Latest News

New CMS FAQ on 2026 Telehealth

CMS released an updated Telehealth FAQ on November 20, 2025, with information regarding the CY 2026 Medicare Physician Fee Schedule Final Rule and telehealth flexibility extensions through January 30, 2026. The FAQ includes clarifications that respond to concerns raised by MGMA members, including:

• Retroactive Billing During Government Shutdown: CMS clarified that telehealth services provided during the recent government shutdown will be paid as if there had been no lapse in telehealth flexibilities. Telehealth flexibilities apply retroactively through January 30, 2026, and claims will continue to be processed in the same manner as before October 1, 2025.
• Home Enrollment for Telehealth Services: CMS confirmed that distant site practitioners can provide telehealth services from their home and, in many cases, do not need to report their home address on their Medicare enrollment application.
  • Practitioners who furnish telehealth services from home but maintain a physical practice location are not required to list their home address. They may enroll and bill from their physical practice location as if the telehealth service were furnished in person.
  • Virtual-only telehealth practitioners whose only physical practice location is their home must enroll their home address as a practice location. CMS instructs these practitioners to mark the address as a “Home office for administrative/telehealth use only” in their enrollment application to suppress street address details on the CMS Care Compare website. Practitioners may also email QPP@cms.hhs.gov to suppress the street address and/or phone number.

See more information on Medicare Telehealth Coverage here. 

MGMA Requests Guidance from CMS and OIG on Rebilling of Repriced Part B Claims Starting Oct. 1

MGMA requested guidance from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) on the reprocessing and rebilling of claims on or after October 1, 2025, in localities subject to the 1.0 work geographic practice cost index (GPCI) floor. Congress passed legislation last week that reopened the federal government and included extensions of healthcare policies, such as the 1.0 work GPCI floor, which expired at the end of September and was extended through January 30, 2026. We wrote to CMS and OIG seeking guidance on the reprocessing of claims that were paid at a lower rate than the 1.0 work GPCI floor in localities during the government shutdown. We requested regulatory flexibility to avoid unnecessary rebilling costs for medical groups.

MGMA Advocates for WISeR Model Reform

MGMA urged the House Committee on Appropriations to work with the Centers for Medicare and Medicaid (CMS) to prioritize reforming the Wasteful and Inappropriate Services Reduction (WISeR) Model. The WISeR Model is scheduled to begin in January 2026 in six states and would create new prior authorization processes for certain services. MGMA is advocating for delayed implementation, enhanced transparency, and gold carding exceptions to reduce administrative burdens on practices. If you expect your practice to be impacted by the WISeR Model, please contact govaff@mgma.org.

MGMA Urges Anthem to Rescind its Out-of-Network Hospital Policy

MGMA, along with dozens of national medical societies and state medical associations, urged Anthem Blue Cross and Blue Shield to rescind its policy of penalizing hospitals with a 10% reimbursement cut when using out-of-network physicians to provide care. This policy is set to start in 11 states on January 1, 2026, and the announcement indicates Anthem will consider terminating hospitals from Anthem networks should they continue to use nonparticipating physicians. The letter discusses how this policy attempts to circumvent the No Surprises Act and reviews the negative impact it would have on physician practices.

BREACH NOTIFICATIONS

MGMA sent a letter to the Department of Health and Human Services’ Office for Civil Rights (OCR) in response to its recent position that covered entities (i.e., medical groups) with protected health information impacted by the Change Healthcare cyberattack may delegate HIPAA breach notification requirements to Change. Specifically, we urged OCR to offer further, definitive guidance that:

• Change/United is fully and solely responsible for all HIPAA breach notification requirements,
• No action needs to be taken by providers to ensure Change/United fulfill these obligations, and
• Providers are protected from regulatory scrutiny in connection with breach notifications rightfully performed by Change/United.

PRIOR AUTHORIZATION BILL REINTRODUCED IN CONGRESS

The Improving Seniors’ Timely Access to Care Act has been reintroduced in Congress. This legislation would significantly improve the prior authorization process within the Medicare Advantage program by codifying the establishment of an electronic prior authorization process, increased transparency requirements for health plans on their prior authorization utilization, and more. The bill has widespread support from both chambers of Congress and over 380 endorsing organizations.

MGMA helped draft this legislation and strongly supports its passage. Utilize our Contact Congress portal to send a pre-populated letter to your congressional representatives expressing your support for the bill.

CFPB RELEASES PROPOSED RULE ON MEDICAL DEBT

The Consumer Financial Protection Bureau (CFPB) released a proposed rule that would ban medical bills from credit reports, stop credit reporting companies from sharing medical debts with lenders, and bar lenders from using medical debt to make lending decisions. This is a proposed rule and still has to go through a public comment period prior to CFPB issuing a final rule. MGMA plans to submit comments on the proposal.

MGMA RESPONDS TO CMS RFI ON MEDICARE ADVANTAGE TRANSPARENCY

MGMA responded to the Centers for Medicare and Medicaid Services’ (CMS) Request for Information on Medicare Advantage (MA) transparency. As the number of MA beneficiaries continues to grow, it is imperative that the MA program ensures adequate and transparent coverage to patients, timely payment to medical groups, and remains a viable pathway for medical groups to participate in value-based payment arrangements. These priorities cannot be achieved without accurate and robust data on MA utilization management practices including prior authorization, onerous care denials, and value-based contracts.

2024 QUALITY PAYMENT PROGRAM EXCEPTION
APPLICATIONS OPEN

CMS has opened the application window for 2024 Quality Payment Program (QPP) Exceptions through Dec. 31, 2024, at 8 p.m. ET. There are two types of exceptions groups can apply for if they are unable to report data for one or more Merit-based Incentive payment System (MIPS) categories — the MIPS Promoting Interoperability Performance Category Hardship Exception and the MIPS Extreme and Uncontrollable Circumstances (EUC) Exception.

Visit CMS’ QPP Exception website for more information.

MGMA SUPPORTS POLICIES TO ALLEVIATE ONEROUS REGULATORY BURDENS

The Senate Committee on the Budget and House Committee on Small Business both held hearings centered on over regulation in healthcare. MGMA submitted written testimony outlining the negative effects of onerous administrative burdens on medical groups and recommending policy solutions that promote innovative, high-quality, and cost-effective care delivery untethered from excessive, one-size-fits-all regulations. 

Read our full testimony here. Utilize our Contact Congress portal to send letters to your policymakers on these critical issues.

OCR FINALIZES RULE ON NONDISCRIMINATION FOR PEOPLE WITH DISABILITIES

The Department of Health and Human Services Office for Civil Rights (OCR) finalized its rule updating regulations under Section 504 of the Rehabilitation Act that prohibit discrimination on the basis of disability in programs and activities that receive federal financial assistance. The rule clarifies and strengthens protections for people with disabilities – ensuring treatment decisions are not based on stereotypes or biases, adopts enforceable standards for accessible medical diagnostic equipment, sets forth a technical standard for accessible websites and mobile applications, and more.

See OCR’s fact sheet for more information.

MEDICARE BOARD OF TRUSTEES RELEASES 2024 ANNUAL REPORT

The Medicare Board of Trustees released their 2024 annual report, projecting the Hospital Insurance Trust Fund will be able to pay 100 percent of total scheduled benefits until 2036. This is five years later than the Board’s estimate from last year. The report also highlights physician payment and anticipates access to Medicare-participating physicians would become a significant issue in the long term without payment reform.

CMS RELEASES 2022 QPP PARTICIPATION & PERFORMANCE INFORMATION

The Centers for Medicare and Medicaid Services (CMS) released participation and performance data for the 2022 performance year of the Quality Payment Program (QPP). CMS has resources available in the QPP Resource Library that provide information on payment adjustments, final 2022 Merit-based Incentive Payment System (MIPS) scores, and more.

FTC ISSUES RULE BANNING NONCOMPETES

The Federal Trade Commission (FTC) voted to issue a final rule that would ban most noncompete clauses nationwide. Existing and new noncompetes for most workers would not be enforceable after the rule’s effective date; the rule does not ban existing noncompete agreements for senior executives earning more than $151,164 annually in policymaking positions.

Partners in a business, such as physician partners of an independent physician practice, would also generally qualify as senior executives, assuming the partners have authority to make policy decisions about the business. In contrast, a physician who works within a hospital system but does not have policymaking authority over the organization as a whole would not qualify.

The U.S. Chamber of Commerce has filed a lawsuit challenging the rule. Implementation is likely to be on hold pending resolution in the courts.

RULE PROHIBITING DISCLOSURE OF CERTAIN REPRODUCTIVE HEALTH INFORMATION FINALIZED

The Department of Health and Human Services Office for Civil Rights (OCR) finalized a rule to prohibit the disclosure of protected health information (PHI) related to lawful reproductive healthcare in certain situations. OCR is updating the HIPAA Privacy Rule to prohibit the use or disclosure of PHI when it is sought to investigate or impose liability against patients, healthcare providers, or others related to legal reproductive health services.

The final rule requires covered entities and business associates to obtain a signed attestation that certain requests for PHI potentially related to reproductive healthcare are not for prohibited purposes. Covered entities must also modify their Notice of Privacy Practices (NPP). For more information, see OCR’s fact sheet.

MGMA OPPOSES EXPANDING PRIOR AUTHORIZATION IN ASCS

MGMA commented on the Centers for Medicare and Medicaid Services' (CMS) proposed demonstration project to expand prior authorization requirements in traditional Medicare to Ambulatory Surgical Centers (ASCs) for certain procedures in ten states. Our letter outlines the onerous administrative burden that prior authorization places on medical groups and our opposition to expanding prior authorization requirements in ASCs for Medicare Part B.

MGMA ADVOCATES FOR PERMANENT TELEHEALTH REFORM

The House Committee on Energy and Commerce Subcommittee on Health held a hearing on legislative proposals to support telehealth. Congress and the Administration extended many of the telehealth flexibilities in place during the COVID-19 Public Health Emergency through 2024. MGMA submitted a statement for the record outlining our priorities for permanent telehealth reform. These recommendations included removing originating site and geographic restrictions, permanently covering audio-only services, and more.

RECOMMENDATIONS TO CONGRESS ON IMPROVING MEDICARE PAYMENT

MGMA sent a letter to the Senate Committee on Finance ahead of their hearing on bolstering Medicare payment for chronic care. The letter focuses on the importance of long-term, sustainable reform to the Medicare physician payment system by enacting an annual inflationary update and addressing budget neutrality. We also expressed support for the Chronic Care Management Act of 2023 and discussed making important changes to advanced alternative payment models.

FEDERAL GOVERNMENT FUNDED THROUGH FY 2024

President Biden signed into law legislation to fund the government through the end of FY 2024 (Sept. 30). The passage of this bill avoided a partial government shutdown, and funded Department of Health and Human Services (HHS) programs. Congress can now focus on next year’s spending bills.

CMS TO REQUIRE REVISED EFT APPLICATION

The Centers for Medicare and Medicaid Services (CMS) will require a revised electronic funds transfer (EFT) application starting May 1, 2024. If you need to request EFT for Medicare payments, Medicare Administrative Contractors will accept the current and revised CMS-588 EFT application through April 30, 2024. Starting on May 1, you must use the revised form that includes minor updates.

CONGRESS EXAMINES FDA LDT PROPOSED RULE

CMS provided updated billing requirements clarifying providers cannot bill comprehensive preventive medicine evaluation and management services (CPT codes 99381-99397) with annual wellness visits (AWV) or initial preventive physical exams (IPPE) (HCPCS codes G0402, G0438, G0439) services. CMS also strongly encourages, but does not require, physicians to provide an Advance Beneficiary Notice of Non-coverage to patients when providing and billing for comprehensive preventive medicine evaluation and management services.

BIDEN'S BUDGET FOCUSED ON HEALTHCARE CYBERSECURITY, MEDICAL SUPPLY CHAIN

Following the State of the Union, President Biden released his $7.3 trillion budget proposal for FY 2025, which included a hefty investment in healthcare cybersecurity, an expansion of Medicare’s drug negotiation program, an extension of the Medicare hospital insurance trust fund, and an investment in the domestic medical supply chain. Presidential budgets are not legally binding, rather they are used to message the Administration’s priorities.

CHANGE HEALTHCARE OUTAGE UPDATE

The Centers for Medicare and Medicaid Services (CMS) announced over the weekend the availability of advanced Medicare payments for medical groups in response to the Change Healthcare cyberattack. The agency sent a letter to healthcare leaders urging UnitedHealth Group and other insurance companies to take additional actions.

MGMA appreciates CMS heeding our calls to provide financial relief to medical groups and remains steadfast in our efforts to advocate with policymakers for additional support. CMS extended the MIPS submission window for performance year 2023 to April 15, 2024, in response to the Change Healthcare outage.

ENSURE YOUR PRACTICE'S COMPLIANCE WITH INFORMATION BLOCKING RULES

Join MGMA and Micky Tripathi, PhD, MPP, National Coordinator for Health Information Technology on Thursday, March 21 at 1 p.m. ET for a member-exclusive webinar reviewing information blocking regulations, including the proposed provider disincentive rule. Attendees will gain an understanding of the significance of compliance with the 21st Century Cures Act and the consequences which will result from committing information blocking. The webinar will outline key provisions, including proposed disincentives for providers participating in Medicare’s Promoting Interoperability Program, the Quality Payment Program, and the Medicare Shared Savings Program.

For more information, including how to register, please click here.

MGMA SUPPORTS PERMANENT TELEHEALTH REFORM

The House Committee on Ways and Means held a hearing this week examining ways to enhance access to care at home in rural and underserved communities. MGMA submitted a statement for the record outlining our 2024 advocacy priorities for telehealth. We recommended permanently extending many of the telehealth policies currently in place, allowing practitioners offering telehealth services from their home to continue reporting their work address for Medicare enrollment, and more.

CMS ANNOUNCES ADVANCED PAYMENTS TO MEDICAL GROUPS IN RESPONSE TO CHANGE HEALTHCARE OUTAGE

The Centers for Medicare and Medicaid Services (CMS) has announced the availability of advanced Medicare payments for medical groups in response to the Change Healthcare cyberattack. The advanced Medicare payments may be granted in amounts representative of up to 30 days of claims payments for eligible physician practices.

Medicare Administrative Contractors (MACs) will provide public information on how to request advanced payments as soon as today. MGMA appreciates CMS heeding our calls to provide financial relief to medical groups and remains steadfast in our efforts to advocate with policymakers for additional support. Please see the agency’s press release and fact sheet for more information.

CONGRESS PASSES PARTIAL PHYSICIAN PAYMENT FIX

President Biden has signed into law a legislative package to fund certain federal agencies for 2024. This legislation includes healthcare polices such as the extension of the 1.0 work GPCI floor, extension of the Advanced Alternative Payment Model (APM) incentive payment for 2024 at 1.88%, maintaining the 2023 Qualifying Participant (QP) threshold levels for 2024, and more.

Additionally included is an increase of 1.68% to Medicare physician payment effective today through the end of the year. This partially mitigates the 3.37% cut to the Medicare conversion factor that went into effect on Jan. 1, 2024, and leaves a reduction of 1.69% in place for the rest of the year. We are significantly disappointed by Congress’ failure to reverse the full cut and are calling on them to enact long-term sustainable Medicare reform that provides annual inflationary updates and modernizes the antiquated budget neutrality policies that jeopardize patient access to care.