DEC 07, 2017
Congress Nearing Deal to Reinstate Medicare Savings Targets that Cost Ophthalmology Millions of Dollars
Congress is close to reinstating misvalued-code targets that currently cost our profession millions of dollars. These targets force the Centers for Medicare & Medicaid Services to identify overpriced procedures or make across-the-board cuts to achieve an annual savings goal. Lawmakers would use the program to pay for other fixes to the Medicare program. Currently, negotiations center on how long — one year or two — with the Academy told that the annual savings would need to reach $1 billion or more.
The Academy is working with the American Medical Association and the American College of Surgeons to derail this dangerous initiative.
Before the previous mandate ended in 2016, our codes were frequent targets for review as CMS searched for $1 billion in annual savings.
When CMS labels ophthalmology’s codes as “misvalued,” our profession launches a vigorous defense to ensure fairness. We defend the value and other factors influencing the code’s valuation before the American Medical Association’s Relative Value-Scale Update Committee. The RUC in turn makes its own recommendations of the procedure’s value.