Important News – July 1st Medicare Cut Question

Question: What should you do if Medicare institutes the physician payment cut on July 1 that reduces the Medicare Physician Fee Schedule 10% or more?

Check list of possible action items

  • Hold claims for 2-3 weeks in July while you wait to see if Congress acts to reverse the cut. Over and over again, we see Congress step up to the plate at the last moment.
  • Raise your fee for refraction to offset some of the cut.
  • Check your utilization patterns. Look for underutilized services.
  • Strengthen your optical dispensary. Increase your attention to the sales and operation efficiencies of your optical dispensary.
  • Offer vitamins in a medically prudent manner to inhibit onset of AMD or for patients with dry AMD. Vitamins are non-covered and an out-of-pocket expense.
  • Tune up coding for office visits. CCG finds that ophthalmologists accurately code about 60% of all office visits. If accuracy is improved, we usually find that reimbursement increases about 1-2% of total payments from payers.
  • Perform non-covered, refractive procedures to enhance surgical revenue.
  • onsider limbal relaxing incisions, monovision, presbyopia-correcting IOLs or toric IOLs.
  • Provide screening services. Medicare does not cover screening or routine eye care. It’s a patient-pay service. Screening might include prophylactic exams and associated diagnostic tests.
  • Consider moving to non-participating status in January 2009. If you do not accept assignment, you’ll increase Medicare related payments by 9.25%.
  • Improve efficiency in claims administration. Resubmissions and appeals require diligence and perseverance. Zealously follow-up on outstanding claims.
  • Expand the patient schedule by 1-2 patients per day. Higher volume brings in more revenue.
  • Move surgical cases to an ambulatory surgery center (ASC) where possible to speed up surgical time. Garner an equity stake in an ASC if offered.
  • Add a Physician Assistant or Nurse Practitioner to your practice to help perform history and physicals prior to surgery, assist at surgery, perform minor procedures, administer intravenous dyes such as fluorescein, manage chronic disease such as diabetes, take weekend call and triage emergencies.

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