Louisiana Medical Group Management Association


(Photo U.S. Capitol Building from Wikimedia Commons)

Tim Barrett
MGMA-Louisiana National Legislative Chair


July 31, 2015   Action Advisory

The MGMA Government Affairs team is asking each of us to advocate in favor of the Coding Flexibility in Healthcare Act of 2015.  In short, the proposed legislation would require a six-month dual coding period not just on the part of Medicare, but all public and private insurers as well. I’ve attached a document that summarizes the Code FLEX act which you are welcomed to share with others including your Congressional contacts.  

At this time, H.R. 3018 has been introduced and is being considered by co-sponsors. The best way to generate interest on a bill is to attain cosponsors, which is precisely why all of our support is so critical. In Washington, MGMA has witnessed some renewed interest in ICD-10 in recent weeks as the October 1st compliance date approaches and the August Congressional recess provides an excellent opportunity to capitalize on this and gain some real traction on this bill. 

MGMA’s advocacy strategy involves a two-pronged approach:


Lawmaker Email Contact One of the easiest and most critically-important ways you can help to move this bill forward is by joining the ongoing MGMA email-writing campaign.  With your help, the MGMA SGR repeal grassroots email campaign was one of the most successful to date, and MGMA hopes to repeat this high level of engagement with HR 3018.

Urge your lawmaker to cosponsor the Code FLEX Act and support an ICD-10 coding glide path.  In an effort to establish a responsible transition period from ICD-9 to ICD-10 beginning Oct. 1, you are encouraged to access MGMA’s Legislative Advocacy Center to write your members of Congress and ask them to cosponsor the Coding Flexibility (Code-FLEX) in Healthcare Act  HR 3018. Introduced by Reps. Marsha Blackburn (R-Tenn.) and Tom Price, M.D. (R-GA), this legislation would establish a transition period of 180 days after October 1st for physician group practices and other providers to submit healthcare claims to public or private payers using either ICD-9 or ICD-10 codes.  Additionally, HR 3018 would require the Secretary of Health and Human Services to submit a report to Congress assessing the impact of ICD-10 code sets on healthcare providers and other stakeholders no later than 90 days following enactment of the legislation. MGMA worked closely with the sponsors while they drafted this legislation and issued a letter expressing our support.

Congressional District Office Visit.  The second component of the MGMA two-pronged grassroots approach entails how you can leverage your particularly influential role and go one step farther by calling or setting up meetings with your member of Congress during the upcoming August recess, which will occur between Aug. 3 and Sept. 4 for the House, and Aug. 10 - Sept. 4 for the Senate.  These meetings provide a unique opportunity for you to develop or maintain a relationship with your lawmakers and serve as a vital resource on healthcare matters moving forward.  Attached is a guide on making a congressional district office visit.  The guide contains helpful tips and a list of MGMA resources.

 Visit MGMA’s Advocacy Center to contact your lawmakers and ask them to cosponsor HR 3018! This advocacy weblink is also located on our own website homepage on the right.

04-15-15: Senate repeals SGR (92-8) -  Focus now turns to language of the bill

So often nowadays it’s said the healthcare landscape is changing at a record pace, both on a national and state level.  For proof, we need look no further than the current evolution of the SGR Fix legislation in the House and now last night with the Senate (92-8) having passed landmark legislation repealing Medicare’s Sustainable Growth Rate formula.  The President has previously signaled his support and is expected to sign the bill soon.

Thanks to all of you who followed the updates responding to the grassroots Call to Action emails that MGMA—Louisiana published recently.  Your participation in an industry-wide grassroots efforts was instrumental in achieving the SGR repeal. 

Soon, we’ll turn our focus to the “value” language in the repeal bill to figure out how to lead our industry forward.  All of us should be thankful that we have largely avoided the billing quagmire of having the 21% reduction implemented on a wholesale basis thanks to CMS’ rolling hold initiative.

We appreciate your attention to the notices we’ve shared about important legislative matters as MGMA—Louisiana endeavors to keep its membership alerted to national and state matters that might impact your organization. 

I encourage you to frequent MGMA—Louisiana’s  national and state legislative webpages for information, updates, and resources on how you can be an effective advocate for the healthcare profession. Your voice can make a difference. Advocacy matters!


04-06-15:   SGR cut goes into effect, uncertainty remains until Congress returns

(information courtesy MGMA's Government Affairs Department) www.mgma.org

Last week, the House of Representatives passed H.R. 2, a bill that would permanently repeal the flawed Sustainable Growth Rate (SGR) formula, along with enacting other provisions. In the very early morning of March 27, after completing votes on the budget resolution, the Senate adjourned for April recess without voting on the SGR repeal legislation. Senate leaders said they plan to vote on permanent repeal when they return from recess on April 13.
The Centers for Medicare & Medicaid Services (CMS) released an announcement regarding claims processing for April 1 and beyond in the absence of congressional action to avert Medicare physician payment cuts resulting from the SGR. For the full announcement, click here.

CMS states:  "The negative 21% payment rate adjustment under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015. CMS is taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time beginning on April 1st. Holding claims for a short period of time allows CMS to implement any subsequent Congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction. Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. As we stated in our recent email to physicians, CMS will provide more information about next steps by April 11, 2015."
Once they return from recess, the Senate must act quickly to vote on and pass the legislation. If the Senate passes a clean bill, it will be sent directly to the President, who has already expressed his support for the bill and is expected to sign it into law. If the Senate amends the bill in any way, it will need to go back to the House for a final vote before arriving at the President's desk.
MGMA has repeatedly urged Congress to put an end to temporary short-term patches and pass a permanent solution to the SGR. Join the effort today! Contact your Senators and urge them to repeal SGR once and for all. Stay tuned to the Washington Connection for up-to-date alerts. See MGMA-Louisiana home page and click on the CONTACT CONGRESS GRAPHIC.


March 26, 2015 - Special Alert: Historic SGR repeal passes in House

Today, the House of Representatives passed the Medicare Access and CHIP Reauthorization Act, H.R. 2, by a vote of 392–37. This legislation permanently repeals the SGR and returns stability to physicians and Medicare patients.

The House passed by an overwhelming affirmative vote of 392-37 the “Medicare Access and CHIP Reauthorization Act of 2015” teeing-up action in the Senate, which could take up the measure as early as Friday morning, prior to the chamber’s adjournment for the two-week Congressional recess. The bill, as previously conveyed, repeals the long-flawed Medicare Sustainable Growth Rate (SGR) payment formula for physicians, includes several so-called Medicare ‘extenders’ (including those effectuated in the current incarnation of the ‘doc fix’), and provides for a two-year extension of the Children’s Health Insurance Program (CHIP) at the Affordable Care Act (ACA)-enhanced rates, among a number of other provisions.  

We are continuing to follow the Congressional deliberations closely, particularly in the Senate where action on the broader SGR measure could occur as early as tomorrow, following that chamber’s final vote on its pending Fiscal Year (FY) 2016 budget resolution, leaving just enough time to clear the measure for the President’s signature prior to the Mar. 31 payment cliff.  

 03-19-15 - Legislation introduced to repeal and replace SGR

This morning lawmakers in Washington introduced legislation to repeal and replace Medicare’s Sustainable Growth Rate (SGR) formula.   While the bill represents significant progress on the SGR repeal front, members of Congress continue to negotiate other key provisions, including how to pay for the estimated $200 billion cost of the legislation.

In order to keep the momentum going, all state MGMA members need to contact their members of Congress, urging them to reach a consensus and end the cycle of short-term fixes.  Now is the time to permanently repeal the SGR once and for all. No more excuses, no more patches.

As things develop in Washington, MGMA—Louisiana will strive to provide you with updates, including additional grassroots messages that will be critical in our efforts to put the SGR behind us. Please stay tuned!


03-18-15: Congressional SGR repeal negotiations show promise

As the March 31 deadline nears to avert a 21% cut to Medicare physician payments, a bipartisan deal to permanently repeal the Sustainable Growth Rate (SGR) formula is in the works. Speaker John Boehner and Minority Leader Nancy Pelosi are close to an agreement on the substance of a bill, which is predicted to be released soon. The legislation is expected to include provisions that would ensure five years of 0.5% annual updates, provide additional bonuses for physicians that move into alternate payment models and harmonize and streamline existing Medicare quality reporting programs.

While both sides appear to agree on the underlying policy of repealing the SGR, how or whether to pay for the estimated $200 billion legislation remains the largest political and practical hurdle to passage. Stay tuned for special alerts from MGMA with important developments on the SGR repeal effort.

MGMA has repeatedly urged Congress to permanently repeal the SGR and put an end to temporary short-term patches. Join this effort! Visit our Advocacy Center (see homepage of this website) and tell your lawmakers to repeal the SGR now. (This information courtesy of MGMA)


While discussions continue, House leaders outlined a conceptual deal that would permanently repeal Medicare’s Sustainable Growth Rate (SGR) formula and partially offset $70 billion of the estimated $213 billion cost. Highlights include:

  • Providing a 5-year period of 0.5% updates under the Physician Fee Schedule;
  • Refining Medicare fee-for-service systems, with – among other provisions – a consolidation of existing quality programs and incentives for care coordination for patients with chronic care needs;
  • Incorporating incentives for alternative payment models (APMs), such as a 5% bonus to providers receiving a significant portion of revenue from APMs, among other provisions;
  • Extending funding for the Children’s Health Insurance Program, which – although not specified in the document – appears to be for two rather than four years as envisioned in the House document;
  • Permanently extending the Medicare Qualifying Individual program to assist Medicare beneficiaries in paying Part B premiums; and
  • Including certain Medicare and Medicaid extenders that traditionally travel with the “doc fix.”

The document defers the remaining offsets (beyond the anticipated $70 billion) to today’s House Republican budget resolution for fiscal year 2016, which included an array of proposals aimed at balancing the federal budget in 10 years.

It is believed there would be more Medicare means-testing in Medicare Parts B and D for those earning more than $133k, and some changes with Medicare Advantage plans. Limitations on Medigap first-dollar coverage would begin in 2020 for new enrollees, the document indicates, with an additional approximately $35 billion in cuts deriving from provider and hospital cuts.

As the contours of a House deal take shape, Senate Democrats have expressed hesitation, particularly about the achievement of only a short-term CHIP funding extension despite the prospect of a permanent doc fix. (This article taken from a report by Michael R. Mabry, Executive Director of the Radiology Business Management Association)


03-17-15  - Senate HELP Committee hearing sheds light on EHR concerns

See video here

On Tuesday, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing to discuss issues surrounding the EHR Incentive (meaningful use) Program and the slow progress of system-wide interoperability. There was unanimous agreement among the Committee members that more must be done to ensure that the significant public investment made through the meaningful use EHR incentive program translates into improved data interoperability. Issues raised included:

  • High infrastructure costs to practices
  • General reluctance of vendors and institutions to share data with competitors
  • Concerns with the "all or nothing" approach for successfully attesting
  • The high number (approximately half) of eligible professionals that will receive penalties; and
  • Lack of demonstrated value in data-sharing for providers and vendors.

HELP Committee members pledged to continue exploring opportunities to improve the nation’s ability to efficiently and securely share health data. (This information courtesy of MGMA)


 03/16/15 - MGMA expresses support for the elimination of the Independent Payment Advisory Board

U.S. Reps. Phil Roe, R-Tenn. and Linda Sanchez, D-Calif. have reintroduced legislation to repeal the Independent Payment Advisory Board (IPAB) created under the Patient Protection and Affordable Care Act (ACA). Sen. John Cornyn, R-Texas, reintroduced companion legislation in January. Unless repealed, the IPAB will be comprised of an unelected 15-member panel appointed by the President and subject to Senate confirmation. Any year in which the Medicare per capita growth rate exceeds a target growth rate, the IPAB would be required to recommend Medicare spending reductions.

MGMA supports repeal of the panel and sent a letter to Senate leadership and House Energy and Commerce Committee members and leaders urging them to support and vote on the legislation to repeal the IPAB. The IPAB usurps congressional oversight of the Medicare program and limits the ability of Medicare beneficiaries and providers to work with Congress to improve the program. We urge members, their practices’ physicians and staff to access the MGMA Advocacy Center to contact their members of Congress and tell them to support legislation repealing the IPAB.




















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