Call to action: Tell Congress to hold health plans accountable for surprise billing

In recent months, Congress introduced a number of bills that address the issue of surprise billing. There is widespread agreement that patients should be protected from surprise medical bills and taken out of the middle of payment disputes. However, the current legislative “solutions” give too much power to health plans. Instead of the discounted in-network benchmark rate solution proposed by many of these bills, MGMA advocates for out-of-network payments to be set by leveraging commercial data from independent sources. When this payment rate is insufficient, an independent dispute resolution process should be utilized to determine fair payment for the physician.

Please take a moment to submit a letter to Congress through our Contact Congress portal and ask your representatives to hold health plans accountable for providing adequate provider networks, so that surprise bills do not ocurr. 

2018 QPP performance results released

CMS has released data outlining preliminary, high-level results of participation data in the 2018 Quality Payment Program (QPP). A key takeaway from 2018 performance is that a higher percentage of participants in MIPS avoided a negative adjustment compared to 2017 performance (almost 98% versus 93%). Additional details of 2018 QPP participation include:

  • The total number of clinicians who participated in MIPS in 2018 was 559,230, down from 716,603 in 2017;
  • Small practice participation in MIPS increased to 89.2% in 2018, up from 81% in 2017; and
  • The number of Advanced Payment Model Qualifying Participants (QPs) rose to 183,306 in 2018, up from 99,076 in 2017.

MGMA members who believe an error has been made to their 2018 performance final scores can request a targeted review through the QPP website (here) until September 30, 2019.