Tag: Medical Group Management Association (MGMA)
CMS Releases 2024 MIPS Scores
The Centers for Medicare & Medicaid Services (CMS) has released MIPS performance feedback and final scores for the 2024 performance year. Sign in to the Quality Payment Program (QPP) website using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) system credentials to view your feedback from CMS. The targeted review period will be open for approximately 60 days, beginning with the release of final scores and closing 30 days after the release of MIPS payment adjustments that CMS plans to announce in one month.
Call Now to Reserve Your Seat
Limited Seating
2025 Washington Policy Mid-Year Update – MGMA Webinar
Where: POET Office
When: July 22, 2025, Tuesday
Time: 12 noon
Lunch will be served
Limited Seating Available
During this webinar, MGMA Government Affairs staff will provide an update on current and potential policy developments impacting medical group practices. The speaker will discuss the latest legislative and regulatory issues covering topics such as Medicare reimbursement, telehealth, quality reporting, and surprise medical billing.
This 60-minute webinar will provide you with the knowledge to:
Identify key regulatory developments
Discuss legislative issues impacting medical groups
Describe MGMA advocacy initiatives
Please call (936) 637-7638 or Email [email protected]
What is the Security Rule Anyway?
The Security Rule specifically sets out to ensure the “confidentiality, integrity,
and security” of electronic protected health information (ePHI). What does that mean?
• Confidentiality: ePHI is not available or disclosed to unauthorized persons.
• Integrity: ePHI is not altered or destroyed in an unauthorized manner.
• Availability: ePHI is accessible and usable on demand by an authorized person.
2025 Medicare Outlook
1st Come, 1st Served
POET will host MGMA’s 2025 Medicare Outlook Web Event
Date: December 10, 2024
Time: 12 o’clock, noon
Where: POET Office 111 Gaslight Blvd. Ste.B, Lufkin, TX 75949
Lunch will be provided
Limited Seating Available
Call or Email to reserve your place.
Benchmarking Your Team Effectiveness
Is the Health of Your Practice Looking a little Sickly:
New Requirement – DEA Registered Practioners
HEADS UP!
All practitioners registered with the Drug Enforcement Agency (DEA) will be responsible for fulfilling a one-time, eight-hour training requirement on the treatment or management of patients with opioid or other substance use disorders. Practitioners need to satisfy this requirement before their initial or next scheduled DEA registration submission on or after June 27, 2023.
There are multiple ways that a practitioner may satisfy this new requirement — the DEA sent a letter outlining these options and providing a list of accredited groups that may provide trainings. The Substance Abuse and Mental Health Services Administration (SAMSHA) has additional information about frequently asked questions. MGMA Government Affairs will discuss this policy in more detail during our upcoming mid-year policy update webinar.
PLEASE CLICK ON THE LINKS IN THE ABOVE PARAGRAGH FOR MORE INFORMATION.
Billing Codes Reported to Payor May Differ from Codes Authorized.
Have you ever requested authorization on a particular procedure (CPT Code) only to find out afterward there are additional codes or even a totally different CPT code than you requested?
It doesn’t help that only some payors allow for a retro authorization (auth)
and usually they have a short turnaround time.
Below are some tips from the MGMA Community.
From a Surgical Practice:
- Have the Surgical attendee to inform the Prior Auth. Manager or Coder as soon as the procedure is completed.
- The coder should compare procedure notes to the auth prior to billing.
From an ENT Practice:
- Have the physician give you all the possible CPT codes that could be performed and precert. them to be on the safe side.
From a Gastro Practice:
- Again request an auth. for all possible code combinations from the payor.
From an Ortho:
- Create a report that compares billed codes to approved codes.
- Then hold the claim for business days to make certain you have time to reach out to insurers and make adjustments.
- They have found that most insurers want it updated before they process the claim. Which is what the office wants also because it prevents refiling. Even if it takes additional months to get the prior auth. changed.
Summarized:
- Authorize all possible codes for the procedure.
Work with your insurance follow up team to identify our opportunities. This may lead to updates on how you order certain procedures. An update to both system and workflow.
- Timely charge capture. Because retro auth windows are short for some payors, it is imperative to understand if the codes being captured is different from codes authorized.
Same as #1. You have to assess how the charge lag is contributing to the denials.
- A process to compare codes being captured vs authorized and request retro auth.
This concept is for review before charges are submitted. Compare codes in charge sessions vs the codes authorized and flag sessions that have discrepancies so retro auth can be pursued.
Is Your Medical Practice Compliant?
HOW MGMA HELPS YOU
STAY COMPLIANT
Staying compliant with ever-changing policies and guidelines can become exhausting and downright confusing. MGMA is here to ensure you can easily track your compliance and stay on top of your checklists.
Take a look at some of our industry-leading compliance resources:
What is the Value of Benefits for Staff
Do you know the actual value of benefits offered to your staff?
Maybe you should.
Maybe your staff should.
If you have been looking for a way to calculate the value of benefits offered for your staff, here is an option found on the MGMA Community.
Just click the download button to view the spreadsheet.
The “how to” instructions are below.
It’s basic, but the employees seem to really like it.
1. Use the + to add a tab for each employee.
2. Rename each tab to your employee’s names.
3. Copy and paste the content from the ‘Employee A’ tab to the rest of your employee tabs.
4. Update the DATA INPUT tab with the amount your clinic pays for each employee on a monthly bases (this info will pull into the employee’s individual tabs).
5. In each employee tab, input the amount you pay monthly for Life Insurance (if you provide that benefit) in column B.
6. In each employee tab, modify as needed, the number of days you give for PTO, Holiday & the Retirement % (you’ll need to update both the description and also the formulas in column C).
7. Add or remove benefits as it applies to your clinic and employee.
I hope you find this to be helpful!
Connie McVein, Chief Executive Officer
Oregon Neurology, Springfield OR
Is Cigna Stealing?
Several Members from the MGMA Community have reported that Cigna has made ACH withdrawals from their bank account without permission.
One POET physician has reported the same.
MGMA Members suggest you contact your bank if you see a non-approved withdrawal from your account.
Update from MGMA, 6/15/2022: Please be aware Cigna experienced an isolated issue resulting in some EFT payments from settlement date May 23 being paid over the amount of the remittance advice. To minimize disruption to providers, Cigna worked with the bank to retract these EFT payments on June 1, 2022. The EFT payments for the correct amounts will be reissued around June 8, 2022 and should be available within 1 business day from reissue. Please also note that during this time, some remittance advices were delayed but have since been released.
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