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Government Advocacy

September 11, 2017: MGMA 2018 CMS Physician Fee Schedule Comment Letter

Advocacy Letter

Medicare Payment Policies

September 11, 2017

The Honorable Seema Verma
Centers for Medicare & Medicaid Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Submitted via

Re: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program; Proposed Rule (Federal Register Vol. 82, No. 139, July 21, 2017)

Dear Administrator Verma:

The Medical Group Management Association (MGMA) appreciates the opportunity to submit comments on the rule, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program,” released on July 21, 2017 with file code CMS-1676-P. We look forward to continuing to work with the Centers for Medicare & Medicaid Services (CMS) on the issues in this proposed rule.

MGMA is the premier association for professionals who lead medical practices. Since 1926, through data, advocacy and education, MGMA empowers medical group practices to create meaningful change in healthcare. With a membership of more than 40,000 medical practice administrators, executives, and leaders, MGMA represents more than 12,500 organizations of all sizes, types, structures, and specialties that deliver almost half of the healthcare in the United States.

In summary, we urge CMS to:
  • Remove administrative barriers to billing care management services by aligning the codes with the CPT Editorial Panel guidelines, eliminating certification requirements for use of electronic health records, and seeking opportunities to waive patient cost-sharing.
  • Verify the accuracy of data collected during the initial data collection period under the Clinical Laboratory Fee Schedule before applying it to payment and, moving forward, notify applicable physician office laboratories in advance of the data collection period.
  • Finalize the proposed implementation delay of appropriate use criteria (AUC) and extend the education and testing year through at least 2019.
  • Hold clinicians harmless from 2018 penalties under the largely obsolete PQRS, Value-Based Payment Modifier (VM) and EHR Incentive Program (Meaningful Use) programs if they demonstrated a clear attempt to participate in these programs in 2016 by successfully reporting at least one measure.
  • Clarify eligibility requirements for furnishing care under the expanded Medicare Diabetes Prevention Program and allow physician group practices to furnish these services virtually.
  • Implement MGMA’s detailed recommendations in response to the Request for Information on CMS Flexibilities and Efficiencies to significantly decrease unnecessary regulatory paperwork and improve the quality and efficiency of healthcare delivery in this country.
  • Use the results of MGMA’s regulatory burdens survey as a tool to help provide regulatory relief for medical group practices (see attached).

Misvalued code target

CMS proposal: Due to laws passed in recent years, CMS must meet annual targets for reductions in PFS expenditures by adjusting the RVUs of codes identified as misvalued. For 2018, the annual target is 0.5%. CMS estimates the net readjustment to misvalued codes in 2018 would be 0.31%, falling below the 2018 annual target and triggering a requirement to lower the conversion factor by the difference between the net adjustment and the target. If finalized, the conversion factor would be reduced by 0.19%.

MGMA comment: We recognize the challenge of meeting the 0.5% misvalued code threshold established by Congress and were disappointed the agency missed the targets in 2016 and 2017 due to its narrow approach, thus decreasing overall Medicare physician payments. MGMA continues to suggest a broad approach that fully and accurately accounts for payment changes due to misvalued codes under the PFS and allows the agency to more easily meet the target. It would be unfortunate if CMS diminished the 0.5% update under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) for the third year in a row by taking a narrow approach to the misvalued code target.
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