Advocacy News

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.

As policymakers look to drive new payment models, the Academy outlined how we believe the Centers for Medicare & Medicaid Services can make new payment models accessible to medical specialties like ophthalmology.

In a win for patients, Humana announced it will stop requiring prior authorization for cataract and YAG surgery for Medicare Advantage members in Georgia, effective Aug. 1.

About 3,500 hospitals and 6,000 ambulatory surgical centers (ASC) that perform ophthalmic procedures would be affected by the proposed pay hike.  

We are working with Congress to fix Medicare’s broken payment system, highlighting the need to fix a physician payment program that fails to account for inflation and increasing practice costs.

HHS and MedPAC Reports Encourage Significant Changes to Part B Drug Payment The Academy is monitoring congressional reaction to these reports given that the recommendations would impact ophthalmologists.

Members reported to the Academy and ASOPRS that prior authorization requests have been denied for medically necessary injections into the brow and corrugator/procerus muscles to treat blepharospasm.

Your investment is crucial in helping us preserve quality eye care for patients and ensure that surgery is done by surgeons.

Florida and Georgia state societies joined the Academy in driving home the burdens of prior authorization.

Cigna’s action means that providers will not have to submit medical records to comply with the insurer’s now-delayed policy.