Latest News

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  • 07/17/2019 5:07 PM | Rebekah Francis (Administrator)

    In recent months, Congress introduced a number of bills that address the issue of surprise billing. There is widespread agreement that patients should be protected from surprise medical bills and taken out of the middle of payment disputes. However, the current legislative “solutions” give too much power to health plans. Instead of the discounted in-network benchmark rate solution proposed by many of these bills, MGMA advocates for out-of-network payments to be set by leveraging commercial data from independent sources. When this payment rate is insufficient, an independent dispute resolution process should be utilized to determine fair payment for the physician.

    Please take a moment to submit a letter to Congress through our Contact Congress portal and ask your representatives to hold health plans accountable.

  • 07/17/2019 5:06 PM | Rebekah Francis (Administrator)

    As part of CMS’s continued phased-in approach to public reporting on Physician Compare, the agency recently published a subset of 2017 QPP information submitted under MIPS and APMs. The information added on profile pages for MIPS eligible clinicians and groups includes select quality measure and CAHPS survey data.

    To learn more about Physician Compare and the 2017 QPP data publication, review CMS’s fact sheet. MGMA Government Affairs encourages members to share feedback with us regarding their experiences with Physician Compare.
  • 07/17/2019 5:04 PM | Rebekah Francis (Administrator)

    CMS announced the creation of two voluntary and two mandatory Medicare APMs for CY2020. The voluntary models are Kidney Care First and Comprehensive Kidney Care Contracting. CMS also proposed a regulation that would create two mandatory models – End-Stage Renal Disease Treatment Choices (ETC) and Radiation Oncology. 

    CMS anticipates that all models will open for participation in CY 2020 and that each model, except for the proposed ETC model, will qualify as an Advanced APM starting in performance year CY 2021. While MGMA strongly supports the creation of new voluntary APM opportunities, we oppose mandatory models that subject group practices to untested payment structures that lack evidentiary support. To learn more about these new opportunities, visit MGMA’s APM landing page.

  • 07/17/2019 5:03 PM | Rebekah Francis (Administrator)

    CMS has released data outlining preliminary, high-level results of participation data in the 2018 Quality Payment Program (QPP). A key takeaway from 2018 performance is that a higher percentage of participants in MIPS avoided a negative adjustment compared to 2017 performance (almost 98% versus 93%). Additional details of 2018 QPP participation include:

    ·     The total number of clinicians who participated in MIPS in 2018 was 559,230, down from 716,603 in 2017;

    ·     Small practice participation in MIPS increased to 89.2% in 2018, up from 81% in 2017; and

    ·     The number of Advanced Payment Model Qualifying Participants (QPs) rose to 183,306 in 2018, up from 99,076 in 2017.

    MGMA members who believe an error has been made to their 2018 performance final scores can request a targeted review through the QPP website until September 30, 2019.

  • 07/10/2019 7:15 PM | Rebekah Francis (Administrator)

    CMS is hosting a webinar on Wednesday, July 24, 2019 at 12 p.m. ET on the Primary Care First Model option for Seriously Ill Populations (SIP). Topics to be discussed include how eligible practices can participate in the SIP payment track of Primary Care First, eligibility requirements, quality measures, and payment. Click here to register for this webinar.

    For more information about the new Primary Care First model, please refer to the "Top Member Resources" section of the Washington Connection.
  • 07/10/2019 7:14 PM | Rebekah Francis (Administrator)

    If your group practice submitted 2018 Merit-based Incentive Payment System (MIPS) data, you can now view performance feedback, final scores, and 2020 payment adjustments by logging into the Quality Payment Program (QPP) website. MIPS participants that feel there is an error in their 2020 payment adjustment may submit a “targeted review” request by Sept. 30. More information on the targeted review process and FAQs on 2018 performance feedback/2020 payment adjustments can be found on the QPP website in the Resource Library.

    The Centers for Medicare & Medicaid Services (CMS) estimates that 98% of MIPS eligible clinicians avoided a negative payment adjustment based on 2018 performance. Because MIPS is a budget neutral program, positive payment adjustments will be low even for very high scores. For example, based on inaugural performance year data from 2017, 95% of eligible clinicians avoided a payment penalty and the maximum payment adjustment in 2019 was 1.88% for a perfect score. By statute, the maximum payment adjustment is 4% for 2017 reporting and 5% for 2018 reporting, plus an additional 10% for exceptional performance.

  • 07/10/2019 7:11 PM | Rebekah Francis (Administrator)

    CMS reports that as of June 14, practices have submitted 75% of Medicare fee-for-service claims with the new Medicare Beneficiary Identifier (MBI). Practices are urged to remind Medicare patients to present their new card and to collect MBIs at the time of service. As a reminder, starting Jan. 1, 2020, Medicare will only accept the MBI on claims. MBIs are accessible via your Medicare Administrative Contractor web portal.

    Download the MGMA member-benefit New Medicare Card Toolkit for additional information on this transition to MBIs and downloadable posters you can post in your practice to educate your patients on the new card.

  • 06/12/2019 5:50 PM | Rebekah Francis (Administrator)

    CMS has released a new Merit-based Incentive Payment System (MIPS) resource on the Cost performance category. The resource outlines details on the different Cost measures, reporting requirements, and scoring methodology. As a reminder, in additional to the historic Total Per Capita Cost and Medicare Spending Per Beneficiary MIPS Cost measures, CMS added eight new episode-based measures that cover five different procedures and three acute inpatient medical conditions. MGMA has heard from members that this category unfairly penalizes group practices that treat sicker patients and has significant concerns about the way CMS evaluates clinicians on certain measures. A top advocacy priority for MGMA is supporting efforts that more accurately measure the Cost component of MIPS and only hold clinicians accountable for resource use within their control.

  • 06/12/2019 5:49 PM | Rebekah Francis (Administrator)

    The Department of Veterans Affairs (VA) launched its new Veterans Community Care Program (VCCP) on June 6, which consolidates several programs that pay for veterans' care outside the VA system, including Veterans Choice, into one. With community care, veterans can receive care from a private practitioner in their community depending on specific eligibility requirements. TriWest will continue as interim third-party administrator for the VCCP while the new contractors ramp up networks and processes over the coming year. These changes were required by the VA MISSION Act of 2018, which MGMA supported. For more information, review the VA’s announcement.

  • 06/12/2019 5:48 PM | Rebekah Francis (Administrator)

    MGMA submitted feedback last week on the Lower Health Care Costs Act, a legislative draft proposed by the U.S. Senate Health, Education, Labor and Pensions Committee. The draft bill outlined potential solutions for addressing unexpected or “surprise” medical bills, improving transparency, and lowering drug costs.

    The Association recommended an approach to unexpected medical bills that holds insurers accountable for narrow and inflexible networks and protects patients from unexpected healthcare costs that their insurance will not cover.
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