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Optometrists Billing for Part B Services for Medicare Enrollees in Nursing Facilities

Medicare Part B covers many medical services (e.g., optometry services, mobile x rays, and psychological therapy) provided to enrollees, including those residing in nursing facilities (NFs). NFs are required to provide services necessary to ensure their residents attain or maintain sound health. Sometimes, an NF does not have the staff to meet residents' needs and arranges for services to be furnished by outside resources. Some of these services are provided by optometrists who, like many other providers, often visit NFs. Their on-site services include following up on cataract surgeries, treating dry or itchy eyes, and providing annual eye exams because transportation to and from an NF might be difficult for some enrollees. Opportunities for fraudulent, excessive, or unnecessary Part B billing exist because an NF may not be aware of the services for which a provider is billing when submitting a claim to Medicare. We will identify line items billed by optometrists for services performed in an NF. We will review medical records to determine whether the services were appropriately documented and billed according to Medicare requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
January 2024 Centers for Medicare and Medicaid Services Optometrists Billing for Part B Services for Medicare Enrollees in Nursing Facilities Office of Audit Services WA-24-0026 (W-00-24-35909) 2024