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Related Experiment Videos

Comprehensive vision care under third party programs: increased services and increased scrutiny.

M Soroka1

  • 1State University of New York, State College of Optometry, NY 10010.

Journal of the American Optometric Association
|July 1, 1990
PubMed
Summary
This summary is machine-generated.

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Medicare physician reimbursement is rising due to unnecessary procedures. New legislation introduces a Medicare fee schedule and expenditure targets to control costs through increased claims monitoring and utilization reviews for all health professions.

Area of Science:

  • Healthcare economics
  • Health policy
  • Medical practice management

Background:

  • Physician reimbursement under Medicare has seen annual increases of approximately 15%.
  • A significant portion of this rise is attributed to an increase in unnecessary medical tests and procedures.
  • Growing concerns over healthcare costs and provider billing practices necessitate regulatory intervention.

Purpose of the Study:

  • To outline the legislative and administrative measures being implemented to control Medicare provider billing.
  • To examine the impact of new policies on diagnostic procedure utilization and reimbursement.
  • To inform healthcare professionals, including optometrists, about upcoming changes in utilization and quality review.

Main Methods:

  • Analysis of legislative changes aimed at establishing a Medicare fee schedule and expenditure targets.

Related Experiment Videos

  • Description of increased surveillance and monitoring of Medicare claims.
  • Overview of managed care techniques adopted by private insurers.
  • Examination of the development of clinical practice guidelines by health professions.

    • Main Results:

    • Legislation has been passed to establish a Medicare fee schedule and expenditure targets.
    • Increased surveillance and monitoring of Medicare claims are actively being implemented.
    • Diagnostic procedures are subject to scrutiny and denial if deemed inappropriate for the diagnosis.
    • Private insurers are adopting managed care techniques to curb overutilization.
    • Health professions are developing clinical practice guidelines.

    Conclusions:

    • Healthcare providers, including optometrists, will face heightened utilization and quality reviews.
    • New policies aim to control escalating physician reimbursement by addressing unnecessary services.
    • The healthcare landscape is shifting towards greater accountability and evidence-based practice.