Medicare cuts, ASC rates, new FDA-approved drugs: Latest for 2022
Click Here to Manage Email Alerts
WAIKOLOA, Hawaii — Medicare payment changes, ASC payment rates and new FDA approved drugs were a few of the topics discussed in a presentation on 2022 updates for ophthalmic practices at Hawaiian Eye 2022.
Paul M. Larson, MBA, MMSC, COMT, CPC, COE, CPMA, a senior consultant from Corcoran Consulting Group, said that the Medicare Physician Fee Schedule was just updated a few weeks ago.
“With the revised numbers, in many cases, it did result in revised payments, the conversion factor in general, went down by about 29 cents,” Larson said.
According to Larson, when generating the Medicare Physician Fee Schedule, an estimate for the impact on all various specialties must be considered.
“The estimate of the impact from CMS for the Medicare Physician Fee Schedule and the average practice was that you would end up with on the optometry and ophthalmology side with a value of 0% impact,” he said.
PAYGO, the portion of the federal budget that’s pay as you go, was originally supposed to take a 4% pay cut, Larson said. However, Congress delayed that from happening for at least another year.
The budgets neutrality adjustments were originally set for 3.75%, but Congress reduced that to 0.75%.
“In the end, the worst-case scenario [for Medicare cuts] is about 14%,” Larson said. “Most of which is made up with MIPS which is probably unlikely to take place.”
Regarding ASC payment rates, conversion rates will increase by 2%. Although, if the conversion factor went up, but the revenue decreased, there may be a neutral or small downward trend, he said.
“If you're an ASC and you're an exceptional ASC that did not meet the quality reporting standards, then you take a 2% hit,” Larson said. “What it means is, you don't get a raise. In general, that's what it means. Instead of getting the 2% bump, you get the bump, and we take the 2% away, so you end up with about the same.”
The first of two new FDA-approved drugs that Larson discussed was Xipere from Bausch + Lomb, a triamcinolone acetonide injectable suspension, which was approved in October 2021, for “suprachoroidal use for the treatment of macular edema associated with uveitis.” Coded, 0465T, the drug is approved for a single dose of 4 mg, and payable in ASCs.
The second approval was for Susvimo from Genentech, an ocular implant delivering 100 mg/mL of ranibizumab, approved only for wet age-related macular degeneration at this time. Larson noted the drug is very expensive and can cost in the range of $10,000.
“The initial placement is 67027, mostly because of the use of the endoscopic laser probe,” he said. “You will likely do this at an ASC at initial placement, and then refill it in your office and the refills are done with 67028, your standard individual injection scenario. There is no J code.”
Collapse
Larson PM. What’s new for 2022? Presented at: Hawaiian Eye; Jan. 15-21, 2022; Waikoloa, Hawaii.
Click Here to Manage Email Alerts