medicare iol payment policies
play

Medicare IOL Payment Policies AAO/FDA Workshop March 28, 2014 John - PowerPoint PPT Presentation

May 21, 2023 •314 likes •429 views

Medicare IOL Payment Policies AAO/FDA Workshop March 28, 2014 John McInnes, MD, JD Director Division of Outpatient Care CMS Disclosures No Financial Relationships to Disclose Disclaimer This presentation was prepared by Dr. McInnes in

  1. Medicare IOL Payment Policies AAO/FDA Workshop March 28, 2014 John McInnes, MD, JD Director Division of Outpatient Care CMS

  2. Disclosures No Financial Relationships to Disclose

  3. Disclaimer • This presentation was prepared by Dr. McInnes in his personal capacity. The opinions expressed in this presentation are his own and do not reflect the view of the Centers for Medicare & Medicaid Services, the Department of Health and Human Services, or the US government.

  4. Topics • Medicare Payment for IOLs – Default Payment Policy – Presbyopia-Correcting (PC) and Astigmatism- Correcting (AC) IOLs – New Technology IOLs (NTIOLs)

  5. Default IOL Payment Policy • Payment for IOL included in overall facility payment for cataract surgery procedure: – 2014 OPPS Payment = $1,766 – 2014 ASC Payment = $976

  6. PC/AC IOL • 2005 Presbyopia-Correcting IOL (PC-IOL) Ruling • 2007 Astigmatism-Correcting IOL (AC-IOL) Ruling • Part of the overall service is a Medicare covered benefit and part not a Medicare covered benefit  Covered part – “conventional cataract surgery” – Medicare pays  Noncovered part – “presbyopia correcting surgery” and “astigmatism correcting surgery” – Patient pays • PC-IOL = “corrects presbyopia” and provides relief from reading glasses • AC-IOL = corrects astigmatism and provides relief from astigmatic correction

  7. NTIOL • 20 year old statutory provision (1994) • $50 separate payment for every NTIOL for 5 years • 3 classes since 1999 – Astigmatism-Correcting – Multifocal – Reduced Spherical Aberration • Revised NTIOL Regulations at 42 CFR 416.195 in 2013

  8. NTIOL • NTIOL Criteria: – (1) The IOL is approved by the FDA. – (2) The IOL shall have a new lens characteristic in comparison to currently available IOLs. The labeling, which must be approved by FDA, shall contain a claim of a specific clinical benefit imparted by the new lens characteristic. – (3) The IOL is not described by an active or expired class of new technology IOLs; that is, it does not share a predominant, class- defining characteristic associated with improved clinical outcomes with members of an active or expired class. – (4) Any specific clinical benefit referred to in paragraph (a)(2) of this section must be supported by evidence that demonstrates that the IOL results in a measurable, clinically meaningful, improved outcome. Improved outcomes include:

  9. NTIOL • Improved outcomes include: – (i) Reduced risk of intraoperative or postoperative complication or trauma; – (ii) Accelerated postoperative recovery; – (iii) Reduced induced astigmatism; – (iv) Improved postoperative visual acuity; – (v) More stable postoperative vision; – (vi) Other comparable clinical advantages.

  10. NTIOL • Additional points: – EDOF IOLs as NTIOLs?  If they can obtain “a claim of a specific clinical benefit” that results in an “improved outcome” for the beneficiary.  Benefit/outcome possibly evaluated by validated visual function measurement tools. • NTIOL timing: – 5-year clock starts with first IOL to establish NTIOL category – Claim can be established after initial IOL approval

  11. Thank you john.mcinnes@cms.hhs.gov

Recommend

Will Bundled Payment Become Medicare Medicare Bundled Pmt. Heart Bypass Acute Care for Care the

Will Bundled Payment Become Medicare Medicare Bundled Pmt. Heart Bypass Acute Care for Care the

Overview Primer on Medicare bundled payment Early experiences and emerging trends Medicare Bundled Payment: Risks, Opportunities & Future Implications Opportunities for improved efficiency Managing financial risk Robert Mechanic,

205 views • 9 slides
Medicare Conditional Payment and Medicare Advantage Plan Reconciliation Processes Techniques to

Medicare Conditional Payment and Medicare Advantage Plan Reconciliation Processes Techniques to

Presenting a live 90-minute webinar with interactive Q&A Medicare Conditional Payment and Medicare Advantage Plan Reconciliation Processes Techniques to Minimize Repayment Obligations and Maximize Medicare Refunds After a Liability

1.23k views • 50 slides
State Innovation Model 1 Context: Centers for Medicare and Medicaid Services Payment Reform

State Innovation Model 1 Context: Centers for Medicare and Medicaid Services Payment Reform

State Innovation Model 1 Context: Centers for Medicare and Medicaid Services Payment Reform Targets Planned percentage of Medicare FFS payments linked to quality and alternative payment models 2016 2018 30% 50% 85% 90% All Medicare Fee

429 views • 21 slides
Overview Primer on Medicare bundled payment Early experiences and emerging trends

Overview Primer on Medicare bundled payment Early experiences and emerging trends

Medicare Bundled Payment: Risks, Opportunities & Future Implications Robert Mechanic, MBA The Estes Park Institute January 27, 2015 Overview Primer on Medicare bundled payment Early experiences and emerging trends Opportunities for

551 views • 26 slides
Medicare Shared Savings Program in the Quality Payment Program October 27, , 2016 1 Quality

Medicare Shared Savings Program in the Quality Payment Program October 27, , 2016 1 Quality

Quality Payment Program Medicare Shared Savings Program in the Quality Payment Program October 27, , 2016 1 Quality Payment Program Quality Payment Program 2 Quality Payment Program Medicare Payment Prior to MACRA Fee-for-service (FFS)

645 views • 40 slides
Global and Professional Options Payment Part One Webinar January 15, 2020 Center for Medicare

Global and Professional Options Payment Part One Webinar January 15, 2020 Center for Medicare

Direct Contracting: Global and Professional Options Payment Part One Webinar January 15, 2020 Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services (CMS) 1 Webinar Agenda Payment Part 1 Webinar Agenda (Today)

377 views • 34 slides
Medicare Part A SNF Payment Reform www.zhealthcare.com (877) SNF-2001 Guiding SNFs The Final

Medicare Part A SNF Payment Reform www.zhealthcare.com (877) SNF-2001 Guiding SNFs The Final

Medicare Part A SNF Payment Reform www.zhealthcare.com (877) SNF-2001 Guiding SNFs The Final Countdown to PDPM through complex payment reform for over 25 years September 26, 2019 PDPM is Nigh PDPM is simply a new Revenue Delivery

1.06k views • 91 slides
Addressing Medicare payment differences across settings: Ambulatory care services Dan Zabinski

Addressing Medicare payment differences across settings: Ambulatory care services Dan Zabinski

Addressing Medicare payment differences across settings: Ambulatory care services Dan Zabinski and Ariel Winter October 4, 2012 Overview Multiple payment systems for ambulatory services But similar patients receive similar services

624 views • 19 slides
Part D Payment Modernization Model Model Overview Centers for Medicare & Medicaid Services

Part D Payment Modernization Model Model Overview Centers for Medicare & Medicaid Services

Part D Payment Modernization Model Model Overview Centers for Medicare & Medicaid Services (CMS) Innovation Center 1 CMS Introductions Center for Medicare and Medicaid Innovation Laura McWright, Seamless Care Models Group, Deputy Director

878 views • 20 slides
QUALITY PAYMENT PROGRAM Disclaimer This presentation was current at the time it was published

QUALITY PAYMENT PROGRAM Disclaimer This presentation was current at the time it was published

The Medicare Access & Chip Reauthorization Act of 2015 QUALITY PAYMENT PROGRAM Disclaimer This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source

1.3k views • 94 slides
QUALITY PAYMENT PROGRAM Disclaimer This presentation was current at the time it was published

QUALITY PAYMENT PROGRAM Disclaimer This presentation was current at the time it was published

The Medicare Access & Chip Reauthorization Act of 2015 QUALITY PAYMENT PROGRAM Disclaimer This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source

702 views • 37 slides
Final Requirements for the Quality Payment Program (QPP) Update on the Medicare Access and CHIP

Final Requirements for the Quality Payment Program (QPP) Update on the Medicare Access and CHIP

Final Requirements for the Quality Payment Program (QPP) Update on the Medicare Access and CHIP Reauthorization Act (MACRA)/QPP Final Rule with Comment Period Infectious Diseases Society of America (IDSA) November 14, 2016 CHRISTINE G

404 views • 28 slides
Claims Submission and Payment Claims denied for non-Medicare covered services provided to dual

Claims Submission and Payment Claims denied for non-Medicare covered services provided to dual

Claims Submission and Payment Claims denied for non-Medicare covered services provided to dual eligible beneficiaries (Medicare/Medicaid). This was fixed and implemented 09/27/2018 Claims denied for adult services provided to

147 views • 12 slides
A Historical Perspective of Encompass Health has successfully managed through Medicare payment

A Historical Perspective of Encompass Health has successfully managed through Medicare payment

A Historical Perspective of Encompass Health has successfully managed through Medicare payment cuts, regulatory changes, and an economic recession $210 Adjusted EBITDA (1) (millions) $190 Recession $170 $150 $130 $110 $90 $70 $50

475 views • 9 slides
Client Alert Medicare Payment Initiatives to Promote Quality Improvement for Pa- Contact

Client Alert Medicare Payment Initiatives to Promote Quality Improvement for Pa- Contact

Client Alert Medicare Payment Initiatives to Promote Quality Improvement for Pa- Contact Attorneys Regarding tient Care in Hospitals This Matter: Tracy M. Field In an efgort to reduce costs and increase the quality of patient care, the Cen-

329 views • 3 slides
New Medicare Alternative Payment Models: Options and Opportunities for Hospice and Palliative

New Medicare Alternative Payment Models: Options and Opportunities for Hospice and Palliative

11/20/2019 The National Coalition of Hospice and Palliative Care presents New Medicare Alternative Payment Models: Options and Opportunities for Hospice and Palliative Care Programs In partnership with: American Academy of Hospice and

264 views • 23 slides
Bundled Payment: 15,000 Its Time to Get Real 10,000 $11,079 5,000 Robert Mechanic, MBA

Bundled Payment: 15,000 Its Time to Get Real 10,000 $11,079 5,000 Robert Mechanic, MBA

Avg. 2008 Medicare Payment for Select DRGs 25,000 20,000 Bundled Payment: 15,000 Its Time to Get Real 10,000 $11,079 5,000 Robert Mechanic, MBA $6,437 $6,075 $5,347 $5,322 Brandeis University 0 470 Maj. Joint 194 Pne w/CC 292

182 views • 3 slides
Fiscal pressure and Medicare payments to hospitals Presentation to the Brookings Institution

Fiscal pressure and Medicare payments to hospitals Presentation to the Brookings Institution

Fiscal pressure and Medicare payments to hospitals Presentation to the Brookings Institution Hospital Productivity Trends: Implications for Medicare Payment Policy James E. Mathews, Ph.D. Executive Director June 25, 2019 Outline of brief

600 views • 10 slides
Payment Modifier under the Medicare Physician Fee Schedule CMS National Provider Call Physician

Payment Modifier under the Medicare Physician Fee Schedule CMS National Provider Call Physician

CMS Proposals for the Physician Value-Based Payment Modifier under the Medicare Physician Fee Schedule CMS National Provider Call Physician Feedback and Value-Based Modifier Program Wednesday, August 1, 2012 1 Disclaimers This presentation

236 views • 20 slides
Direct Contracting: Global and Professional Options Payment Part Two Webinar January 22, 2020

Direct Contracting: Global and Professional Options Payment Part Two Webinar January 22, 2020

Direct Contracting: Global and Professional Options Payment Part Two Webinar January 22, 2020 Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services (CMS) 1 Webinar Agenda Payment Part 1 Webinar Agenda

493 views • 35 slides
Health Care Industry Medicare Advantage Risk Emerging Legal Adjustment Payment Issues: Issues

Health Care Industry Medicare Advantage Risk Emerging Legal Adjustment Payment Issues: Issues

Health Care Industry Medicare Advantage Risk Emerging Legal Adjustment Payment Issues: Issues Webinar Series Latest Developments, Risk Areas, & Mitigation Strategies Christine Clements Scott Douglas David OBrien July 23, 2015 The

455 views • 26 slides
MEDICARE BASICS Welcome to Medicare Presented by the Aging & Disability Resource Center of

MEDICARE BASICS Welcome to Medicare Presented by the Aging & Disability Resource Center of

MEDICARE BASICS Welcome to Medicare Presented by the Aging & Disability Resource Center of Central Wisconsin Last updated: 12/9/2019 What are the parts of Medicare? Medicare A Medicare B Medigap Policy Medicare D Medicare C + 1

375 views • 15 slides
Model Overview Center for Medicare & Medicaid Innovation (CMS Innovation Center) September

Model Overview Center for Medicare & Medicaid Innovation (CMS Innovation Center) September

Model Overview Center for Medicare & Medicaid Innovation (CMS Innovation Center) September 2019 1 Webcast Outline Model Overview Who Can Participate Advanced Alternative Payment Model Criteria Defining the Clinical Episodes Payment and

900 views • 53 slides
Original A/B Medicare and Medicare Advantage Part C or Medicare Advantage Whats The

Original A/B Medicare and Medicare Advantage Part C or Medicare Advantage Whats The

Original A/B Medicare and Medicare Advantage Part C or Medicare Advantage Whats The Advantage?!? Daniel Bailey, FSA, MAAA ACUMEN ACTUARIAL 1 Overview Medicare in 2018 ~55.5 mil Medicare beneficiaries ( benes ): ~84% are

865 views • 29 slides

More recommend