Optometry Coding & Billing Alert

Published on Wed Jul 25, 2012 PDF

Our expert weighs in with her views.

In the wake of the U.S. Supreme Court's ruling upholding the Patient Protection and Affordable Care Act ("Obamacare"), the effects are already evident on the ground, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla., and Brooklyn, N.Y.

"I'm already starting to see a major transition of Medicaid services to mandatory plans that will provide greater benefits to the patient in an attempt to keep patients out of the hospital and/or long term care facilities," says Mac. "And there is a swing in New York to enroll dual eligibles (Medicare and Medicaid) who qualify for long-term care plans into Medicare Advantage programs. These initiatives will save billions of dollars in healthcare spending."

More changes: "I've also seen an increase in compliance initiatives with whistleblower cases, anti-kickback and enforcement of Stark violators regarding designated health services (DHS)," she says. "Fines and recoupments seem to start in the millions of dollars."

Effects hitting home: "On a personal level, as a consultant, I am interested in seeing insurance premiums more affordable and insurance available for small businesses -- or businesses of one person such as myself," Mac says. "Insurance premiums are ridiculous and I'm also concerned about small businesses not being able to afford health care for their employees even if the premiums are lower. They will just never be at an affordable level for most of us."