Alerts, recalls and updates

September 25, 2015 - CMS Releases Updated ICD-10 Guidance  

The Centers for Medicare & Medicaid Services (CMS) has released additonal guidance to doctors regarding the first year of ICD-10 implementation.  Read the updated guidance here.

September 22, 2015 - 2016 Physician Quality Reporting Systems (PQRS) and Value Based Modifier (VBM) Payment Penalties

PQRS Penalties

In 2016, the Centers for Medicare & Medicaid Services (CMS) will apply a negative payment penalty to claims submitted by physicians, including doctors of optometry, who did not satisfactorily participate in PQRS in 2014. Individuals and groups that did not participate in PQRS in 2014 will be subject to a 2.0% payment reduction on all 2016 Medicare Part B Physician Fee Schedule (MPFS) claims in 2016.

How to Determine if You are Subject to the Payment Reduction

Individual physicians and group practices that will be subject to the 2016 negative PQRS payment penalty were sent letters from CMS on September 11, 2015.

How to Appeal Payment Penalties

If you participated in PQRS in 2014 and you received notification that you are subject to the PQRS penalty in 2016 but you believe the payment penalty should not be applied, you can submit an informal review request. All informal review requests must be submitted online at the Quality Reporting Communication Support Page by November 9, 2015 at 11:59 (EST).

How to Participate in PQRS to Avoid Future Penalties

For specific guidance on how doctors of optometry can participate in PQRS, please access AOA's PQRS webinars and resources at: CMS also regularly holds general PQRS teleconferences.  More information is available here.   

Additional Impact of the Value Based Payment Modifier

Doctors of optometry that are part of group practices with 10 or more health care practitioner may have additional incentives and penalties assessed under the Value Based Payment Modifier Program (VBM) in 2016. 

Doctors of optometry with 10 or more eligible professionals (EPs) in their practice who did not participate in PQRS in 2014 will be subject to an additional 2% VBM payment reduction on claims in 2016.  In total, practices with 10 or more EPs that do not participate in PQRS in 2014 will be receive a 2% PQRS payment reduction and a 2% VBM payment reduction in 2016. 

Doctors of optometry who are part of practices with 10-99 eligible professionals that successfully participated in PQRS in 2014 would be eligible for VBM payment increases in 2016, but would not be subject to any penalties as long as the group was successful in participating in PQRS.  Larger practices with more than 100 health care practitioners eligible to participate in PQRS could potentially earn a payment increase or decrease depending on the CMS evaluation of the practice under the VBM.

To obtain information on how the VBM could impact your practice in the future, all physicians, including solo practitioners, should access their Quality and Resource Use Report (QRUR).   The 2014 Annual QRURs can be accessed on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.

Additional Resources

· Incentive Eligibility & 2016 Negative PQRS Payment Adjustment - Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website)

· Payment adjustment toolkit on the 2016 PQRS Payment Adjustment Information page

· AOA Value-Based Payment Modifier website

· CMS Value-Based Payment Modifier website

· For additional questions, please contact Kara Webb at or the CMS QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via


September 14, 2015

CMS Releases Information on Opting-Out of Medicare

The Centers for Medicare & Medicaid Services (CMS) has released additional information for those physicians who choose to opt-out of Medicare. Read the information here.

September 9, 2015 - Doctors of Optometry May Use Certified Paraoptometric Staff for Electronic Order Entry

CMS Defers to Physicians, Federal and State Law in Determining Who Can Enter Medication and other Orders for Meaningful Use

Many doctors of optometry who participate in the Medicare & Medicaid Electronic Health Records (EHR) Incentive Programs have asked whether credentialed staff members are qualified to perform computerized provider order entry (CPOE) to fulfill meaningful use requirements. Based on AOA's review of the regulations and guidance from the Centers for Medicare & Medicaid Services (CMS), the AOA recommends that doctors of optometry only allow credentialed staff members with designations such as Certified Paraoptometric Technician (CPOT), Certified Paraoptometric Assistant (CPOA), and Certified Paraoptometric (CPO) to enter orders related to CPOE. Doctors of optometry must also personally ensure that any individual selected to enter orders has the education and training to perform the clinical expectations for this task and that designating this task to the credentialed staff member is in accordance with local, state and federal law.  Read AOA's complete clarification here.

September 2, 2015 - All commercial health plans offering small group coverage or individual coverage are required to provide eye exams and eyeglasses to children as an essential benefit in 2017

On Monday Aug. 31, the Centers for Medicare & Medicaid Services (CMS) published a list of proposed benchmark health plans for each state for coverage beginning in January, 2017.  The proposed benchmark plans will assure that eye exams and eyeglasses are covered for children in all states.  All health plans offering small group coverage (up to 100 employees) or individual coverage are required to provide these essential benefits, posted here:

More specifically, pediatric vision benefits were included in the existing coverage of the proposed benchmark plans in 30 states (including Washington DC).  If the selected benchmark plan did not include coverage for pediatric vision services, then the states were required to supplement their benchmark plan with the benefits covered by Federal Employees Dental and Vision Insurance Program (FEDVIP), which covers annual eye exams and eyeglasses, or the state's Children's Health Insurance Program (CHIP) benefits for pediatric vision.  According to CMS, 18 states will supplement pediatric vision coverage based on FEDVIP, and three states will follow the state CHIP benefits.  A summary is accessible here.

Each state affiliate may want to review the state's proposed benchmark plan for 2017, and consider submitting written comments to HHS in support of the state's selection of a benchmark plan (and any supplementation) that will cover eye exams and glasses.  Public comments will be accepted until 11:59 p.m. EDT on September 30, 2015. Please submit comments electronically to with the state clearly identified in the subject line (e.g., "Maryland 2017 Benchmark Plan Comments"). The CMS Center for Consumer Information and Insurance Oversight (CCIIO) will review all comments and then post the list of final 2017 EHB benchmark plans.

For the essential benefits for 2014-2016, 38 states and DC supplemented their benchmark plans with FEDVIP, 7 states opted for their CHIP plan benefits, and 5 states selected a benchmark plan that included pediatric vision benefits. 

For any questions, please contact the AOA Third Party Center at

 July 30, 2015 - CMS Offers Additional Guidance on Year 1 of ICD-10 Implementation

As AOA previously reported, earlier this month, the Centers for Medicare & Medicaid Services (CMS) released additional guidance on the transition to ICD-10.  CMS indicated that while the October 1, 2015 implementation date would remain unchanged,  CMS would provide some leeway in diagnosis reporting to allow physicians an opportunity to gain experience with the greater specificity of ICD-10 amid the first year of implementation.  This week, CMS released additional clarifying information regarding year 1 of ICD-10.  This new information addresses important questions such as "What is a valid ICD-10 code? " and "What is meant by a family of codes?" Review the CMS additional clarifying guidance here to learn more about CMS allowances for the first year of ICD-10.  To prepare for ICD-10 be sure to review AOA's Ask the Coding Experts ICD-10 webinar series and order AOA's ICD-10 manual from the marketplace.

July 29, 2015 - Important Updates Related to Medicare

MACRA Changes to Medicare Physician Opt-Out

Doctors of optometry and certain other physicians who do not want to enroll in the Medicare program may "opt out" of Medicare. When a physician chooses to opt out, neither the physician nor the Medicare beneficiary may submit a bill to Medicare, and the patient must agree to pay the physician out-of-pocket. The Centers for Medicare & Medicaid Services requires a physician to submit an affidavit to Medicare that communicates his/her decision to opt out of Medicare.

Doctors of optometry who opt out of Medicare, and those who choose to do so in the future, should take note of changes made by the Medicare Access and CHIP Reauthorization Act (MACRA). Prior to the passage of MACRA, the longest interval that a Medicare opt-out affidavit from a physician could be effective was two years.  MACRA mandated that opt-out affidavits will now automatically renew every two years.   If a doctor of optometry no longer wants to opt out of Medicare, he/she will be able to rescind his/her opt-out status if the doctor of optometry notifies CMS at least 30 days prior to the start of the next two-year period.  This change should reduce some of the administrative burden on those physicians who choose to opt out of Medicare.

Following AOA Advocacy Efforts, CMS Revises Open Payments CME Guidance

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) updated the Law and Policy page on the Open Payments website with information about reporting requirements for manufacturer support of continuing medical education (CME).  As AOA has previously reported, the Open Payments program requires that certain manufacturers and others report any payments or gifts provided to doctors of optometry and other physicians. Such items include consulting fees, honorarium, gifts, food and beverage, lodging and travel, and education.

When CMS implemented the Open Payments program in 2014, the agency created several exemptions from the reporting requirements.  One exemption for payments supporting continuing education did not include continuing education programs for optometrists

AOA met with CMS officials several times to discuss concerns with the inequitable policy and in response, in October 2014, CMS eliminated the exemption for payments made to physician speakers at certain accredited continuing education events. After securing this key regulatory win, AOA then fought alongside other physician organizations to convince lawmakers to include within MACRA important refinements to the Open Payments program.

In removing the special reporting considerations for payments made to support continuing education, CMS clarified an exemption remained for indirect payments that may apply to some transfers of value to continuing education programs.  Indirect payments are payments that flow from a manufacturer through other entities to the eventual benefit of a physician. These payments do not need to be reported when the manufacturer making the payment does not control who eventually benefits and does not immediately know who eventually benefits.  This exemption for indirect payments allows much industry support of continuing education to be unreported unless the manufacturer directs or knows the support will go to specific individual physicians, and also eliminates the discriminatory exemption specifically for continuing education that had been in effect.

The recent CMS update clarifies the policy change to eliminate this exemption and to create a consistent reporting requirement in 2016.  Read More

Have you received a RUC Survey?  

AMA RUC-identified OCT Codes Being Surveyed as Potentially Misvalued

June 10, 2015 - The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) recently identified certain Current Procedural Terminology (CPT) codes reported by doctors of optometry as potentially misvalued requiring further review.  For the upcoming October RUC meeting, the AOA is surveying three codes:

CPT® 92132 Scanning computerized ophthalmic diagnostic imaging, with interpretation and report, unilateral or bilateral; anterior segment

CPT 92133      Scanning computerized ophthalmic diagnostic imaging, with interpretation and report, unilateral or bilateral; optic nerve

CPT 92134      Scanning computerized ophthalmic diagnostic imaging, with interpretation and report, unilateral or bilateral; retina  

Data gathered from the surveys will be presented to the RUC for review. The RUC will then develop value recommendations for consideration by the Centers for Medicare & Medicaid Services (CMS).  Ultimately, CMS makes all final decisions about what payments should be for each service under the Medicare program. Physicians selected to participate in the RUC survey will receive an e-mail from If you receive the survey, please complete it by June 22.  If you have questions, please contact Kara Webb at  

CMS Five More Facts About ICD-10

May 6, 2015

CMS has released five more facts that physicians should know about the transition to ICD-10.  Read More.  

Reminder: Open Payments Physician Review and Dispute Period Ends May 20, 2015

April 30, 2015 - Optometrists have until May 20, 2015 to voluntarily review data reported by drug and medical device makers about them, and, if necessary, dispute payments, before the data is made public on June 30, 2015.  To review data, optometrists must register in both the CMS Enterprise Portal and the Open Payments system.   Read More

Access Your Mid-Year Quality and Resource Use Report Now!

April 30, 2015 - The Centers for Medicare & Medicaid Services (CMS), has released the 2014 Mid-Year Quality and Resource Use Reports (MYQRURs). The 2014 MYQRURs are available for informational purposes only and contain information on a subset of the measures used to calculate the 2016 Value Modifier. Read More.  

CMS Five Facts About ICD-10

April 23, 2015 - According to the Centers for Medicare & Medicaid Services (CMS), agency offiical recently talked with providers to identify common misperceptions about the transition to ICD-10. CMS identified five facts to address some of the common questions and concerns CMS has heard about ICD-10. Read More.  

New NCQA Recognition Program Open to Doctors of Optometry

April 7, 2015The National Committee for Quality Assurance (NCQA), has announced their new "Patient-Centered Connected Care Recognition Program."  According to NCQA the program, "will evaluate sites delivering outpatient health care that communicate effectively with a patient's other providers-especially primary care providers that constitute a patient's medical home. The result is integrated, patient-centered care for patients receiving care at multiple different care delivery sites.  Patient-Centered Connected Care Recognition uses evidence-based standards to evaluate how care teams collaborate with patients and how a care site connects to other providers."  Doctors of optometry are eligible to participate in this new program.  Read AOA's Frequently Asked Questions regarding the program here

Open Payments Physician Review and Dispute Period Begins April 6!

April 2, 2015 - As part of the Open Payments program, optometrists and other physicians  can begin to review payments attributed to them on Monday, April 6, 2015. Drug and medical device makers are required to report certain payments made to physicians and teaching hospitals on an annual basis. Optometrists participation in the registration and review process is voluntary, but is encouraged so that optometrists  can review and, if necessary, dispute payments before the information is made public on June 30, 2015. After the review and dispute period officially ends, optometrists can continue to register and initiate disputes, but resolutions will not be publicly displayed until the next reporting cycle.

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.