ical necessity in your
appeal. Be sure to re-
engage the manufac-
turers' reimbursement
team for further help if
there are issues while implementing these products.
The effort you make to connect all the dots in this process goes
beyond making sure patients have access to innovative therapies.
Remember, CMS sets aside the amount of money for innovative-but-
expensive products the year before it's paid out. If a high-volume of
cardiologists utilize more pass-through payments than ophthalmolo-
gists, that may inadvertently limit future innovations that benefit
ophthalmic patients. Understanding how these payments work will
allow for better patient care without your facility having to foot the
bill. That, in turn, will encourage companies to continue their
research and development efforts for even more ophthalmologic
breakthroughs in years to come.
OSM
A P R I L 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 8 7
The pot of money that CMS sets
aside each year for pass-through
payments remains underused.
Dr. Nijm (lmnijm@uic.edu) is founder and medical director of Warrenville
EyeCare and LASIK in Warrenville, Ill., and an assistant clinical professor of
ophthalmology at University of Illinois Eye and Ear Infirmary in Chicago.