Advocacy News

The Centers for Medicare & Medicaid Services is approving some 2022 MIPS targeted review requests made by retina groups who were inappropriately scored on the diabetes episode-based cost measure.

Medicare administrative contractor WPS said last week it will revise its recently released final local coverage determination policy for minimally invasive glaucoma surgery following objections raised by the Academy and our ophthalmic partners. 

After major Medicare contractors released identical coverage policies that would limit patients’ access to sight-saving care, the Academy spearheaded a joint effort with ophthalmic specialists to ask CMS to intervene and halt implementation.

Four more Medicare administrative contractors published their final local coverage determinations for glaucoma surgical procedures today, following the lead of WPS. The policies will take effect Dec. 24.

Medicare administrative contractor WPS published its final local coverage determination for glaucoma surgical procedures today, after months of Academy advocacy and public input on this important coverage issue. The policy will take effect Dec. 24.

The Centers for Medicare & Medicaid Services’ Center for Clinical Standards and Quality was responsive to suggestions from the Academy and the American Society for Cataract and Refractive Surgery on how to improve the cataract cost measure for ophthalmology in a meeting Tuesday.

Committee action in the House and Senate this week focused on Medicare, with hearings on Academy priorities to improve patient access to care, including policies to reform prior authorization and update the Medicare physician payment system.

The Academy and other groups participated in an Oct. 4 meeting with CMS in which we successfully convinced the agency that the diabetes cost measure is not applicable to ophthalmology. Members who believe they have been incorrectly applied cost measures have until 8 p.m. ET Monday, Oct. 9, to submit a targeted review.

The Academy and ASCRS have alerted CMS to potential errors with cataract cost measure scores and called for the agency to immediately remedy the issue. Check your MIPS score and file a targeted review, using Academy suggested language, if necessary.

With a growing number of Medicare and Medicaid beneficiaries enrolled in managed care arrangements, the Department of Health and Human Services Office of Inspector General plans to scrutinize the programs to address waste, fraud and abuse.