The information presented below comes from a number of sources including the MGMA Washington Connexion.
March 27, 2014
House passes one-year SGR patch
Today the House of Representatives passed by voice vote H.R. 4302
, which would temporarily delay the 24% cut to Medicare physician payments resulting from the sustainable growth rate (SGR) formula for one year. MGMA has joined with physician organizations in Washington to continue to advocate
for a permanent SGR fix, and does not support what would be the 17th short-term patch Congress has enacted since the SGR's inception.
Though the House has passed this legislation, the Senate must now act and choose to either take up full repeal of the SGR, or another temporary solution to this problem. MGMA will continue to update members on the status of the SGR through the Washington Connection.
HCFA 1500 Form Update
Effective 04/01/2014, Medicare is no longer accepting paper claims on the old CMS 1500 claim form with a date of 08-05 in the lower right hand corner. The new form has a date of 02-12. Qualifiers to identify an ordering, referring, or supervising role should be entered to the left of the dotted vertical line on item 17. Additional information regarding this initiative can be found in the CMS Medicare Learning Network (MLN) Matters: MM8509
; and in a published article
by the National Uniform Claim Committee (NUCC) which gives a quick list of updates and claim form order information.
March 31 attestation deadline for Meaningful Use
Eligible professionals (EPs) have until the end of the day on March 31 to attest to meeting the Meaningful Use requirements for the 2013 reporting year. The Centers for Medicare & Medicaid Services (CMS) recently extended
the deadline after MGMA raised concerns
that website related issues could result in EPs not being ready in time. CMS is concerned that high traffic close to the end of the month could lead to additional system delays and recommends EPs submit their attestation data as early as possible to avoid any problems. In preparation for the deadline, MGMA has updated its Meaningful Use Top Member Questions
and encourages members to visit our Meaningful Use Resource Cente
r for more information.
March 19, 2014
Don't miss March reporting deadlines for PQRS and Meaningful Use
As a result of MGMA advocacy
, the Centers for Medicare & Medicaid Services (CMS) has extended
the deadline for eligible professionals (EPs) to attest to Meaningful Use for the 2013 program year until the end of the day on March 31. CMS is recommending that EPs submit their attestation data as early as possible to avoid any problems. The agency is concerned that the expected large volume of EPs seeking to attest close to the end of the month could lead to system delays. Visit MGMA's Meaningful Use Resource Center
for more information.
Two key PQRS reporting deadlines are also quickly approaching. March 21, 2014 will be the last day groups may submit 2013 data through the GPRO Web Interface reporting method. March 31, 2014 will be the last day to submit 2013 PQRS registry reporting data, as well as Maintenance of Certification (MOC) Program Incentive quality data. To learn more about this program, visit MGMA's PQRS Resource Center
MGMA emphasizes importance of in-office exception to "Stark" Law to congressional leadership
On March 18, MGMA along with 30 other medical organizations sent a letter
to congressional leadership emphasizing the importance of preserving the in-office ancillary services exception (IOASE) to the "Stark" Law. This letter is in response to the president's budget
, which includes a proposal to restrict the IOASE for advanced imaging, radiation therapy, anatomic pathology and physical therapy. The president's budget serves as a blueprint for larger discussions, but has limited details and is nonbinding. Ultimately, Congress is responsible for passing final budget legislation. MGMA has long supported
the ability of group practices to provide ancillary services to patients within their practices and will continue to advocate on this issue. A sample letter for members to send their representatives in Congress can be found at MGMA's Advocacy Center
CMS issues additional guidance on Meaningful Use hardship exemption
The Centers for Medicare & Medicaid Services (CMS) released additional guidance
related to the new hardship exeption for the Medicare EHR Meaningful Use Incentive Program. Eligible professionals (EPs) can now avoid the 2015 payment adjustment if they have experienced difficulties with their EHR software vendor. CMS defines this exeption category as the EP's EHR vendor being unable to obtain 2014 certification or the EP being unable to implement Meaningful Use due to 2014 EHR certification delays.
New participants intending to demonstrate Meaningful Use for the first time who are unable to implement 2014 certified EHR technology for the 2014 reporting year may still apply for a hardship exception for the 2015 payment adjustment using the EP hardship exception form
EPs who have successfully demonstrated Meaningful Use for the 2013 reporting year will not be subject to the 2015 payment adjustment. If you are not able to implement 2014 certified EHR technology for a 2014 reporting period, you may also apply for a hardship exception for the 2016 payment adjustment using the EP hardship exception form for 2016, which will become available July 1.
All EPs must indicate the reason they are applying for a hardship exemption, select "2014 Vendor Issues" and submit their applications
by July 1, 2015. For more information, read the CMS updated Hardship Exemption Tip Sheet
and visit MGMA's Meaningful Use Resource Center
Aetna to eliminate paper checks
Aetna is moving to electronic funds transfer (EFT) payments and eliminating payments via paper checks. The insurance company recently announced
it will require physicians to receive payments and explanation of benefits statements electronically beginning in a few months. Aetna's plan to go paperless coincides with the federal requirement that health plans must offer EFT payments in a standardized format and utilize new "operating rules" for both EFT and electronic remittance advice (ERA). Those regulations, mandated as part of the Affordable Care Act, went into effect Jan. 1.
Practices that move to EFT and ERA can reduce or eliminate the cost and inconvenience of manually processing paper payments and remittance. In addition, practices typically will receive payments faster and be able to verify payments more quickly using the ERA transaction. Practices looking to take advantage of these and other administrative simplification opportunities should discuss options with their practice management system vendor. MGMA has produced an EFT/ERA Guide
to assist practices in this transition to electronic transactions.
March 14, 2014 - Special Alert
House passes SGR bill amid "pay-for" controversy
Today, by a vote of 237 to 182, the House of Representatives passed H.R. 4015, "The SGR Repeal and Medicare Provider Payment Modernization Act of 2014," which would repeal the Sustainable Growth Rate (SGR) formula. The legislation pays for repeal of the SGR by delaying for five years the Affordable Care Act's (ACA) "individual mandate," which imposes tax penalties on individuals who do not purchase health insurance. Although the House of Representatives has passed this legislation, the Senate opposes inclusion of the individual mandate repeal provision and the White House has issued a veto threat for the same reason. This represents the 51st House vote on repealing provisions of the ACA, which the Senate has blocked each time. In the current environment, tying SGR repeal to the ACA ultimately politicizes an issue that enjoys widespread bipartisan support.
The Democratic-led Senate plans to take up their own legislation repealing the SGR after returning from a congressional recess scheduled for next week. The Senate is not expected to offer an offset to pay for their bill, an approach opposed by Republicans who are concerned it will increase the national debt.
While there is still bipartisan agreement on the underlying policy to repeal the SGR, there is not yet agreement on how, or whether to pay for the legislation estimated to cost more than $138 billion.
MGMA strongly advocates for Congress to put aside their partisan differences and repeal the SGR once and for all. Another short-term solution to this problem only creates instability for practices and Medicare patients alike. We encourage you and your physicians to contact
your lawmakers and demand Congress return to bipartisan negotiations and repeal the SGR once and for all.
March 12, 2014
March 24 deadline to apply for ICD-10 end-to-end testing with Medicare
After receiving pressure
from MGMA and other industry groups that testing plans were inadequate, the Centers for Medicare & Medicaid Services (CMS) announced
it will perform full "end-to-end" ICD-10 testing with a limited number of providers. This more expansive testing will include final receipt of the remittance advice and provide information on whether the claim was paid, and for what amount. CMS has instructed Medicare Administrative Contractors (MACs) to identify a small number of volunteers to conduct the testing July 21-25. Each MAC will select 32 participants representing a broad cross-section of provider, claims and submitter types. To apply, the practice must fill out a volunteer form and be ready to submit claims using ICD-10 codes, submitting a maximum of 50 codes. Contact
your MAC by March 24 if your practice is interested. All testers will be notified of selection by April 14.
CMS has also developed several resources to assist practices in the Oct. 1 transition to ICD-10. The new "Road to 10
" tool allows the user to explore the common codes, primers for clinical documentation, clinical scenarios and additional resources associated with different specialties, including family practice, pediatrics, OB/GYN, cardiology, orthopedics, internal medicine and others. The site additionally includes links to several coding webinars
. MGMA has long advocated for the development of such resources to better prepare physician practices for ICD-10. For more information, visit MGMA's ICD-10 Resource Center
MGMA urges CMS to revisit ACA 90-day grace period
MGMA, along with 85 provider organizations, recently sent a letter
to the Centers for Medicare & Medicaid Services (CMS) reiterating our long-standing concerns
with the Affordable Care Act (ACA) 90-day grace period, which places unnecessary financial burdens on medical practices. The letter asked CMS to revisit its current policy, which allows health insurers who offer qualified health plans on the ACA exchanges (issuers) to pend and deny claims during the second and third months of the 90-day grace period. MGMA urges CMS to require issuers to provide grace period information as soon as a patient enters the first month and when responding to eligibility verification requests. We also urge the agency to require issuers to assume full financial responsibility if they provide inaccurate eligibility information during the last 60 days of the grace period. The grace period applies to patients who receive premium subsidies through the ACA exchanges and do not pay their share of the premium. Learn more at MGMA's ACA Resource Center
Industry groups announce new practice management system software accreditation program
The Workgroup for Electronic Data Interchange (WEDI
), in partnership with the Electronic Healthcare Network Accreditation Commission (EHNAC
), recently announced
plans to develop the new Practice Management System Accreditation Program (PMSAP). Practice Management System (PMS) vendors typically perform various administrative and clinical functions on behalf of providers. Currently, there is no third party review of these vendors and their ability to meet these standards. The purpose of this joint effort is to create a comprehensive review of PMS vendors in the areas of privacy, security, mandated transaction standards, operating rules and key operational functions. The project aims to help stakeholders take full advantage of the various administrative simplification opportunities included in both HIPAA and the Affordable Care Act. As a long-time advocate for such a program, MGMA helped to broker the WEDI-EHNAC partnership and will participate in future program development.
MGMA comments on proposed Medicare Advantage/ Part D rule
MGMA recently submitted comments
on a controversial proposed rule
outlining 2015 changes to Medicare Advantage and the Medicare Part D prescription drug program. The letter addresses several specific provisions of the rule, including a proposal that would allow the Centers for Medicare & Medicaid Services (CMS) to revoke a physician's Medicare billing privileges as a result of "improper prescribing practices," and another that would require physicians to be enrolled in Medicare in order to prescribe medication for Medicare beneficiaries. MGMA urges the agency not to finalize either proposal.
February 12, 2014
MGMA launches PQRS-Value Modifier Survival Guide
MGMA receives numerous questions from members struggling to understand the myriad of Medicare quality reporting programs. To help practices navigate these complex requirements, the Association has created the PQRS-Value Modifier Survival Guide
. This member-benefit leads you through the various reporting mechanisms in PQRS and the requirements that accompany them. The guide also reviews criteria for earning incentives and avoiding penalties in the programs and deciphers the critical connection between PQRS and the Value Modifier, which will impact all groups with 10 or more eligible professionals in 2016, based on 2014 performance.
Visit our PQRS Resource Center
to access this member-exclusive tool and arm your practice with the knowledge to be successful in these programs.
EHR attestation deadline extended to March 31
The Centers for Medicare & Medicaid Services (CMS) is extending the deadline for eligible professionals (EPs) to attest to Meaningful Use for the Medicare EHR Incentive Program 2013 reporting year from Feb. 28, 2014 to 11:59 pm ET on March 31, 2014. This extension will allow additional time for EPs to submit Meaningful Use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment. Note that this extension does not impact the deadlines for the Medicaid EHR Incentive Program or any other CMS program, including electronic submission for the PQRS EHR Incentive Program Pilot
CMS Registration and Attestation Tips:
- Ensure payment assignment and other relevant information is up to date in the Medicare payment system (PECOS)
- Include a valid email address in your EHR program registration
- Access the attestation system during non-business hours
- Enter 2013 attestation data early to identify potential problems well before the new deadline
- Report any problems to the EHR Incentive Program Help Desk
- If your organization has more than 1,000 providers assigned to a proxy user, use the PECOS system to designate additional proxies to facilitate attestation
MGMA urges Congressional leadership to repeal SGR
On Feb. 10, MGMA, along with the AMA and other state and national specialty organizations, sent a letter
to House and Senate leadership congratulating them on their significant progress
towards advancing repeal of the Sustainable Growth Rate (SGR) formula. To show your support for finding a long-term solution, visit our advocacy center
and tell your lawmaker to repeal the SGR now!
Further delay for ACA employer mandate
The Treasury Department issued new regulations
and an accompanying fact sheet
delaying full implementation of the Patient Protection and Affordable Care Act (ACA) provision stipulating that certain employers must provide health insurance or face fines. The employer responsibility provision will be phased in, applying to firms with 100 or more full-time employees starting in 2015 and to employers with 50 or more full-time employees starting in 2016. To avoid a penalty for failing to offer health coverage, employers need to offer coverage to 70% of full-time employees in 2015 and 95% in 2016 and beyond.
Congress advances SGR repeal legislation
Today the House Committees on Energy & Commerce and Ways & Means and the Senate Committee on Finance reached a bi-cameral, bi-partisan deal on legislation to repeal and replace the current Sustainable Growth Rate (SGR) formula. In addition to repealing the SGR, the proposed legislation
provides for 0.5% annual fee schedule updates for five years during a transition period that integrates value-based programs into the Medicare physician payment system. There is still little information on how Congress might pay for the legislation, expected to cost in excess of $128 billion. The cost is the largest political and practical hurdle to passage of this bill. MGMA will continue to update members on any further SGR movement through the Washington Connection
New MGMA ICD-10 research suggests industry coordination lagging
With less than eight months before the Oct. 1 compliance date to transition to ICD-10
, MGMA research suggests
that overall industry readiness for implementation continues to lag. The results, compiled through the Association's Legislative and Executive Advocacy Response Network (LEARN), indicate that less than 10 % of practices report making significant progress when rating their overall readiness for ICD-10 implementation, up only slightly (from 4.7%) since June 2013, when MGMA previously conducted LEARN research
to assess readiness levels. The research also suggests that practice testing with software vendors, clearinghouses and health plans is significantly behind schedule. The new research includes responses from more than 570 medical groups where more than 21,000 physicians practice.
Learn about the future of Medicare payment at FMPC
Despite frustration over another short-term patch
to the Sustainable Growth Rate (SGR) formula, there are promising signs that SGR repeal may be on the horizon. Three key congressional committees passed SGR repeal legislation in 2013, making 2014 ripe for continued discussion on how to replace this flawed Medicare payment system with value-based and alternative payment models. Gain a deeper understanding of new Medicare payment models that may impact medical practices in the coming years by attending the MGMA Government Affairs Update on Emerging Medicare Payment Models at the 2014 MGMA Financial Management and Payer Contracting Conference
in Orlando, March 2 – 4.
Attendees will also learn more about the impact of other timely legislative and regulatory issues affecting group practices at the MGMA Government Affairs Update on Recent Developments and Hot Topics. This session will review a number of federal regulatory developments such as changes for 2014 to Medicare quality reporting programs (and how to avoid program penalties), compliance and new Medicare policies.
OIG releases 2014 work plan
The HHS Office of Inspector General (OIG) released its 2014 Work Plan
, which provides brief descriptions of activities that the OIG plans to initiate or continue in fiscal year 2014. While the annual document is usually released in the fall, the OIG delayed its release to better align with priorities HHS has set for the year.
CMS announces interim results from Accountable Care Organizations
On Jan. 30, the Centers for Medicare & Medicaid Services (CMS) announced
interim financial results for selected value-based payment initiatives including Pioneer ACOs, Medicare Shared Savings Program ACOs and the Bundled Payments for Care Improvement Initiative. The CMS press release
noted that in their first 12 months, 54 out of 114 ACOs had lowered expenditures while only 29 lowered expenditures in amounts exceeding their benchmarks to generate shared savings.
HHS allows patients direct access to their lab results
The Department of Health and Human Services released a final rule amending the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations to allow patients to receive test results directly from laboratories. While some states currently allow patients to receive test results directly from a lab, the majority do not. The final rule will provide a national standard. MGMA submitted comments on this rule when it was proposed in 2011.