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Payments for IOLs facing reduction

Ambulatory Surgery Reimbursement Update, January 11, 2005

For ambulatory surgery centers (ASCs) receiving payment for intraocular lenses (IOLs), the money coming in from Medicare may see a significant decrease.

The Office of the Inspector General (OIG) has recommended to the Centers for Medicare & Medicaid Services (CMS) that the Medicare payment to ASCs for IOLs be reduced. The OIG said, in its semiannual report, that "the current $150 per lens Medicare payment to ambulatory surgical centers for intraocular lenses is not 'reasonable and related to the cost,' as required by law." The report said that for the 12 months ending in June 2002, 40% of these IOL payments were in excess of the ASC's IOL costs. Average IOL costs, the OIG said, were $90.30 per lens, well below the $150 Medicare payment.

The OIG said payment should be reduced "in a manner that takes into account the different types and cost of IOLs." CMS has agreed to take this information into consideration when addressing the revised payment system for ASCs, which will be implemented sometime between January 1, 2006 and January 1, 2008.

To view the OIG's semiannual report, click here.

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