How participating in an AOA survey can benefit optometry
From AOA's Coding Experts Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.
The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) offers recommendations to the Centers for Medicare & Medicaid Services (CMS) for how revised or new Current Procedural Terminology (CPT©) codes are to be valued according to a standardized physician payment schedule based on a resource-based relative value scale. Essentially, the RUC offers a forum for doctors to provide specific input regarding the health care services they perform and how they should be valued. How a service is valued directly impacts how it is ultimately reimbursed under Medicare.
Holding a seat on the RUC Health Care Professionals Advisory Committee since 1991, the AOA is represented at all RUC meetings and assists in the development of recommendations for CPT code values that doctors of optometry report. These recommendations are referred to CMS to determine code values used to develop payment rates. The RUC process is critical for any profession involved in the Medicare payment system, and the valuation process is no different for optometry than for any other specialty—and no less important.
Answer the call: Provide survey feedback
The collection of accurate, current values of services as codes selected for review is integral to this process. Once a code is selected for review, the collection of accurate information about the cost, effort and time needed to deliver the service is integral to the process. And in order to present a precise assessment, the AOA conducts member surveys. Member participation in these surveys directly impacts how the AOA prepares recommendations to the RUC and influences how services that doctors bill are ultimately valued.
When a code that is commonly performed by both optometry and ophthalmology has been selected for review, the survey process is coordinated alongside the American Academy of Ophthalmology (AAO), and AOA and AAO jointly develop a consensus recommendation for presentation before the RUC. These recommendations divide the cost of providing each service into three parts:
- Physician work and time.
- Practice expense.
- Professional liability insurance.
In 2019, the AOA also participated in the RUC surveys regarding the valuation of the updated evaluation and management services codes. That surveying process involved more than 30 physician specialties and was a critical opportunity for optometry to give input on office visits that serve as the foundation for many practices.
If you receive a survey and perform the service under review, it is critical to provide feedback and complete the survey. The AOA manages the survey process. Members with questions regarding a survey can contact Kara Webb, AOA director for coding and regulatory policy.
Ask the coding experts
While the AOA, and others, urge HHS to rethink implementation of this No Surprises Act provision, an upcoming #AskAOA webinar will help doctors meet the requirements that took effect Jan. 1, 2022.