MSEPS At Your Service
MSEPS is committed to the delivery of the best possible quality eye care in the State of Maryland. To that end, MSEPS fosters a dynamic, collaborative environment that is rooted in sound medicine and mindful of the unique contributions of the entire medical team. Therapeutic changes continue to evolve in the treatment of medical and surgical eye disease and MSEPS members are among those in the medical community at the forefront of this evolving science. Comprehensive coalitions, inclusive of ophthalmology-specific and the entire spectrum of health professionals, renders MSEPS ophthalmology's leader in the State of Maryland regarding managed care effects on the delivery of eye care; legislative action that best serves the patient and public education and access to care initiatives. Ours is a time when most potentially blinding eye disease can be controlled with proper and prompt diagnosis and treatment; The Maryland Society of Eye Physicians & Surgeons is dedicated to bringing these benefits to the citizens of Maryland.
Congress Passes SGR Repeal
– Medicare Fee Cuts Avoided!
The Senate, in a bipartisan manner, passed a repeal of the long-standing SGR payment methodology that will negate the planned 21% reduction in Medicare payments that would have impacted claim payments this week. The Senate bill mirrors the House Bill passed a few weeks ago and the full bill is expected to go to the President for his signature shortly.
Per the American Medical Association, the Medicare Access and CHIP Reauthorization Act was adopted in the Senate by a vote of 92 to 8 on the eve a 21 percent cut to physicians’ Medicare payments was set to take place.
Instead, the bill provides positive annual payment updates of 0.5 percent, starting July 1 and lasting through 2019.
Claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21 percent cut was scheduled to take effect (the fees from January through March 2015).
While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.
No action is necessary from providers who have already submitted claims for the impacted dates of service.
In addition to addressing Medicare payment, the legislation outlines several provisions including:
• Medicare’s current quality reporting programs will be combined into one merit-based incentive payment system, referred to as “MIPS.” This consolidation will reduce the aggregate level of financial penalties physicians otherwise could have faced.
• Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care.
• Incentive payments will be available for physicians who participate in alternative payment models and meet certain thresholds.
• Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.
While the bill supports physicians who choose to adopt new payment and delivery models, it also retains Medicare’s fee-for-service model. Participation in new models is entirely voluntary.
For guidance on this issue, contact us through the Third Party Insurance Help Program.
James A. McNally, CPC
Health Care Consultant Services
John Thompson, MD was Recognized for Participation
in the Council of the American Academy of Ophthalmology
Dr. John Thompson was recognized for participation on the Council of the American Academy of Ophthalmology during AAO 2014, the Academy’s annual meeting in Chicago. Dr. Thompson served for 6 of years as a councilor for The Maryland Soci-ety of Eye Physicians and Surgeons.
The Council serves as an advisory body to the Academy’s Board of Trustees. More than 100 Academy members serve on this body and act as liaisons between their society and the Academy bringing issues identified by their societies to the atten-tion of the Academy’s Board of Trustees. Issues are brought to the Academy Board of Trustees as Council Advisory Recom-mendations (CARs). Each spring the Council meets to debate and formulate its recommendations for the Academy Board.*
This year, one of the Council recommendations that was approved by the Board of Trustees included action in response to the heightened concern of the electronic exchange of health information. The Academy’s Medical Information Technology Committee incorporated additional questions to its survey of imaging vendors to assess whether security features in their devices would protect personal health information that may be stored on the respective devices. A supplement that outlined survey results was made available onsite at AAO 2014, so that ophthalmologists who were considering purchase of equip-ment or own equipment, would have the information at hand and could further question vendors for details about particular security features.
Additionally, based on an earlier Council recommendation, “Advocating for Patients” presentations were delivered by advo-cacy leaders at each of the eight Subspecialty Days at AAO 2014. These presentations provided messaging regarding the critical importance of contributing to all three ophthalmology funds – the Surgical Scope Fund, OPHTHPAC and state eye PACs in order to protect quality patient eye care and the profession.
The Council has also recommended that the Academy recognize ophthalmologists for outstanding efforts in the state and/or federal advocacy arenas via a CAR that was considered and ultimately approved by the Academy’s Board. Each year, all societies represented on the Council, are solicited for nominees for the Academy’s Outstanding Advocate Award. All nomi-nees are reviewed by the Academy’s Awards Committee which ultimately selects recipient(s) who is then approved by the Board. The Outstanding Advocate Award recipient is recognized each year at the Opening Session of the Academy’s annual meeting. In 2014, Cynthia Mattox, MD was nominated by the American Glaucoma Society and Women in Ophthalmology along with Kenneth D. Tuck, MD, who was nominated by the Virginia Society of Eye Physicians and Surgeons. They were honored at the Opening session in Chicago as Outstanding Advocates.
Representatives to the Council are elected by each state society and by subspecialty societies and specialized interest groups in ophthalmology. On December 31st, Dr. Thompson will conclude his term on the Academy Council.
Congressional Advocacy Day (April 15-16) will be held in conjunction with the Mid-Year Forum in Washington DC, and we encourage all members to attend this vital Academy function. You can make a difference in Washington by becoming an active advocate. There is no registration fee for this event and the Academy will educate you about the issues and set up appointments for you with Members of Congress. Look for registration information in January 2015 on the Academy’s Web site at: www.aao.org/myf.
Finally, it is vitally important that every member support the Academy’s Surgical Scope Fund (SSF) and OPHTHPAC. Your SSF contribution is confidential and will help to support their legislative and public education efforts on safe eye surgery. Your OPHTHPAC contribution will help us help our friends in Congress. For more information and to contribute visit: www.aao.org/advocacy (login required).
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Have a coding question? Use the new MSEPS member benefit!