- AOA Investigator Initiated Research Award
- Best Practices for Offering Discounts to Private Pay Patients
- FCLCA
- Health Insurance Portability and Accountability Act (HIPAA)
- Medicare & Insurance
- Coding and Reimbursement
- MIPS Resources
- Optometric Care of Nursing Home Residents
- AOA’s Policy Statement on Telemedicine
- Patient Experience Considerations for Doctors of Optometry
Practice Success Resources
When a law is passed related to the practice of optometry, it’s up to the regulatory process to define the details. Everything from how much Medicare pays for an eye exam to what, exactly, constitutes a prescription verification is determined by the regulatory agencies of the federal government.
As a legislated profession, optometry is defined by the laws governing its practice. However, legislation rarely determines the finer points of the law. Staff and volunteers in the AOA Advocacy Group work with regulatory agencies every day to define the details that determine the impact of legislation on doctors of optometry and their patients. This happens in the form of official comment letters, meetings with federal officials, collaboration with others in the health care community, consultation with doctors regarding the precise details that go into a single Medicare code, the development of an optometric registry and much more.
Best Practices for Offering Discounts to Private Pay Patients
As a healthcare provider navigating payment structures, it is essential to understand the legal and contractual implications of offering a discount from the Usual, Customary, and Reasonable (UCR) charge when same day payment is made. Since the costs to the practice can be less when no insurance is involved, healthcare providers sometimes offer prompt pay discounts to patients without insurance. We define private pay patients as patients not using any form of insurance but rather using cash, check or credit/debit card at the time of the service or purchase. This document is intended to help encourage compliance with regulations and payer agreements.
Understanding the Difference Between Vision Exams and Medical Eye Exams
Vision plans and medical insurance are very different in terms of the services they cover, and it is important for patients to understand these differences. This patient facing resource can be used to help educate your patients.
Eyeglass Rule Compliance Toolkit
This toolkit includes frequently asked questions, template authorizations and information regarding AOA’s advocacy regarding the Eyeglass Rule.
Federal Trade Commission Non-Compete FAQ April 24
The Federal Trade Commission (FTC) voted in April 2024 to finalize new rules that would prohibit employers from issuing non-compete agreements with workers. The rule would also invalidate existing non-compete agreements for many individuals. This resource includes some commonly asked questions regarding the final rule.
Medicare Advantage and Vision Benefits Explained
This resource helps educate patients about Medicare Advantage plans.
This form is for use when communicating eye exam findings to other diabetes care team members.
Medicare and Medicaid Fee Schedules
This resource includes a compilation of Medicare and Medicaid Fee Schedules.
This resource includes an overview of what it means to opt out of Medicare.
21st Century Cures and Information Blocking Frequently Asked Questions
This FAQ provides needed information for doctors of optometry on information blocking rules.
This resource provides AOA members with the total solution to the challenges of HIPAA compliance.
Become a successful MIPS participant.
This resource is a list of key considerations developed by AOA based on the principal antitrust statutes. The following description of the antitrust laws is necessarily very general and is meant primarily to raise a red flag regarding prohibitedactivities. The AOA expects Covered Individuals, defined as employees, volunteers, and others acting on its behalf, to observe these guidelines.
This resource was developed by AOA to help doctors of optometry evaluate contracts with third-party payors. It is critical to understand what to look for and what questions to ask when considering a payer contract.
State by State CLIA Requirements
This resource provide state specific requirements related to CLIA.
Guidance for Substitute Physician Arrangements
AOA created this specific practice success resource to provide information for offices that may be getting denials with insurance due to the fact that they have contracted with a fee-for-time compensation arrangement physician. A fee-for-time compensation arrangement physician is the substitute for a physician who is absent. Private payer policies may vary significantly. Some health or vision plans might not accept these arrangements at all.
Risk Adjustment Audits/Records Requests
Doctors of optometry often receive records requests related to the Medicare Advantage Risk Adjustment Data Validation (RADV) program. These are different from typical audits doctors receive to ensure that proper payment was made to the doctor. These audits are the primary way for the Centers for Medicare & Medicaid Services (CMS) to address improper overpayments to Medicare Advantage Organizations (MAOs). During a RADV audit, CMS confirms that any diagnoses submitted by an MAO for risk adjustment are supported in the enrollee's medical record.
Sample Letter for Optometry Practices to Negotiate Fee Schedules with Health and Vision Plans
This resource provides guidance on negotiating a fee schedule with a health or vision plan.