Improve Ophthalmology Collections In Spite of Medicare Payment Cuts

Proposed Medicare Payment Cuts

Centers for Medicare and Medicaid Services (CMS) proposed 2022 Medicare Physician Fee Schedule and Quality Payment Program rules and included a 3.75 percent reduction in the conversion factor used to calculate payments to physicians. The cuts are the result of a reduction that is necessary to keep Medicare payments budget neutral. CMS is proposing to cut the Medicare conversion factor, the basic starting point for calculating Medicare payments for CY 2022 by 3.75 percent. The proposed rule with Medicare payment cuts would have a huge effect on ophthalmology’s ability to run a successful ophthalmology practice, which has one of the highest Medicare beneficiary bases.

This proposed 2022 rule threatens ophthalmologists’ financial viability and ability to run a successful ophthalmology practice. These Medicare payment cuts are even more devastating during an extremely financially stressful time due to the COVID-19 pandemic. Ophthalmology practices are just returning to our pre-pandemic clinical or surgical volumes but may face setbacks. All practice has already suffered greatly the last couple of years, and this final rule adds salt to the wound. The final rule may likely force ophthalmologists to restructure our practices and take fewer Medicare patients, leading to longer wait times and reduced access to care for older Americans. It may also force more ophthalmologists, who already have the highest overhead in medicine, to back out of Medicare participation entirely.

Improve Ophthalmology Collections

According to an American Medical Association analysis, ophthalmology as a specialty experienced the second largest cumulative reduction in Medicare Physician Fee Schedule spending. Each year ophthalmologists go through the same stress and anxiety over possible Medicare cuts until we find out for sure what will actually be instituted for the year. Ophthalmologists have to adjust to the changes each year and strive to continue to provide our patients with the same excellence of care that they’re familiar with. The challenge, of course, is to stay up-to-date with the ever-increasing billing guidelines and continue to provide cutting-edge care to our patients in light of the ever-decreasing reimbursement. Here are a few tips to improve your ophthalmology collections In spite of proposed Medicare payment cuts.

Optimize Billing

One incorrect demographic entry error or failure to take prior authorization could lose you $1,000 or more. Insurance carriers are looking for reasons not to pay you, and you have to be on top of it if you want to be paid properly. Always look for an opportunity to improve your billing and collection process, we will never regret it. While working with one of the clients, we found that the insurance carrier had reduced a couple of comprehensive exams to intermediate. We really worked on that to improve the billing bottom line considerably, resulting in cleaning up the billing and coding. Educating patients and collecting more upfront could help a long way toward improving your practice collections.

Fill Gaps in the Schedule

You will be surprised to know that seeing just one or two more patients per day could add a significant boost to your practice collections. You could have a waiting list. The second you get the notification that an appointment has been canceled, start calling patients on the waiting list and keep calling until you will find somebody to fill the spot. Medical billing software or various tools for appointment reminders would help in reducing patient no-shows.

Cost Sharing

An article from the Review of ophthalmology suggests the option of cost sharing. As per the article, when individual physicians come together and build a medical condominium, they’ll benefit in a number of ways. The real estate aspect of owning your own building won’t immediately offset the impact of the cuts, but in the long term it’ll pay off. Private equity is another option that can reduce some operational costs. The administrative burden and HR department can be shared, which reduces costs and improve collections.

Outsource Ophthalmology Billing

Outsourcing your ophthalmology billing to an expert medical billing company could greatly help in improving ophthalmology practice collections. Experts in medical billing companies are well updated on billing and coding guidelines and payer-wise reimbursement policies. So, the billing company ensures that you will get paid for every single patient visit. The billing company will share insurance coverage prior patient visit so that you can collect the patient portion at the time of the visit only.

Medical billing company also offers flexible payment options where you have to pay a percentage of actual collections received. If you are a solo provider or run a group practice or represent a big healthcare organization, outsourcing could provide customized billing solutions for your billing requirements.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. We can assist you in improving your ophthalmology practice collections in spite of proposed Medicare payment cuts. To know more about our ophthalmology billing services, email us at: or call us: 888-357- 3226.

Reference:  Review of Ophthalmology: Staying Ahead of the Cut