CMS’ ‘Patients Over Paperwork’ Turns 2, Academy Requests Prior Authorization Reform, Audit Oversight

The Academy continues to hold a seat at the table as the Centers for Medicare & Medicaid Services works to reduce administrative burdens in Medicare.  

CMS marked the two-year anniversary of its flagship reform program, “Patients Over Paperwork,” by convening the Academy and other medical groups for an invitation-only listening session and round table discussion of areas where barriers could be lessened between physicians and those for whom they care. 

The program has already resulted in decreased administrative requirements for ambulatory surgical centers (conditions of participation) and reduced E/M documentation requirements. 

The Academy urged CMS Administrator Seema Verma to take bold action to reform prior authorization, especially for surgical services. Additionally, her agency’s proposed 2021 reform of E/M codes that includes a reimbursement boost is incomplete. The Academy is arguing that this fee increase must be applied to postoperative visits. We’re pushing for this in conjunction with the American Medical Association. 

We also called on agency officials to increase oversight of Medicare auditors. The Academy pointed out that too often these individuals lack clinical understanding of the specialties they’re tasked with auditing, resulting in increased burdens and inconvenience for ophthalmologists.