Retina Billing

[percyeye]

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graphics.wsj.com/medicare-billing/

Looking over this website it shows all Medicare billing for providers in each states and exactly what codes are used and how much you are reimbursed for those codes.

I noticed that in most states Retina Docs were billing 3-4x as much as General Ophthalmologists. I was wondering if Retina Docs actually make that much more than the General Ophthalmologists or if most of that money went to the medication they have to use?

And someone shared the Retina podcast on here which was interesting, especially the episode about the infamous Retina doc in Florida that was convicted of fraud. So looking at numbers you have to wonder, if you're making 3-4x more than the next highest earner in the US and lets assume you take no vacation and take no days off and average about 150 injections per day it seems a little suspicious. Not going to name any names.

 

[ophthapp1]

what is an OMD

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[percyeye]

what is an OMD

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Sorry, was using charting jargon. Ophthalmologist.

 

[ophthapp1]

Never heard omd, thought you meant OD. I guess I prefer MD 🙂

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[percyeye]

Never heard omd, thought you meant OD. I guess I prefer MD 🙂

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Must be a regional thing. I see OMD in charts pretty frequently.

 

[hello lady!]

Must be a regional thing. I see OMD in charts pretty frequently.

I think optoms gave us this label. It's an attempt to make ophthalmologists appear to be less of a medical doctor.

 

[percyeye]

I think optoms gave us this label. It's an attempt to make ophthalmologists appear to be less of a medical doctor.

There is an app that is labeled OMD. An app for Ophthalmologists made by an Ophthalmologist.

Why are we talking about name jargon. It’s not a slight at all.

 

[MstaKing10]

Back to the OP, had a hard time understanding what you were getting at in that last sentence (about days off and whatever), but keep in mind this is only medicare billing. This does not include commercial insurance billing or fee for service payments. So an ophthalmologist with a purely refractive Surgery or premium IOL practice would have very little medicare billing but is likely on the higher end of compensation for an ophthalmologist. Also medicare reimbursement figures also include drug, and given the high cost of the drugs that retina docs inject these figures are skewed. Lastly, the grotesque actions of a few corrupt individuals should not overshadow the large majority of ethical retina specialists

 

[percyeye]

Back to the OP, had a hard time understanding what you were getting at in that last sentence (about days off and whatever), but keep in mind this is only medicare billing. This does not include commercial insurance billing or fee for service payments. So an ophthalmologist with a purely refractive Surgery or premium IOL practice would have very little medicare billing but is likely on the higher end of compensation for an ophthalmologist. Also medicare reimbursement figures also include drug, and given the high cost of the drugs that retina docs inject these figures are skewed. Lastly, the grotesque actions of a few corrupt individuals should not overshadow the large majority of ethical retina specialists

Thanks for answering, you answered my main question.

I enjoy looking at information like that because you can really learn a lot about billing by seeing how other people are practicing. And I know most Retina Docs are great, I have a really good relationship with the Retina specialists I send my patients. And it's not picking on Ophthalmology you can look at any profession on there and see some of the top billers and make you wonder if an audit is coming their way.

 

[estes8000]

A fundamental misunderstanding of Medicare reimbursement rates is not uncommon. Retina doctors, like oncologists, purchase large quantities of drugs that are given (injected intravitreally) to patients in the office. Medicare reimburses doctors for the cost of the drugs plus a small percentage extra for overhead, etc. Many of these injectable drugs cost $1600-$1800 per dose. Thus, if one were to inject 20 patients on a given day the cost to the doctor's practice could be up to $36,000. Medicare would pay that to the doctor (plus the small extra to compensate for overhead, etc). That $36,000 would show up as payment to the doctor, but would really be money just "flushed through" and sent to the drug company. Many retina doctors may end up receiving large amounts of money from Medicare that is simply ending up in the drug companies' pockets, not the doctor's . I hope that this make sense.

 

[percyeye]

A fundamental misunderstanding of Medicare reimbursement rates is not uncommon. Retina doctors, like oncologists, purchase large quantities of drugs that are given (injected intravitreally) to patients in the office. Medicare reimburses doctors for the cost of the drugs plus a small percentage extra for overhead, etc. Many of these injectable drugs cost $1600-$1800 per dose. Thus, if one were to inject 20 patients on a given day the cost to the doctor's practice could be up to $36,000. Medicare would pay that to the doctor (plus the small extra to compensate for overhead, etc). That $36,000 would show up as payment to the doctor, but would really be money just "flushed through" and sent to the drug company. Many retina doctors may end up receiving large amounts of money from Medicare that is simply ending up in the drug companies' pockets, not the doctor's . I hope that this make sense.

Yikes. That is a ton of money going straight to the drug companies.

 

[MR1]

The amount of money the drug companies make off me is about 2x what I generate. What I generate is not gross income either because there is overhead to pay on that. So yes tons of money is going to these drugs