Frustrated by payer issues? AOA practice success initiative can help

Doctors of optometry can learn best practices for addressing common payer challenges with new resources and expert-led training stemming from an organization-wide prioritization on optometric practice success.

Clawbacks, denials, credentialing requirements, downcoding and stagnant reimbursement levels all fuel doctors’ frustrations with health and vision plans and can feel like daunting tasks to appeal or challenge. However, the AOA is prepared to help doctors understand these undesirable policies and actions and learn what it takes to better advocate for their practices.

Toward that end, an upcoming #AskAOA webinar will help educate doctors on claims denials and clawbacks, as well as share best practices for helping practices resolve such situations. Additionally, the AOA offers two new template letters for doctors to use to assist in payer denials and patient communication.

What: #AskAOA: Best Practices for Addressing Payer Clawbacks, Denials and Records Requests
When: 9 p.m. ET, Monday, Sept. 19.

Register in advance for this #AskAOA webinar. After registering, you will receive a confirmation email containing information about joining the webinar.

Steven Eiss, O.D., AOA Third Party Center Committee chair, says there’s hardly an easy, “fix-all” answer for these issues, yet there are strategies that practices can use to move forward and more easily remedy the issues when they do crop up. But knowing about these types of audits and clawbacks ahead of time can help alleviate anxieties when they do occur.

“When you understand why and what the payer is looking for, it makes navigating it successfully that much easier,” Dr. Eiss says.

Read more about the AOA’s third party advocacy on behalf of optometry practices.

AOA launches practice success initiative to support members

Third party payer issues top the list of concerns that AOA members and nonmembers shared with the AOA as the organization began a process of reprioritization to ensure optometry practices have what they need to succeed in 2022 and beyond.

Two years ago, the AOA Board of Trustees approved an organization-wide reprioritization in all-out support of members’ response to the unfolding public health emergency, ensuring that not only more than $2.1 billion in pandemic relief was accessed by optometric practices but also practices had the resources to continue providing their community eye health and vision care. Now, the AOA is reprioritizing itself once again as the profession progresses from surviving to thriving.

Incorporating feedback from a nationwide survey of the profession, the AOA Board of Trustees launched a new practice success initiative to ensure members have the resources to compete and prosper. Manifesting as the AOA’s Practice Success Group, this organizational reprioritization will focus on matters that immediately affect optometric practices, including:

• Challenging and overcoming third party payer issues
• Expanding support to member doctors and growing membership via tangible benefits
• Increasing cross-organization collaboration to ensure alignment on behalf of doctors

The initiative is intended to help AOA members’ bottom lines, be they tied to financial success, staff success or success in optometry’s advocacy, and it spans across all practice modalities, per a statement from the AOA Board of Trustees.

“If you are in private practice, a corporate setting, a large group practice or any other practice setting, we are working with our leadership team and committee structure to make sure you have the resources, access to education, knowledge and skill to provide the level of care you are comfortable with and to do it very well,” the board notes.

Help AOA hold insurers accountable

Interested in learning more about payer advocacy efforts or aware of harmful actions or policies by insurers? Help the AOA’s payer advocacy by taking the following steps:

• Report plan abuses to the AOA by emailing stopplanabuses@aoa.org.
• Visit the AOA’s Action Center to learn more about federal legislation, such as the Dental and Optometric Care Access Act, H.R. 3461 / S. 1793, that would curb common and egregious plan abuses.
• Invest in AOA-PAC. Use your eight-digit AOA membership ID number and log in from your computer to make an immediate investment* to support your patients and the profession. Text “EYES” to 41444 to invest directly from your mobile device.

The AOA’s Third Party Center Committee is comprised of doctors of optometry nationwide working continuously to monitor plan policies and actions and is the profession’s payer advocacy nerve center. Supported by a team of AOA attorneys and staff, the Third Party Center has experience challenging and defeating abuses and barriers to eye health and vision care provided by doctors of optometry.

“It is important for us to know when these types of situations are occurring,” Dr. Eiss notes. “Often times when we speak with payers about issues, they will say they haven’t heard complaints from the provider side. So, hearing these issues from our members really helps us to come to them fully prepared.”

For more information or questions about the AOA’s payer advocacy, please contact the AOA Third Party Center at tpc@aoa.org.

*Contributions to the AOA-PAC are for political purposes and are not tax deductible. Only AOA members and other eligible persons may contribute. Contributions will be screened and those from non-eligible persons will be returned. You have the right to refuse to contribute without fear of reprisal. You will not be advantaged or disadvantaged because of how much you give or because you do not give.