• 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.
  • 07/23/2020 9:09 AM | Rebekah Francis (Administrator)

    Participate in the latest #MGMAAdvocacy poll on practice financial sustainability

    Help MGMA learn how COVID-19 has financially impacted your medical group so far by taking this 3-minute survey. The information collected will be used to inform MGMA’s advocacy efforts, educate policymakers, and develop new resources to assist your practice. All responses will remain anonymous. The MGMA COVID-19 Financial Impact Survey will close tomorrow, July 24 at midnight ET. 

    HHS publishes timeline for Provider Relief Fund reporting requirements

    The Department of Health and Human Services (HHS) released an overview of future reporting requirements for providers that received payments under the Provider Relief Fund. HHS outlined the timing of future reporting requirements for providers that receive payments exceeding $10,000 in the aggregate from any Provider Relief Fund distribution (i.e., any payment under the $50 billion general distribution; Medicaid distribution; or a targeted distribution). The overview does not indicate whether providers that received $10,000 or less will be subject to any reporting obligations and does not provide detail as to the form or content of reports. However, the following timeline is provided:

    ·     August 17, 2020: Release of detailed instructions

    ·     October 1, 2020: Reporting system is available

    ·     February 15, 2021: Report due for calendar year 2020 expenditures

    ·     July 31, 2021: Second report due for those who expended funds in 2021 

    2020 APM participation: Check qualifying participant status now

    The Centers for Medicare & Medicaid Services (CMS) updated the Quality Payment Program (QPP) participation tool to include the first snapshot of 2020 performance year data from alternative payment model (APM) participants. Group practice leaders can now use the tool to see if clinicians achieved qualifying participant (QP) status through an advanced APM based on the first snapshot period, which includes payment and patient data from dates of service between Jan 1, 2020 and March 31, 2020. There are three snapshots in a given performance year and clinicians participating in an advanced APM only need to achieve QP status during one snapshot period to qualify for advanced APM incentives (e.g., a 5% bonus and exemption from MIPS). At this time, you may also use the tool to see if clinicians within your group are affiliated with a MIPS APM. 

    New recommendations on anti-discrimination rules during COVID-19

    HHS’ Office for Civil Rights released guidelines for healthcare providers aimed at preventing discrimination based on race, color, and national origin during the COVID-19 pandemic. The guidance is applicable to group practices and providers that receive federal funding and suggests that these entities create proactive policies preventing discrimination, including:

    ·     Adopting policies to prevent harassment and discrimination;

    ·     Confirming existing policies and procedures with respect to COVID-19 related care does not exclude individuals on the basis of race, color, or national origin; and

    ·     Making available information available to individuals and patients on how the practice complies with anti-discrimination laws and regulations.

    MGMA recommends members review these guidelines and use this as an opportunity to ensure compliance with existing federal laws. 

    Deadline extended to apply for Medicaid/CHIP Provider Relief Fund payment

    HHS announced an extension to the application deadline for Medicaid and Children’s Health Insurance Program (CHIP) providers seeking a payment from the Provider Relief Fund. Eligible Medicaid and CHIP providers now have until Aug. 3 to complete an application for this distribution. A new fact sheet from HHS reflects the updated deadline, along with additional information on eligibility and the application process.
  • 07/16/2020 10:17 AM | Rebekah Francis (Administrator)

    Practices see rise in cyberattacks during COVID-19 pandemic

    Healthcare entities, including medical practices and hospitals, are seeing an increase in the number of cyberattacks since the start of the COVID-19 pandemic. In particular, practices are vulnerable to ransomware, a type of malware that locks valuable digital files and then demand a ransom in order for these files to be unlocked. As well, stealing electronic health records can be more valuable than getting access to credit card numbers alone, allowing thieves to file fraudulent insurance claims, obtain prescription medication, and steal identities. To assist in protecting your practice against cyberattacks, members are encouraged to visit the MGMA HIPAA Resource Center to access resources such as the Cybersecurity Action Steps for Medical Practices tool and the Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients resource developed by the federal government.

    MGMA advocates for changes to tax treatment of Provider Relief Funds

    The Internal Revenue Service clarified on July 6 that for-profit healthcare providers must pay taxes on any grant payments received from the Provider Relief Fund. In response to this announcement, MGMA urged Congress to change this policy to ensure these funds are not taxed. The CARES Act established both the Provider Relief Fund and the Paycheck Protection Program (PPP) and specifically addressed the taxability of the PPP by stating any PPP loan payments that are forgiven are not counted as taxable income. However, the Act did not address the tax treatment of the Provider Relief Fund. MGMA believes this was an oversight and is advocating for change. 

    Apply for Medicaid/CHIP Provider Relief Fund payment by July 20

    July 20 is the deadline for eligible Medicaid and Children’s Health Insurance Program (CHIP) providers to apply for funding via the Enhanced Provider Relief Fund Payment Portal. The Department of Health & Human Services (HHS) expects to distribute $15 billion to eligible providers that did not previously receive a payment from the $50 billion General Distribution. The portal will allow such providers to report their annual revenue data to HHS and apply to receive a payment equal to at least two percent of reported gross revenues from patient care. For additional information on eligibility and the application process, providers can refer to the program’s application instructions

    HHS modifies substance use disorder privacy regulations

    The Substance Abuse and Mental Health Services Administration, an agency within HHS, released a final rule modifying the 42 CFR Part 2 regulation governing the confidentiality of records for patients with substance use disorder (SUD). While HIPAA permits the sharing of patient data for treatment, payment, and healthcare operations without patient consent, Part 2 creates a separate standard for the sharing of SUD information that requires patient consent. Key modifications include:

    ·     Treatment records created by non-Part 2 providers are explicitly not covered by Part 2, unless any SUD records previously received from a Part 2 program are incorporated into such records;

    ·     SUD patients may consent to disclosure of Part 2 treatment records to a practice without naming an individual (previously, they would have had to identify a specific person in the practice); and

    Non-opioid treatment program and non-central registry treating providers are now eligible to query a central registry in order to determine whether their patients are already receiving opioid treatment.
  • 07/09/2020 7:41 AM | Rebekah Francis (Administrator)

    New CMS report details 2018 MIPS, APM performance results

    The Centers for Medicare & Medicaid Services (CMS) released its 2018 performance results from the Quality Payment Program's Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). 2018 was the second year of the program and informs 2020 payment adjustments. Highlights include:

    1. 98% of MIPS eligible clinicians avoided a negative payment adjustment by scoring at least 15 points. 84% received an exceptional performance bonus by scoring 70 points or higher. The maximum positive payment adjustment, inclusive of the bonus, was just 1.68% due to the small pool of payment penalty money.
    2. The average MIPS score was 86 points. MIPS APM participants had the highest average score at 98 points, followed by groups at 82 points, and individuals at 52 points.
    3. Individual reporting is down to just 6% overall. 
    4. More clinicians are participating in Advanced APMs. The number of qualifying participants nearly doubled in 2018 (183,306) from 2017 (99,076).

    The report contains more information including the most commonly reported measures, average scores, and more.

    Congress advances HHS spending bill

    On July 7, a House Appropriations subcommittee approved the FY 2021 Labor-Health and Human Services (HHS)-Education funding bill, which would raise the HHS annual budget to $96.4 billion. The proposal includes billions of dollars in emergency supplemental funding in addition to regular, discretionary funding. The bill also includes a handful of Democratic priorities, such as money directed towards ACA outreach and enrollment as well as gun violence research. The subcommittee voted along party lines to advance the proposal to the full Appropriations committee for debate next Monday the 13th. Any package must be approved by the full House and Senate before going to the President’s desk for signature and becoming law.

  • 07/08/2020 1:12 PM | Rebekah Francis (Administrator)

    The "new normal" of the COVID-19 environment is so dynamic that it can be hard to prepare for the next day. One constant we have found in an ocean of variables is the practicality of telehealth in this environment. Understanding how to optimize telehealth technology and the workflows around it is essential for your practice's success, during COVID-19 and beyond.

    Our new in-depth report,
    Optimizing Telehealth During COVID-19 and Beyond, details strategies, insights and best practices from practice leaders that are essential in moving forward in this unpredictable environment. Get your free report today.

  • 06/25/2020 8:15 AM | Rebekah Francis (Administrator)

    2020 MIPS: Hardship exception available due to COVID-19

    The Centers for Medicare & Medicaid Services (CMS) announced flexibilities for clinicians participating in the Merit-based Incentive Payment System (MIPS) in 2020. Clinicians significantly impacted by the COVID-19 public health emergency may submit an Extreme & Uncontrollable Circumstances application to reweight any or all of the MIPS performance categories by logging into their HARP account at If a group practice or individual clinician submits 2020 MIPS data for one or more performance categories, that data submission will override an approved application on a category-by-category basis. 

    Updated PPP forgiveness guidance released

    The Small Business Administration (SBA) released further guidance on Paycheck Protection Program (PPP) loan forgiveness. The Interim Final Rule updates previous loan forgiveness guidance to reflect the changes made under the recently enacted Paycheck Protection Program Flexibility Act. In the guidance, SBA clarifies that a borrower may submit a loan forgiveness application before the end of the covered period if he or she has used all the loan proceeds for which he or she is requesting forgiveness. For more information on the PPP, you can access MGMA’s recently updated resource.

    CMS updates COVID-19 coverage FAQ

    CMS released new FAQs regarding COVID-19 coverage issues included in the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act. FFCRA requires insurers to cover COVID-19 tests without patient cost-sharing, but this new guidance clarifies that the requirement for coverage does not extend to tests conducted for general workplace health and safety (such as screening for employees to come back to work) or for any purposes not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition.

    New Medicare prior authorization requirements go into effect July 1 

    The Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule issued by CMS established nationwide prior authorization requirements for certain hospital outpatient department services. The following Medicare services will require prior authorization when provided on or after July 1, 2020:

    ·     Blepharoplasty

    ·     Botulinum toxin injections

    ·     Panniculectomy

    ·     Rhinoplasty

    ·     Vein ablation

    CMS is, however, removing HCPCS code 21235 (Obtaining ear cartilage for grafting) from the list of codes that require prior authorization as a condition of payment, as it is more commonly associated with procedures unrelated to rhinoplasty that are not likely to be cosmetic in nature. The full list of HCPCS codes requiring prior authorization is available here


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