CMS Extends Deadline for MIPS 2023 Data Submission

CMS has extended the data submission period for the Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the Quality Payment Program (QPP). Data can now be submitted and updated until 8 p.m. ET on April 15, 2024. CMS noted that the attack on our nation’s healthcare infrastructure coincides with…

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Congress Passed bill for MPFS

The recent passing of a partial government funding bill by Congress on March 8 is important to Medicare beneficiaries. This bill includes policies aimed at addressing the cuts to the Medicare Physician Fee Schedule (MPFS) that were implemented on Jan. 1, 2024.  The legislation softens the decrease from -3.37% to -1.69% and would take effect on March 9 and run…

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Change to Processing for Telehealth Services Billed with POS 10

In calendar year (CY) 2024, the Centers for Medicare & Medicaid Services (CMS) issued a change to processing for telehealth services billed with POS 10. As of 1/1/2024, these claims are to be paid at the nonfacility physician fee schedule (PFS) rate. A system processing issue resulted in incorrect payments at the facility rate, which…

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Diabetes Cost Measure Misattributed to Ophthalmologists

The American Society of Cataract and Refractive Surgery (ASCRS), the American Society of Retina Specialists (ASRS) and the American Academy of Ophthalmology (AAO), met recently with CMS to discuss issues with ophthalmologists inappropriately having the Diabetes Cost Measure attributed to those participating in MIPS if they reported at the group level. The meeting was in…

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Review Your 2022 MIPS Performance Feedback and Final Scores

The Centers for Medicare & Medicaid Services (CMS) has released the Merit-Based Incentive Payment System (MIPS) performance feedback and final scores for the 2022 performance year and associated MIPS payment adjustment information for the 2024 payment year. Eyecare providers should review their 2022 MIPS performance scores, including the patient-level data report supplement on the Quality…

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JZ Modifier Required July 1, 2023

The much-anticipated mandatory reporting of the JZ modifier for Part B Medicare begins July 1, 2023.  The new Medicare policy can be found here.  The JZ modifier denotes that no medication waste occurred with a single-use or single-dose medication.  CMS instituted this policy to improve tracking and to obtain more rebates from pharmaceutical companies for…

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Cigna Hits the Brakes on Their New Modifier 25 Policy

Following fierce opposition from the physician community, the insurer Cigna announced today a delay in implementing a policy (PDF) that would have required submitting medical records to support the use of modifier -25 on evaluation and management (E/M) services when billed with a minor procedure. The delay applies to all states. Physicians in most states…

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Medical Consulting Group and Corcoran Consulting Group Announce Merger

Springfield, MO, April 27th, 2023. Medical Consulting Group (MCG), a provider of consulting services to ophthalmic practices and companies, and Corcoran Consulting Group (CCG), a company specializing in billing, coding, and reimbursement issues for ophthalmology and optometry practices, today announced a definitive merger agreement. MCG and CCG believe this merger will enhance the ophthalmic community…

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IHEEZO Gel gains Medicare Pass-Through

On March 13, 2023, Harrow® announced that the Centers for Medicare & Medicaid Services (CMS) has approved transitional pass-through reimbursement status for chloroprocaine hydrochloride ophthalmic gel 3% (IHEEZO™), which is indicated for ocular surface anesthesia. According to the manufacturer, IHEEZO is a sterile, single-patient use, physician-administered, ophthalmic gel preparation, containing no preservatives, for ocular surface…

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Cigna Change Modifier 25 Policy

As a result of a recent review, Cigna has announced it will require the submission of office notes with claims submitted for evaluation and management (E/M) CPT codes 99212, 99213, 99214, and 99215, and modifier 25 when a minor procedure is billed.  The required office notes must be submitted via the dedicated fax number (833)…

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