It’s Sunday morning and I find myself sitting in an airline lounge at La Guardia Airport. I’m looking out at the vista of the Manhattan skyline after a glorious weekend in New York City. As crazy as it may sound, I’m struck by the calm… The city was full of life, as always, but calm. The weather was uncharacteristically calm—mid-70s and no humidity. All would appear to be blue skies and smooth sailing ahead…

But then, I look to the forecast—tropical storms approaching, high winds and heavy thunderstorms coming.

As metaphoric as it may be, that too is the state of optometry right now. People are uncharacteristically calm. After a couple of very hard years, business sentiment is on the upswing after what were very good first and second quarters for most of the O.D.s I have spoken to.

Dark Skies Ahead
Unfortunately, as business gets better, complacency gets worse. I have been the beneficiary of many e-mails over the past few years from you, thanking me for helping to introduce the benefits of medical eye care and proper medical coding to your practices. Some of you have gone so far as to say that, if it wasn’t for doing this, your practices may not have survived the recent recessionary cycle.

While I believe that the optometric practice of today (and of the future) incorporates “total patient care,” and not just refractive or medical eye care, we need to stay vigilant about what else the future is going to bring. (Notice that I said “is” and not “may.”)

Things are always calmest before the storm. This month, the Supreme Court will decide the fate of health care reform. But make no mistake about it—no matter what the court may decide, the behaviors, policies and attitudes that have formed over the last couple of years are here to stay.

Anticipate an Audit
Third-party audits of your practice are going to happen. It is not a question of if, but when; and you need to be prepared. In recent announcements, about 10 contractors for the Centers for Medicare & Medicaid Services (CMS) have indicated that they will be stepping up their audits—Medicare Comprehensive Error Rate Testing (CERT) audits and Medicare Recovery Audit Contractor (RAC) audits.

A couple of CMS contractors have specifically targeted outpatient-based ophthalmic claims; more specifically, they’re targeting 920XX office visits as well as many of the procedures that we perform on a daily basis, such as fundus photography, anterior segment photography and visual fields. The documentation of these services is of concern. It has to be complete, must clearly demonstrate the medical necessity of the procedure performed, and should fall within the commonly accepted standards of practice.

CMS and other medical carriers are not the only entities that have found that conducting audits have improved their fiscal bottom line. Refractive carriers are also increasing the number of audits of optometric providers.

And the economics of these situations are significant. It’s not unusual for an optometric audit by a refractive or medical carrier to easily be in the hundreds of thousands of dollars.

So, don’t be lulled into complacency by the relative, recent calm within our profession and industry. Yes, things in the economy are slowly getting better, but the winds of change are still blowing strong and threaten our viability in ways we have yet to fully understand.

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