NEWS FROM ALAO
JULY, 2010
CMS to Start Processing Medicare Payments at New Rate by July 1, 2010
Temporary Fix Provides 2.2 % Update
The six-month Medicare physician pay fix passed by the House of Representatives on June 24th has been signed into law by President Obama. CMS issued the following explanation to Capitol Hill with their plan to implement and reprocess claims previously paid at the negative update:
"We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual. Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.
Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 % update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2% update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor."
CMS Releases 2011 Proposed Fee Schedule Changes
In its just released 2011 proposed fee schedule rule, CMS indicates that there will be no change to the phase-in of practice expense (PE) data for specialties that began last year. Ophthalmology will see a 3% increase in its PE payments for 2011. Additionally, ophthalmology will see another 1% increase due to changes that CMS is implementing to rebase how it calculates the Medicare economic index, a major component in determining the annual update. Overall, ophthalmology gains another 4% in addition to the 5% increase this year.
Due to the continuation of the flawed sustainable growth rate (SGR) formula, CME anticipates that the conversion factor will be reduced by 6.1% in 2011. The final rule could make significant changes to that amount, depending upon what happens in any further SGR legislation considered this year.
Questions: Contact the American Academy of Ophthalmology Office of Governmental Affairs at 202-737-6662.
Alabama Board of Optometry Proposes New Definition for Invasive Surgery
Current Regulation: 630-X-12-.07 Definition of Invasive Surgery. For the purpose of this act, invasive surgery is defined as any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or other means except as specifically allowed by this act.
Proposed New Regulation by the Alabama Board of Optometry: 630-X-12-.07 Definition of Invasive Surgery. For the purpose of this act, invasive surgery is defined as injections into the eyeball, cataract surgery, muscle surgery, retinal surgery, radical keratotomy, laser surgery, cryosurgery, and any procedure in which human tissue is cut or altered in a manner that normally requires closure by suturing, except as specifically allowed by this act.
The Alabama Board of Optometry (ABO) and Alabama Optometric Association (AOA) recently proposed under the Alabama Administrative Procedures Act (AAPA), a revised-new definition of the term "invasive surgery."
The Alabama Academy of Ophthalmology (ALAO) and the American Academy of Ophthalmology's (AAO) position is that the new proposed rule would open up the regulation so as to allow optometrists to perform surgery on eyelid lesions as well as injections around the eye. ALAO and AAO maintain that these procedures are not allowed under current law.
The Alabama Board of Optometry (ABO) and Alabama Optometric Association (AOA) state that these procedures are allowed under current law and the new rule would only serve to "clarify" this situation.
A public hearing will be held on Saturday, July 10, at 10:00 a.m. before the ABO in Montgomery. ALAO and AAO along with MASA, will present their objections to the new rule at this time. Thereafter, the ABO will render a decision as to the legitimacy of the new rule.
Under the rules of the AAPA, ALAO, AAO, and MASA will thereafter have the opportunity to respond to the ABO's decision at a hearing before the Alabama Legislature's Joint Committee on Administrative Regulation Review. The Joint Committee on Administrative Regulation Review is comprised of certain State Senators and State Representatives. Click here for listing of members of the Alabama Legislature's Administrative Rule Review Committee.
ALAO Working with BCBS on New Fee Schedules ALAO BCBS Committee Selected
ALAO has selected a committee to represent ALAO in continuing discussions with BCBS of Alabama regarding BCBS new fee schedules set to be announced later this summer. Members of the Committee are: Dr. Britton B. Carter, Dr. Eric Hein, Dr. Jason Swanner, Dr. Matthew Vicinanzo, Dr. Price Kloess, Dr. Ronald Braswell, and Dr. Scott Parma.
The next meeting with BCBS is set for Tuesday, August 3, 2010, at 4:00 p.m. in Birmingham.
S.E. EYE 2010 Annual Meeting Status
ALAO has received several inquiries as to the status of the S.E. Eye 2010 Annual Regional Meeting, July 22-24 at Sandestin, in light of the recent oil spill off the gulf coast.
AS OF JUNE 26, 2010, THE SE EYE 2010 ANNUAL MEETING IS STILL ON AS PLANNED.
For meeting information and for a copy of the annual meeting brochure, see: www.regonline.com/SEEye2010
ALAO will continue to monitor the situation in Destin and keep members apprised of any changes.
Alabama Run-Off Election July 13, 2010
ALAO reminds everyone to vote in the Run-Off Election set for Tuesday, July 13.
New Federal Healthcare Timelines Available from ALAO
A listing of the year-by-year timelines and "what to do when" pursuant to the new Federal Healthcare Act is available on the ALAO website at www.alabamaeyedoctors.com. Click the "Links" tab.
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