Ophthalmology and Optometry Coding Alert

The OIG is watching, so be sure to meet the incident-to standard. If an auditor comes knocking at your door, be prepared to prove that the ophthalmologist provided the claimed service or procedure -- or that the technician performing the test met certain Medicare rules. The Office of the Inspector General's (OIG's) recent discovery that unqualified nonphysician practitioners (NPPs) performed 21 percent of incident-to services is sure to have Medicare auditors focused on documentation for claims of commonly performed technician services/procedures. Many practices believe that as long as they meet the minimum requirements of incident to (the physician is onsiteand sees patients for any new problems), they can report all types of tech services incident to and collect their extra 15 percent of Medicare reimbursement. In many cases, "physicians feel as long as they can just simply peek in or sit somewhere nearby, they're covered by these rules," unaware that [...]