COVID-19 PHE Renewed

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.

Congress Releases Year-end Legislation, Addressing Medicare Cuts and Telehealth

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.

Act Now: Only 17 Days Until Medicare Cuts Take Effect

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.

Call To Action: 31 Days Until Medicare Payment Cuts Take 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!

MGMA Sends Congress Year-end Legislative Recommendations

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!

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!

New Surprise Billing FAQ Released

Originally published in the April 7, 2022, issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

The Centers for Medicare and Medicaid Services (CMS) released a new FAQ document providing additional information about the uninsured and self-pay good faith estimate (GFE) requirements. These new policies went into effect on Jan. 1, 2022, and were implemented under the No Surprises Act.

MGMA is encouraged by the continued engagement from CMS to provide necessary clarifications; however, we are continuing to advocate for additional guidance and education to ensure all practices have the information necessary to comply with the requirements.

Regulatory Alert: CMS Announces New Flexibilities

Originally published on March 31, 2020 in MGMA’s Washington Connection
Reprinted with permission from MGMA

Last night, the Centers for Medicare & Medicaid Services (CMS) issued a series of temporary regulatory waivers to further support the ability of the nation’s healthcare system to respond to COVID-19. The changes outlined below will take effect immediately across the entire country:

• New telehealth codes. CMS will pay for 80 additional telehealth codes, including home visits, emergency department visits, and therapy services. Providers can waive copayments for all telehealth services for Original Medicare beneficiaries.
• Virtual check-ins. Clinicians can provide virtual check-in services (HCPCS G2012, G2010) to both new and established patients. Previously, these services were limited to established patients only.
• Telephone codes. CMS will reimburse for telephone evaluation and management services provided by a physician (CPT 99441-99443) and telephone assessment and management services provided by a qualified nonphysician healthcare professional (CPT 98966-98968). These codes are only available to established patients but may be furnished using audio-only devices.
• E-visits. Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists can provide e-visits (HCPCS G2061-G2063). These codes are only available to established patients and must be initiated by the patient.
• Removal of frequency limitations on Medicare telehealth. Subsequent inpatient visits (CPT 99231-99233), subsequent skilled nursing visits (CPT 99307-99310), and critical care consult codes (CPT G0508-G0509) no longer have limitations on the number of times they can be billed.
• Medicare physician supervision requirements. Physician supervision can be provided virtually using real-time audio/visual technology for services requiring direct supervision by a physician or other practitioner.
• “Stark Law” waivers. CMS is implementing waivers that exempt providers from sanctions for noncompliance of certain Stark Law rules, permitting certain referrals and the submission of related claims that would otherwise violate the Stark Law.
• MIPS flexibilities. CMS will allow clinicians adversely affected by COVID-19 to submit an application to request reweighting of the MIPS performance categories for the 2019 performance year.

MGMA Government Affairs will continue to educate medical groups as the Administration releases additional waivers and further guidance on COVID-19 related regulatory changes. For a comprehensive list of Medicare telehealth waivers and regulatory developments, please click here.

COVID-19 Regulatory Alert: CMS Announces Expanded Advance Payment Program to Provide Accelerated Loans to Healthcare Providers

Originally published in the March 30, 2020 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

On Saturday, the Centers for Medicare & Medicaid Services (CMS) announced nationwide expansion of the existing accelerated Advance Payment Program (APP), making the program available for most Medicare physicians and group practices. The APP provides a quick mechanism for healthcare entities to obtain accelerated, interest-free cash flow. Specifically, the APP fact sheet outlines that:

• Physician practices can request an advanced payment of up to 100% of the Medicare payment amount based on a three-month lookback period. Hospitals can request up to 100% (125% for critical access hospitals) based on a six-month lookback period. The guidance does not specify how the lookback period is determined.
• Healthcare entities must make a request for an accelerated payment under the APP by submitting a form to their Medicare Administrative Contractor (MAC).
• Once requested, CMS anticipates MACs will issue payment within seven calendar days from the request.
• The criteria for applying for the APP are:
  • Having billed Medicare for claims within 180 days immediately prior to the date of request;
  • Not in bankruptcy;
  • Not under active medical review or program integrity investigation; and
  • No outstanding delinquent Medicare overpayments.
• APP payments are subject to repayment, which for most healthcare entities begins 120 days after the payment is received.
  • During the 120-day period, the healthcare entity will continue to be paid like normal for claims submitted to Medicare.
  • After the 120 days, the recoupment process starts and every claim submitted will be offset to repay the advanced payment.

   

This announcement is a step in the right direction; however, MGMA is advocating that the Administration make available funding that is not subject to repayment or recoupment. Recently passed legislation (the CARES Act) creates several financial assistance programs, including $100 billion in grants for Medicare physicians and hospitals. Although the APP fact sheet states that the APP reflects the passage of the CARES Act, which did expand the APP, this program is not part of the $100 billion in funding authorized under that law.

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.