Office Polices and Procedures Dr. Lynn Hammonds EyeCare Associates, Inc. Hoover, Alabama [email protected]
Mar 31, 2015
Office Policesand Procedures
Dr. Lynn Hammonds
EyeCare Associates, Inc.
Hoover, Alabama
PRACTICE SETTINGS
• Solo Practice
• Associate - Individual or Group Practice
• Corporate Affiliate
• Referral Center
• Veterans Administration
• Academia
WHY HAVE OFFICE POLICIES AND PROCEDURES?
• AVOIDS CONFUSION
• TO COMPLY WITH FEDERAL AND STATE LAWS
• REDUCES LIKELIHOOD OF LITIGATION
Things To Remember
• IF IT IS IMPORTANT – Write it down
• BE CONSISTENT
• BE OPEN TO CHANGE WHEN NEEDED
THE EMPLOYEE
EMPLOYEE RELATED POLICIES
• Employee Handbook
• Employee Training – Introductory Period
• Office Meetings
• Documentation
The Employee Handbook
• Purpose – Mission Statement
• Employee Benefits
• Personnel Policies and Regulations
• Operation Policies and Regulations
THE EMPLOYEE
• Employee Job Descriptions
• Employee Evaluations
• Employee Compensation
• Employee Warnings and Termination
Office Policies not Addressed in Employee Handbook
WHEN IN DOUBT
SEEK LEGAL ADVISE FROM A PROFESSIONAL!
Patient ManagementPolicies and Procedures
• Dictated by Federal Law
• Dictated by State Law
• Dictated by Third Party Carriers
• Dictated by Surgeon
• Determined by Experience
PATIENT SERVICES
SCHEDULING PATIENTS
SCHEDULE TEMPLATE
LAST NEW PATIENT – MORNING
LAST NEW PATIENT –AFTERNOON
WHEN TO DOUBLE BOOK
HOW TO BOOK EMERGENCY PATIENTS
Administrative Code- Alabama Law
• 630-X-12-.08 Emergency Services Outside of
Normal Practice Hours.
The optometrist shall have an established and appropriate procedure for the provision of services to patients in the event of an emergency outside of the normal practice hours, or when the licensee is not available due to vacation, illness, attendance at professional meetings or continuing education programs, or other absences of a similar nature.
Emergency Services Outside of Normal Practice Hours
• The procedure referred to herein may include, but is not limited to, cooperative arrangements with another licensed optometrist or licensed physician, a telephone answering system or pager through which the patient can obtain access to services, or written instructions to patients setting out how reasonable access to services may be obtained.
CELL PHONES
PATIENTS LATE FOR THEIR APPOINTMENT
or
DOCTOR RUNNING LATE
HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT (HIPAA)
• Enacted by the US Congress in 1996 - Protection of confidentiality and security of health data through setting and enforcing standards.
POLICIES REGARDING FEES
• ALL PROFESSIONAL FEES MUST BE PAID AT TIME OF SERVICE
• ALL CONTACT LENSES MUST BE PAID IN FULL BEFORE DISPENSING
• HALF MUST BE PAID BEFORE GLASSES ARE ORDERED
• FULL AMOUNT PAID BEFORE GLASSES ARE DISPENSED
DETERMINING IF FEES WILL BE REIMBURSED BY
INSURANCE
INSURANCE MANUAL
CASH PAYMENTS
• GIVE PATIENT A RECEIPT SHOWING PAYMENT OF CASH
• MAKE COPY OF RECEIPT AND PUT IN PATIENT FILE
• RANDOM AUDIT OF CASH DRAWER
PATIENT REFUNDS
• Who has the authority to approve a patient refund?
• When to give the patient’s money back.
CLINICAL SERVICES
HARD COPY FILES OR ELECTORNIC MEDICAL
RECORDS
EXAM FORMS
CHART DOCUMENTATION
• BLACK INK
• ADDITIONS/CORRECTIONS
• WRITING LEGIBLY
• ADEQUATE HISTORY
• OBJECTIVE FINDINGS
WHAT ARE THE MINIMUM TESTING REQUIREMENTS FOR A COMPREHENSIVE
EXAM IN ALABAMA?
Administrative Code- Alabama Law
630-X-12-.06 Failure to Meet Standard of Care
Minimum Testing for a Comprehensive Eye Exam
• Case History• Determination of Refractive Error• Binocular Vision Evaluation • Ophthalmoscopy• Evaluation of Health of External Eye & Adjacent Structures• Tonometry or Other Appropriate Glaucoma Testing• Other Test Necessary under the Circumstances
INSURANCE REIMBURSEMENT
Documentation is the Basis for all Coding
• Claims are transmitted to insurance companies with codes that reflect professional services rendered to patients
– These codes consist of• E/M codes to document and support charges
submitted• CPT codes to delineate charges and to further
document services, and,• ICD codes to specify the diagnosis
CPT and HCPCS Codes
• Current Procedural Terminology - CPT• Healthcare Common Procedure Coding System -
HCPCS
• Developed by the American Medical Association and Centers for Medicare and Medicaid Services
• Numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services.
• Insurance companies use procedure codes to determine the amount of reimbursement that a practitioner will receive by an insurer.
Evaluation and Management (E&M) Coding
• 1995 Guidelines issued by the AMA and the Centers for Medicare and Medicaid Services (CMS)
• Information in the record must substantiate coding or payment is denied or reduced
• If it isn’t in the record, it didn’t happen
CPT CODES
• 92XXX
• 99XXX
• 6XXXX
• 7XXXX
GLAUCOMA PATIENTS
• Comprehensive Exam - 92004 or 92014 every year
• IOPS - 99213 - every 3-4 months• VISUAL FIELDS - 92083 - every year• DIGITAL IMAGING - 92135 - every year• FUNDUS PHOTOS - 92250 - every year• PACHYMETRY - 76514 - once • GONIOSCOPY - 92020 - every 1 to 2 years• Serial Tonometry - 92100 -
CATARACT PATIENTS
INTRAOCULAR IMPLANT OPTIONS
POST OPERATIVE CARE
YAG CAPSULOTOMY
REFRACTIVE SURGERY PATIENTS
PRE-OPERATIVE VISITS
POST-OPERATIVE VISITS
DIABETIC PATIENTS
Report Findings to Primary Care Physicians
• One-time no-cost public health program provides eye care for infants
─for babies 6-12 months of age
─complements pediatrician well-baby vision screenings
no cost regardless of income
Contact Lens Fitting Policies and Procedures
Contact Lens Fitting Fees
• Global Fees vs. Per Visit Fees
• Minors
• Unsuccessful Patients
Procedures for Contact Lens Insertion and Removal Training
• PATIENTS MUST BE ABLE TO INSERT AND REMOVE CONTACT LENSES BEFORE THEY ARE ALLOWED TO LEAVE OFFICE WITH THE LENSES
• CARE AND WEARING SCHEDULE FORMS
PATIENT FOLLOW-UP
• CONTACT LENS FOLLOW-UP VISIT MADE FOR 1-2 WEEKS AFTER INSERTION AND REMOVAL TRAINING
• TECHNICIAN THAT DID CONTACT LENS TRAINING CALLS PATIENTS 1-2 DAYS AFTER TRAINING TO ANSWER ANY QUESTIONS THEY MAY HAVE
FAIRNESS TO CONTACT LENS CONSUMERS ACT - 2004
Act Requires that contact lens prescribers provide patients with a copy of their contact lens prescriptions after a contact lens fitting and verify prescriptions to any third party designated by a patient, such as an online seller.
DRUG PRESCRIPTIONS
PRESCRIPTIONS FOR MEDICATION
• DOCTOR SIGNATURE REQUIRED ON ANY Rx FOR PRESCRIPTION DRUGS
• DOCTOR APPROVAL FOR ANY Rx CALLED INTO THE PHARMACIST FOR PATIENT
E-PRESCRIBE
PQRI – PHYSICIAN QUALITY REPORTING INITIATIVE –
EARN 2% OF TOTAL ALLOWED CHARGES in 2010
MEDICAID PRESCRIPTIONS
• The US Troop Readiness, Veterans’ Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007
• Act contains a provision that requires all written Rxs for Medicaid patients to be written on “tamper-resistant” Rx pads.
OSHA STANDARDS
• PROPER STERILIZATION OF EQUIPMENT
• TONOMETER PROBE CLEANING
• PROPER DISPOSAL OF NEEDLES
• Employee Accidents
PATIENT RECORDS
• 630-x-12.03 Release of Patient Records.
• ….The board shall deem it unprofessional conduct for a licensee to fail to maintain, in his or her possession, all records pertaining to a patient for a period of not less than seven years from the date of the last service provided to that patient.
RECORD RELEASE FORM SIGNED BY PATIENT FOR RELEASE OF RECORDS
Optical Services
PRESCRIPTION RELEASE RULE
• EYEGLASSES 1 – 1980
• Federal Trade Commission Rule requiring eye doctors to give patient a copy of the glasses prescription immediately after an eye exam that includes a refraction
WARRANTIES
• FRAMES
• ANTI-REFLECTIVE COATINGS
• SCRATCH COATINGS
MEDICARE FEES NOT COVERED BY INSURANCE
• PATIENTS MUST BE INFORMED THAT THE SERVICE IS NOT COVERED BY MEDICARE
• PATIENTS MUST SIGN A FORM STATING THAT THEY ARE LIABLE FOR THE AMOUNT NOT COVERED BY MEDICARE
SPECIAL OPTICAL SITUATIONS
• PUTTING NEW GLASSES PRESCRIPTION INTO PATIENT’S OLD FRAME
• USING LENSOMETER READINGS OF OLD Rx TO DETERMINE GLASSES Rx TO BE USED IN NEW FRAME
• PATIENTS ORDERING GLASSES OVER THE INTERNET
PATIENT ACCOUNTS
ACCOUNT RECEIVABLES
• When to send bill to patient.
• When to send to collections.
• When to write off as bad debt.
UNHAPPY PATIENTS
• WHEN TO GET DOCTOR INVOLVED
• EMPOWERING STAFF
QUALITY CONTROL
• Chart Auditing
• Account Auditing
• Auditing Petty Cash
• Managing Contact Lens and Frame Inventory
WHAT IF?
Protocol for Office Emergencies
Protecting Yourself and Your Future
• Membership in the AOA
• Membership in your State Optometry Association
• Membership in your Local Optometry Group
• Membership in the UABSO Alumni Association