AOA member feedback impacts Medicare valuations for services

Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.

From the April 2016 edition of AOA Focus, pages 44-45.

Many physicians may be unaware of the process that is used by organized medicine to develop values for procedures reimbursed under Medicare. And even more physicians also may be unaware of the role they play in this important process.

The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) focuses exclusively on code values and offers recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding appropriate values for new or revised Current Procedural Terminology (CPT^©) codes. This is a significant process shared by every specialty in medicine as a service's valuation impacts how it is ultimately reimbursed under Medicare. The AOA is fully engaged in this valuation process and has held a seat on the RUC Health Care Professionals Advisory Committee 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 that are relevant to everyday practice 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 randomly disseminated to doctors of optometry. The input 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.

In 2015, the AOA conducted two RUC surveys to gather data from doctors of optometry on appropriate code values. The surveys focused on fundus photography (CPT 92250) and scanning computerized ophthalmic diagnostic imaging (CPT 92132-92134). To gather feedback, these individual surveys were disseminated to a total of 1,500 doctors of optometry. In response, AOA received feedback from 92 doctors of optometry, which is equivalent to a 16% response rate. Given the frequent use of CPT 92250 and CPT 92132-92134 in optometric practice and the implications of the survey, more robust feedback from doctors of optometry was expected.

The AOA anticipates that in 2016, additional services provided by doctors of optometry will be required to be surveyed and values will need to be presented to the RUC. If a member receives a survey and performs the service under review, it is critical to provide feedback and complete the survey. Your profession is depending on you.