The Ohio Department of Insurance has released a graphic depicting Individual/Patient/Member appeal rights and process flow, including external review. You may find this helpful to supply this to your patients when you are aware they are not in agreement with their health insurer. It may also help complement and reinforce an appeal you as a provider…
By Elizabeth Muckley, OD – Overview: The Sunshine Act, also referred to as the “Open Payments” Initiative, requires certain manufacturers that produce drugs, medical supplies and devices to publicly report payments or “other transfers of value” they made to physicians (including optometrists) and teaching hospitals. Certain Group Purchasing Organizations (GPOs) will also be required to report…
By Charles B. Brownlow, OD – I’ve been involved in some very frustrating experiences lately. I thought I would share them with you so that you gain perspective on your own frustrations. I was asked by an old friend practicing in another state to help find a way that ODs can bill more than their…
By Mark Ridenour, OOA Consultant – Medicare now contracts with more than 360 ACOs nationally, each covering at least 5,000 patients for three years with Shared Savings. Ten ACOs are in Ohio; here’s a link to Medicare’s website where you can search for those organizations serving Ohio: https://data.cms.gov/ACO/Medicare-Shared-Savings-Program-Accountable-Care-O/ay8x-m5k6 Medicare rules include that patients are informed…
By Erica Keller, Ohio State University, AOSA Trustee-elect – Recently, Rick Cornett, Executive Director of the Ohio Optometric Association, came to speak at The Ohio State University College of Optometry about the Affordable Care Act (ACA)/Obamacare and how it will affect optometrists, both positively and negatively. More than 150 students came to listen, making it…
Jason R. Miller, OD, MBA, FAAO – Please note: The following column is based on my experience and not an official opinion of the OOA. Every optometrist must decide how to handle this issue. Are you confused about how to bill your diabetic patients? Especially your diabetic patients who also have VSP? Many health care…
Charles B. Brownlow, OD, a national consultant for optometry on issues related to third party, recently provided these answers to questions from OOA members. Question: If we see a patient with early stage cataracts and recommend a 12-month recall for their annual exam to monitor the cataract progression, would that exam at the 12-month time…