The American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) called for immediate intervention to address concerns with the Routine Cataract Removal with Intraocular Lens (IOL) Implantation episode-based cost measure in a Sept. 26 letter (PDF) to the Centers for Medicare & Medicaid Services (CMS).
Upon conducting research with its members, the AAO has uncovered discrepancies in the patient-level data files that arise when performing second eye cataract surgery within 31 to 90 days after the initial surgery. These errors pose a potential threat to the Merit-Based Incentive Payment System (MIPS) score, potentially leading to a negative payment adjustment in 2024.
It is not uncommon to come across charges for both the facility fee and professional fee on these reports. However, if you notice instances where patients seem to have an unusually high number of services attributed to them (for example, four facility fee charges and four professional charges for the surgical code; totaling eight CPT 66984), it is important to carefully review your billing records and verify if the data provided by CMS matches.
What You Can Do
Access the Quality Payment Program (QPP) website to preview your final score and if you identify any discrepancies or suspect any other errors, it is crucial to request a targeted review by 8pm Eastern on October 9th.
AAO has developed suggested language for you to use in your targeted review if you believe the cataract cost measure has incorrectly attributed additional services to you or your group. Tailor this template to your specific practice and situation.