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Originally published in the January 12, 2023, issue of MGMA’s Washington Connection Reprinted with permission from MGMA
U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) yesterday. This renewal extends the PHE through mid-April 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. HHS has reiterated its promise to give a 60 days’ notice before letting the PHE expire.
While many telehealth flexibilities are tied to the PHE, it is important to note that the recently passed Consolidated Appropriations Act, 2023, does ensure certain ones will remain in effect through Dec. 31, 2024, regardless of PHE status.
More information may be found in MGMA Government Affairs’ newly updated telehealth resource.
Originally published in the December 22, 2022, issue of MGMA’s Washington Connection Reprinted with permission from MGMA
Earlier this week, Congress released the text of their year-end spending package, which contains a handful of healthcare provisions that will impact medical groups.
Medicare physician payment: The legislation averts 6.5% of the scheduled 8.5% reduction to physician reimbursement in Medicare, resulting in an approximate 2% cut to the Medicare conversion factor for 2023. By way of background, in 2021, CMS shifted funds in the physician fee schedule to pay for an increase in work RVUs, which raised reimbursement for office visits. This shift resulted in a decrease to the conversion factor due to a statutorily mandated budget neutrality adjustment. Congress provided funds to offset the adjustment in 2021 and partially offset it again in 2022. Going into 2023, we expected a cut of 8.5%, resulting from both a decrease to the conversion factor (4.5%) and PAYGO cut (4%). For the third year in a row, we’ve urged Congress to address the de facto cuts — this year in the form of adding 4.5% back into the fee schedule and waiving PAYGO. Unfortunately, despite 10,000 letters from MGMA members, Congress did not have the appetite to fully waive budget neutrality requirements to address the slated 4.5% cut. Instead, Congress will only partially mitigate it by allowing a 2% cut in 2023. This is in addition to legislation waiving the 4% PAYGO for 2023 and 2024. MGMA has voiced its disappointment that Congress is allowing a 2% cut to occur in 2023 and will continue working to find a more sustainable and comprehensive solution.
Alternative Payment Models (APMs): The 5% incentive bonus is set to expire at the end of this year. The legislation would extend the bonus for an additional year, through 2023, at 3.5%.
Telehealth: Many telehealth waivers, including being able to treat a patient in their home, were extended through 2024. This is positive development supported by MGMA to ensure continuity from pandemic-era telehealth policies.
Lab cuts: Pending the passage of this legislation, practices will receive a one-year reprieve from the laboratory cuts of up to 15% that would have gone into effect in January 2023. This provision was also supported by #MGMAAdvocacy.
We expect Congress to pass this legislation into law by Friday. We will let you know if Congress modifies the current text.
Originally published in the December 15, 2022, issue of MGMA’s Washington Connection Reprinted with permission from MGMA
With only 17 days remaining in 2022, time is rapidly running out for Congress to act to avert the 4.5% reduction to the Medicare conversion factor set to effect on Jan. 1. We know from our members that the impact of this cut, especially in light of current inflationary pressures and workforce shortages, will be devastating for medical groups nationwide.
As the Medicare physician fee schedule is the only Medicare payment system without an annual inflationary update, the 4.5% reduction will only exacerbate current financial concerns and is frankly untenable. Should these cuts take effect, medical groups may be forced to make difficult business decisions including reducing the number of Medicare patients served, limiting the number of services provided, laying off staff, and even selling their practices.
MGMA continues to advocate against this detrimental reduction and for permanent payment reforms. If you haven’t done so already, join in #MGMAAdvocacy today by sending a letter to your members of Congress to pass legislation to stop the full 4.5% payment reduction from taking effect.
Already sent a letter? The time is now to pick up the phone. Call your members of Congress immediately and implore them to protect beneficiary access to care by passing legislation to #StopTheFullCut. Already asked your colleagues to take action? Now is the time to ask your friends and loved ones — the health of our nation’s seniors depends on it.
Originally published in the December 8, 2022, issue of MGMA’s Washington Connection Reprinted with permission from MGMA
On Monday, MGMA and over 100 other healthcare stakeholder organizations sent a letter to congressional leadership urging action to avert the entire 4.5% reduction to Medicare payment rates scheduled to take effect Jan. 1, 2023. The letter illustrates the severity of this pending cut and the negative impact it will have on practices, especially in light of current inflationary pressures. As the Medicare physician fee schedule is the only Medicare payment system without an annual inflationary update, the pending 4.5% reduction will only exacerbate current financial concerns.
MGMA is continuing to advocate against this harmful reduction and for permanent payment reforms. Join in #MGMAAdvocacy today by sending a letter to your members of Congress to pass legislation to stop the full 4.5% payment reduction from taking effect.
Originally published in the December 1, 2022, issue of MGMA’s Washington Connection Reprinted with permission from MGMA
With just one month remaining in 2022, MGMA needs your immediate help urging Congress to take action to avert significant Medicare payment cuts set to take effect on Jan. 1. The time to act is now! Utilize our online portal to send a letter to your members of Congress today encouraging the passage of legislation to avert the 4.47% reduction to the Medicare conversion factor, waive the statutory 4% Pay-As-You-Go sequester, provide an inflationary update based on the Medicare Economic Index, and extend the alternative payment model 5% incentive payment.
Already sent a letter? Please share this link with everyone at your practice and ask them to do the same: www.congressweb.com/MGMA/67. Want to get the word out beyond your colleagues? Encourage others to get involved in this critical advocacy effort by sharing a post from our Medicare Cuts Advocacy Social Media Toolkit!
Without congressional action, these payment reductions will take effect and have a drastic impact on beneficiary access to care and group practice financial resiliency. Take a look at our survey results to see what others are saying about the payment cuts, including how they disrupt practice operations and overall investment throughout the healthcare industry. Join in #MGMAAdvocacy today calling for the swift passage of legislation to avert these devastating payment cuts!
Originally published in the November 17, 2022, issue of MGMA Washington Connection Reprinted with permission from MGMA
On Monday, MGMA sent a letter to congressional leadership urging them to address significant Medicare cuts and other important healthcare policies before the end of this year. The letter highlights current issues with Medicare reimbursement that projected payment cuts will exacerbate and asks Congress to act by:
Offsetting the 4.47% reduction to the Medicare physician conversion factor;
Waiving the 4% statutory Pay-As-You-Go sequester; and,
Extending the 5% alternative payment model (APM) incentive payment for six additional years.
Further, MGMA encouraged Congress to pass additional commonsense legislation to address significant administrative burdens impacting group practices and improve the timeliness of clinical care delivery. These recommendations included passing the Improving Seniors’ Timely Access to Care Act, extending telehealth waivers for at least two years after the conclusion of the public health emergency, passing the Saving Access to Laboratory Services Act, and appropriating additional funds to continue rewarding high performing clinicians within the Merit-based Incentive Payment System (MIPS).
Visit MGMA’s Contact Congress portal to send a letter to your legislators on these important issues!
Originally published in the November 1, 2022, issue of MGMA’s MGMA Regulatory Alert Reprinted with permission from MGMA
The Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule this afternoon, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2023. The final rule:
Sets 2023 Medicare payment rates for physician services. For 2023, CMS finalized a conversion factor of $33.0607 and $20.6097 for Anesthesia (a decrease of -4.47% and -4.42%, respectively, over final 2022 rates);
Finalizes implementation of provisions of the Consolidated Appropriations Act, 2022 that extend the application of certain Medicare telehealth flexibilities for an additional 151 days after the end of the COVID-19 public health emergency (PHE), such as allowing telehealth services to be furnished to patients in their homes;
Extends flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time until 2024;
Expands access to behavioral health by permitting marriage and family therapists, licensed professional counselors, and others to furnish behavioral health services under general supervision instead of direct;
Maintains the MIPS performance threshold at 75 points for the 2023 MIPS performance year/2025 payment year;
Adds five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness, for voluntary reporting beginning in 2023; and
Creates an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.
MGMA submitted detailed comments in response to the proposed rule in September. Be on the lookout for a more detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP) in the coming weeks.
Originally published in the October 20, 2022, issue of MGMA’s Washington Connection Reprinted with permission from MGMA
With just over two months left in 2022, MGMA needs your help urging Congress to take action to avert significant Medicare payment cuts set to take effect in 2023. Send a letter to your members of Congress today encouraging the passage of legislation to avert the 4.5% reduction to the Medicare conversion factor, waive the statutory 4% Pay-As-You-Go sequester, and provide an inflationary update based on the Medicare Economic Index. MGMA Government Affairs’ latest report on Medicare cuts showcases what medical groups around the country have to say about these proposed payment cuts, including how they would significantly disrupt patient access to care, practice operations, and overall investment throughout the healthcare industry.
The time to act is now! Join in #MGMAAdvocacy today by sending a letter to your members of Congress urging for the swift passage of legislation to avert these significant payment cuts!
2022 Alliance sponsor feature article courtesy of TowneBank
Medical identity theft has more than tripled over the past five years, as hackers and cyber-criminals target the healthcare industry at alarming rates. So why are medical records so valuable to data thieves? Personal medical data is said to be more than ten times as valuable as credit card information. Just one patient record contains an enormous amount of identity information that hackers can exploit, including:
Full name
Birth date
Social Security number
Medicare number
Email
Phone numbers
Home address
Prescription information
Driver’s license
Payment information such as credit card or bank account numbers
This data is incredibly valuable on the black market, just one Medicare number is said to sell for nearly $500. Keeping this patient information safe from cyber-thieves must be a top priority for hospitals, healthcare organizations, and medical offices. The threat of a data breach not only puts an organization or medical practice at risk for a hefty fine or HIPAA violation, but it also threatens the core of the business because it damages patient trust.
The following are five steps to keeping your patient’s medical data safe:
1) Education Educating your staff may be the best line of defense against data theft. Ensure your employees are informed on privacy policies, security measures, how data breaches occur and how to prevent them. Build staff awareness of medical identity theft and how to keep patient data secure.
2) Mobile devices Patient data may often be stored on mobile devices. Protecting devices such as laptops, smartphones, and tablets with encryption and passwords is another way to avoid a potential data breach. Also, it is important to ensure employees never leave their mobile devices unattended.
3) Email Many attempts for data breach occur through unsolicited emails called “phishing.” Be sure to instruct staff not to open any emails that are unfamiliar and never open any attachments or links from an unknown sender.
4) Antivirus Be sure to keep all software and antivirus programs regularly up to date.
5) Secure your network server and wireless networks To prevent attacks, practices should make sure their network passwords are secure and changed frequently. Ensure routers and other components are kept up to date. Set up firewalls and antivirus for all devices that connect to the internet. Lock down your network server so that it is difficult to physically remove it from your office and lock up any backup or storage devices.
Common mistakes:
Employees sharing workstations or user IDs
Leaving screens or workstations unsecured
Sending patient medical information via unsecured email
Using unsecured laptops, tablets, and smartphones
Sending patient medical information through text messaging
Speaking about private patient medical information to friends, family, patients, or other medical offices.
Failure to obtain the proper release/consent form to release patient medical data.
While there is not one sure way to prevent all data breaches, these best practices will go a long way in keeping your patient data safe and secure from potential theft.
The information provided is not intended to be legal, tax, or financial advice or recommendations for any specific individual, business, or circumstance. TowneBank cannot guarantee that it is accurate, up to date, or appropriate for your situation. Financial calculators are provided for illustrative purposes only. You are encouraged to consult with a qualified attorney or financial advisor to understand how the law applies to your particular circumstances or for financial information specific to your personal or business situation.
The application will close on October 26, 2021 at 11:59 p.m. ET. Applications must undergo a number of validation checks before financial information is submitted so providers are encouraged to begin their application as soon as possible to ensure they are able to meet the deadline.
In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application, and HRSA will use existing Medicaid, Children’s Health Insurance Program (CHIP), and Medicare claims data in calculating portions of these payments.
North Carolina Medical Group Management Association Blog 