From: Drew Voytal
Associate Director
MGMA Government Affairs
Washington, DC

President Trump signed a continuing resolution appropriations bill into law that funds the federal government through December 11, 2020; section 2501 also includes several improvements to the Medicare Accelerated and Advance Payment Program (APP), including relaxing repayment terms. Upon request of a hospital or group practice that received accelerated or advance payments under Medicare Part A or Part B, CMS can:

• Delay recoupment of payments until one year from the issuance of the advanced payments;
• Once recoupment begins, apply a graduated recoupment schedule, where 25% of Medicare payments would be withheld during the first 11 months of recoupment, and 50% of Medicare payments would be withheld during the following six months; and
• Extend the period during which recipients must fully repay the advance payment amount in full to 29 months from the date of the first payment.
• The bill also lowers the interest rate on outstanding balances remaining after the 29-month repayment period from 10.25% to 4%.

CMS has not yet published information for groups wishing to avail themselves of these benefits, but we anticipate the agency will provide further information on how to make such a request. We will notify members once we see something.

HHS Secretary Alex Azar has officially renewed the COVID-19 public health emergency, resulting in a continuation of the telehealth waivers and other flexibilities that have allowed medical groups to care for patients during the pandemic. The renewed PHE determination is effective Friday, Oct. 23, and will terminate 90 days later on Thursday, Jan. 21. 

Announcement from: Matt Devino
Associate Director, Government Affairs MGMA
Washington DC

From MGMA

Today, HHS has announced that applications will be accepted beginning on Monday, Oct. 5 for $20 billion in new funding under Phase 3 of the PRF General Distribution allocation. Under this new phase, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers will also be eligible for relief payments.

Deadline: Providers will have from Monday Oct. 5 through Nov. 6 to apply, however HHS is encouraging early application to “expedite [its] review process and payment calculations.”

Eligibility

• Providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
  • Importantly, even if you already received payments of approximately 2% of annual revenue from patient care, you may submit more information to become eligible for an additional payment.
• Behavioral Health providers, including those that previously received funding and new providers.
• Healthcare providers that began practicing January 1, 2020 through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers.

Payment Methodology

1. All provider submissions will be reviewed to confirm they have received a Provider Relief Fund payment equal to approximately 2 percent of patient care revenue from prior general distributions. Applicants that have not yet received Relief Fund payments of 2 percent of patient revenue will receive a payment that, when combined with prior payments (if any), equals 2 percent of patient care revenue.
2. With the remaining balance of the $20 billion budget, HRSA will then calculate an equitable add-on payment that considers the following:
   1. A provider’s change in operating revenues from patient care
   2. A provider’s change in operating expenses from patient care, including expenses incurred related to coronavirus
   3. Payments already received through prior Provider Relief Fund distributions.

We (MGMA) expect to see more information released by HHS over the coming days which we expect will be posted to the Provider Relief Fund website. We will communicate those details to members as they are made available.

The Texas Chapter of MGMA has announced it’s annual meeting will be virtual. The price for Members and Non- Members ($99) are the same.

The 2020 Annual Meeting is going Digital! 

September 8-11, 2020 

As a precaution and in consideration for the safety of our members and vendors the TMGMA Board has decided to hold a virtual meeting this year.

Topics Include:

• Best Practices for Medical Group Managers & the Pandemic
• Active Shooter Training: Stop the Bleed
• Cybersecurity Panel
• How to Avoid Burnout
• Commercial Payor re: Denials/Appeals Process for Prior Authorization and/or Contract Negotiations for In Network
• Medicare/Medicaid: Coding Updates for 2020
• Prior Authorizations in Texas: Burdens and Policy
• Status of Rural Health
• TMGMA Annual Business Meeting
• Principal Care Management
• MGMA Legislative UpdateTexas Bills: Prior Authorization, Claim Denials, Sales Tax Bills, Surprise Billing

Registration Information

Before August 15, 2020
*ALL PRICING BELOW WILL INCREASE $100 AFTER 08/15/20

Members
Active – $99
Affiliate – $99
Faculty – $99
Student – $99

Non-Members
Non-Member – $99
Affiliate Non-Member – $99

by Joey Berlin, July 17, 2020

The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.

The eight-page white paper, first released last December, covers the ins and outs of Senate Bill 1264, the 2019 legislation now in effect. SB 1264 took patients out of the middle of surprise-billing disputes between certain out-of-network physicians and state-regulated health plans, allowing them to settle those disputes through an arbitration process similar to the one used to settle salary disputes in Major League Baseball.

The white paper update comes after the Texas Department of Insurance  adopted a final rule touching on exceptions to SB 1264’s general ban on balance billing for out-of-network services the law covers. SB 1264 prohibits balance billing except in certain circumstances, which include required notice and disclosure.

The newly amended rules include these changes that TMA requested:

• Legal representatives or guardians of a patient may be the people to agree to an out-of-network physician’s required notice and disclosure of a potential balance bill;
• A physician may delegate the record-keeping of that notice and disclosure statement by allowing a practitioner’s “agent or assignee” to maintain a copy of the statement. Also, the statement only has to be maintained if the practitioner provides the medical service or supply at issue and sends a balance bill.

You can read the complete adopted rule on page 4,204 of the June 19 Texas Register.

To view the TMA updated white paper on Ink, follow this link.

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/07/Overview-of-SB-1264-TMA-06302020.pdf” download=”all” viewer=”google”]

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/06/The-Rising-Trend-of-Nonphysician-Provider-Utilization-in-Healthcare.pdf” download=”all” viewer=”google”]

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/05/MGMA-On-Telephone-Only-Visits-05132020.pdf” download=”all” viewer=”google”]