Ophthalmology and Optometry Coding Alert

But the news isn't all good -- first, you faced a week of lower payments, and second, there's still no permanent fix.

For one week in June you faced substantially lower Medicare payments for ophthalmology services, due to a 21.29 percent cut that hit your Part B claims. Fortunately, the House of Representatives reversed those cuts on the evening of June 24, with a vote that also gives you a 2.2 percent pay increase through November 30. Check Up on Claim Reprocessing On June 18, 17 days' worth of claim holds expired, and with Congress slow to come to a legislative agreement, your practice paid the price after MACs began processing claims based on a conversion factor 21.29 percent lower than what you'd been collecting.

"CMS today directed contractors to lift the hold and begin processing June 1 and later MPFS claims under the law's negative update requirement," CMS said in a June 18 statement. "Held claims will be released and processed on a flow basis, first-in/first-out."

There's hope: It's unclear how many claims were processed using the lower conversion factor, but after the House voted through the 2.2 increase bill on June 24, CMS was expected to automatically reprocess claims that were paid based on the 21.29 percent cut. However, practices still worry about If the submitted charge is equal to or higher than the new rate, the contractor will automatically reprocess the claim. If the submitted charge is lower than the new rate, you should call the contractor to ensure correct payment. A contractor will not increase the fees without a review request. In addition, you'll have to keep an eye on any secondary insurers' payments to ensure that adjustments are accurate across the board.