What’s all the RUCkus?
Work to ensure optometry's fair treatment under Medicare stems from AOA participation on an influential committee tasked with valuating care, and members can have a crucial say in that process.
"Member participation in these surveys directly impacts how the AOA prepares recommendations to the RUC."
The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) offers recommendations to the Centers for Medicare & Medicaid Services (CMS) for how revised or new Current Procedural Terminology (CPT)© codes are to be valued according to a standardized physician payment schedule based on a resource-based relative value scale.
Essentially, the RUC offers a forum for doctors to provide specific input regarding the health care services they perform and how they should be valued. How a service is valued impacts how it is ultimately reimbursed under Medicare.
Holding a seat on the RUC Health Care Professionals Advisory Committee (HCPAC) since 1991, the AOA is represented at all RUC meetings and assists in the development of recommendations for CPT code values that optometrists report. These recommendations are referred to CMS to determine code values used to develop payment rates.
The RUC process is critical for any profession involved in the Medicare payment system, and the valuation process is no different for optometry than for any other specialty and no less important. Click here (member login required) to read more about the RUC and AOA participation from the AOA advocacy group.
Answer the call: Provide survey feedback
The collection of accurate, current values of services as codes selected for review is integral to this process. And in order to present a precise assessment, the AOA conducts member surveys, explains Charles Fitzpatrick, O.D., AOA RUC representative.
"Member participation in these surveys directly impacts how the AOA prepares recommendations to the RUC, and influences how services that ODs bill are ultimately valued," Dr. Fitzpatrick says.
As optometrists and ophthalmologists provide many of the same services, when both specialties typically perform a specific service under review by the RUC, the survey process is coordinated alongside the American Academy of Ophthalmology to develop a consensus recommendation for presentation before the RUC. These recommendations divide the cost of providing each service into three parts:
- Physician work and time
- Practice expense
- Professional liability insurance
If a member receives a survey and performs the service under review, it is critical to provide feedback and complete the survey. The AOA manages the survey process. Members with questions regarding a survey can contact Kara Webb, AOA associate director for coding and regulatory policy, at firstname.lastname@example.org.