Ophthalmology Specialists Must Keep an Eye on ACA and Medicare Changes

Healthcare in the United States is a constantly evolving landscape, and it’s important for those operating within the space to stay aware of the latest changes, including eye care specialty professionals. Updates to the Affordable Care Act and changes to the 2017 Medicare Fee Schedule can have a tremendous impact on the bottom line of practices. The good news is that some of the recent modifications represent a win for the ophthalmology field.

ACA plans sold on the healthcare exchange are not currently required to offer vision care for adults. However, pediatric vision benefits remain part of Essential Health Benefit Packages (EHBPs), that must be offered to individuals and small employers. This provision is a boom to eye care specialists as children can represent a significant portion a practice’s patients.

Medicare does not cover routine eye exams, also known as eye refractions, for corrective lenses. However, Medicare Part B does cover a few preventive and diagnostic eye exams including a yearly eye exam, glaucoma tests, and tests for macular degeneration.

The 2017 Medicare Fee Schedule contains major victories championed by the American Academy of Ophthalmology (AAO). The latest updates modify policies related to calculating payment rates, identifies potentially misvalued codes, adds procedures to the telehealth list, and finalizes new policies. These changes are expected to improve overall rates of physician reimbursements.

With respect to retina and glaucoma, the 2017 Fee Schedule retains The Centers for Medicare & Medicaid Services (CMS) decision to abandon a flawed methodology previously used to decrease glaucoma and retina reimbursements. CMS recognizes that 2016 reimbursements for trabeculectomy and retinal detachment codes did not properly account for the intensity or duration of the procedure.

Eye care specialists seeking reimbursements by third-party payers must submit Current Procedural Terminology (CPT) codes along with International Classification of Disease (ICD-10) codes. The CPT codes identify the procedure that was performed, while the ICD-10 codes identify the reason or justification for performing the treatment. Practitioners can expect to use Category I, Level I CPT codes in most scenarios.

Many of the 553 CPT codes within the Medicare program that apply to eye care specialty changed very little, if at all. Nine procedures saw substantial reimbursement increases, while eighteen were substantially reduced. The average change in reimbursement rates for ophthalmic services is a scant 0.01%.

It is essential for all professionals practicing in eye care to understand how current and potential changes in Medicare or the ACA may impact the health of their businesses. Accutome is a total solutions provider meeting the needs of the ophthalmic industry by supplying high-quality office medications, supplies, surgical instruments, diagnostic equipment, and more. To learn about how we can help your practice thrive, visit Accutome.com today!

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