Advocacy News

The Academy has joined 120 state medical and national specialty societies to help develop and endorse the American Medical Association’s Characteristics of a Rational Medicare Physician Payment System.  

The Academy met with the Center for Medicare & Medicaid Services and other physician and patient groups to ask the agency to reinstate a step therapy prohibition for Medicare Advantage plans for Part B drugs.      

The Academy has joined the AMA and other medical groups in an effort to change the Medicare physician payment system to improve the financial viability of physician practices and ease their administrative burdens.  

A new Office of Inspector General report has found that tens of thousands of patients enrolled in Medicare Advantage plans are denied necessary care and misuse of prior authorization.   

The insurer will require preapproval for 19 ophthalmic procedures in hospital outpatient department covered by its Medicare Advantage plans starting May 1

The Academy and partner groups educated the Department of Health and Human Services Office of the Inspector General on modifier -25 in an effort to end unnecessary audits.

Nine out of 10 physicians surveyed by the American Medical Association said for patients whose treatments required prior authorization, the process had a somewhat or significant negative effect on their clinical outcomes. The Academy continues to work with our members and partners to press for reform.

The Centers for Medicare & Medicaid Services has acceded to Academy-led efforts to eliminate or at least reduce the unnecessary burden imposed by CMS’ prior authorization program for hospital outpatient department services, including removing CPT code 67911, a type of corrective lid surgery, from the list.

We’re concerned that new national standards would override state scope-of-practice laws and other veterans’ patient safety policies.

We continue to sound the alarm about the harm caused by elimination of the ban on step therapy for Part B drugs in Medicare Advantage plans.