Medicare's 2016 Physician Fee Schedule (PFS) contains several AOA-backed policies that promote greater access to doctors of optometry for America's Medicare beneficiaries.
The Centers for Medicare & Medicaid Services (CMS) issued the PFS final rule on Oct. 30 to update policies affecting payment rates for Medicare services furnished during the 2016 calendar year, as well as refine several quality reporting initiatives that are associated with PFS payments.
Among the various changes pertaining to all Medicare providers in this PFS final rule, there are a number of AOA-backed provisions that specifically affect doctors of optometry in 2016.
Among the wins, CMS agreed with the AOA that CPT 92002 (ophthalmological services exam and evaluation) should not be on the list of potentially misvalued codes, and that the refinement panel used in the case of disagreements over codes should not be eliminated.
Additionally, CMS stated they would further consider whether to proceed with development of non-facility practice expense values for cataract surgery.
The CMS also agreed with the AOA that individuals excluded from federally funded programs should be allowed to provide "incident to" services, and that it's inappropriate to include a green check mark on Physician Compare for those doctors receiving an upward adjustment under the value-based payment modifier program.
Separately, the Amblyopia Screening in Children quality measure was not finalized for 2016—a measure that CMS agreed with AOA was not ready for use.
Finally, CMS also did away with a 1-year waiting period for qualified clinical data registries. AOA members should follow aoa.org/news and AOA's Alerts, Recalls and Updates page for future information about what this means for AOA MORE (Measures and Outcomes Registry for Eyecare), by Prometheus Research, and your practice.
As for calendar year 2016, CMS has told the AOA that it expects to pay doctors of optometry approximately $1.17 billion, compared to the $1.16 billion in 2015.
Members can access new, template appeal letters to assist in payer denials and patient communications, as well as attend an #AskAOA webinar on addressing payer clawbacks and denials.