Join in #MGMAAdvocacy to Prevent Medicare Payment Cuts

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!

Save the date: 2020 Washington Update and Policy Outlook webinar

MGMA Government Affairs invites you to join us for a member-exclusive webinar on Thursday, June 25 at 1:00 p.m. ET. With legislative and regulatory changes reshaping the healthcare landscape in response to the COVID-19 pandemic, this timely program will present a mid-year update on the current state of federal healthcare policy impacting medical groups. The session’s forward-looking agenda will also provide considerations for the future of medical group practices and potential new actions Congress and the Administration could take in response to the pandemic. In addition, attendees will learn about ongoing MGMA advocacy in support of medical groups. Attendees will also have a chance to ask their most pressing questions during a question and answer session. Don’t delay – register now to secure your place!

Regulatory Alert: CMS Increases Telehealth Payments and Makes ACO Changes

Originally published on April 30, 2020 by MGMA
Reprinted with permission from MGMA

Today, the Centers for Medicare & Medicaid Services (CMS) issued another round of regulatory waivers through an interim final rule intended to expand care to Medicare beneficiaries and provide more flexibilities to the providers that treat them. The changes outlined below will be effective for the duration of the COVID-19 public health emergency (PHE).

Changes to telehealth policy:

  • Following MGMA advocacy, CMS is increasing payment for audio-only telephone E/M services (CPT codes 99441-99443) such that they are paid at the same rate as similar office and outpatient E/M visits, resulting in increased payments from $14-$41 to $46-$110. CMS believes that the resources required to furnish these services during the PHE are better captured by RVUs associated with level 2-4 established office/outpatient E/M visits. CMS is not increasing payment for CPT codes 98966-98968, which are intended for practitioners that cannot separately bill for E/M. This policy is retroactive to March 1, 2020.
  • For telehealth services other than CPT codes 99441-99443 and 98966-98968 (now added to the list of covered telehealth services), Medicare continues to require modalities that have both audio and video capabilities.
  • CMS is forgoing its typical rulemaking process to add new services to the list of Medicare services that may be furnished via telehealth. Instead, CMS will add new telehealth services on a sub-regulatory basis to speed up the process of adding codes to the list.

Changes to Medicare Shared Savings Program (MSSP):

  • There will be no application cycle for a Jan. 1, 2021 start date, and ACOs in the last performance year of their current agreement period (mainly Track 1 ACOs and Track 1+ Model ACOs) will be allowed to voluntarily extend their agreement period by an additional performance year in 2021.
  • ACOs participating in the BASIC track glide path will be permitted to maintain their current risk level under the BASIC track for PY 2021 and freeze progression to higher risk.
  • CMS is removing all Part A and B payment amounts for episodes of care involving the treatment of COVID-19 for the purposes of determining benchmark year and performance year expenditures.
  • The list of primary care services used for beneficiary attribution will be expanded to include additional telemedicine services.

MGMA Government Affairs will continue to inform medical groups as the Administration releases additional waivers and further guidance on COVID-19 related regulatory changes. CMS’ press release on the changes can be found here and a fact sheet on MSSP changes can be found here.

Regulatory Alert: New MGMA Resources on Federal Financial Assistance

Originally published by MGMA on April 3, 2020
Reprinted with permission by MGMA

MGMA Government Affairs developed two new resources to inform medical groups of available financial assistance opportunities set forth in the CARES Act, which was signed into law on March 27, 2020. The resources are organized by medical group size because the U.S. Small Business Administration (SBA)’s Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL) are only available to businesses with 500 employees or less. Please note that financial lenders should start accepting applications for PPP loans today, although it has been reported that not all lenders are prepared. In the meantime, SBA has supplied a sample application form for applicants to understand what will be requested of them.

Resource for medical groups with less than 500 employees: The CARES Act allocated money to fund the PPP loans and EIDLs. Loans under the PPP can be forgiven if the employer keeps their employees on the payroll for eight weeks after the loan origination date. EIDL loans are available to businesses who have suffered substantial economic injury. Small businesses who have applied for EIDL loans can receive an advance of $10,000 (“emergency EIDL grants”) within three days after the SBA receives their application. Please review MGMA’s resource for more details on both programs.

Resource for medical groups of all sizes: CMS’s Accelerated and Advance Payment Program (APP) and funds distributed from the “Public Health and Social Services Emergency Fund” are two available financial assistance options. The APP provides a quick mechanism for healthcare entities to obtain an accelerated cash flow, which is subject to repayment – funding through this mechanism can be accessed now. Little is known yet on how the $100 billion from the emergency fund will be distributed, but these funds are intended to reimburse eligible healthcare entities for healthcare related expenses and lost revenue stemming from COVID-19.

April 3 MGMA State Affiliate Webinar: COVID-19 Legislative and Regulatory Actions To-Date


MGMA Washington Update: COVID-19 Legislative
and Regulatory Actions To-Date

Friday, April 3, 2020 | 2:00 PM – 3:00 PM EDT

Session Description

This update will provide the latest information from the National MGMA Government Affairs team on the latest actions taken by Congress and federal regulatory agencies in response to the COVID-19 outbreak. Attendees will learn about recent legislative and regulatory developments affecting medical groups, gain a deeper understanding of these changes and their impact on the day-to-day activities of medical group practices, and be directed to clarifying resources.

Topics Include:

  • The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act
  • CMS Advanced Payments
  • Medicare Telehealth
  • MGMA Advocacy and Resources

About Our Speakers

Drew Voytal serves as an Associate Director for MGMA Government Affairs in Washington DC. In his primary role as a Government Affairs member liaison, he works to inform membership of the federal rules and regulations impacting medical group practices around the country. He works closely with MGMA state affiliate chapters to organize grassroots efforts and is a frequent speaker at state and national meetings. In addition to meeting with members and speaking at conferences, Drew manages education and outreach programs that inform MGMA members as well as policymakers in Congress and the administration.

Claire Ernst is an Associate Director of Government Affairs. Claire represents MGMA in Washington DC on a variety of legislative and regulatory issues important to MGMA members. In this role, she helps inform policy makers of the important role group medical practices have in the healthcare system. Before joining MGMA, Claire was the Manager of Government and Regulatory Affairs at HIDA, the national trade association for medical-surgical distributors. In her role there, Claire developed and maintained the association’s regulatory portfolio through Congressional and agency advocacy.


Senate Passes Third Stimulus Package

Originally published in the March 26, 2020 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Late Wednesday night, the Senate passed a much anticipated third emergency funding bill to help combat the spread of the virus and the negative economic impact its having on the country. The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act:

  • Provides $100 billion to hospitals and healthcare providers to ensure they continue to receive the support they need for COVID-19 related expenses and lost revenue;
  • Creates a “paycheck protection program” that would provide 8 weeks of cash-flow assistance to small employers;
  • Gives the Secretary more flexibility to waive additional Medicare telehealth requirements; and
  • Temporarily suspends the 2% Medicare sequestration.

The House of Representatives is expected to vote on the bill as soon as tomorrow. MGMA Government Affairs will continue to monitor these legislative developments and provide updates via the COVID-19 Action Center.

COVID-19: What to Know as a Healthcare Provider

Originally published in the March 5, 2020 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

As Coronavirus Disease 2019 (COVID-19) continues to spread, it is critical that the healthcare community remains informed on the latest guidance released by the Centers for Disease Control and Prevention (CDC), including CDC clinical criteria for “persons under investigation” and treatment guidelines for confirmed COVID-19 cases. As the Administration takes steps to mitigate growing concerns around the virus, Congress is working to pass supplemental funding to contain and treat its associated illness. The “Coronavirus Preparedness and Response Supplemental Appropriations Act” includes a provision to allow the Secretary of the Department of Health and Human Services to waive certain Medicare telehealth restrictions during the coronavirus public emergency. MGMA Government Affairs will continue to monitor and report on this issue as it develops.