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