Update: Merit-based Incentive Payment System quality measures

April 20, 2022
The Centers for Medicare & Medicaid Services made changes to certain quality measures for 2022—find out if they impact you.
Doctor-patient eye exam

Written by the AOA’s Coding & Reimbursement Committee

Each year, the Centers for Medicare and Medicaid Services (CMS) makes policy changes related to the Medicare program. The AOA is fully engaged with the agency on program changes that may impact doctors of optometry and their patients.

For 2022, CMS made changes to certain quality measures that are reported by doctors of optometry. If you are required to participate in the Merit-based Incentive Payment System (MIPS), review this information.

Age-related macular degeneration: Dilated macular examination

For the past several years, CMS has indicated that the agency would like to move away from claims-based reporting of quality measures and to encourage doctors to report via electronic health record or other system. CMS continues to phase out the use of claims-based reporting for certain measures. For 2022, CMS will no longer accept Measure No. 14 age-related macular degeneration: dilated macular examination reported via claims.

Diabetes eye exam quality measure revisions

For 2022, CMS has revised the diabetes: eye exam quality measure. Although the AOA raised concerns with the revision, CMS has finalized an update to the quality measure to allow for the use of artificial intelligence to screen patients. The updated denominator for the quality measure indicates:

“The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation.”

CMS to delay these measure changes, the agency decided to finalize the update.

MIPS value pathways delayed

CMS has continued to refine the MIPS program and had previously indicated that doctors participating in MIPS would need to move toward reporting of MIPS value pathways (MVPs) in 2022. The AOA opposed this shift and implementation deadline, and CMS has announced that the agency will delay the use of MVPs until 2023 and to begin that transition with an initial set of MVPs for a limited number of doctors. The AOA submitted an MVP for CMS review in 2021 and will continue working with the agency to reduce burden under the MIPS program. The AOA will keep doctors updated regarding this new MIPS approach.

Ask the coding experts

If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.

Related News

New noteworthy optometry codes

Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.

Modifier -25: How to use it appropriately and avoid costly penalties

The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.

3 coding questions cracked

Does Medicare allow you to bill fundus photos and an optical coherence tomography on the same day for two different diagnoses? The answer to this question, and more, from the AOA’s experts.