Latest News                   


August 20, 2018

CMS E&M Reimbursement Calculator

Follow-up on a 2019 proposed payment modification by the Centers for Medicare & Medicaid (CMS) for evaluation and management codes. Maryland MGMA has developed a tool for member practices to estimate the financial impact of the proposed rule.

Click here to download the tool from our 2018 member resources page (under August).

August 13, 2018

Administrator of the Year Award 2018

This award recognizes a medical group practice administrator affiliated with the Maryland Medical Group Management Association (MD-MGMA) who has exhibited exceptional management proficiency and improved the effectiveness of the delivery of healthcare in her/his practice and community through a recent, noteworthy achievement.

Any active Maryland MGMA general member, in good standing, who holds a title of practice administrator, practice manager, executive director, C-Suite executive or similar.

Selection Committee
MD-MGMA’s Nominations Committee shall review all nominations and recommends a selection to the Board of Directors who shall, by majority vote, select the one final recipient prior to State Conference.

The awardee will be announced and presented with the award at the MD-MGMA 2018 State Conference October 10-11, 2018 at Live! Hotel & Casino in Hanover, Maryland. Additionally, the recipient will receive free registration to the State Conference (valued at $325).

Click here for the application, required documentation, and further details on nominations.
All items must be submitted with the completed entry form no later than 9/14/2018.

August 11, 2018

Maryland MGMA State Conference 2018: Stack the Odds in Your Favor

Join us on October 11 & 12 for our annual medical practice management conference. Network with peers, gain valuable and current information to help you manage your medical practice, and visit with 40 exhibitors offering outstanding products and services.

Our 2018 conference will feature a new format with a full day of education and exhibitors on Thursday, followed by a cocktail reception, and then a half-day of education and exhibitors on Friday. This is our largest education and networking event of the year - as well as a great opportunity to earn up to 7.5 ACMPE credits.

Click here for more details and online registration!

August 6, 2018

Legislative & Advocacy e-Alert

As there have been many significant legislative developments in Washington, DC and Annapolis, MD over the past several weeks, Maryland MGMA is pleased to offer the following analysis as an exclusive member benefit. 

Click here to view the Legislative & Advocacy e-Alert. (Available under August in the 2018 Member Resources page)

July 11, 2018

CMS issues New Medicare Card guidance

The Centers for Medicare & Medicaid Services (CMS) issued clarifications about the New Medicare Cards and the Medicare Beneficiary Identifier (MBI). Medicare beneficiaries are permitted to request an MBI change and CMS may change an MBI if, for example, their current MBI has been compromised. The agency outlined the appropriate MBI to use in the following fee-for-service claim scenarios:

  • Dates of service before the MBI change date – use the old or new MBI
  • Span-date claims with a “From Date” before the MBI change date – use the old or new MBI
  • Dates of service that are entirely on or after the effective date of the MBI change – use the new MBI

National MGMA members may download a New Medicare Card Toolkit for additional information and implementation tips. 

Review and appeal MIPS results by Sept. 30

CMS recently released final 2017 Merit-based Incentive Payment System (MIPS) feedback, scores, and corresponding bonuses and penalties, which will affect Medicare Part B reimbursement in 2019. If your group participated in MIPS, you are encouraged to closely review your final 2017 MIPS score and payment adjustment information. Groups and clinicians who scored 70 or more points are eligible for an exceptional performance bonus, which is included in the final payment adjustment percentage displayed in your results. MGMA has called on CMS to separately itemize the bonuses, and CMS has said it is working on implementing this functionality. 

If there are issues with your results, such as calculation errors or eligibility problems, submit an appeal under CMS’ targeted review process by Sept. 30. Detailed information about how to access your MIPS results and request a targeted review is available in this CMS user guide.

March 7, 2018

Medicare BPCI Advanced applications due March 12

Applications for the new Bundled Payments for Care Improvement (BPCI) Advanced Model are due March 12 for an Oct. 1, 2018 start date. Applications are non-binding but must include details about the participating physician group practices and hospitals which are locked in until 2020. This model qualifies as an advanced alternative payment model (APM) and MIPS APM starting in 2019. MGMA continues to urge CMS to release more specific information on how the model will impact participation status in the Quality Payment Program. For more information or to apply, visit the BPCI Advanced webpage.

March 1, 2018

Part B drug costs eliminated from MIPS calculations

On Feb. 9, President Trump signed the Bipartisan Budget Act of 2018 into law. Among other things, the Budget Act makes changes to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, such as excluding separately billed items like Medicare Part B drugs from MIPS payment adjustments. The Budget Act also excludes separately billed items from determining whether a clinician meets the low-volume threshold of $90,000 of Medicare Part B billings required for participation in MIPS.

For more information on MACRA-related changes in the Budget Act, download MGMA’s primer.


February 14, 2018

Effective, Thursday, Feb. 15, 2018, all Maryland licensed healthcare providers that prescribe or dispense controlled dangerous substances (CDS) are required to be registered with the Prescription Drug Monitoring Program (PDMP) in order to obtain a CDS registration.

Providers that prescribe or dispense CDS will not be able to obtain a new or renewed CDS registration from the Office of Controlled Substances Administration if they are not already registered with the PDMP. The Department has determined that the Chapter 147 (2016) Section 8 contingency is satisfied and effective Feb. 15, 2018. All CDS prescribers and dispensers applying for a new or renewed CDS registration must be registered with the PDMP, as required in Health-General Article, §21-2a-04.1 and Criminal Law Article, §5-305.

CDS registrants that have already registered with the PDMP do not need to do anything additional at this time. PDMP registration must only be completed once and registration with PDMP does not expire even with disuse.

CDS registrants who need to obtain a new or renewed CDS registration, and who are not registered with the PDMP, will not be issued a CDS registration until the PDMP registration is complete.

For applicants not registered with the PDMP, prior to submission of an application for a CDS registration, the following actions will occur:

  • CDS applications received by mail will have the application and check returned via mail with a notification of the requirement and the link to register with the PDMP.
  • CDS applications received online will be linked to the PDMP website to register. After the PDMP registration is complete, the applicant can return to the CDS application website to complete the CDS registration application.

PDMP Registration is quick, and both registration and access to PDMP are free. Registration can be completed from the PDMP registration homepage at

Providers who are unsure of their PDMP registration status may navigate to the PDMP auto-registration page,, and enter the requested information. If a provider is already registered, the system will confirm registration and provide a unique PDMP registration confirmation code. If a provider is not registered, they will be prompted to complete the registration process.

For questions regarding CDS registration, please contact the Office of Controlled Substances Administration (OCSA) at 410-764-2890 or [email protected]. For online registration assistance, please contact PDMP’s clinical user information technology partner, CRISP, at 877-952-7477 or [email protected]. For any other questions regarding the PDMP, please use the Department’s PDMP voice and email inboxes at 410-402-8686 or [email protected].

February 12, 2018

Paid Sick Leave Bill Now in Effect in Maryland -


January 18, 2018

Effective January 15th, Maryland Health Care Commission’s (MHCC) modified the set of regulations for the State Health Plan that contains policies, methodologies, standards and criteria used in making CON decisions. One of those proposals created flexibility for physician-operated surgical centers (POSCs) to apply for exemptions from CON requirements for two sterile operating rooms.  Section .06 entitled “Exemption from Certificate of Need Review for Establishment of an Ambulatory Surgical Facility” now permits ambulatory surgical facilities (ASFs) and POSCs to apply for exemptions to the CON requirements for up to two sterile operating rooms. Under the old regulation, exemptions were available only for ASFs and POSCs with one sterile operating room. Final Regulations linked here.

July 18, 2017

The Centers for Medicare & Medicaid Services (CMS) released the 2018 Physician Fee Schedule late Thursday, July 13th.  The 815-page document is comprehensive but an initial review has identified a proposed significant reduction in endoscopic anesthesia reimbursement for screening colonoscopies.

In CY 2016, CMS “discussed that in reviewing Medicare claims data, a separate anesthesia service is typically reported more than 50 percent of the time that various colonoscopy procedures are reported.”  Given the increased utilization of anesthesia, they believe that the related CPT codes were potentially misvalued. 

As a result, in the currently released proposed rule CMS has created a series of new CPT codes for CY2018.  Currently, anesthesia is reported for endoscopic anesthesia using two CPT codes: 00740 for Anesthesia for Upper GI Visualization and 00810 for Anesthesia for Lower Intestine Scope.  The new codes are as follows:

New CPT Code


New Base Units

Current Base Units



Anes for Upper GI (EGD)





Anes for ERCP





Anes for Lower GI NOS





Anes for Colonoscopy





Anes for “Doubles"





The new base unit for screening colonoscopy represents a 20% reduction in base units and an estimated 14% reduction in reimbursement (based on an average of 7.2 total units billed).  Note that CMS’ RVS Update Committee (RUC) recommended a reduction in CPT 008X2 to just 3 base units which would be a 40% reduction in base units and an estimated 28% reduction in reimbursement (based on an average of 7.2 total units billed).


June 8, 2017

CMS seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care Act (PPACA)
The Centers for Medicare & Medicaid Services (CMS) today issued a Request for Information (RFI) seeking recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets. Our goal through this process is to identify and eliminate or change regulations that are outdated, unnecessary, or ineffective; impose costs that exceed benefits; or create inconsistencies that otherwise interfere with regulatory reform initiatives and policies.

“We are looking for valuable feedback on how to change existing regulations in ways that put patients first, promote greater consumer choice, enhance affordability and return more control over healthcare to the States,” said CMS Administrator Seema Verma. “Through this step, CMS is asking consumers to send us innovative ideas that will help stabilize and strengthen the individual and small group health insurance markets.”

Consumers who have obtained coverage through the Exchanges are facing significant premium increases. A recent report issued by our Department of Health and Human Services states that the average premium in the 39 states using in 2017 increased from $232 in 2013 to $476 in 2017, which is a 105 percent increase.  Consumers are also dealing with fewer plans to choose from and a continuous stream of issuers exiting the Exchanges. 

The RFI follows steps CMS has already taken to help improve the health care system, including issuing the Market Stabilization Final Rule on April 18, 2017. This new rule will place downward pressure on premiums, limit special enrollment period abuses, and help to improve choices; while also reducing regulatory burden. The RFI will be open for public comment for 30 days.

To view the Request for Information, please visit:

June 5, 2017

CMS Issues Proposed Revision Requirements for Long-Term Care Facilities’ Arbitration Agreements
The Centers for Medicare & Medicaid Services (CMS) issued proposed revisions to arbitration agreement requirements for long-term care facilities.  These proposed revisions would help strengthen transparency in the arbitration process, reduce unnecessary provider burden and support residents’ rights to make informed decisions about important aspects of their health care. 


The Reform of Requirements for Long-Term Care Facilities Final Rule published on October 4, 2016 listed the requirements facilities need to follow if they choose to ask residents to sign agreements for binding arbitration.  The final rule also prohibited pre-dispute agreements for binding arbitration.  The American Health Care Association and a group of nursing homes sued for preliminary and permanent injunction to stop CMS from enforcing that requirement.  The court granted a preliminary injunction on November 7, 2016.   After that decision, CMS reviewed and reconsidered the arbitration requirements in the 2016 Final Rule.

 Proposed Revisions to Arbitration Requirements

This proposed rule focuses on the transparency surrounding the arbitration process and includes the following proposals:

  • The prohibition on pre-dispute binding arbitration agreements is removed.
  • All agreements for binding arbitration must be in plain language.
  • If signing the agreement for binding arbitration is a condition of admission into the facility, the language of the agreement must be in plain writing and in the admissions contract.
  • The agreement must be explained to the resident and his or her representative in a form and manner they understand, including that it must be in a language they understand.
  • The resident must acknowledge that he or she understands the agreement.
  • The agreement must not contain any language that prohibits or discourages the resident or anyone else from communicating with federal, state, or local officials, including federal and state surveyors, other federal or state health department employees, or representatives of the State Long-Term Care Ombudsman.
  • If a facility resolves a dispute with a resident through arbitration, it must retain a copy of the signed agreement for binding arbitration and the arbitrator’s final decision so it can be inspected by CMS or its designee.
  • The facility must post a notice regarding its use of binding arbitration in an area that is visible to both residents and visitors.

For more information, the proposed regulation can be found here:

This proposed rule is scheduled to be published in the Federal Register on June 8, 2017 and comments are due by August 7, 2017.


February 8, 2017

CMS Extends Meaningful Use Attestation Deadline to March 13

The Centers for Medicare & Medicaid Services (CMS) has extended the date eligible professionals (EPs) have to register and attest to meeting the Meaningful Use EHR Incentive Program requirements for 2016. EPs now have until Monday, Mar. 13, 2017, at 11:59 p.m. PT to register and attest in order to avoid the 2018 penalty. Those participating in the Medicaid portion of the EHR Incentive Program should refer to your state’s deadlines for attestation information. Note that EPs eligible to participate in both the Medicare and Medicaid EHR Incentive Programs must attest to meeting the criteria for one or the other to avoid the 2018 Medicare penalty. The Medicare Meaningful Use program for physicians sunsets after this reporting period. EHR use will continue to be measured under the Merit-Based Incentive Payment System (MIPS). The MGMA Meaningful Use Resource Center includes links to the CMS 2016 registration and attestation website, as well as helpful MGMA and CMS resources. 

February 1, 2017

2016 Open Payments data submission now open; register now to review and dispute

Drug and device manufacturers are required to report payments or other transfers of value to physicians and teaching hospitals, which is then posted to the Open Payments website. The submission period for 2016 Open Payments data is now open through March 31. In April, physicians and hospitals will have an opportunity to review and dispute data attributed to them. To do so, they must register in the Open Payments system, which requires an active Enterprise Identity Management System (EIDM) account. For security reasons, EIDM accounts are deactivated after 180 days of inactivity. To reactivate an account, contact [email protected] or 1.855.326.8366. 

In January, CMS released “refreshed” 2015 data, which reflects updates from disputes and other corrections. In total, the 2015 dataset includes over $7.33 billion worth of payments and ownership interests to more than 618,000 physicians and 1,100 teaching hospitals. For more information, visit the updated CMS Open Payments website.

January 25, 2017

Federal judge blocks merger between Aetna and Humana, citing consumer harm

On Jan. 23, a U.S. district court judge blocked the proposed $37 billion merger between insurers Aetna and Humana, holding that the consolidation would substantially lessen competition in markets for Medicare Advantage plans and health insurance sold on public exchanges. The judge rejected the insurers’ arguments that the merger would permit them to become more efficient and pass savings onto consumers, instead “mostly agree[ing]” with the Department of Justice’s (DOJ) position that the resulting market would be too concentrated, anti-competitive and harmful to consumers. Aetna and Humana have the right to appeal the decision. Still pending is a decision on Anthem’s proposed acquisition of Cigna.

December 14, 2016

Physicians to be held harmless for PQRS measures impacted by ICD-10

On Oct. 1, 2016, updates to the International Classification of Diseases (ICD)-10-CM code set went into effect, the first updates since Oct. 2013. As a result of the large number of new codes being added or removed from the ICD-10 code set, the Centers for Medicare & Medicaid Services (CMS) has determined that the ICD-10 code updates will impact the agency's ability to process data reported on certain quality measures for the 4th quarter of CY 2016. As a result, the agency announced that it will not apply 2017 or 2018 PQRS or Value-Based Payment Modifier payment adjustments, as applicable, to any eligible professional or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates. MGMA has reached out to CMS for further clarification regarding how this will impact physician group practices.

Additionally, CMS has indicated it will publish an addendum containing updates relevant to the ICD-10 value sets for 2017 clinical quality measures in the Merit-based Incentive Payment System (MIPS). CMS is expected to provide additional information on the addendum in the coming weeks.

December 12, 2016

'It's door-to-door': MedStar, Uber detail partnership's progress
Uber is investing in the creation of a small team that will do nothing but work with healthcare providers, said Lindsay Elin, director of federal and community affairs at Uber, at the Connected Health Conference.

December 8, 2016

Evergreen won't renew individual health benefit policies
Evergreen Health Cooperative Inc. won’t be issuing or renewing individual health benefit policies on the Maryland Health Connection for the 2017 plan year, Maryland regulators announced Thursday.

November 10, 2016

Medicare finalizes sweeping changes to physician payments
2017 Medicare Parts A & B Premiums and Deductibles Announced

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2017 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Medicare Part B Premiums/Deductibles

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

On October 18, 2016, the Social Security Administration announced that the cost-of-living adjustment (COLA) for Social Security benefits will be 0.3 percent for 2017. Because of the low Social Security COLA, a statutory “hold harmless” provision designed to protect seniors, will largely prevent Part B premiums from increasing for about 70 percent of beneficiaries. Among this group, the average 2017 premium will be about $109.00, compared to $104.90 for the past four years.

For the remaining roughly 30 percent of beneficiaries, the standard monthly premium for Medicare Part B will be $134.00 for 2017, a 10 percent increase from the 2016 premium of $121.80. Because of the “hold harmless” provision covering the other 70 percent of beneficiaries, premiums for the remaining 30 percent must cover most of the increase in Medicare costs for 2017 for all beneficiaries. This year, as in the past, the Secretary has exercised her statutory authority to mitigate projected premium increases for these beneficiaries, while continuing to maintain a prudent level of reserves to protect against unexpected costs. The Department of Health and Human Services (HHS) will work with Congress as it explores budget-neutral solutions to challenges created by the “hold harmless” provision.

“Medicare’s top priority is to ensure that beneficiaries have affordable access to the care they need,” said CMS Acting Administrator Andy Slavitt. “We will continue our efforts to improve affordability, access, and quality in Medicare.” 

Medicare Part B beneficiaries not subject to the “hold harmless” provision include beneficiaries who do not receive Social Security benefits, those who enroll in Part B for the first time in 2017, those who are directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, and those who pay an income-related premium. These groups represent approximately 30 percent of total Part B beneficiaries.

CMS also announced that the annual deductible for all Medicare Part B beneficiaries will be $183 in 2017 (compared to $166 in 2016). Premiums and deductibles for Medicare Advantage and prescription drug plans are already finalized and are unaffected by this announcement.

Since 2007, beneficiaries with higher incomes have paid higher Medicare Part B monthly premiums. These income-related monthly premium rates affect roughly five percent of people with Medicare. The total Medicare Part B premiums for high income beneficiaries for 2017 are shown in the following table:

Beneficiaries who file an individual tax return with income:

Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000

Less than or equal to $170,000



Greater than $85,000 and less than or equal to $107,000

Greater than $170,000 and less than or equal to $214,000



Greater than $107,000 and less than or equal to $160,000

Greater than $214,000 and less than or equal to $320,000



Greater than  $160,000 and less than or equal to $214,000

Greater than $320,000 and less than or equal to $428,000



Greater than $214,000

Greater than $428,000



Premiums for beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax return from their spouse:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000



Greater than $85,000 and less than or equal to $129,000



Greater than $129,000




Medicare Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient hospital deductible that beneficiaries pay when admitted to the hospital will be $1,316 per benefit period in 2017, an increase of $28 from $1,288 in 2016. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay a coinsurance amount of $329 per day for the 61st through 90th day of hospitalization ($322 in 2016) in a benefit period and $658 per day for lifetime reserve days ($644 in in 2016). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $164.50 in 2017 ($161 in 2016).

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to receive coverage under Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $227 in 2017, a $1 increase from 2016. Uninsured aged and certain individuals with disabilities who have exhausted other entitlement and who have less than 30 quarters of coverage will pay the full premium, which will be $413 a month, a $2 increase from 2016.

Part A Deductible and Coinsurance Amounts for Calendar Years 2016 and 2017 by Type of Cost Sharing




Inpatient hospital deductible



Daily coinsurance for 61st-90th Day



Daily coinsurance for lifetime reserve days



Skilled Nursing Facility coinsurance



For more information on the 2017 Medicare Parts A and B premiums and deductibles (CMS-8062-N, CMS-8063-N, CMS-8064-N), please visit


October 14, 2016

Medicare finalizes sweeping changes to physician payments
Today, the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated final rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). With the passage of MACRA, Congress set Medicare on a path away from automatic, annual updates hampered by the threat of payment cuts under the flawed sustainable growth rate formula toward a system that focuses more on clinical quality and cost effectiveness. In response to MGMA’s extensive advocacy efforts, the final rule includes greater flexibility for group practices in the Merit-Based Incentive Payment System (MIPS) and more alternative payment model (APM) opportunities.

Key provisions of the final rule:

  • Establishes 2017 as the first performance measurement year for the new Merit-Based Incentive Payment System (MIPS); 
  • Reduces the quality reporting burden during first year of MIPS by allowing practices to submit one quality measure or one improvement activity to avoid a penalty or submit data for a reduced reporting period of 90 days to potentially earn a positive payment adjustment; and
  • Details criteria for qualification as an APM participant, including eligibility for bonus payments.

MGMA Government Affairs staff are closely reviewing the final rule and will provide detailed resources to members in the coming weeks. A link to the final rule and additional information is posted on MGMA's MACRA Resource Center.


August 10, 2016

Adopted Standards and Operating Rules 
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required HHS to establish digital standards for business-related tasks like submitting claims and getting paid. The goal is to reduce paperwork and streamline business processes across the health care system.  Standards allow information to be shared digitally in consistent ways. With common standards for content and formats, information moves quickly as it is shared between providers and health plans in predictable ways.
All health plans, other payers, and providers who exchange business and insurance-related tasks digitally must comply with these Administrative Simplification standards adopted by HHS under HIPAA.
Visit the newly enhanced Administrative Simplification adopted standards and operating rules page to learn about:

August 4, 2016

Verify your EIDM account status to prepare for forthcoming quality program reports

CMS is expected to release the 2015 PQRS Feedback Reports and 2015 Annual Quality and Resource Use Reports (QRURs) early this fall. These reports will include insight into your group’s 2015 results for the PQRS and Value-Based Payment Modifier programs, including details about bonus or penalty amounts, which will impact Medicare Part B reimbursements beginning Jan. 1. To access both reports, physicians and their representatives must have active Enterprise Identity Management (EIDM) accounts. There are numerous steps involved in creating and maintaining EIDM accounts, and we encourage practice executives to confirm their account is active or establish a new account now in order to avoid delays in retrieving forthcoming quality reporting feedback. For detailed instructions on setting up EIDM accounts, access CMS’ EIDM User Guide. For questions, contact the QualityNet Help Desk at 1-866-288-8912 or [email protected].  


July, 2016

Hackers are getting more bold and are now going after private practices in addition to hospitals. Our members need to check in with their IT and insurance companies and make sure they have adequate data breach protection and coverage.

CMS announced changes to the ACO’s performance goals which will be phased in sometime after Jan 2017.

Congress puts $50 million price tag on Helping Hospitals Improve Patient Care Act. This includes removing penalties for some ASC’s who still do not have EHR systems.

May 12, 2016

Medicare webinar to review Value Modifier reports on cost and patient outcomes

The Centers for Medicare & Medicaid Services (CMS) will host a 90-minute national provider call on Thursday, May 19 at 1:30 pm ET to explain how to access and interpret the 2015 Mid-Year Quality and Resource Use Reports (MYQRURs). The 2015 MYQRURs were released in April and display CMS-calculated cost and hospital admissions and readmissions data collected between July 1, 2014 and June 30, 2015. Using this data, group practices can familiarize themselves with CMS’ methodology for calculating outcomes and costs measures, which the agency proposes to continue measuring in the new Merit-Based Incentive Payment System (MIPS) that replaces PQRS, Meaningful Use, and the Value-Based Payment Modifier (VBPM) starting in 2017. Practice leaders can also compare the 2015 MYQRURs to prior QRURs to identify patient trends and preview how the group may fare under the VBPM. Practices should note that MYQRURs do not contain PQRS quality metrics, which comprise a majority of a practice’s quality composite score under the VBPM. Register for the CMS call and learn more about these feedback reports at MGMA’s QRUR Resource Center.

May 9, 2016

PROPOSED RULE - Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models

Summary: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new Merit-based Incentive Payment System (MIPS) for MIPS eligible clinicians or groups under the PFS. This proposed rule would establish the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS would consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and would continue the focus on quality, resource use, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. This proposed rule also would establish incentives for participation in certain alternative payment models (APMs) and includes proposed criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models. In this proposed rule we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that would be more easily identified and understood by stakeholders.

Read more about this at Healthcare Finance News.

May 6, 2016

CMS provides lifeline to co-ops, pares down special enrollment events - from Modern Healthcare (May 6, 2016)

The CMS unveiled an interim final rule late Friday that could help the Affordable Care Act's struggling co-op plans. The rule also responds to insurers' complaints that people are abusing special enrollments in the exchanges.  See full article, Modern Healthcare.

April 21, 2016

Medicare clarifies billing requirements for care coordination services

In new guidance, the Centers for Medicare & Medicaid Services (CMS) answers several common questions about the complex billing requirements for transitional care management (TCM) and chronic care management (CCM) services. For example, the agency specifies that in the event that a provider is unable to reach a patient within two days of discharge from a hospital, TCM may still be billed if the provider documents at least two attempts to contact the patient and meets all other service requirements. CMS also relaxed its guidance regarding electronic transmission of patients’ records for billing CCM. CMS clarified that practices may fax patients’ care plan information if that is the only way the receiving physician may accept it, or alternatively use a third-party intermediary to meet the transitions of care requirement. For additional information about the care plan requirements for billing CCM and other key aspects of this service, download MGMA’s Chronic Care Management Service Essentials, which has been recently updated to reflect this new information.

March 16, 2016

Prepare now for upcoming Open Payments review period

The Open Payments Program, part of the Patient Protection and Affordable Care Act, is a national transparency program intended to highlight the financial relationships between physicians, teaching hospitals and drug and device manufacturers. Every year, the Centers for Medicare & Medicaid Services (CMS) collects data about payments and other transfers of value made by these drug and device manufacturers and publishes it on the Open Payments website. Beginning in April, providers will have a 45-day review and dispute period of 2015 data. To allow adequate time to review the data before it is published online, providers should begin the registration process as soon as possible. Providers must first register with the CMS Enterprise Portal, and then register in the separate Open Payments system. According to CMS, the registration process should take no longer than 30 minutes to complete and must be completed in one sitting. Those who registered last year do not need to re-register, but may need to reset their password to unlock their account if there has been no activity for 60 days.

March 9, 2016

CMS details 2016 Value Modifier bonus and penalty amounts

In the 2016 payment year, the Medicare Value-Based Payment Modifier (VBPM) applies to 13,813 group practices with 10 or more eligible professionals. According to results released earlier this week by the Centers for Medicare & Medicaid Services (CMS), 1% of these group practices will receive a significant bonus payment for achieving high scores under the VBPM analysis, which compares a group’s cost and quality data against national benchmarks. Fifty-nine practices will be subject to a penalty for poor performance under VBPM metrics, while all other groups who were subject to the VBPM cost and quality analysis will receive no bonus or penalty in 2016. However, 5,418 groups were excluded from the VBPM’s analysis because they did not successfully report PQRS quality data in 2014. As a result, those practices will be subject to an automatic 2% penalty in 2016, in addition to the separate 2% PQRS penalty. MGMA has long advocated that the VBPM’s reliance on the burdensome PQRS reporting program is flawed, as many practices are unable to report clinically-relevant data.

To better understand how the 2016 VBPM results impact your practice, download your 2014 Quality and Resource Use Report. Learn how to obtain these CMS reports here.

February 11, 2016

Avoid 2017 Meaningful Use penalty, remain eligible for 2015 incentive

In direct communication with MGMA, the Centers for Medicare & Medicaid Services (CMS) reiterated that if an eligible professional (EP) submits a 2015 Meaningful Use hardship exception application by March 15, 2016 as insurance against the 2017 penalty, they would still be eligible to receive the 2015 incentive payment as long as they successfully attest. As a reminder, EPs must attest by Feb. 29  to be eligible for an incentive payment. All EPs submitting a hardship exception application by March 15 will not receive a penalty in 2017, as the agency will not be reviewing the applications on a case-by-case basis. Members are encouraged to review MGMA's hardship exception resource, How to Avoid the 2017 Meaningful Use Penalty.

Access the CMS attestation webpage.

January 14, 2016

CMS adjusts 2016 Medicare conversion factor, reissues 2016 payment files

This week, the Centers for Medicare & Medicaid Services (CMS) reissued the 2016 Medicare physician fee schedule (PFS) payment files after making a series of technical corrections. As a result of these corrections, the 2016 PFS conversion factor was reduced slightly from $35.8279 to $35.8043. CMS also revised the relative values of certain codes and corrected invalid or missing payment indicators for several procedure codes. Download the revised 2016 PFS payment files and check your Medicare Administrative Contractor’s website for your updated locality-specific fee schedule. 

To implement these corrections and process claims correctly, CMS previously put in place a hold on processing claims for dates of service after Jan. 1, 2016. However, this short-lived hold is not expected to interrupt provider cash flow, as under current law, clean electronic claims are not paid sooner than 14 calendar days after date of receipt. MGMA members who experience any issues with the processing of 2016 Medicare claims should contact MGMA Government Affairs at 202.293.3450 or [email protected].

January 11, 2016

MGMA Government Affairs has identified the following legislative and regulatory issues as top priorities for physician practices in the coming year:

  1. Election year 2016: Congressional gridlock and regulatory landslide
  2. Massive post-SGR regulations on horizon
  3. Meaningful Use modifications bring some relief, yet headaches remain
  4. PQRS success remains critical to avoiding Medicare penalties
  5. Value-Based Payment Modifier (VBPM) expands its reach
  6. Primary care outlook: ACA bonus expires, new billable services added
  7. More physician data goes public as Medicare ramps up transparency efforts
  8. Healthcare mergers: The race to big draws antitrust scrutiny
  9. Brace for increased government scrutiny on data breaches, other HIPAA violations
  10. Fraud and abuse: Renewed RAC contracts, overpayment rules, Stark refinements

Click here for a summary of each. (Requires Maryland MGMA member login.)

November 16, 2015

Meaningful Use public health reporting requirements

The modified public health reporting criteria for the EHR Incentive (Meaningful Use) Program have proven particularly challenging for physician practices. In the Meaningful Use modification final rule, eligible professionals (EPs) in 2015 are now required to report certain public health measures, which were previously optional. The Centers for Medicare & Medicaid Services recently announced that if EPs were not originally intending to report these public health measures, they may now claim an alternate exclusion in 2015 because the agency issued the changes so late in the year. To better understand the public health requirements and all potential exclusions, review MGMA's member-exclusive Meaningful Use overview.

October 7, 2015

CMS releases final meaningful use Stage 2 modifications and Stage 3 rules

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a long-awaited final regulation that includes modifications to Stage 2 of the EHR Incentive (meaningful use) Program and outlines the requirements for Stage 3 of the program. The rule also specifies EHR certification standards and finalizes the government's "interoperability roadmap." For meaningful use in 2015 through 2017, major provisions include:

  • Shortened 2015 reporting period (from all year to any 90 consecutive days in 2015);
  • Ten objectives for eligible professionals including one public health reporting objective, down from 18 total objectives;
  • Reduced number of measures that are required to be reported;
  • Reduced measure threshold for View, Download or Transmit (from 5% to just one patient in 2015); and
  • Reduced measure threshold for Secure Messaging (from 5% to simply having the capability in 2015).

Read the CMS fact sheet.

October 1, 2015

ICD-10 is here!

Today is the start date for physician practices and others to convert to ICD-10 diagnosis codes. Claims with a date of service of Oct.1 or later must contain ICD-10 codes. Practices should ensure that practice management systems and other software that utilize diagnosis codes are configured for the new code set, appropriate administrative and clinical staff are trained, and effective contingency plans are established should the organization experience cash flow disruption.

MGMA plans to conduct ongoing research regarding the impact of ICD-10 on member practices. Look for the first questionnaire next week. We have also created an email address ([email protected]) to allow members to report ICD-10 related issues directly to MGMA to assist in our advocacy efforts. MGMA offers a wide array of resources to assist members in meeting this challenge, including:

In addition, the Centers for Medicare & Medicaid Services (CMS) has appointed William Rogers, MD, as the ICD-10 Ombudsman to assist in resolving issues practices have with the new code set. He can be contacted at [email protected]. The agency also offers its own set of ICD-10 resources, including:

  • "Road to 10" flyer (including specialty-specific education)
  • New guidance on recent flexibility announcement


30-day Physician Compare PQRS preview begins Oct. 5

The Centers for Medicare & Medicaid Services (CMS) will publicly display on the Physician Compare website new measure performance information on a subset of 2014 PQRS measures. The agency will add new measure performance information for group practices reporting through the PQRS Group Practice Reporting Option and, for the first time, will display individual eligible professional (EP) measure performance data on six PQRS measures reported via claims in 2014.

The 30-day period for groups and EPs to preview this information before it is added to Physician Compare later this year begins Oct. 5, but CMS does not have a formal process in place to appeal this information. To learn more about which measures will be publicly reported and how to preview your measures, visit CMS' Physician Compare Initiative webpage.


July 9, 2015

CMS releases proposed 2016 Medicare physician fee schedule
The Centers for Medicare & Medicaid Services (CMS) released the proposed Medicare physician fee schedule (PFS) rule for 2016. CMS will accept public comments on the rule until Sept. 8, 2015 and intends to issue the final 2016 PFS by Nov. 1, 2015.

The proposed rule:

  • Sets 2016 Medicare payment rates for physician services, including a modest payment increase as a result SGR repeal under the Medicare Access and CHIP Reauthorization Act (MACRA);
  • Establishes criteria for the 2016 performance year for the value-based payment modifier (VBPM), which could result in penalties of 4% in 2018 for high cost/low quality providers;
  • Details criteria for 2016 performance in PQRS to avoid a 2% penalty in 2018;
  • Outlines proposed RVU and payment changes for services CMS considers misvalued;
  • Increases the amount of information about physicians and practices on the Physician Compare website, including information pertaining to quality measure and VBPM performance; and
  • Includes discussion of how the agency may consolidate existing Medicare quality reporting programs in the coming years, as required under MACRA.

In a separate rule, CMS proposed changes to policies and payments regarding hospital outpatient and ambulatory surgical centers.
Visit the Federal Register to view the full proposed 2016 Medicare PFS. CMS has also posted several fact sheets.

CMS to permit non-specific ICD-10 codes for one year

The Centers for Medicare & Medicaid Services (CMS) announced a set of new policies related to the Oct. 1, 2015 transition to ICD-10. For the first year that ICD-10 is in place, Medicare claims will not be denied, and eligible professionals will not be penalized under PQRS, the value-based payment modifier or meaningful use based soley on the specificity of the diagnosis codes, as long as they are from the appropriate "family" of ICD-10 codes. In addition, CMS will authorize advance payments to physicians should Medicare contractors be unable to process claims as a result of ICD-10 complications. The Agency also announced plans to create a new communication center to monitor and resolve issues as quickly as possible, as well as an "ICD-10 Ombudsman" to assist providers. In a separate announcement, CMS indicated that nationally it accepted 90% of claims from more than 1,200 submitters who participated in CMS' third round of ICD-10 "front end" (acknowledgement) testing.


May 20, 2015

Attention PQRS Participants:  CMS to transition from IACS to EIDM System in July

On July 13, 2015, the Centers for Medicare & Medicaid Services (CMS) will be transitioning authorized users of the Individuals Authorized Access to CMS Computer Services (IACS) system to the existing Enterprise Identity Management (EIDM) system.  The EIDM system provides a way for business partners to apply for, obtain approval, and receive a single user ID for accessing multiple CMS applications.

Existing PQRS IACS users, their data, and roles will be moved to EIDM and will be accessible from the ‘PQRS Portal’ portion of the CMS Enterprise Portal at Users will then access the PQRS Portal to submit data, retrieve submission reports, view feedback reports, or conduct various administrative and maintenance activities. New PQRS users will need to register for an EIDM account.

CMS promises more information and resources in the coming weeks and months.  In the meantime, please ensure that your IACS account is active, current, and you’re able to log in. This will help ensure a smoother transition to EIDM. For additional assistance regarding IACS or EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via email at [email protected].


May 15, 2015

Final Opportunity to Volunteer for ICD-10 End-to-End Testing in July — Forms Accepted May 11 through 22

Deadline extended

During the week of July 20 through 24, 2015, a final sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. CMS is accepting additional July volunteers from May 11 through 22, 2015. Don’t miss your chance to participate in end-to-end testing with Medicare prior to the October 1, 2015, implementation date.

Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing. This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Note: Testers who are participating in the January and April end-to-end testing weeks are able to test again in July without re-applying.

To volunteer as a testing submitter:

  • Volunteer forms are available on your MAC website
  • Completed volunteer forms are due May 22
  • CMS will review applications and select additional July testers
  • The MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing by June 12

If selected, testers must be able to:

  • Submit future-dated claims
  • Provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs) that will be used for test claims. This information will be needed by your MAC for set-up purposes by the deadline on your acceptance notice; testers will be dropped if information is not provided by the deadline

Any issues identified during testing will be addressed prior to ICD-10 implementation. Educational materials will be developed for providers and submitters based on the testing results.

For more information:

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates.


February 2015

Attention Part B Providers – Update – Information Regarding Enrollment in Novitasphere Portal

Part B Providers who are interested in enrolling for access to the Novitasphere Portal, or who have begun the process of enrollment, please carefully review the following update regarding impacts to the Novitasphere enrollment process.

In preparation for the upcoming transition from Individual Authorized Access to the CMS Computer Services (IACS) to Enterprise Identity Management (EIDM) on February 7, 2015, Novitas Solutions had previously suspended enrollment for Novitasphere Portal.  Enrollment for Novitasphere Portal will be resuming in two parts over the next few days. 

Important dates to know:

  • On Friday, February 6, 2015, Novitas will resume accepting Novitasphere Portal Enrollment forms (8292P/8292PJH).  These forms are available now on our website for customers interested in enrolling for Novitasphere Portal access. 
  • On Monday, February 9, 2015, Novitas will resume accepting Novitasphere EIDM ID requests.  Please remember that this step of the Novitasphere Portal enrollment can only be completed after the Enrollment form has been processed and approved.

For additional information on Novitasphere, please visit Novitasphere Portal centers on the website (JL) (JH).
1-877-235-8073 (JL)  |  1-855-252-8782 (JH)  |  1-855-880-8424 (Novitasphere)  |


January 29, 2015


HHS Announces goals for Medicare value-based payment


The Department of Health and Human Services (HHS) has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements, by the end of 2016, as well as tying 50% of payments to these models by the end of 2018. The agency set an additional goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018, all through programs such as the Physician Value Based Payment Modifier (VBPM), Hospital Value-Based Purchasing and the Hospital Readmissions Reduction Program. 

Based on MGMA analysis, there is little in the Administration's announcement in terms of new programs impacting physician group practices. Beginning Jan. 1, Medicare began evaluating virtually all physicians under the VBPM and will apply bonuses or penalties on 2017 claims based on CY 2015 physician performance on cost and quality measures. Using the HHS criteria, well over 90% of physicians are already subject to this program that meets its larger goal.

In response to a new proposed rule, next month MGMA will submit formal comments in February on how CMS can improve the Medicare Shared Savings ACO program. To date, only approximately 25% of ACOs have successfully shared in savings generated under the Medicare program. Without significant program improvements, as many as two-thirds of ACOs have indicated they are likely to drop out after the first three year ACO contract period.

To achieve true progress toward value-based payment reform in Medicare, Congress must intervene to repeal the Medicare sustainable growth rate formula to avert a 21% physician payment cut scheduled for April 1, and pass legislation that creates significant, overall enhancements to the program. 

Forbes posted an article on 1/23 about United Healthcare’s moved toward value-based pay.


January 28, 2015 - International Data Privacy Day

Are Your Practice’s Medical Records Safe?

By Nathalie Griffin-Ames, CPA and Manager at KatzAbosch

According to Redspin, a leader in healthcare IT security, a total of 804 large breaches of protected health information affecting over 29.2 million patient records have been reported to the Secretary of Health and Human Services between August 2009 and December 2013. The following are some more statistics they found:

  • Over $7 million patient health records breached in 2013
  • 137.7% increase in the number of patient records breached in 2012-2013
  • 83.2% of patient records breached in 2013 resulted from theft
  • 22.1% of breach incidents in 2013 resulted from unauthorized access
  • 35% of 2013 incidents were due to the loss or theft of an unencrypted laptop or other portable electronic device

Medical record protection is a very important part of today’s medical practice.  Although the switchover to electronic recordkeeping has many advantages, there are also many risks.  Why are so many medical records at risk?  Here are several reasons:

  • Hackers – The number of attacks on hospitals, private clinics and medical practices has substantially increased and accounted for 33% of all medical record theft in 2013.
  • Lost or stolen electronic devices.
  • Failure to delete – Equipment used by medical practices such as laptops, copiers, ultrasound machines, etc are being discarded without fully deleting the sensitive information they contain.  Third party error – Many healthcare organizations outsource medical record storage and management to third-party vendors, but in some cases these vendors are not qualified to secure this type of information.
  • Open Wi-Fi networks that are not properly secured.
  • Insider Access –Such as employees leaving a file open on their computer or allowing an unauthorized person to view a medical record, etc.
  • The Cloud – More and more healthcare organizations are moving their patient health records to the cloud.  However, very few are confident that they can protect this information from thieves.

So, what can you do to protect your practice’s medical records?  Listed below are several security tips to combat some of the risks listed above:

  • Install USB locks on computers, laptops or other mobile devices to prevent unauthorized data transfer.
  • Install Geolocation tracking software on mobile devices –Geolocation tracking software allows you to track, locate, and wipe the mobile device of all data in the event it is lost or stolen.
  • Encrypt – All mobile devices and USB drives should be encrypted if they will be used remotely. Even if medical practices allow their employees to use their own tablets, laptops, and or smart phones, they should require encryption if sensitive data will be stored on those devices.
  • Turn “OFF” laptops/computers – Even if you have installed full-disk encryption on all your devices you should always completely turn these devices off when not in use.  The reason for this is that most of the leading encryption products are configured so that once the password has been entered, the laptop is unencrypted and unprotected until it is booted down.  Simply putting the laptop in “sleep” mode does not cause the encryption protection to kick back in.
  • Educate your employees about security awareness – Discourage your employees from downloading applications and free software that may contain malware, turning off security settings and not encrypting data in transit or at rest as these are all behaviors that put you at risk.  Educate your employees on IT security through frequent security awareness training.
  • Before disposing of old equipment, wipe the hard drive – All too often organizations simply dispose of old equipment without confirmation that they have been wiped of all data.  Equipment at risk includes but is not limited to copiers, smart phones, laptops, ultrasound machines, etc. 
  • Implement Electronic Protected Health Information (EPHI) security – As electronic medical records are being accessed more and more from various mobile devices, the risk of contamination from a virus increases significantly.  Therefore it is more important than ever to invest in a proactive data management strategy.
  • Conduct an Annual HIPAA Security Risk Analysis – Since periodic risk analysis is a requirement of the HIPAA Security Rule anyway, it would be wise to plan and budget for it in advance.  It is important to assess security risk by identifying real vulnerabilities and developing a solution to those vulnerabilities.  It is recommended that health care organizations engage in ongoing vulnerability scanning and remediation, by implementing a monthly or quarterly test schedule.
  • Engage with your Business Associates – It is your responsibility to ensure that any third party you engage to safeguard your electronic medical records is doing so effectively.

- Redspin’s BREACH REPORT 2013: Protected Health Information

- MichaelGregg:  “Why your medical records are no longer safe?”
ID Expert’s “13 Security Tips to combat mobile device threats to healthcare”


December, 2014

Is your Practice Ready for the Changing OSHA Reporting & Recordkeeping Requirements?

The Occupational Safety and Health Administration (OSHA) has announced that its reporting and recordkeeping requirements will change effective January 1, 2015.

What are the Changes?
Two main changes are coming: the types of severe work-related injuries that must be reported to OSHA; and the types of employers that are required to comply with OSHA’s recordkeeping requirements by completing OSHA Forms 300, 300A and 301.

Which Severe Work-Related Injuries Must be Reported?
All employers are required to file a report with OSHA in the event that an employee suffers a severe work-related injury. What constitutes a “severe work-related injury” according to OSHA? Currently, it is either: a work-related fatality; or in-patient hospitalization of three or more workers as a result of a work related accident.

Effective January 1, 2015, the definition of “severe work-related injuries” that must be reported to OSHA will expand to include:

  • Work-related fatality
  • In-patient hospitalizations of one or more employees as a result of a work-related incident
  • Work-related amputations
  • Work-related losses of an eye

Employers must verbally report work-related fatalities within 8 hours if death occurs within 30 days after the work-related incident and must report any in-patient hospitalization, amputation or loss of an eye within 24 hours if the hospitalization, amputation or eye loss occurs within 24 hours after the work-related incident.

Reports of severe work-related injuries can be made in one of three ways: (i) by telephone to the nearest OSHA Area Office during normal business hours; (ii) by telephone to the 24-hour OSHA hotline at 1-800-321-OSHA (6742); or (iii) electronically at (once OSHA completes that portion of its website).

It is worth noting that all required reports of severe work-related injuries will be made publically available on OSHA’s website.

Which Employers Must Comply with the OSHA Recordkeeping Requirements?
OSHA requires all employers to complete OSHA Forms 300 (Log of Work-Related Injuries and Illnesses), 300A (Summary of Work-Related Injuries and Illnesses) and 301 (Injury and Illness Incident Report) unless the employer is specifically “exempt” from that requirement. Currently, an employer is exempt from the OSHA recordkeeping requirements if the employer: employs 10 or fewer employees in all of the prior calendar year; or is in a low hazard industry that is specifically exempted from the OSHA recordkeeping requirements. Those two exemption categories will remain the same in 2015. What will change is the industries that are exempt.

OSHA used to “code” exempt industries using the Standard Industrial Classification (SIC). Beginning January 1, 2015, OSHA will switch to using North American Industry Classification System (NAICS) codes to identify exempt industries. For example, in 2015, these are some of the general NAICS codes that relate to the medical industry and that will be exempt from the OSHA recordkeeping requirements:

6211 Offices of Physicians
6212 Offices of Dentists
6213 Offices of Other Health Practitioners
6214 Outpatient Care Centers
6215 Medical and Diagnostic Laboratories

The following NAICS codes will become non-exempt in 2015 (which is a change for those industries from 2014):

6219 Other Ambulatory Health Care Services
6241 Individual and Family Services

These lists are not exhaustive and do not address the many sub-codes that apply to the medical community. All businesses should confirm their NAICS code prior to January 1, 2015 to determine their recordkeeping obligations. To do so, to go and click on, “Am I required to prepare and maintain records under the new rule?” and confer with your attorney.

Please keep in mind that even employers that are exempt from the OSHA recordkeeping requirements are obligated to report severe work-related injuries to OSHA.


Prior to January 1, 2015, every business should:

  1. Understand the new events that constitute “severe work related injuries” and, therefore, trigger an obligation to report those injuries to OSHA; and
  2. Determine whether they are required to comply with OSHA’s recordkeeping requirements.

Susan Stobbart Shapiro has been representing businesses, with an emphasis in employment law matters, for over 20 years. To learn more go to


October 31, 2014

Final 2015 Medicare Physician Fee Schedule Released

The Centers for Medicare & Medicaid Services (CMS) finalized the 2015 Medicare physician fee schedule (PFS). Unless Congress intervenes, current law requires physician fee schedule rates to be reduced by an average of 21.2% on April 1, 2015 due to the sustainable growth rate (SGR) formula. MGMA is continuing our steadfast advocacy efforts to repeal the flawed SGR formula.

The final rule:

  • Sets the physician and anesthesia fee schedule conversion factors (CFs) for CY 2015. The CY 2015 PFS CF for Jan. 1, 2015 through March 31, 2015 is $35.8013. The CY 2015 PFS CF for April 1, 2015 through Dec. 31, 2015 is $28.2239. The CY 2015 national average anesthesia CF for Jan. 1, 2015 through March 31, 2015 is $22.5550. The CY 2015 national average anesthesia CF for April 1, 2015 through Dec. 31, 2015 is $17.7913.
  • Continues implementation of the value-based payment modifier (VBPM) by applying the 2017 VBPM, based on 2015 reporting, to all physicians, regardless of group size, and increases the amount of payment at risk for groups with 10 or more eligible professionals (EPs) to 4%.
  • Makes changes to criteria for avoiding a Physician Quality Reporting System (PQRS) penalty in 2017, based on 2015 reporting. To avoid this 2% penalty, EPs will generally have to report nine measures in 2015.
  • Finalizes the agency's proposal to eliminate the use of 10 and 90-day global surgical codes, beginning in 2017.
  • Establishes payment beginning in 2015 for chronic care management services, utilizing CPT code 99490, rather than creating a new G-code.
  • Increases the amount of information about physicians and practices on the Physician Compare website, including quality measure performance for groups and individuals.  

CMS released additional information, including fact sheets, on its website.  To view the estimated impact of work, practice expense, and malpractice RVU changes by specialty, national MGMA members may click here.

In a separate rule CMS also finalized Hospital Outpatient and Ambulatory Surgical Centers Policy and Payment Changes for 2015.

Stay tuned for details as Maryland MGMA is planning to offer a webinar on this topic on December 5.  This is a free benefit for Maryland MGMA members.  (MGMA national is also offering a webinar $129 MGMA members/$239 non-members). 


July 7, 2014

Medicare Proposed Rules Released

The Centers for Medicare & Medicaid Services (CMS) released their latest round of proposed rules for the Medicare program just as the nation started Independence Day festivities. In a set of rules, the Agency shared their ideas about reforms to the physician fee-for-service payment program along with the outpatient prospective payment system used for hospital outpatient departments and ambulatory surgical centers (ASCs).

Highlights of the rule:

  • The cut to physician payment starting March 31, 2015 is estimated at -20.9 percent. Congress will need to intervene with another “doc fix” bill to prevent the overall slash in payment.
  • The hospital outpatient department market basket update is proposed at 2.1 percent with an ASC update of 1.2 percent for calendar year 2015.
  • A new complex chronic care coordination (CCM) code is confirmed in the rule with an average reimbursement at $42 for a 30 day management service. Incident to billing rules would allow support staff to provide management services. To quality, the Agency proposes that management must be documented in a certified electronic medical record.
  • Changes to the global day period to promote office visits during surgical periods
  • Updates and changes to the quality reporting programs for physicians, hospital outpatient departments and ASCs. Notably, the Agency is reducing the number of measures available for claims-based reporting. Also, the Agency proposes the expansion of the value-based modifier to physician groups of all sizes and non-physician practitioners. The rule also escalates the penalty for non-reporting in the value based modifier to -4 percent.
  • Exclusion of continuing medical education credits paid by pharmaceutical company, manufactures and group purchasing organizations from the Sunshine Act reporting requirements. Currently, the amounts, if given by the companies under strict guidelines, are exempt from public reporting.
  • Additional quality reporting data for inclusion in the provider directory.

The specialty specific impact chart for the physician fee schedule is available here.

The proposed rules are located on the CMS website. To view the physician rule go here. To view the hospital outpatient and ASC rule is posted here. The associated files for the physician rule are located on the CMS website. Hospital outpatient department and ASC rule files are located here. Fact sheets are also available on both rules that will be published in the Federal Register on July 11, 2014. Comments are due to the Agency by Sept. 2, 2014.

May 1, 2014

Novitas News

Are you interested in learning more about what is changing and trending in Medicare? Join us on May 7 in Edison, NJ for the Novitas Solutions 2014 Medicare Symposium! This year’s symposium offers ten classes with multiple sessions dedicated to give you the knowledge necessary to be a successful Medicare provider.

It’s not too late to attend! To register, visit the Workshop/Symposium page in the Education & Training Center of our website.  The symposium brochure and handout materials are also available.

March 27, 2014

SPECIAL ALERT! 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

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 Center for more information.

Novitas News

Novitas Solutions would greatly appreciate including the information below on your website or in other communications with your Association members as you deem appropriate. Thank you for being a valued Novitas Solutions partner.

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 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 exception 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 exception 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 for 2015.

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.

March 4, 2014

Novitas Solutions would greatly appreciate including the information below on your website or in other communications with your Association members as you deem appropriate. Thank you for being a valued Novitas Solutions partner.

Novitas Solutions is pleased to announce enhancements to the Novitas Solutions website. After selecting your jurisdiction from the Home Page, the website opens to the new Novitas Start Center with the familiar Navigation Centers on the left hand side. This new Novitas Start Center prominently displays frequently used items and information. The creation and format of this Center was based on feedback received from you, our customer, and your requests to provide quick access to those items and information. The Center contains Self-Service Features, New & Popular Topics, Contact Information and System & Informational Alerts. The Self-Service Features provide a direct link to some of the most utilized features and tools currently available on the Novitas Solutions website. Some of the tools available are the Appeals Status Inquiry Tool and the Enrollment Status Lookup. By selecting the Appeals Status Inquiry Tool, you are able to determine status of a Part A or Part B appeal that has been submitted. The Enrollment Status Lookup provides a status history of all Part A and Part B Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) or paper–submitted CMS-855/588 (EFT) applications. Some of the other enhancements include updates to some of the main titles on the left side Navigation Centers (e.g., LCD/Medical Policy, News & Bulletins, Contact Us, etc.), including placing the listing in alphabetical order for ease of use and quick location of information. Please visit the Novitas Solutions website, select your jurisdiction and view the most recent updates.

Thank you for your patience as we continue to work toward a quality product and provision of information that is easily accessed and available on the Novitas Solutions website.

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

For more information, visit MGMA's Meaningful Use Resource Center or CMS' EHR Incentive Program webpage.

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.

Read the agency's press release and the final rule to learn more.