The Centers for Medicare & Medicaid Services’ (CMS’) new Merit-based Incentive Payment System (MIPS) reporting year began Jan. 1, 2017. In order for doctors to avoid penalties for failure to report, they must take steps before December 31.
Doctors who do not report in 2017 will be assessed a 4% penalty on their Medicare reimbursements in 2019. However, this can be avoided but reporting ANY data this year. You can avoid the penalty by reporting just one Clinical Practice Improvement Activity or one Quality Measure for one patient you see before December 31, 2017. For more information, visit the AOA website. Besides the AOA, CMS and your practice management software vendor are other good resources.
The AOA reports 81 percent of doctors of optometry are currently receiving a 2 percent payment penalty for failure to meet CMS Physician Quality Reporting System program requirements in 2015. Doctors who fail to report under MIPS will continue to see their payment reductions increase to a max of 9% or their reimbursements in 2022 based upon their 2020 MIPS performance. As an external billing company, OBS has little to do with your this side of your practice since it involves internal reporting of patient care. However, we do see the reductions taken from your Medicare payments if you are not currently participating and would encourage you to take steps to avoid future penalties. Besides the AOA, CMS and your practice management software vendor are good resources for additional information.
We find that staff members at our offices often have many of the same questions. This is especially true when you hire new staff. Therefore, OBS has compiled a video training library on common topics our offices often ask us about. Topics include standard billing procedures for coding, check-in, and checkout; medical vs routine billing; cataract post-op co-manages; traditional Medicare vs replacement plans; VSP medically necessary contacts; and coordination of benefits. If you do not have the password to gain access to these videos, please call your coordinator or Mary, our training and curriculum manager, toll free at 877.727.3695. Check back frequently since we are adding new content regularly! 
New ICD-10 Coding Changes Coming 10/1/2016
For those of us who live in the world of health insurance, we sometimes forget how confusing it can be for our patients. We recently had a doctor who was concerned because so many of her patients didn’t understand their deductibles, copay, coinsurance, etc., and their confusion resulted in frustration that was often directed at her staff.
6.1.16 On March 14, 2016, new Medicare legislation called the 60 Day Final Rule went into effect that directly impacts our clinics and doctors. The law concerns refunding Medicare money when the clinic realizes that Medicare overpaid on an account. Please note that this new legislation does not change the existing process when Medicare realizes that they’ve overpaid and issues a Demand Letter, but rather addresses those instances in which the clinic discovers the overpayment before Medicare. The new law requires offices to return any overpayment, regardless of the amount, within 60 days. There are now serious fines for failure to comply, as well as the possibility of prosecution for fraud under the False Claims Act. It should be noted that the law only applies to traditional Medicare, not Medicare Advantage plans, Medicaid, or commercial carriers.
