Charles B. Brownlow, OD

I can’t imagine any patient or health care provider would argue with the logic included in the title of this article.

I have retired from traveling around the country doing live presentations, but I do not think I will ever be retired long enough to not care what is going on in the optometric profession.

I retired from active consulting Jan. 1, 2016, but I do not think I will ever retire from being concerned about eye care, eye care patients, my optometric colleagues and the importance of excellent medical records. Indeed, Medicare would not have been repaid to the tune of $5.6 billion in 2016 if providers totally understood the importance of keeping good records.

The Office of the Inspector General acts as the “enforcer” for the Centers for Medicare and Medicaid Services. This office establishes requirements for Medicare providers and creates a plan each year to guide compliance efforts throughout the system. Contractors are kept busy, conducting reviews and audits of provider billing practices as well as reviews of patient records where appropriate.

I am sure most of the nation’s health care providers have heard or read about Medicare’s recent comparative billing reports, which began during the final quarter of 2015. Knowing my colleagues as I do, I imagine that many doctors of optometry whose billing practices were reviewed, as well as those who have heard about the CBRs “through the grapevine,” are wondering what will be coming next. Audits? Site visits?

Medicare audits are increasing in frequency, volume and impact. Within the past month, I have heard of doctors who are being told to repay hundreds of thousands of dollars in Medicare payments following audits of their claims and medical records.

Some of you may recall that I have done two previous surveys of optometrists’ fees, published in Primary Care Optometry News in 2005 and again in 2008. In each case, the data were drawn from the collection of fee analyses that I had done during the previous year. This was an attempt to glean useful information regarding eye doctors’ patterns of billing and to provide useful information for doctors contemplating changes in their own fee schedules.

Just as your new diagnostic imaging instrument is delivered and you are feeling good about the great discount you got and the break it provided for your 2010 income taxes, your 2011 edition of Current Procedural Terminology (CPT, American Medical Association) shows up in your mailbox.

If you are writing prescriptions (orders) in your practice for post cataract glasses, aphakic glasses or contact lenses or for any other materials considered durable medical equipment by Medicare, your name and National Provider Identifier must be registered in the federal government’s Internet-based Provider Enrollment, Chain and Ownership System. If your office fills prescriptions for other optometrists or ophthalmologists for Medicare patients’ glasses or contact lenses, those doctors must also be registered.

For those of you who have been holding out, now is the time to buy a computer for your office, talk to your telephone company or cable provider to get on the Internet and snap yourself right into the 1990s.