The proposed 2020 Physician Fee Schedule rule includes updates to the quality payment program (QPP), policy changes regarding E/M and telehealth services, and more- all of which promises to impact physician group practices. For more information about this proposed rule and its potential impact on your practice, download MGMA's member-exclusive resource on these proposed physician payment and quality reporting changes.

In order to qualify for advanced APM benefits such as the five percent incentive payment, clinicians must become qualifying participants (QPs) through the APM. CMS makes QP determinations at three "snapshot" dates during a given performance period, based on claims data: March 31, June 30, and Aug. 31, using a 60-day claims run-out for each of these calculations. The agency estimates it will determine QP status about three months following each snapshot date. Assuming CMS is accurate, this sets the first QP determination date around late June/early July. QP status can be checked on qpp.cms.gov later this year
 

Final 2018 MIPS scores are now available on the QPP website. MIPS participants should review for accuracy and request a Targeted Review for scores that need potential recalculation. Please note: practices interested in requesting a Targeted Review of their scores must submit their request by September 30, 2019.

In recent months, the Centers for Medicare & Medicaid Services (CMS) has proposed several new payment models for 2020, which you can find on the CMS webpage. CMS has proposed two new primary care models, several new kidney care models, and an Emergency Triage, Treat, and Transport (ET3) model. MGMA will continue to update members on the development of these models.

For more information about the proposed primary care first model and kidney care payment models, download MGMA's member-exclusive analyses.

Right now, the general feeling in D.C. tends to support scaling back the Stark Law rather than extending it. The Trump administration has made clear that reducing administrative burden on the physician community is a priority, and limiting the Stark Law would go a long way towards reducing that burden. 

The exception to this point is the Promoting Integrity in Medicare Act (PIMA), introduced earlier this year in Congress. PIMA would limit the in-office ancillary services exception (IOASE) to the Stark Law by removing certain services from the exception. MGMA opposes PIMA, and has recently joined in a letter to Congress reiterating our opposition to this legislation. MGMA will be monitoring the legislation as the year progresses. 

Here is a response MGMA submitted in August 2018 to a Request for Information regarding the Stark Law. 

The Office for Civil Rights (OCR), the government agency responsible for oversight and enforcement of HIPAA Privacy and Security, recently issued guidance to assist physician practices and others better understand the new environment of Application software (better known as “APPs”). Increasingly, EHRs have the capability of supporting practice and patient use of APPs to capture and use electronic protected health information (ePHI). There are, however, significant privacy and security implications as practices and their patients seek to leverage this new technology. With this guidance, OCR provides much needed clarification to practices (and other covered entities) deploying APP technology or releasing information to patient-designated APPs. Download the MGMA toolkit to guide your practice through the use of apps.

The Affordable Care Act required HHS to issue standards and operating rules for electronic funds transfer (EFT) payments from health plans to providers. The regulations, which went into effect in 2014, mandated that the health plan MUST issue payments via EFT when requested by the provider. Even with these regulations, MGMA has seen plans issue payments in the form of "virtual" credit cards, deny reimbursement in the form of paper checks while practices enroll in EFT, and also assigned a percentage fee for the EFT transaction for practices that do enroll.

MGMA advocated for CMS to curb these unfair business, reiterating that providers had to be paid via EFT when they requested this method, and address other key payment issues. As a reminder, plans must offer payment via EFT when requested by the provider. MGMA has developed an EFT guide and sample EFT request letter to assist members receive their payments quickly and fairly. If a practice finds that a plan is not abiding by these rules, a formal complaint can be filed through the CMS Administrative Simplification Enforcement and Testing Tool webpage.

 

Beginning in the 2020 plan year, MA health plans will be able to offer telehealth services as a basic benefit to all their enrollees, regardless of whether they live in a rural or urban area (the rules that currently govern original Medicare beneficiaries). Enrollees may also utilize telehealth services from their home. MA plans can choose to include these benefits in their annual benefits package rather than offering them as a supplemental benefit. (These changes were set forth in the Balanced Budget Act of 2018.) CMS has announced that they plan to release more sub-regulatory guidance relating to telehealth for both MA plans as well as traditional, fee for service Medicare in the future.

Following MGMA advocacy efforts to expand access to virtual care, the Centers for Medicare & Medicaid Services (CMS) created new codes for communications-based technology services starting Jan. 1, 2019. Newly covered services include a virtual visit (i.e., a brief 5-10 minute check-in via telephone), interpretation of patient-submitted images and videos, remote patient monitoring, and interprofessional consultations. MGMA Government Affairs developed at member-exclusive analysis that outlines these new technology codes including the billing requirements, code descriptions, qualifying technologies and more.