Volume 9, Issue 38│October 10, 2025 | | |
Thank you to our newest PAC donor!
Brigette Colley, OD
| | | The Annual Meeting photo gallery is live! Take a look using the link below. 📸 | | IOA member Dr. Neil Margolis presented at the 2025 Annual Stroke and Neuroscience Symposium where he presented a 2-hour lecture on vision skill rehabilitation for concussion and stroke to occupational and speech therapists. | | IOA past presidents pictured at an event for Rep. Darin LaHood & Mike Pompeo. Pictured left to right: Mike Pompeo, Dr. Pete Kehoe, Dr. Dennis Brtva, Dr. Brian Plattner, Dr. Tim Cundiff, & Rep. Darin LaHood. | | |
Focused on You: Get to know fellow IOA member and Chicago College of Optometry's Dean Dr. Brianne Hobbs!
Name: Brianne Hobbs
School & Graduation Year: UMSL College of Optometry, 2010
Practice Location: Midwestern University, Chicago College of Optometry
Birthplace: West Plains, MO
Awards: Early Career Achievement Award – UMSL College of Optometry
Q: What did you want to be when you grew up as a child?
Q: Growing up, what was your first job?
- I raised pigs and sold them (unofficial job). Official job—working at the movie theater (The Glass Sword) in my hometown of West Plains, MO
Q: What is your greatest memory from your optometric career?
- So many great moments to choose from!
- As a faculty member, I think watching our first class graduate from the Arizona College of Optometry was one of my happiest moments because I was so proud of all our students and the program we were building.
Q: If you weren’t an optometrist, any guess as to what your profession would be?
- Hmm…maybe a basketball coach or a cross-country coach?
Q: What is something you are looking forward to in the coming year – career related or otherwise?
- I am really excited about getting to know all the CCO students, faculty and staff. The people are the best part of any organization. On a personal note, my kids are very excited about getting to go sledding (there was never enough snow to sled in while we lived in North Carolina)
Q: What is a message you’d like to tell current optometric students?
- Run your race—focus on your strengths and move at the pace that feels right to you; don’t compare yourself to others because they have different strengths and different obstacles to navigate
Q: What is your favorite hobby or pastime?
- I really love to run, and I have since I was very young.
Q: What is one thing you cannot live without?
- Diet Mountain Dew (feel free to judge)!
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Illinois Legislators Visit Midwestern’s Downers Grove Campus
Midwestern | By Staff
October 2, 2025
Midwestern University welcomed a group of Illinois legislators and staff members to its Downers Grove Campus on September 12, 2025, for a lunch meeting and campus tour highlighting the University’s mission of educating the next generation of healthcare professionals.
The visit provided an opportunity for University leadership, faculty, and students to share how Midwestern prepares highly skilled healthcare providers and serves the community through its Multispecialty Clinic in Downers Grove. The clinic provides compassionate, accessible care to local residents while also giving students valuable hands-on training.
During their visit, legislators explored the Optometry Simulation Lab, where cutting-edge virtual reality tools are used to prepare students for real-world patient care.
Joshua Baker, O.D., M.S., President and Chief Executive Officer of Midwestern University, greeted the group, while Matthew Sweeney, CPA, CFA, Senior Vice President and Chief Financial Officer, offered insight into how recent national legislation related to student loans may affect future healthcare providers. Mr. Sweeney also shared how Midwestern is working to support its students as they prepare for healthcare careers.
During the program, legislators and staff were introduced to medical students from the Chicago College of Osteopathic Medicine, many of whom hail from Downers Grove and nearby communities. A presentation on the history of the University was followed by a tour of the state-of-the-art Optometry Simulation Lab, where guests experienced firsthand how Midwestern is using advanced technology to train tomorrow’s providers.
Among the guests were:
- State Senator Laura Ellman (21st District; Naperville)
- State Representative Terra Costa Howard (42nd District; Glen Ellyn)
- State Representative Marti Deuter (45th District; Lombard)
- State Representative Janet Yang Rohr (41st District; Naperville)
- State Representative Barbara Hernandez (50th District; Aurora)
- Staff members representing U.S. Congressman Sean Casten (6th District), U.S. Senators Tammy Duckworth and Dick Durbin
“State Representative Barbara Hernandez (50th District; Aurora) has already made a wonderful connection for us with Tri City Health Partnership in St. Charles, which will create volunteer opportunities for our students at a free medical and dental clinic,” said James MacKenzie, D.O., Director of Clinical Education Relationship Management at the Downers Grove Campus. “The visit also gave us the chance to highlight how Midwestern prepares compassionate, skilled healthcare professionals who will return to serve Illinois communities, particularly those that are underserved.”
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MEMBER BENEFIT: FREE On-Demand CE Series!
Don't forget! The IOA offers FREE On-Demand CE, as part of your membership you gain access to a variety of free continuing education courses. Courses for the 2024-2026 licensing cycle are now available on the On-Demand CE platform. ODs can take all 18 regular hours of CE online through the On-Demand CE Series.
As an Illinois licensed CE provider, all courses taken through IOA will count for an Illinois license renewal.
| | The Eyes on Tomorrow Fund, previously known as the Legislative Equity Fund, is a dedicated resource created by and for optometrists to support the Illinois Optometric Association’s (IOA) state-level advocacy efforts. This fund directly empowers optometry’s fight for scope expansion, the regulation of Vision Benefits Managers (VBMs), and other legislative battles crucial to protecting the profession and ensuring patient care. Unlike political action committees (PACs), this fund is not used to support candidates but instead provides critical resources for advancing optometry in Illinois. | | |
The PAC (Political Action Committee) is a group organized to promote its members' views on selected issues, usually through raising money that is contributed to the campaign funds of candidates who support the group's position to keep our friends in office. Now more than ever, we need strong, principled leaders who will fight for equal rights, and access to essential services —Will you pitch in today to help us protect our profession and the patients we serve?
Contributions to the IOA PAC can be made as a One-Time Donation or as Recurring Monthly Donation and deducted automatically from donor's bank account or charged to their credit card. Selecting to contribute a set amount on a monthly basis is a painless and effortless way to contribute to and support the IOA PAC. Contributions to the IOA PAC fund are not deductible for federal income tax purposes.
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We want to hear from YOU!
Do you have a business question or a dilemma we can answer for you? Others may have the same inquiry. Ask away! We will answer your question in an upcoming issue.
(Don't worry, we won't include your name.)
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Eye care practitioners should report all violations of the FCLCA, including instances in which contact lens sellers fail to comply with the prescription verification provisions of the law.
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Aetna and Humana Collaborate with AOA to Exempt Optometrists from Auto- Downcoding Edits
AOA advocacy has resulted in a first-of-its-kind organizational agreement to eliminate certain automatic downcoding programs, which have been targeting optometry practices across the country. In addition, the highly productive dialog involving the AOA and insurance giants Aetna and Humana that has been focused on optometry’s essential and expanding role in health care are continuing in an effort to build on these important medical insurance claim processing changes.
“In health care, partnerships are highly essential to solving urgent patient access, coverage and reimbursement issues, and that is the case here,” says Steven T. Reed, O.D., AOA advocacy chair and immediate past president. “Today’s favorable claim processing changes are the direct result of our joint efforts with Aetna and Humana to address concerns and progress toward a fair and mutually respected medical eye care claim processing and reimbursement system.”
Across the health care sector, physician complaints about downcoding—a payer practice of assigning a lower-cost medical service code than what was actually provided without record review—have been on the rise. Until now, downcoding complaints have been typically addressed through individual escalation efforts, including those backed by the AOA and state affiliates, through internal appeals processes and by alerting state insurance departments.
Specifically, on Aug. 24, Humana removed doctors of optometry from its “auto-downcoding” program for 99xxx codes (evaluation and management codes). No auto-downcoding program exists for CPT 92xxx codes for Humana.
As of Sept. 28, Aetna will no longer apply “auto-downcoding” to 92xxx codes for any doctor of optometry but may select “billing outliers” to retain the 99xxx downcoding program that applies to all physicians. Doctors who have claims that were auto-downcoded prior to those dates should appeal against those denials.
The AOA’s resources for appeals are available here.
In addition, Cigna has announced a new downcoding program that went into effect on Oct. 1, for level 4 and level 5 evaluation and management codes. Cigna has indicated that certain conditions were targeted, such as sore throat and earache, to identify doctors routinely billing higher-level evaluation and management codes. The AOA met with Cigna leaders to discuss the program and, based on the criteria of the program shared, it is anticipated that few doctors of optometry will be included in the Cigna downcoding program. Doctors who have claims downcoded by Cigna should appeal and also report to stopplanabuses@aoa.org immediately.
Pushback continues against ongoing downcoding practices
The AOA continues to oppose the use of any automatic downcoding systems, such as Aetna’s 99xxx downcoding program. “AOA has been working closely with Aetna for more than a year,” says Rebecca Wartman, O.D., chair of the AOA Coding & Reimbursement Committee. “We have been able to get Aetna to stop auto-downcoding the general ophthalmologic codes. However, we need more progress in getting optometrists completely removed from the auto-downcoding for the Evaluation and Management codes.”
Doctors of optometry who are impacted by any downcoding should appeal every claim, Dr. Wartman says, and report the downcoding to stopplanabuses@aoa.org. AOA’s Third-Party Center (TPC) can help you craft an appeal and will provide updated and ongoing guidance.
“With AOA assistance, the AOA TPC has been successful in getting optometrists removed from the Aetna plan on the second level of appeal,” Dr. Wartman says. “Providers should ensure that all medical records submitted for any appeal process are legible and complete and are not abbreviated in any manner.”
Appropriate and complete and comprehensive documentation is the best defense against any downcoding or post payment review audit.
Health plans are obligated to review and scrutinize claims and documentation to ensure appropriate payment under program payment integrity guidelines. Clinical documentation is the most important safeguard to being paid appropriately and keeping the money paid should retrospective audits occur in the future.
Key recommendations for top-tier documentation
Be specific and accurate: Document clinical findings in detail, including the severity, duration and impact of patient symptoms. Ensure you are signing your records as required.
Support medical necessity: Ensure your notes clearly explain why services were provided and how they relate to the patient’s condition.
Align codes with notes: Make certain that the codes selected accurately reflect the care and complexity documented in the patient’s health record.
Use consistent language: Avoid ambiguity—consistent terminology strengthens the record and reduces questions from payers.
Keep it patient-centered: Records should tell the story of the patient’s encounter, not just meet billing requirements.
Check your electronic health record (EHR): When submitting documentation with an appeal, ensure that the full documentation is pulled from your EHR and submitted.
Essential elements of a complete patient record
To ensure a patient’s medical record is properly documented, doctors of optometry should adhere to the following:
- The patient record must uniquely identify the individual with biographical information.
- The patient record must identify the name of the person providing care and the date of service.
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The patient record should contain an appropriate medical history including medications, conditions presently treated and the social determinants of health, which may impact the care of the patient.
- The chief complaint and reason for the visit should be clearly stated and expanded as needed.
- An appropriate physical examination based upon the needs of the patient should be documented.
- Laboratory and diagnostic testing that has been ordered or completed should be documented with a report.
- A diagnosis should be formulated as well as a treatment plan consistent with the diagnosis or clinical needs of the patient.
- Prescription and medication orders are clearly written and legible.
- Orders for additional testing or consultations should be properly drafted.
- Proper ICD-10 diagnosis codes and CPT procedure codes are listed, which correspond to the physical examination, testing, diagnosis and treatment plan
Key Takeaways
- Across the health care sector, physician complaints about downcoding have been on the rise.
- The AOA continues to oppose the use of any automatic downcoding systems.
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Doctors of optometry who are impacted by any downcoding should appeal every claim and report the downcoding to stopplanabuses@aoa.org.
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Resources for appeals can be found here.
- Appropriate and complete and comprehensive documentation is the best defense against any downcoding or post payment review audit.
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AOA on Capitol Hill 2025
WASHINGTON, D.C. — Nearly 600 doctors of optometry, optometry students, and affiliate leaders from across the country convened in Washington, D.C., this week for AOA on Capitol Hill 2025, the American Optometric Association’s (AOA) largest annual advocacy event. Together, they delivered a clear, unified message to federal policymakers: protect Americans’ access to essential eye health and vision care.
This three-day fly-in serves as a powerful reminder of the AOA’s leadership in federal advocacy, directly connecting optometry’s frontline providers with members of Congress to advance critical eye health priorities. During more than 280 in-person meetings with lawmakers and congressional staff, AOA advocates pushed for action on key legislation including the Dental and Optometric Care (DOC) Access Act and the Vision Lab Choice Act, to stop harmful vision benefit manager (VBM) practices that drive up costs, limit patient choice, and disrupt the doctor-patient relationship. Advocates also urged Congress to permanently fix Medicare’s broken reimbursement formula, strengthen access to vision care for veterans, and modernize federal safety standards for contact lens sales.
“This week, optometry’s voice was heard loud and clear in Washington,” said AOA President Jacquie M. Bowen, O.D. “Backed by the unmatched passion of nearly 600 advocates—including more than 230 optometry students representing every school and college—we made it clear that abusive middlemen policies, Medicare underpayment, and barriers to veterans’ care cannot be ignored any longer.”
Elevating Optometry’s Voice in Washington
AOA’s advocacy extended to the White House, where Dr. Bowen, alongside AOA leadership, met with senior presidential staff to emphasize the profession’s essential role in America’s health care system and the urgent need to eliminate barriers that limit patient access to comprehensive eye care services.
AOA also recognized champions of patient care, honoring Members of Congress, veterans’ advocates, and national consumer leaders with the 2025 AOA Health Care Leadership Awards for their efforts to preserve and expand access to quality vision care.
Inspiring the Next Generation of Advocates
A record-setting student turnout this year demonstrated the rising energy and commitment among future leaders of the profession. “By being here in Washington, we’re proactive in shaping the future of our profession and our patients’ care,” said James Chung, president of the American Optometric Student Association (AOSA).
Driving Policy Change at a Pivotal Moment
This year’s event comes at a critical time, as lawmakers increase scrutiny of middleman-dominated health care markets. With bipartisan momentum building around reforms to pharmacy and vision benefit managers, the AOA’s strong presence helped reinforce congressional support for meaningful, pro-patient policy solutions.
“From Capitol Hill to the White House, we advanced a clear, pro-patient agenda that will deliver lasting results for Americans’ eye health,” Dr. Bowen said. “Our profession’s advocates proved that when we stand together, we are a force for real change.”
The AOA extends its gratitude to the 2025 advocacy partners, including CooperVision, Vision Source, InMode, the Health Care Alliance for Patient Safety, Barti, and Vision HQ, for their generous support of this year’s AOA on Capitol Hill.
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'Guilty until proven innocent': Inside the fight between doctors and insurance companies over 'downcoding'
—Doctors say insurers are automatically downgrading their claims and paying less. Insurers say it’s their duty to prevent overbilling.
NBC News | By Kenzi Abou-Sabe
October 9, 2025
In the beginning of the year, Dr. Terry Wagner’s office manager came to him and said “something weird is going on.”
For weeks, the office manager told him, Wagner had been quietly underpaid by the insurance company Aetna on a seemingly random selection of higher level claims.
“It’s blatantly disrespectful,” said Wagner, a family medicine doctor who has run a small practice in Hudson, Ohio, for the last 28 years. “It’s not like they came back to us saying, ‘Hey, we need more information,’” he said, adding that Aetna just paid the claims as if they’d been billed for a lower level of service.
It’s a practice called “downcoding.” Insurance companies — in Wagner’s case, Aetna — automatically downgrade the claims a doctor sends them to a lower tier of reimbursement, without actually reviewing details about the visit itself.
For Wagner, that means a “level four” office visit that might yield $170 is being paid as if it’s a “level three” for about $125. That $45 difference might not seem like much, but when it’s happening on dozens of claims, and to a physician-owned practice like Wagner’s, the damage mounts. “This can really hit a small company hard, especially if you’re not catching it,” he said.
If the doctor wants to challenge the decision, they have to appeal each claim with documentation defending their medical opinion.
“Some computer program is deciding what my level of care is,” Wagner said. “If they question my level of care, then ask for my notes. Look at the tests I ordered. Look at my charts.”
It’s not just Aetna: Other insurers including Anthem Blue Cross and Blue Shield, Humana and Molina Healthcare have all acknowledged downcoding higher level claims for certain office visits, or “adjusting” as it’s sometimes called. This summer, the insurer Cigna Healthcare announced that it will begin downcoding on certain claims starting in October.
The practice of automatic downcoding seems to have taken off in the last few years, as health care costs soar and insurance companies use third party vendors and AI programs to reduce costs. NBC News spoke to doctors’ offices across numerous specialties from around the country, all of whom rely heavily on office visits — rather than surgeries and procedures — for their revenue, and all of whom are experiencing downcoding from insurers.
The problem, doctors say, is that lower and lower reimbursements mean reliable community doctors, like Wagner, could have to make choices that are inherently bad for patients, like cramming more patient visits into a single day to make up for lost revenue, dropping patients on certain insurance plans, or selling their practices altogether.
“There’s a break point and it’s like you either see more [patients] and give them less time, or you just give up. It’s exhausting,” Wagner said.
Doctors being downcoded by Aetna are told they are coding visits “at a higher level” compared to their peers. “We may adjust your payment if the details on the claim don’t support the level of service billed,” a notice reviewed by NBC News says.
A similar letter from Anthem says doctors “whose coding patterns improve and are no longer identified as an outlier are eligible to be removed from the program.”
Wagner's office estimates he lost over $3,000 to downcoding in the first half of the year, but other doctors across the country have fared far worse.
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What the Shutdown Means for Medicare, Medicaid, and Other Health Programs
CNBC | By Berkeley Lovelace Jr
October 2, 2025
Your Medicare, Medicaid or Affordable Care Act coverage won’t vanish during the government shutdown, but changes to some benefits and fewer government workers to help could still disrupt care for millions.
At the heart of the shutdown fight is whether Republican leaders accept a demand from Democrats to extend Obamacare subsidies before they expire at the end of the year and premiums start skyrocketing. Democrats also sought to undo President Donald Trump’s Medicaid cuts, but the GOP has shown no interest.
Fortunately for everyday people, core programs like Medicare and Medicaid will keep running because their funding is built into law. But a popular Medicare benefit — telehealth — has already ended for many, and so-called discretionary programs, such as Community Health Centers (CHCs), may be at risk unless Congress acts soon.
More than 167 million people — roughly half the U.S. population, according to data from the Centers for Medicare & Medicaid Services — are covered by the programs.
Here’s what the shutdown means for health care coverage:
Medicare and telehealth
One of the first casualties of the shutdown are telehealth services offered to people on Medicare. A pandemic-era rule that let Medicare patients see doctors from home — not just rural clinics — and expanded which providers were covered expired Tuesday, cutting off access to many homebound seniors. The service will remain expired unless Congress includes funding in a coming spending bill.
That means telehealth coverage will revert to pre-pandemic rules, under which it was largely limited to people living in rural areas, said Alex Cottrill, a senior policy analyst at KFF, a nonpartisan health policy research group. The policy had a few exceptions, which allowed coverage for people on home dialysis or those who experienced strokes.
More than 6.7 million older adults got care through telehealth services last year.
Joseph Furtado, a registered nurse and the president of the Arizona Association for Home Care, which advocates for telehealth, said he will continue to see patients for now, with the risk of not getting reimbursed if Congress decides not to extend funding. Other providers may not take that risk and turn patients away, he said.
“Telehealth is not a convenience thing,” he said. “This is Grandma can’t get out of the house. This is Grandma just came home from the hospital and she can’t get out to see her doctor. You don’t want to go to the doctor when you come home, and it’s dangerous sometimes to do that.”
In the near term, Medicare coverage more broadly will continue during the shutdown, meaning patients will be able to see their doctors and other health care providers — albeit most likely in person, Cottrill said.
“Because Medicare is categorized as a mandatory program, its funding doesn’t require annual approval from Congress, and Medicare-covered services will still be available during the shutdown,” he said.
Patients may have longer wait times when they call Medicare, Cottrill said, and providers might experience some delays in payments due to some agency workers’ being furloughed.
Medicaid
Coverage for people enrolled in Medicaid — which is jointly funded by states and the federal government — will also continue throughout the rest of this year and some of next year, according to CMS.
In a statement on its website, CMS said it “will have sufficient funding for Medicaid to fund the first quarter of FY [fiscal year] 2026.”
Art Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center in New York City, said it’s very likely that the agency will get additional funding by then.
It’s slim chances the shutdown “would last that long,” he said.
Coverage for the Children’s Health Insurance Program — which provides health care coverage to children and pregnant women in families that earn too much money to qualify for Medicaid — will also remain.
“CMS will maintain the staff necessary to make payments to eligible states for the Children’s Health Insurance Program (CHIP),” the agency said.
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Check out the newest IOA classifieds here!
Northern IL:
Excellent Opportunity for Optometrist, Bloomington IL (Read more)
Join Aroura Health Optometry (Read more)
Great Full-time or Part-time Associate OD Opportunity Available in Melrose Park (Read more)
American Vision Center is Seeking Full or Part Time OD (Read more)
Looking for an Optometrist to Join Team Full or Part-Time (Read more)
Optometrist Wanted at Trusted Practice (Read more)
Part-Time Opportunity at Low Vision Rehab Non-Profit (Read more)
Optometrist Needed in Algonquin & Mundelein (Read more)
Optometrist Needed in Western Chicago Suburbs (Read more)
Optometrist Needed in Glenview & Pingree Grove IL (Read more)
Central IL:
Excellent Opportunity for Optometrist, Central IL (Read more)
Optometrist Opportunity – Advanced Medical Eye Care Practice (Read more)
Gailey Eye Clinic Seeking OD in Peoria/Galesburg (Read more)
Southern IL:
Join our Team and be Part of 100 Years of Optometry Excellence (Read more)
Optometrist Needed in Southern IL & Greater STL Area (Read more)
Out of State:
Pediatric Optometrist Needed in West Des Moines, Iowa (Read more)
OD Needed in Jackson Michigan (Read more)
Join Our Dynamic and Growing Practice in Beautiful Door County, WI (Read more)
Practices for Sale:
Long-established family owned private practice in the South Chicago Suburbs (Read more)
22-Year-Old Private Practice for Sale in Oak Brook, IL (Read more)
Practice for Sale in Peoria, IL (Read more)
Equipment for Sale:
Canno RK 5 Autorefractor-Keratometer-PD-retro- illumination (Read more)
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