AOA secures important wins in historic SGR reform legislation

AOA secures important wins in historic SGR reform legislation

AOA lobbying efforts on Capitol Hill paid off this week.

"This win ... offers a new reason for AOA members to be proud of our organization's impact."

In a big win for optometry, historic legislation to repeal and replace Medicare's physician payment formula fully recognizes optometrists as physicians for all major quality improvement and payment and delivery reforms.

"This win—after years of attacks on our role as physicians and repeated payment disruptions—offers a new reason for AOA members to be proud of our organization's impact and results in Washington, D.C.," according to AOA President David A. Cockrell, O.D.

More than 500 AOA doctors and students attending AOA's 2015 AOA Congressional Advocacy Conference were on Capitol Hill April 14, just hours before  the Senate cast its historic 92-8 vote to repeal Medicare's sustainable growth rate (SGR) formula and reverse a 21 percent payment cut, which had taken effect April 1.

The Senate's passage of the bill took place several weeks after the House voted to approve the bipartisan legislation. At this story's deadline, President Obama was expected to sign the bill into law.

AOA lobbied for full recognition on Capitol Hill
In the hours leading up to the final vote, Dr. Cockrell says he and his fellow optometrists on Capitol Hill took the opportunity "to remind senators about optometry's essential and expanding role in Medicare, and kept OD physician status as a non-negotiable foundation of the final bill."

The bipartisan bill, H.R. 2, replaces the SGR with a new merit-based incentive payment system that offers the only pathway to growing physician payments. 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.

AOA offers further claims guidance
In response to Senate passage of the bill, AOA offered fresh guidance regarding the submitting of claims.

"AOA recommends members continue holding claims, if practical, until CMS and its contractors announce they are ready to process claims at the new, higher rates.  We expect the Medicare contractors will be able to process claims at new rates within a week, but the transition might have some bugs," says Rodney Peele, AOA's chief regulatory counsel.  

As always, individual members should weigh their cash flow needs to get paid promptly against the additional administrative burden of receiving payment in two parts. In determining the feasibility of holding claims longer, members should keep in mind that CMS will not pay claims until 14 days after they are submitted, Peele adds.

In the days and weeks ahead, AOA will be providing members-only updates and briefings aimed at saving members' time and offering vital information and assistance as doctors of optometry position their practices, particularly for the bill's sweeping reforms, which offer the only pathway to increased reimbursements for ODs and other physicians.

For more information on the final SGR bill, contact AOA Washington office staffers Matt Willette, director of congressional relations, or Alicia Kerry Mica, associate director, congressional relations.

April 15, 2015

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