It is the question you find yourself facing each new year when Medicare’s fee schedule may or may not be finalized: Do I hold the claims or chance doubling payment posting weeks from now?

The “right” answer is practice dependent. As you ponder yours, here are key revenue facts to consider.

The ultimate concern is the financial stability of the practice. Do you have the cash reserves to float while holding a payer’s claims? Although having to process remits multiple times for the same claim may not seem appealing, is it as much of a burden as lack of cash flow?

Start by knowing your revenue volume by payer. Run financial production reports by payer and determine how large of a share Medicare represents. Then verify if other top payer’s contracts are based on Medicare’s fees. Knowing your top revenue sources allows you to make healthy financial decisions. Many ophthalmic practices cannot afford to withhold income flow and still be able to provide care.

The Medicare conversion factor determines the final allowable reimbursement for all CPT codes; however, it is only a part of the equation. Each CPT code is assigned a Relative Value Unit (RVU). RVUs are multiplied by the conversion factor to determine the Medicare Physician Fee Schedule. Annual valuation changes are not proportional for all codes and subspecialties. The monetary impact on individual practices is determined by the combination and volume of procedures you perform. Once again analyze your historic production numbers to determine where you will be impacted the most.

Although ophthalmic surgical codes have seen decreases in RVUs, evaluation and management (E/M) RVUs have increased over the past few years. The everyday bread and butter services you provide can help provide sustaining revenue. Guarantee you are maximizing your E/M reimbursement by providing comprehensive documentation and medical decision-making education to all staff. Academy coding resources are found at aao.org/em.

What if Medicare announces they are holding claims to minimize reprocessing on their end? It is even more important to have accurate knowledge of the potential impact on your practice. 

Will you need to subsidize revenue to meet financial obligations? In this scenario it is best not to hold your claims but ensure they are submitted in a timely manner to be in queue for processing as soon as the release occurs.

In a season of change, a strong knowledge of your revenue cycle will empower you to make the best decisions for your practice.