Video: Michael X. Repka, MD, MBA, Discusses High Error Rate
Michael X. Repka, MD, MBA, explores the reasons behind the high failure rate for cataract surgery audits.
Cataract surgery continues to draw scrutiny for improper payments. A recent audit by Noridian, the national Supplemental Medical Review Contractor (SMRC), revealed a 51% error rate for cataract surgery documentation. Due in large part to the high failure rates of these audits, some payers are considering use of prior authorization.
Ophthalmologists may receive comparative billing reports (CBRs) when billing differs from their peers within the state and/or across the United States. These reports are not audits but they are a call to action to conduct your own internal chart audit to assure compliance.
Help us help you meet the documentation requirements for cataract surgery. Audit-proof your cataract surgery procedures and avoid costly payment recoupments through the resources we have provided for you.
Audits
At some point, every practice faces an audit. Initiate internal audits to prevent documentation deficiencies by following these 10 steps and using these resources:
Note: Even with proper documentation, practices can still fail an audit if they do not respond to a documentation request.
Comparative Billing Reports
Insurance payers monitor physician billing for exams, tests and surgical procedures and analyze data to identify outliers. Facilitated by the contractor RELI Group, the Centers for Medicare & Medicaid Services issued a comparative billing report on Medicare Part B claims from Jan. 1 to Dec. 31, 2019 for these three key metrics: complex cataract surgery, co-management and YAG laser. These resources can help you review your documentation and be prepared for any outside scrutiny whether you are an outlier or not.
Complex Cataract Surgery
Co-Management
YAG Laser
Prior Authorization
Prior authorization (PA) for cataract surgery is a reality for a few payers and a growing concern for all cataract surgery practices.
Academy Solutions
Further Resources