News from the AOA's Blog

Despite objections raised by the AOA and other patient and provider groups, Congress has failed to prevent a massive 21 percent cut in Medicare physician reimbursement from taking effect Apr. 1 (see Mar. 29 article).

As a result of this inaction, the AOA Washington Office has advised ODs to hold claims, if possible, with dates of service on or after Apr. 1, until Congress completes action on AOA-backed legislation to correct these drastic cuts in Medicare physician payments. AOA expects Congress to address this issue quickly when lawmakers return to Washington, D.C. next week.

The U.S. Centers for Medicare & Medicaid Services (CMS) has instructed its contractors to temporarily hold fee-for-service claim processing for 10 days; anticipating Congress will once again intervene to prevent the planned cuts. CMS will not process claims (with dates of service in April) for 10 days, but still expects to make payments within legal limits of 14 days (electronic claims) or 29 days (paper claims).

For optometrists, there are several options for services provided to Medicare beneficiaries this month:

1) Make no changes in Medicare claim submission – ODs may submit their claims the way they always do. After the 10-day hold, Medicare carriers and contractors may pay the claims at the current lower rate. If Congress acts to address the cut and makes it retroactive to April 1 as expected, then the doctor should receive an additional payment in the future but it’s not clear when or how the doctor will get the additional amount. Most likely, carriers and contractors will automatically reprocess paid claims. It can be challenging to account for the partial payments.

2) Refrain from submitting Medicare claims until Congress acts – If the practice’s cash flow can handle the delay, then this approach would allow the doctor to conceivably receive the full, proper payment at one time. However, it’s not certain when or if Congress will act, or when CMS will be able to process claims under the new rates. CMS will face a large influx of claims, while trying to correct previously processed claims that were paid at the lower rate.

AOA will keep members up-to-date on the latest from the nation’s capital and any steps that optometrists may need to take to ensure they receive full and proper payment for Medicare claims, including through AOA First Look as well as regular postings on the AOA blog at: http://www.newsfromaoa.org.

Concerned doctors and students are encouraged to use the AOA’s Online Legislative Action Center to contact their elected officials directly and urge them to reverse these payment cuts as well as advocate for equitable and lasting reform. For more information on this priority issue and how to join the AOA’s efforts on Capitol Hill, please contact the AOA Washington Office directly at ImpactWashingtonDC@aoa.org.