Medicare reimbursements decrease – temporarily? – 21 percent:

Data shows 75 percent increase in Medicare provider payment over last decade

We’re so close – Congress’ abolishment of the sustainable growth rate (SGR) formula that has threatened doctors of optometry and other health care provider’s Medicare reimbursements for decades. However, because the US Senate has not acted on a bill passed overwhelmingly by the US House to repeal SGR – which President Obama has promised to sign – the SGR triggered a 21 percent decrease in reimbursements effective this past Tuesday, April 1. The Senate has until April 14 to send the president an SGR repeal bill that would result in optometrists not seeing reimbursement reductions. That measure, as currently written, raises reimbursement rates 0.5 percent in the last half of 2015 and annually through 2019, while shifting the program from fee-for-service to pay-for-performance. Regardless of the timeframe for enactment, it is widely expected that Congress will send the president legislation that will reform SGR and reverse this rate cut.

When doctors bill claims to Medicare, contractors by law must wait two weeks before paying (four weeks for paper claims). Clean claims must be paid within 30 days. Thus, Medicare can hold claim payments for nearly a month. Therefore, AOA recommends that doctors consider holding April claims as long as practical to delay the harm of drastically reduced payments, and to avoid retroactive accounting of Medicare payments and patient obligations. CMS has indicated that it will provide an update by April 11 – COA will apprise members of the announcement. Meanwhile, claims submitted for Medicare services provided March 31 or earlier should be processed, and paid, without delay.

Notwithstanding the latest developments, on the good news side, Centers for Medicare & Medicaid Services data reviewed by AOA shows that Medicare will pay doctors of optometry approximately $1.163 billion in 2015. This is a slight increase over 2014's estimate of $1.116 billion. Some optometric services are expected to gain payment increases in 2015, while a few may go lower (to read more about Medicare payment increases, click here).

Additionally, data reveals that Medicare payments to ODs have risen steadily over the past decade—by at least 75 percent—despite fluctuations in reimbursement for individual services, due to ceaseless advocacy by AOA.  By comparison, Medicare payments to ophthalmologists have increased 24 percent over the same time period.