May 2014
May 2014: Volume 1, Number 3
American Society of Retina Specialists Cautions Patients Against Making Treatment Decisions Based Solely on CMS Payment Data
In the late hours of April 8, the Centers for Medicare and Medicaid Services (CMS) posted searchable, physician-specific Medicare 2012 claims data on its website. The spreadsheet files show each physician’s National Provider Identifier (NPI), name and address, average charge and Medicare payment amounts, unique beneficiary counts, and other information for the various Medicare services that physician provides. Several newspapers subsequently posted their own searchable databases that aggregate the CMS data spreadsheets, so patients can get a consolidated report on their physician.
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Are You Ready for Reactivation of CMS’ Injection Bundles?
Following the unexpected July 1, 2013 National Correct Coding Initiative (NCCI) edits that bundled eye exams with minor surgical procedures, including intravitreal injections, there was widespread confusion and complaints about denied claims. According to a letter from the NCCI Medical Director to the American Academy of Ophthalmology (AAO), the claims for office visits 92012 and 92014, with modifier -25 appended, should have bypassed this NCCI edit, however the computerized claims processing system failed.
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ASRS POSITION: Recent NCCI letter does not adequately address “PRN” or treat and extend protocols that depend on a complete comprehensive exam
When the retinal specialist is using a non-fixed schedule for treatment – either “PRN” or treat and extend – many physicians believe that the clinical evaluation of the patient, along with the review of the critical imaging studies, are crucial in the decision to treat (‘PRN” therapy) or in the determination of the interval to the next evaluation after treatment (treat and extend).
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Update on SGR
Earlier this year, legislation to repeal the Sustainable Growth Rate (SGR) formula was agreed upon by the Senate Committee on Finance and the House committees on Ways and Means and Energy and Commerce. The bill was strongly supported by organized medicine.
Unfortunately, rather than permanently repealing the SGR, leaders in the both the House and Senate imposed the 17th temporary Medicare physician payment patch, with leaders arguing that neither chamber was able to reach agreement on how to cover the $138 billion cost of the bill.