MGMA Washington Connection 03/02/2022

03/03/2022 4:45 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.

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