The HHS Office of Inspector General (OIG) recently reported that optometrists and ophthalmologists might be billing inappropriately for treatment of cataracts and age-related macular degeneration (AMD). There are nine measures of service utilization that can help tip off inappropriate billing. The nine measures are broken down into four categories:
- Procedure with unusually high billing to treat AMD.
- Providers with unusually high billing for complex cataract surgery.
- Providers with unusually high billing for test to diagnose wet AMD.
- Providers with unusually high billing for ophthalmology claims using modifiers.
The measures were developed by the OIG with assistance from CMS and the American Academy of Ophthalmology. CMS and the OIG have agreed to review billing for wet AMD and cataract related services more closely as well as providers who have been identified as potentially abusing billing of these services.