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  • 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.


  • 03/13/2019 7:17 PM | Rebekah Francis (Administrator)

    President Trump released his $4.7 trillion fiscal year (FY) 2020 budget request, which includes several Medicare proposals relevant to medical practices, such as expanding prior authorization. Presidential budgets do not have the force of law and are intended to serve as statements of administrative priorities, while Congress negotiates the budget. MGMA will continue to advocate on behalf of our members throughout the budget negotiation process. 

  • 03/13/2019 7:15 PM | Rebekah Francis (Administrator)

    MGMA reminds members that the deadline for submission of 2018 performance year data for the Merit-based Incentive Payment System (MIPS) is April 2, 2019 at 8:00 p.m. ET. MIPS participants must submit data and receive a minimum of 15 points in order to avoid a negative payment adjustment in 2020.

    MGMA encourages all members to log into their HCQIS Access Roles and Profile (HARP) accounts as soon as possible and make sure they are on track to complete all data submissions by this deadline. Reach out to MGMA’s Government Affairs team with any questions or concerns about submitting your MIPS performance data. 

  • 03/01/2019 10:34 PM | Rebekah Francis (Administrator)

    In 2019, seven new Merit-based Incentive Payment System (MIPS)-eligible clinician types were added: physical therapist, occupational therapist, speech-language pathologist, audiologist, clinical psychologist, and registered dietitian or nutritional professional. This Q&A article covers common questions from newly eligible clinician types.

  • 02/28/2019 10:20 AM | Rebekah Francis (Administrator)

    In a letter to the Secretary of the Department of Health and Human Services (HHS), the National Committee on Vital and Health Statistics (NCVHS) recommended new approaches to improve the adoption of national healthcare standards. The NCVHS, a federal body named in HIPAA as an HHS advisor, issued a number of recommendations: (i) remove the regulatory mandate for modifications to adopted standards and move towards industry-driven upgrades; (ii) promote and facilitate voluntary testing and use of new standards or emerging versions of transactions or operating rules; (iii) improve the visibility and impact of the administrative simplification enforcement program; and (iv) provide policy-related guidance from HHS regarding administrative standards adoption and enforcement. MGMA testified before the NCVHS in December and the letter closely aligns with the Association’s recommendations. HHS is expected to act on the NCVHS recommendations later this year. 

  • 02/28/2019 10:18 AM | Rebekah Francis (Administrator)

    In response to MGMA member concerns whether new Medicare Beneficiary Identifiers (MBIs) contain the number “0” or the letter “O” on new Medicare cards, CMS clarified that the MBI uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. As a reminder, starting Jan. 1, 2020, Medicare will only accept the MBI on claims, and practices can access their MBIs via your Medicare Administrative Contractor web portal. Download the member-benefit New Medicare Card Toolkit for additional information on the transition to the new cards and numbers.  

  • 02/13/2019 4:31 PM | Rebekah Francis (Administrator)

    The Office of the National Coordinator for Health Information Technology (ONC) released its proposed rule implementing provisions of the 21st Century Cures Act. Issues covered in the rulemaking include prohibitions against the blocking of data by providers or EHR vendors, the development and deployment of Application Programming Interface (API) standards, EHR developer certification, development of pediatric health information technology, practice ability to export patient data from one EHR to another, and other topics. Concurrently, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on patient access to data using APIs, health information exchange across health plans, and other topics. Both agencies also included an RFI on the issue of accurately matching patient records. ONC and CMS will accept comments on these proposals until mid-April. MGMA will comment on each of these rules and the RFI.

  • 02/13/2019 4:30 PM | Rebekah Francis (Administrator)

    MGMA joined over 100 medical societies and associations to voice concern to Congress regarding the impact unexpected medical bills have on patient out-of-pocket costs. In the letter, we argue that the issue is complex and requires a balanced approach to resolve. Included in the letter is a list of policies for Congress to consider, including insurer accountability, limits on patient responsibility, and promoting transparency. 

  • 02/13/2019 4:29 PM | Rebekah Francis (Administrator)

    MGMA submitted comments in response to an Office for Civil Rights (OCR) Request for Information (RFI) on modifying HIPAA to facilitate care coordination and support value-based care. MGMA identified opportunities to reduce administrative burden, particularly with regards to patient acknowledgement of practice privacy policies. The Association pushed back on forcing practices to disclose patient records when requested by other providers or business associates, arguing clinicians should be permitted to use professional judgement to determine when a disclosure is appropriate. Also, MGMA strongly opposed the expansion of the current accounting of disclosures report to include disclosures made for purposes of treatment, payment, or healthcare operations. OCR is expected to publish regulations later this year.

  • 01/10/2019 9:57 AM | Rebekah Francis (Administrator)

    2019 promises to be another busy year in healthcare. The 2018 midterm elections shifted the balance of power in Washington as Democrats now hold the gavel in the U.S. House of Representatives, creating a divided Congress with the Republican-held Senate. MGMA has identified the following legislative and regulatory issues critical for medical practices in the coming year. We will keep members apprised of key developments in these areas and their impact on medical practices and will continue to advocate for policies that enable practices to thrive in their mission to furnish high-quality, cost-effective patient care.

    1. HHS doubles down on risk

    Despite an anemic pipeline of new voluntary Medicare alternative payment models (APMs) trickling out of the Department of Health and Human Services (HHS), Secretary Alex Azar is planning a new approach to accelerate participation in risk-based APMs. Forgoing incremental implementation, the Secretary is expected to unveil new mandatory models in 2019 and to emphasize performance-based risk as a necessary component of any new APM.

    MGMA strongly supports voluntary participation in APMs when it makes financial sense for individual practices and disagrees with the Secretary that the way to expedite the move to value-based care is to mandate participation. We will continue to advocate for new opportunities for practices to participate in voluntary APMs and for development of more physician-led models.

    2. Regulatory relief from government burdens

    It is expected that Congress and the Administration will continue to work toward reducing the regulatory burden on medical practices participating in government healthcare programs. The Centers for Medicare & Medicaid Services’ (CMS’) “Patients Over Paperwork” initiative is one such example. However, this has translated into only modest relief for practices thus far, as 88% of MGMA members polled reported an increase in overall regulatory burden last year. MGMA will continue to make regulatory relief a top advocacy priority in 2019. Keep up with our efforts at

    3. Kicking back the Stark Law

    As part of the effort to accelerate payment innovation, HHS leaders pledge to revisit antiquated fraud and abuse rules such as the Stark Law and Anti-Kickback Statute. In 2019, watch for proposed rules that expand exceptions and safe harbors to protect value-based arrangements and benefit providers willing to take on performance-based risk. 

    While a push to simplify Medicare compliance rules is welcomed, it is likely that congressional intervention will be necessary to achieve meaningful reform. It remains to be seen if Congress will also prioritize this issue in 2019. 

    4. Surprise! Here is a medical bill you didn’t expect

    Medical practices can expect to see a push to curb surprise medical bills, including efforts to empower patients and consumers through improved access to healthcare cost information. The sticker shock of surprise hospital bills continues to make headlines and draw bipartisan attention in Congress, making this issue ripe for legislative action in 2019.

    5. A spoonful of new regulations to help drug prices go down

    With a new Congress and support from the Administration, reducing Medicare drug prices is on the action list for 2019. For physician-administered drugs, one proposal seeks to curb the price of drugs in Part B by tying prices to a new International Price Index, create new private-sector vendors to supply practices with drugs, and set drug administration cost as a flat fee. CMS is also looking to give Part D drug plans greater flexibility to negotiate drug prices in protected classes. 

    6. The stakes are higher in MIPS

    Implementation of the Merit-based Incentive Payment System (MIPS) continues to ramp up. In 2019, MIPS performance will determine whether clinicians receive a positive or negative payment adjustment of up to 7% on 2021 Medicare reimbursement. Medicare is accelerating cost accountability for MIPS clinicians by increasing the cost component to 15% of the overall MIPS score and introducing episode-based measures. The performance threshold required to avoid a payment penalty also doubles from 15 to 30 points in 2019. With more on the line this year, it is critical that MGMA members prepare their practices for success. Visit for helpful resources. 

    7. Data interoperability a priority for feds

    The Office of the National Coordinator for Health Information Technology (ONC) is expected to release regulations to meet requirements of the 21st Century Cures Act and facilitate improved data sharing between healthcare entities. ONC will define and seek to discourage “information blocking,” develop a framework to facilitate data movement between heath information exchange entities, and release specifications for the use of apps to foster data exchange between different providers and between providers and patients. The goal of using apps, a component of MIPS and Stage 3 Meaningful Use, is to permit practices to efficiently and securely move administrative and clinical data via their EHR.    

    8. Cybersecurity continues to be a top practice concern

    Medical practices can be a prime target for phishing and other cybersecurity attacks because they possess valuable information assets (patient clinical and financial data) and often have inadequate cybersecurity protections. HHS’ HIPAA enforcement arm is expected to ramp up audits and fines in 2019. Medical practices should protect both their data and business continuity by completing a comprehensive risk assessment, identifying vulnerable areas of the organization, and taking the steps necessary to mitigate risk. Check out MGMA security resources to prepare your practice this year. 

    9. Site-of-service payment differentials remain a target

    Policymakers will continue the trend toward site-neutral payments with the goal of equalizing Medicare payments for the same services across clinical sites. Medicare expanded this policy through 2018 rulemaking by phasing-in payment reductions for clinic visits at hospital outpatient departments (HOPDs), including HOPDs expected from previous site-neutral payment rules. In addition to saving money for patients and the government, site-neutral payments are viewed as a policy lever for increasing market competition, eliminating the incentive for hospitals to purchase freestanding clinics and leveling the playing field. 

     10. “Repeal and replace” is out, “Medicare for all” is in 

    This shift in power within Congress will recast the role the federal government plays in healthcare in 2019. With “Medicare for all” a key platform for many progressives during the 2018 primaries, the politicized debate over a single-payer health system shows no signs of slowing down and will likely gain steam ahead of 2020 elections.

    Passage of any major health reform bill is highly unlikely anytime soon. However, as presidential contenders begin campaigning for the 2020 primaries, universal healthcare will almost certainly become a point of debate.

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