Latest News

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.

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:

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

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.

On Dec. 27, 2021, the Occupational Safety and Health Administration (OSHA) issued a statement on the status of its COVID-19 healthcare emergency temporary standard (ETS), confirming that it is withdrawing the ETS with the exception of the recordkeeping portions.

Last August, MGMA urged OSHA to not make this standard permanent, due to it disrupting ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. Although OSHA is letting this ETS sunset, it expressed its intentions to revisit the issue of protecting healthcare workers from COVID-19 in the future by issuing another standard. MGMA will urge the Agency to solicit input from stakeholders, such as medical groups, when developing such a standard.

Updated member resources to navigate surprise billing

On Jan. 1, 2022, the No Surprises Act requirements prohibiting certain out-of-network balance billing and new uninsured (or self-pay) good faith estimate price transparency requirements took effect. Throughout 2021, the Biden Administration released several rules implementing these newly effective requirements. The Administration will continue to release additional rules throughout 2022 outlining the remaining patient protections that have not yet been implemented.

The MGMA Government Affairs team has updated member-exclusive resources to help group practices better understand the requirements in place. Check out the most up-to-date resources on the MGMA Surprise Billing landing page.

MIPS 2021 data submission window open

Clinicians can now submit and review data for the 2021 performance year for the Merit-based Incentive Payment System (MIPS). The data submission window closes on March 31, 2022 at 8 p.m. (ET). The Centers for Medicare and Medicaid Services provided several flexibilities for clinicians due to the COVID-19 public health emergency, including applying an automatic reweighting of performance scores for individual clinicians.

MGMA to HHS: Provide flexibilities for surprise billing requirements

In a letter to the U.S. Department of Health and Human Services (HHS), MGMA called for additional flexibilities for group practices as new surprise billing requirements are implemented on Jan. 1, 2022. The final rules implementing requirements related to surprise billing were released less than three months before their effective date, not allowing practices sufficient time to understand and implement new workflows in compliance with these new requirements.

MGMA recently published a surprise billing FAQ and launched a new surprise billing landing page containing member-exclusive resources, advocacy materials, and federal resources to help guide practices as they begin complying with the new requirements in the new year.

Dec. 31: Upcoming MIPS deadlines

As 2021 comes to a close, clinicians must prepare for the upcoming deadlines for the Merit-based Incentive Payment System (MIPS) program. There are two key deadlines on Dec. 31, 2021:

• EUC Application deadline for groups, virtual groups and APM entities, and
• Virtual group election for PY 2022

While the automatic and extreme and uncontrollable circumstances (EUC) policy applies to individual MIPS clinicians due to the COVID-19 pandemic, groups, virtual groups, and APM entities must apply to have performance categories reweighted for PY 2021. Virtual group election must be made before the start of PY 2022. More information about both of these deadlines may be found on the Quality Payment Program website.

MGMA to Congress: Prevent cuts to Medicare in CY 2022

On Monday, MGMA and hundreds of other healthcare organizations sent a letter to congressional leadership urging them to address the cuts to Medicare reimbursement slated to take effect Jan. 1, 2022. More specifically, the groups asked Congress to extend the 3.75% payment adjustment through at least CY 2022. Last year, Congress appropriated funds to the Medicare physician fee schedule (PFS) to mitigate cuts stemming from payment policy changes that went into effect in CY 2021. That 3.75% increase to the PFS expires at the end of this year. MGMA will soon share resources and grassroots letters addressing these impending cuts for members to engage in #MGMAAdvocacy! The letter may be viewed here.

MGMA to Congress: Prevent cuts to labs in CY 2022

This week, MGMA and two dozen other leading healthcare organizations wrote to Congress asking to extend the hold on laboratory payment cuts and the private payer data reporting period under the Clinical Laboratory Fee Schedule (CLFS) for a year. In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) with the goal of giving Medicare beneficiaries access to critical health services, such as laboratory tests. The way that the U.S. Department of Health and Human Services implemented PAMA led to severe cuts to laboratories under Medicare. The CARES Act, passed in 2020, delayed the implementation of the CLFS cuts in 2021. Without congressional intervention, physician office laboratories could see cuts up to 15% for tests. The letter may be viewed here.

New MGMA vaccine mandate resource

Last week, the Biden administration published new rules pertaining to COVID-19 vaccination and testing. To assist medical groups in navigating these complex mandates, MGMA Government Affairs created a new member-exclusive resource covering both mandates: (1) the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) published an emergency temporary standard (ETS) requiring employers with 100 or more employees to implement a COVID-19 vaccination and testing policy; and (2) the Centers for Medicare & Medicaid Services (CMS) issued an Interim Final Rule (IFR) requiring healthcare workers at facilities participating in Medicare and Medicaid to be fully vaccinated. Both mandates are slated to go into full effect on Jan. 4, 2022, although have already been challenged in court.

Additional information:

• MGMA Vaccine Mandate Resource
• White House Fact Sheet on Mandates

New MGMA surprise billing resource

Several federal requirements related to surprise billing and related patient transparency requirements take effect on Jan. 1, 2022. To assist members in implementing these new requirements, MGMA Government Affairs created a member-exclusive resource outlining critical surprise billing policies impacting group practices.

While the federal regulation of balance billing generally only applies to clinicians providing care at in-network facilities, other patient transparency requirements may impact clinicians providing care in group practice settings. MGMA will also be hosting a member-exclusive informational session and answering questions about the new surprise billing requirements later this month. More information will be posted in the member-exclusive Government Affairs Communities page in the coming weeks.

Additional information:

• MGMA No Surprises Act Resource
• Government Affairs Communities

CMS finalizes 2022 Physician Fee Schedule

On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) released the final 2022 Medicare Physician Fee Schedule rule, finalizing changes to physician payment policies, including changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements. Most of the final policies will take effect Jan. 1, 2022. MGMA submitted detailed comments in response to the proposed rule and thanks CMS for incorporating MGMA’s feedback into the final rule.

CY 2022 CF:
- Physician: $33.5983
- Anesthesia: $20.9343

Additional information:
PFS fact sheet
QPP fact sheet
MGMA comments

CMS finalizes 2022 outpatient facility and ambulatory surgical center rule

This week, the MGMA Government Affairs team released the 2021 Annual Regulatory Burden Report. This annual report captures the impact of federal regulations on medical group practices, and these data points and stories will help drive #MGMAAdvocacy.

With responses from 420 medical group practices, the survey findings demonstrate the impact that increasing regulatory burden has on practices. An overwhelming majority (91%) of respondents reported that the overall regulatory burden on their medical practice has increased over the past 12 months. And an even greater number of respondents (95%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

Thank you to all of our members who participated in this survey! This is only one of many opportunities for members to partner with the Government Affairs team in #MGMAAdvocacy. For more information about how to engage in current advocacy efforts, please visit the MGMA Advocacy webpage.

Prior authorization reform bill introduced in the Senate

Yesterday, the Senate introduced an MGMA-supported bill which would deliver much-needed reform to prior authorization under the Medicare Advantage program. The bipartisan Improving Seniors’ Timely Access to Care Act of 2021 (S. 3018) is the companion bill to the House legislation introduced earlier this year.

As prior authorization continues to rank as one of the most burdensome issues for medical groups year over year, MGMA is committed to working with lawmakers to expedite the passage of this critical legislation.

MGMA engages in advocacy around electronic payments, value-based care, and vaccines

As the voice of medical practices in Washington, D.C., MGMA actively engages with other leading health organizations and coalitions to promote our advocacy agenda. This past week, MGMA joined in advocacy around a variety of pertinent issues, including the electronic funds transfer (EFT) transaction standard, the Medicare Shared Savings Program (MSSP), and COVID-19 vaccine access. Read more about these recent advocacy initiatives below:

• MGMA urged the Centers for Medicare & Medicaid Services (CMS) to affirm providers’ right to receive EFT payments without being forced to pay percentage-based fees for additional services.

• MGMA requested that CMS allow MSSP accountable care organizations to elect pre-pandemic years to set benchmarks for agreements beginning in performance year 2022.

• MGMA encouraged the White House COVID-19 Response Coordinator and U.S. Surgeon General to leverage office-based physicians, including primary care physicians and pediatricians, in the COVID-19 vaccine rollout.

HHS extends COVID-19 Public Health Emergency

The Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective Oct. 18, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90 days.

Unless it is further extended, the current PHE determination will lapse on Jan. 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide the healthcare community with 60 days' notice prior to allowing the PHE to lapse.