News

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  • 06/12/2019 4:50 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 4:49 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 4:48 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.
  • 05/30/2019 8:35 AM | Rebekah Francis (Administrator)

    For practices seeking to participate in the Medicare Shared Savings Program (MSSP) beginning Jan. 1, 2020, the Notice for Intent to Apply (NOIA) will become available on June 11 and must be submitted by June 28 at 12 p.m. ET. Practices must submit a NOIA if they intend to apply to the BASIC or ENHANCED track of the MSSP, apply for a Skilled Nursing Facility 3-Day Rule Waiver, and/or establish and operate a Beneficiary Incentive Program. 

    While a NOIA submission is not binding, it is required to submit a formal application, which will be available for submission from July 1-29. For more information on the application process, please visit the MSSP website. For resources and guidance on Accountable Care Organizations and the MSSP, visit MGMA.com/ACO.

  • 05/30/2019 8:33 AM | Rebekah Francis (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) issued a final rule enabling Medicare Advantage (MA) plans to implement step therapy for Part B drugs as a recognized utilization management tool. CMS did however, put some parameters on how step therapy may be implemented by these plans. Starting Jan. 1, 2020, MA step therapy programs:

    ·     Only apply to new starts of medication;

    ·     Must be reviewed and approved by the plan’s pharmacy and therapeutics committee; and 

    ·     Must have a shorter decision-making time frame when patients request coverage of or appeal a denial of a Part B drug. 

    The rule also codified the longstanding policy that Part D sponsors are permitted to implement prior authorization and step therapy requirements for beneficiaries starting treatment for five of the six Part D drug classes.

  • 05/30/2019 8:31 AM | Rebekah Francis (Administrator)

    MGMA members interested in learning more about the new Emergency Triage, Treat and Transport (ET3) care model from the CMS Innovation Center are encouraged to review these FAQs. The FAQs are intended to help potential applicants ahead of the official request for applications (RFA), which is expected to be released later this summer. The goals of the ET3 model are to offer alternative interventions following a 911 call. Specifically, the model will offer reimbursement to participating ambulance care teams to:

    1.  Transport an individual to a hospital emergency department;

    2.  Transport to an alternative destination such as a doctor’s office or clinic; or

    3.  Provide treatment in place.

    MGMA will notify members when the official RFA is released this summer.
  • 05/09/2019 10:06 AM | Rebekah Francis (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) will host a series of open-door forum calls outlining a new initiative to develop a Medicare Fee for Service (FFS) Documentation Requirement Lookup Service (DRLS) prototype. MGMA serves on the DRLS workgroup. The first call will be held Tuesday, May 14, 2019 from 2:00 - 3:00 p.m. ET and will permit physician practices and others to provide feedback on this initiative. The goal of the DRLS is to improve "provider to payer" information exchange and thereby reduce provider burden. The prototype will allow practices to discover at the time of the patient encounter and within their EHR or practice management system: 

    ·     If Medicare FFS requires prior authorization for a given item or service; and

    Documentation requirements for Oxygen and Continuous Positive Airway Pressure (CPAP) Devices. 
  • 05/09/2019 10:06 AM | Rebekah Francis (Administrator)

    MGMA's statement to the Senate Committee on Finance articulates the association’s priorities related to the MACRA statute and its two payment pathways: The Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). While supporting MACRA’s overall framework, MGMA makes a number of recommendations aimed at improving MACRA, including:

    ·     Simplify MIPS scoring and reduce reporting burdens;

    ·     Extend the availability of the APM incentive bonus; and

    ·     Continue to provide stable, positive updates to the Physician Fee Schedule for all services.

  • 05/09/2019 10:04 AM | Rebekah Francis (Administrator)

    Congress introduced the Safe Step Act (H.R. 2279), which requires group health plans to adhere to common-sense parameters and reasonable timelines around the practice of step therapy. MGMA supports this bipartisan bill as it aims to improve step therapy protocols to ensure that patients have timely access to appropriate care while reducing physician practice burden associated with step therapy. Members are encouraged to contact their congressional representatives through MGMA’s “Contact Congress” portal and urge them to support the Safe Step Act.

  • 03/13/2019 7:19 PM | Rebekah Francis (Administrator)

    MGMA joined a broad industry coalition including the American Academy of Family Physicians, American College of Cardiology, American College of Radiology, America’s Health Insurance Plans, UnitedHealthcare, and more than 20 other organizations to develop a set of four considerations focused on improving, reforming, and streamlining the prior authorization (PA) process. The considerations include: 

    • Increasing transparency;  
    • Reducing PA volume;
    • Increasing use of existing electronic standards; and 
    • Exploring bundled authorizations. 

    The coalition is exploring pilot programs based on these considerations.

     

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