Alerts, recalls and updates

Access Your Quality and Resource Use Report (QRUR) Today

March 31, 2015 - The Centers for Medicare & Medicaid Services (CMS) provided Quality and Resource Use Reports (QRURs) to physicians in groups of all sizes and physician solo practitioners in September of 2014. The 2013 QRURs provide  information that is intended to be used to improve the quality and efficiency of care provided to Medicare beneficiaries and also to help physicians understand and improve performance on quality and cost measures. The reports also contain information about how physician performance will affect Medicare payments in 2015.  View Complete Details.

CMS Meaningful Use Program:  It is Better to Attest and Fail, Than to Never Attest At All?

March 12, 2015 -  The AOA has received reports from doctors who are attempting to participate in the Centers for Medicare & Medicaid Services (CMS) Meaningful Use program, but are facing difficulties meeting certain reporting requirements, such as the patient portal objective.  Some optometrists have contacted the AOA asking whether they should proceed with attesting even if they believe they will not meet all of the required CMS thresholds and objectives.  Knowing that CMS has indicated that the agency plans to issue rulemaking later this year that is "intended to be responsive to provider concerns about software implementation, information exchange readiness, and other related concerns," it may be beneficial to attest even if you believe that you may not meet all of the CMS program requirements.  CMS officials have recently noted their desire not to penalize doctors who actively attempt to engage in the program.  By attempting to attest to meaningful use for the 2014 reporting year, doctors show a good faith effort to participate in the program which may bring relief from future penalties in 2016.  CMS will conduct official rulemaking later this year that will implement changes to the Meaningful Use program and until that time we will not know all the specifics regarding how the program will be revamped.   The rulemaking this year will mostly affect 2015 reporting, but AOA will argue for all those who try to attest to be exempt from penalties.  The AOA understands that the attestation process can be time consuming, but the factors noted above may be worth considering as optometrists decide how best to proceed before the attestation deadline.  For the 2014 reporting year, doctors have until March 20 to attest.   If you have questions please contact Kara Webb at

CMS Clarifies Impact of PQRS, EHR and Value Modifier Payment Adjustments on Drug Reimbursement

March 10, 2015 -  The negative payment adjustments for EHR, PQRS, and VM only apply to Medicare Physician Fee Schedule (MPFS) claims for Part B covered professional services.  The Part B drugs themselves are not services, and therefore are not paid under the MPFS. Only the services associated with the Part B drugs, such as injections, that may be necessary to administer the drugs are considered covered professional services that are paid under, or are based on, the MPFS. View complete details.

New EHR Attestation Deadline
February 25, 2015 - Eligible professionals now have until 11:59 pm ET on March 20, 2015, to attest to meaningful use for the Medicare Electronic Health Record Incentive Program 2014 reporting year. CMS extended the deadline to allow providers extra time to submit their meaningful use data. CMS continues to urge providers to begin attesting for 2014 as soon as they can.  View complete details.

Optometrists subject to $500+ fee for Medicare DMEPOS enrollment
December 9, 2014 - ODs who enroll with Medicare to provide durable medical equipment are required to pay a "revalidation" fee every three years. The DMEPOS revalidation fee for 2014 is $542—all physicians who are now enrolled as health care practitioners or suppliers under Medicare will be required to re-enroll by March 2015. View complete details.

Now Available: 2013 Quality and Resource Use Reports
On September 30, CMS made 2013 Quality Resource Use Reports (QRURs) available to group practices and physician solo practitioners nationwide. View complete details.

Save the date: 2015 Third Party Conference and State Government Relations Committee meeting
November 24, 2014 - The 2015 State Legislative and Third Party National Conference and State Government Relations Committee meeting will be held October 22-25, 2015, at the Hyatt Regency in Denver, Colorado. Demonstrate your commitment to advocacy and advancing our profession by attending.

CMS Releases 2015 Physician Fee Schedule Final Rule
November 14, 2014 - On October 31, 2014, CMS issued the final rule that updates the payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2015. For more information about participating in PQRS in 2015, visit the CMS PQRS website.

CMS Announces Distribution of 2012 PQRS Supplemental Incentive Payments has Begun
November 14, 2014 - CMS is pleased to announce that the 2012 Physician Quality Reporting System (PQRS) Supplemental Incentives have begun to be distributed to eligible professionals who submitted data for the reporting period of January 1, 2012 through December 31, 2012 and met criteria for satisfactory reporting. View more information.

Open Payments data correction period begins
Open Payments data correction period began on September 15, 2014, and will last for a minimum of 15 days. Applicable manufacturers and group purchasing organizations have the opportunity to acknowledge and resolve disputes initiated by physicians and teaching hospitals. View complete details.

Final EHR rule
Revised Medicare regulations fail to adequately address the AOA's longtime request for more flexibility in electronic health record (EHR) programs. The AOA states the changes don't go far enough to assist most users of certified EHRs. View complete details.

New PQRS Remittance Advice Codes now effective

PQRS-eligible professionals participating in claims-based reporting this year will now have to use the updated Remittance Advice Remark Codes (RARCs) for PQRS claims-based reporting that went into effect on April 1, 2014. View complete details.

HHS finalizes Oct. 1, 2015 as the new compliance date

The U.S. Department of Health and Human Services issued a rule finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. View complete details.

Revised face-to-face and written order requirements for high cost durable medical equipment (DME)
For certain specified items of durable medical equipment the Affordable Care Act requires that an in-person, face-to-face examination (F2F) documenting the need for the item must have occurred sometime during the six (6) months prior to the order for the item. Click here for a summary of these requirements.

Eligible professionals: Hardship exception applications due July 1, 2014
ODs eligible for hardship exceptions-to avoid the upcoming Medicare payment adjustment for the 2013 report year-must submit their application by July 1, 2014. View complete details.

New Meaningful Use Calculator Helps Providers Attest to Stage 2
April 8, 2014 - Are you a provider participating in Stage 2 of meaningful use? If so, use the new CMS Stage 2 Meaningful Use Attestation Calculator to determine if you will successfully meet Stage 2 requirements.

Information Regarding the Holding of April 2014 Claims for Services Paid Under the 2014 Medicare Physician Fee Schedule
March 28, 2014 - The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1, 2014. That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014. View complete update.

CMS: Implementation of National Automated Clearinghouse Association (NACHA) Operating Rules for Health Care Electronic Funds Transfers (EFT)
February 21, 2014 - The Centers for Medicare and Medicaid Services (CMS) released additional information regarding the new payer rules that took effect January 2014. In order to comply with these new requirements, Medicare Administrative Contractors (MACs) have to modify or change the data elements that are currently included in payment information that is transmitted through the Electronic Funds Transfer (EFT) Network. Optometrists and other physicians may notice that the Company Entry Description and the TRN Segment that is transmitted from the physician's financial institution may change in terms of content or length. View complete details.

HHS Issues Model of Notices of Privacy Practices in Spanish
A Spanish version of the Model Notices of Privacy Practices (NPP) has been issued by the U.S. Department of Health and Human Services Office for Civil Rights (OCR) and Office for the National Coordinator for Health Information Technology (ONC).  This resource provides patients and health plan subscribers culturally competent information about their rights under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. View complete details.

2014 Joanne Angle Investigator Award—a research grant by Prevent Blindness
The 2014 Joanne Angle Investigator Award provides funding for research investigating public health related to eye health and safety. The application deadline is Monday, March 31, 2014. View complete details and award application.

NGS: Incorrect Denials of Claims for bevacizumab (i.e., AvastinTM) for Ophthalmologic Indications
January 23, 2014 - Some claims with CPT code 67028 (intravitreal injection of a pharmacologic agent) for bevacizumab (i.e., AvastinTM) are denying. This issue is impacting two types of Avastin claims. The first is for Avastin-related claims with dates of service on or after 10/25/13 that are billed with HCPCS code J9035 (bill one unit per eye). View complete details.

CMS: Incorrect Denials of Claims for bevacizumab (i.e., AvastinTM) for Ophthalmologic Indications
January 23, 2014 - CMS began receiving claims on the revised CMS 1500 claim form (02/12) on January 6, 2014. The CMS 1500 claim form is the required format for submitting professional and supplier claims to Medicare on paper, when submitting paper claims is permissible. View complete CMS Reminder (Scroll to page 4, Claims, Pricers, and Codes).

FDA: The Mentholatum Company Issues Voluntary Nationwide Recall of Rohto® Eye Drops Made in Vietnam
January 17, 2014 - The Mentholatum Company announced a voluntary recall of Rohto Arctic, Rohto Ice, Rohto Hydra, Rohto Relief and Rohto Cool eye drops. The recall was initiated due to a manufacturing review at the production facility in Vietnam involving sterility controls. To date, there has been no evidence indicating that product does not meet specifications. View complete recall.

FDA: Acetaminophen Prescription Combination Drug Products with more than 325 mg: FDA Statement—Recommendation to Discontinue Prescribing and Dispensing
January 14, 2014 - FDA is recommending health care professionals discontinue prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acetaminophen per tablet, capsule or other dosage unit. View complete FDA alert.