CMS Change Allows Illinois Optometrists to Claim EHR Incentive

Good news for optometrists in Illinois: The Illinois State Plan for Medicaid has been changed to fully recognize optometrists as physicians, clearing the way for ODs in the state to be eligible for federal electronic health records reimbursement. The Illinois Eye Institute advocated for this significant change with a team of key players, led by Dr. Leonard Messner: Dr. Vince Brandys, IEI consultant Barry Maram, Rodney Peele from the American Optometric Association, and leaders from the Illinois Optometric Association.

Illinois ODs already were treated as physicians for Medicaid payment purposes under the Centers for Medicare & Medicaid Services, but they could not claim the EHR incentive without this change. Providers with a patient base of 30 percent Medicaid or more – such as the IEI – can claim $66,000 under EHR, instead of the $44,000 available as Medicare providers.

The increased benefit also applies to doctors working in hospital settings, clinic settings or in qualified MD/OD settings. In addition, doctors who practice in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics in Illinois will now be able to receive the encounter rate, rather than the Medicaid rate, for the facility in which they work.

Illinois and Kentucky have successfully amended their state plans, and several states are working with the AOA to make this change as well.