F. Curtis Smith, President and Joan W. Miller, MD, Chief and Chair of the Department of Ophthalmology
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1 To: From: MEEI Affiliated Ophthalmic Surgeons F. Curtis Smith, President and Joan W. Miller, MD, Chief and Chair of the Department of Ophthalmology Date: April 14, 2006 re: Cataract and Cosmetic Surgery with a Presbyopia Correcting Intraocular Lens As you are aware, the federal Centers for Medicare and Medicaid Services (CMS) ruled in May, 2005 that Medicare patients undergoing cataract surgery may elect to receive a presbyopiacorrecting intraocular lens (PC IOL) in place of a conventional IOL. The beneficiary is responsible for payment of that portion of the charges that exceed conventional cataract surgery reimbursement. The major insurers in Massachusetts have decided to follow suit for their standard coverage packages. We are writing to communicate the MEEI process for scheduling surgery and the financial terms in these cases and for elective refractive use. The MEEI process and policies regarding PC IOL scheduling are attached. Please note several important points: MEEI requires prepayment of the patient s out of pocket expense at least two weeks before the date of the procedure in order to make the necessary arrangements for patient accounts management and lens acquisition. If the case is not prepaid at two weeks, your office will be contacted to cancel or revert to conventional IOL insertion. Scheduling of cataract cases with employer specific PPO coverage will require individual confirmation of the waiver and payment policies before booking, in order to clarify the insurer and patient financial responsibilities. Medicare and other payors require that beneficiaries sign printed waivers that stipulate their financial responsibility. We include here an initial supply of MEEI waivers for your patients to sign and return to us by fax or mail. Additional waivers, as required, may be printed from website
2 As questions arise, please contact the MEEI offices noted on the enclosed policy. Thank you very much for your affiliation with the Infirmary. CS/JWM/jec
3 MASSACHUSETTS EYE AND EAR INFIRMARY PRESBYOPIA CORRECTING INTRAOCULAR LENS (PC IOL) April 28, 2006 updated May 9, 2006 IN ALL CASES 1. All surgeons requesting surgical time for a PC IOL cataract patient are required to be fully certified by the supplier of the lens that will be used in surgery. We are verifying certification with the suppliers before surgery can be scheduled. Please notify us of your certification before you start scheduling cases, so that we can obtain confirmation from the supplier and make the necessary adjustments to your operating room (OR) preference lists. 2. Prepayment of the patient s MEEI charge responsibility is required at least two weeks in advance of the surgery date in order to allow time for the lens to be obtained and to put special handling billing arrangements into place. Patients may contact the MEEI Financial Counseling Office for information about credit card or bank check payments. If the MEEI prepayment is not received at least two weeks before the procedure, the Scheduling Office will contact your office to cancel the case or revert to conventional lens insertion. 3. When ordering the lens, indicate on the standard IOL form which presbyopic style will be used, and fax to Carol Alton at (The lens order form is attached.) FOR CATARACT PATIENTS 4. CMS and other payors require that beneficiaries sign a waiver that stipulates the financial responsibilities of the patient for this procedure. We will supply you with MEEI waivers for your patients to sign and return to us. Your practice will also need to develop and administer a waiver that stipulates any additional professional fees you may elect to charge the patient for this service. 5. The MEEI waiver stipulates the patient s financial responsibility for $908 (subject to change) in additional Infirmary charges for each such surgery. This charge includes the acquisition of the lens, which will be ordered after the payment and signed waiver is received. 6. When physician office staff schedule these cases with MEEI, the procedure must be noted as a presbyopia correcting IOL cataract case, and the type of lens you will
4 use must be specified (Restore, Rezoom, Crystal, etc.). In all other respects, follow standard MEEI cataract scheduling procedures for ordering the lens.
5 FOR ELECTIVE REFRACTIVE PATIENTS 7. As with any elective procedure, the patient is required to sign and return a statement of financial responsibility for the entire cost. Prepayment in full is required at least two weeks in advance of surgery, or the surgery will be canceled. The patient s financial responsibility to MEEI for refractive surgery with PC IOL insertion is $ (subject to change). This charge will comprise all Infirmary and anesthesia charges, including the acquisition of the lens, which will be ordered after payment and the signed waiver are received. 8. Please state in the ordering process if the procedure is a Clear Lens Extraction (CLE) for cosmetic purposes only. In all other respects, follow standard MEEI cataract scheduling procedures for ordering the lens. The patient s financial responsibility to MEEI for refractive surgery with Clear Lens insertion is $ (subject to change). This charge will comprise all Infirmary and anesthesia charges, including the acquisition of the lens. Contacts: To notify us of physician certification by the lens providers: OR Scheduling at To return MEEI waivers: Fax to Financial Counselors at , attention Regina Franklin, or return by mail to: MEEI Financial Counselors Mass. Eye and Ear Infirmary 243 Charles Street Boston, MA 0211 ***Financial counselors will fax a copy to , attention Dawn Boyd, for billing records. For questions regarding insurance approval requirements: MEEI Admissions Office, at For patient payment status/questions: Financial Counselors at or at and Additional waivers may be printed from our website:
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