AOA continues fight for permanent SGR fix, advises members to hold claims

AOA continues fight for permanent SGR fix, advises members to hold claims

AOA fought for and won major changes to the House's Medicare payment reform bill that would solidify optometry's central role in Medicare for decades to come.

"We can urge passage and continue fighting to keep intact the bill's overarching recognition of optometrists as physicians."

In the weeks ahead, AOA members will be lobbying senators on Capitol Hill to continue to improve and then finally pass this important legislation.

On March 26, the House voted overwhelmingly to approve H.R. 2, a bipartisan bill that would replace Medicare's sustainable growth rate (SGR) formula with a new merit-based incentive payment system that offers the only pathway to growing physician payments.

The bill recognizes optometrists as physicians for all major quality improvement and payment and delivery reforms, and the changes secured by AOA over the past year prevented a two-tiered Medicare pay system, as was originally envisioned under previous versions of the SGR reform bill.

The bill's Merit-Based Incentive Payment System (MIPS)—which combines the Physician Quality Reporting System, Electronic Health Records Meaningful Use and Value-Based Payment Modifier, "fully recognizes our profession," says Roger Jordan, O.D., chairman of the AOA Federal Relations Committee. "There are opportunities for significant incentives for delivering quality care throughout the bill. While we've made major gains—we still want more."

AOA is calling for additional improvements. For instance, the bill would delay for one year the start of a resource use measurement effort and would restrict who could bill Medicare for care management of the chronically ill.

Although the House approved its bill by an overwhelming majority, the Senate decided to hold off on a vote until after its spring recess. With no congressional stopgap measure in place, a 21 percent cut to Medicare physician payments took effect on April 1.

AOA advises members on pay cut
ODs and other Medicare physicians are unlikely to immediately feel the impact of this cut. By law, the Centers for Medicare & Medicaid Services (CMS) may not process and pay claims any sooner than 14 days. CMS does have the option of delaying claims until the Senate acts on the bill.

CMS plans to update providers by April 11. In the meantime, AOA has advised members to hold off on submitting April claims for as long as practical, giving Congress time to complete the legislative process on H.R. 2 and Medicare contractors the ability to implement new payment rates.

No processing or payment delays should occur for claims submitted to Medicare that are dated March 31 or earlier, AOA informed members.

A call to action
With Senate action delayed, 2015 AOA Congressional Advocacy Conference attendees will have the opportunity to lobby the Senate on Capitol Hill as it considers the bill. This is excellent timing, Dr. Jordan says. "We can urge passage and continue fighting to keep intact the bill's overarching recognition of optometrists as physicians while working to make additional improvements."

For more information on the SGR fix, contact AOA Washington staff Matt Willette, director of congressional relations, or Alicia Kerry Mica, associate director, congressional relations. Doctors of optometry and students may also use the AOA's Online Legislative Action Center to fight for passage of the bill.

April 2, 2015

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