Practice management committee explains Medicare patients' access to new technology

April 16, 2005

Washington, DC &#8212 The American Society of Cataract and Refractive Surgery (ASCRS) issued a paper last year regarding the mission to deliver safe and effective cataract surgery services to all Medicare patients and that all beneficiaries have the right to "essential services," explained Priscilla P. Arnold, MD, immediate past president of ASCRS and the chairman of the government relations committee.

April 17 - Washington, DC - The American Society of Cataract and Refractive Surgery (ASCRS) issued a paper last year regarding the mission to deliver safe and effective cataract surgery services to all Medicare patients and that all beneficiaries have the right to "essential services," explained Priscilla P. Arnold, MD, immediate past president of ASCRS and the chairman of the government relations committee.

She also emphasized the right for Medicare beneficiaries to pay out-of-pocket for new technology that may represent "elective enhancement over and above essential services."Innovations in technology can be placed into two groups-those that enhance essential outcome and safety and those that enhance outcomes from an elective point, such as new IOLs, she said.

"ASCRS is going to continue to seek options for expanding treatment choices for our Medicare beneficiaries," Dr. Arnold said.

The most recent discussion regarding cataract surgery is that this procedure is a covered service of Medicare. However, correction of presbyopia with new IOL technology is a non-covered, elective surgery and should be coded and billed separately to Medicare for the surgery and to the patient, she noted.

"I think this is going to be a difficult battle (with CMS)," she continued. "This is an important topic as this new technology is here and we want our patients to have access to it. Stay tuned to all the information you will receive from email, direct mail, print, etc."

Nancey McCann, director of government relations for ASCRS, clarified the Medicare law and what physicians can and cannot do.

"Medicare covers only services that are reasonable and necessary," she explained. "Physicians are required to submit claims on behalf of Medicare beneficiaries for all items and services that they provide for which Medicare payment may be made under part B. Physicians and practitioners are not allowed to charge beneficiaries in excess of the limits on charges that apply to the item or service being furnished."

She also covered the law concerning opting out of Medicare. Physicians can opt out of Medicare, which lasts 2 years. Doctors may not opt out of Medicare for some beneficiaries but not others or for some services and not others, she said.

"Physicians who opt out of Medicare can enter into private contracts with Medicare beneficiaries. The only situation in which non-opt out practitioners are not required to submit claims to Medicare for covered services is where the beneficiary refuses to authorize the submission of the bill to Medicare. However, the limits on what the physician or supplier may collect from the beneficiary continue to apply to charges for the covered service, not withstanding the absence of a claim to Medicare," McCann said.

If physicians who opt out want to provide services to Medicare beneficiaries, it can only be done through private agreements or contracts, she noted.