January 10, 2024 - MGMA seeks rebilling clarification should Medicare cut be retroactively addressed

January 10, 2024 

The Honorable Chiquita Brooks-LaSure
Administrator
The Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

The Honorable Christi A. Grimm
Inspector General
Department of Health and Human Services
330 Independence Avenue, SW
Washington, DC 20201

Re: Request for Immediate Guidance on Rebilling of Repriced Part B Claims Submitted on or after January 1, 2024

Dear Administrator Brooks-LaSure and Inspector General Grimm:

On behalf of our member medical group practices, the Medical Group Management Association (MGMA) thanks you for your longstanding leadership in supporting medical groups' ability to offer high-quality care. Legislative delays affecting Medicare physician fees once again place MGMA members in a position of considerable uncertainty, facing potential billing disruptions and compliance risk. Similar uncertainties face their Medicare patients if services billed currently are later repriced pursuant to congressional action, affecting the application of Part B deductibles and co-payments.

With a membership of more than 60,000 medical practice administrators, executives, and leaders, MGMA represents more than 15,000 group medical practices ranging from small private medical practices to large national health systems, representing more than 350,000 physicians. MGMA’s diverse membership uniquely situates us to offer the following recommendations.

As it now stands, services provided on or after Jan. 1, 2024, are being billed under the new Medicare Physician Fee Schedule conversion factor with its untenable 3.4% reduction from 2023 levels. Medicare contractors will soon be processing these claims, paying practices, and calculating patient deductible and copay responsibilities, all at the reduced level. Practices will be billing patients for their share of the claim accordingly. Should Congress intervene to retroactively restore the payment cut to 2023 levels, as widely anticipated, these claims will be repriced, payments adjusted, and allowable copays increased.

In that scenario, physician practices will be faced with rebilling patients an additional increment which could in some cases be less than $1.00 and in many, if not most, cases will be small amounts that are less than the administrative cost of rebilling. Such rebilling will leave patients confused, and providers will be blamed even though rebilling is necessary through no fault of their own. Alternatively, providers might choose to forego the incremental copay, but in that event, may risk civil money penalties and even

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