AOA member surveys impact Medicare valuations for services
Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
Excerpted from page 44 of the September 2017 edition of AOA Focus.
Many physicians may be unaware of the process that is used to develop values for procedures reimbursed under Medicare, and of the role that practicing physicians play in this important process.
The American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC) focuses exclusively on code values determining both the work involved and the office expense incurred in the delivery of a service to a patient. The RUC then offers recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding appropriate values for new or revised Current Procedural Terminology (CPT)© codes. All of medicine has a stake in this process.
This is a significant process as a service's valuation impacts how it ultimately is reimbursed under the Medicare Physician Fee Schedule. The AOA is fully engaged in this valuation process and has held 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 doctors of optometry report.
All doctors of optometry also play an important role in how codes are valued. In order for AOA's RUC representatives to present values for RUC and CMS consideration, the AOA relies on data gathered from surveys disseminated to doctors of optometry. The input that the AOA receives regarding the work and time spent performing various services directly impacts the recommendation that AOA makes to the RUC regarding a code's potential value. As doctors of optometry 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.
Historically, doctor of optometry response rates on RUC surveys have been very low, even for procedures that are performed in large number by doctors of optometry. The AMA RUC has developed videos to educate physicians regarding the RUC process:
- Understanding the RUC Survey Instrument: Physician Services
- Understanding the RUC Survey Instrument: Surgical Services
The AOA anticipates that in 2017 and 2018, additional services provided by doctors of optometry will be required to be surveyed and values will need to be presented to the RUC. If you receive a survey and perform the service under review, it is critical to provide feedback and complete the survey. Your profession is depending on you!
The AOA Ethics and Values Committee releases topical and timely case study on coding abuse and what to do about it once suspected.