  • 01/27/2022 9:44 AM | Rebekah Francis (Administrator)

    MGMA to HHS: Delay good faith estimate mandate

    In a letter sent yesterday, MGMA urged the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to use their enforcement discretion and delay implementation of the uninsured or self-pay good faith estimate (GFE) requirements until practices have had appropriate time to understand and implement the requirements.

    Passed as part of the No Surprises Act, these GFE requirements took effect on Jan. 1, 2022. Additional information about the No Surprises Act and member-exclusive resources are available on the MGMA surprise billing landing page.

    OSHA withdraws COVID-19 vaccination and testing ETS

    Following a U.S. Supreme Court ruling, the Occupational Safety and Health Administration (OSHA) published an announcement that it is withdrawing its COVID-19 vaccination and testing emergency temporary standard (ETS).

    Although OSHA is withdrawing the ETS, the agency conveyed its intention to pursue future action on COVID-19 workplace safety down the road.

    HRSA announces $2 billion in Provider Relief Fund assistance

    On Tuesday, the HHS, through the Health Resources and Services Administration (HRSA), announced it will make $2 billion in Provider Relief Fund (PRF) Phase 4 payments this week. More than 7,600 providers nationwide should receive these funds, which are based on lost revenues and expenses due to COVID-19. Medical groups must have previously applied for relief funds.

    For more information on the PRF, visit HRSA’s PRF landing page.
  • 01/20/2022 8:46 AM | Rebekah Francis (Administrator)

    MGMA releases 2022 Advocacy Agenda

    As we enter a new year, MGMA continues to ensure the voice of medical groups is heard in Washington. Our 2022 Advocacy Agenda outlines key federal issues we are tackling, such as protecting the financial viability for medical group practices, improving the implementation of surprise billing requirements, and advancing value-based care.

    Follow the MGMA Government Affairs team on Twitter for updates on the latest #MGMAAdvocacy efforts this year:

    @AndersGilberg, @ClaireErnstJD, @KelseyMHaag, and @EmilyRDowsett.

    HHS renews COVID-19 PHE

    The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective Jan. 16, 2022. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90-days. In a letter to HHS, MGMA called on the Department to expeditiously renew the PHE to ensure groups practices can continue to leverage existing critical flexibilities as they continue to respond on the frontlines of the pandemic.   

    Unless further extended, the current PHE will lapse on April 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide a 60-day notice prior to allowing the COVID-19 PHE to lapse.

    Provider Relief Fund portal open for 'Period 2' reporting

    Medical groups who received Provider Relief Fund (PRF) payments exceeding $10,000 in the aggregate from July 1, 2020 to Dec. 31, 2020 (‘Period 2’) can now report on the use of those funds. Providers have until March 31 to complete the reporting.

    Additionally, the Health Resources and Services Administration released new reporting resources specific to ‘Period 2,' which can be accessed here.
  • 01/13/2022 3:35 PM | Rebekah Francis (Administrator)

    Today, the U.S. Supreme Court ruled on both the Occupational Safety and Health Administration (OSHA) vaccination and testing emergency temporary standard (ETS) and the Centers for Medicare & Medicaid Services (CMS) facilities rule. The Supreme Court blocked the OSHA ETS, which would have required workers of large employers (100+ employees) to get vaccinated or tested weekly for COVID-19. The CMS facilities rule, which would require vaccination of healthcare employees in facilities that receive Medicare and Medicaid payments, is allowed to move forward nationally. The CMS facilities rule generally does not apply to physician practices, although some might be subjected to it based on how they are structured.

    The OSHA ETS opinion can be viewed here.

    The CMS facilities rule opinion can be viewed here.

    The CMS facilities rule FAQs can be viewed here.


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