Excerpted from the March/April 2023 edition of AOA Focus.
The AOA’s coding experts offer guidance to support doctors and staff in providing the best possible patient care while ensuring accurate reimbursements are received.
Here are some recent questions posed to the experts and their answers.
For doctors of optometry who are opening a new practice and need help with setting a fee schedule, are there any resources or guidelines?
Most optometry practices base their fee schedule on Medicare. A general rule of thumb is to set your fees at or slightly above that of the highest reimbursement you receive from any given insurance plan. Bear in mind that you will have some private-pay patients whom you cannot charge any differently than what you charge your insured patients.
Medicare will offer the highest reimbursement rates when it comes to billing and coding. You can obtain their fee schedule to set yourself up and use that as a guide to base your fees on.
When will the 2023 MIPS Quality Measures for claims-based reporting be released, and where will this be posted?
The measures were published at the very end of December 2022. Now available for download on the AOA’s EyeLearn, a pre-recorded webinar by Rebecca Wartman, O.D., chair of the AOA’s Coding and Reimbursement Committee, explains these changes to MIPS and how they will impact doctors of optometry. In addition, the AOA’s 2023 MIPS Guidebook and a rundown of the claims measures available to doctors of optometry can now be downloaded here.
Ask the coding experts
If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.