Medicare/Medicaid--Five Years to Recoup Overpayments

The U.S. Centers for Medicare & Medicaid Services (CMS) will now have up to five years to recoup Medicare overpayments resulting from coding mistakes or other claims errors, according to the AOA Advocacy Group. A 2012 report found the previous three-year recoupment limit prevented the CMS from collecting more than $300 million dollars annually. Read more.

Washignton State Sues Optician

"The federal Medicaid program allowed health care providers to charge a fee of $20 to repair broken eye glasses," reports KING5 News. "Some eye doctors provide that kind of service for free.  Other eye care providers occasionally bill the federal Medicaid program for the $20 repair fee.
But Rev. Harriett Walden turned it into a one-woman industry. The Seattle optician earned hundreds of thousands of dollars in Medicaid eye glass repair fees over the course of three years - the top biller in the state." Read more.

Medicare Giving EHR Practitioners in HPSA's Additional Bonus

Qualified EHR (Electronic Health Records) practitioners who practiced last year in federally recognized Health Professional Shortage Areas (HPSA) will be getting an additional bonus payment for their participation in the program – if they haven’t received it already, according to the U.S. Centers for Medicare & Medicaid Services (CMS). Read more.

CMS Prepayment Reviews More Common with ECPs

The rapid expansion of a U.S. Centers for Medicare & Medicaid Services (CMS) initiative, launched last year to crack down on improper billing and claim errors, has meant more optometrists across the nation are receiving Medicare prepayment review notices, according to the AOA Third Party Center Executive Committee. The new prepayment review program means health care practitioners, including optometrists, will have to more diligently avoid common claim filing errors – such as coding mistakes or missing signatures – if they wish to ensure prompt payment, according to AOA Third Party Center Executive Committee members. Read more.

Illinois Cuts Vision Benefits for Medicaid Patients

Legislators will cut Illinois's budget for the state's Medicaid program, according to the Huffington Post. The story notes that "dental and vision care for adults will be heavily scaled back, and chiropractic and podiatric coverage has been cut altogether." Read more.

Providers Told to Hold Medicaid Claims to Avoid Payment Cut

"The Centers for Medicare and Medicaid Services is directing providers and claims administration contractors to delay filing claims for services paid under the 2012 Medicare Physician Fee Schedule," according to the OSNSuperSite. "Providers are advised to hold 2012 claims for the first 10 business days of January. The directive is intended to help providers avoid a 27.4% Medicare physician payment cut scheduled to take effect Jan. 1.The hold is expected to have a minimal impact on providers' cash flow because, under the current law, clean electronic claims are paid no sooner than 14 calendar days after the date of receipt and paper claims are paid no sooner than 29 days after the date of receipt." Read more.

States Limit Medicaid Vision Benefits

"The new federal health law requires states to maintain Medicaid eligibility and enrollment standards until 2014, when the expansion begins to add 16 million Americans to the program. States are still free, however, to cut optional benefits, which include drugs, vision care and visits to certain providers such as chiropractors and podiatrists," reports USAToday. For example, "North Carolina this month stopped covering regular eye examinations and eye glasses for adults in Medicaid, and Connecticut in July cut the number of dental [and vision] exams covered for adults in Medicaid from twice a year to once a year." Read more.

Hoosier ODs Protest Medicaid Cuts

"Indiana eye care professionals are worried Medicaid cuts by the state could have a negative impact on the health of Hoosiers and end up costing taxpayers more in the long run," goes the post on TheIndyChannel. "Beginning in July, the state implemented a 5 percent cut in Medicaid reimbursement for eye care and vision wear provided by optometrists." Read more.


This increasingly is occurring across the United States as more legislatures grapple with budget deficits and an electorate reluctant to raise taxes.

NC Cuts Medicaid Eye Benefits

The NewsObserver  notes that "new cuts to health services for the poor take hold in October, with the elimination of eye exams and glasses for adults on Medicaid. Medicaid recipients are receiving notices about reductions, eliminations or other changes to an array of health services in the next few months. The $354 million Medicaid cut in the state budget includes limits and other changes to services totaling $16.5 million." Read more.

As Forrest Said, "Stupid Is as Stupid Does"

"All families, no matter how poor, can afford eyeglasses, County Executive Chris Collins said Tuesday as he mentioned eye care as one of the Medicaid offerings he would drop as an option in Erie County if he could," according to a BuffaloNews report.