TakeontheChallengeofMedicalBilling - alldocsod.com · partnersofthisCoope rV is oneduc at lp g m. Enrollatlearning.coopervision.com.First-time usersneedtoregisterviathe“Don’thaveanac

A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

ALLDocsALLDocsThe

NewsletterRx Therapeutics for Practice Growth

Third Quarter2008 MeetingAgendaInside

Richard C. Malara, O.D., Clay,NY, graduated from optometryschool 16 years ago—when the

billing and coding medical insurancepart of the practice management cur-

riculum was less de-veloped. “Learningthe process in-volved with appro-priate medical cod-ing and billing hashad its challenges,but there are manypositives. Patientsappreciate thatthey’re not referred

to another provider, and they appreci-ate that we can bill their medical in-surance company directly. And thepractice benefits by being able to re-tain these patients who might other-wise leave the practice,” he says.As a result of developing the

medical model, Dr. Malara says hisrevenue is increasing. Medical pa-tients account for about 15 percent of

his patient visitsand between 20percent and 25 per-cent of the practicerevenue. “Thelion’s share of whatI do each day is re-fractions, but themedical patientsbring variety.”In fact, says

Dr. Malara, med-ical patients com-plement the refrac-tive practice.They’re often thesame patients—just seen at differ-ent times of the year. “I’m seeing mypatients on more occasions, such asduring allergy season or for ocularemergencies. I feel it has enhanced pa-tients’ perception of what we do, andthat’s a big advantage of medical cod-ing,” he says. “Optometry has beenunderutilized. I have a lot of respect

Take on the Challenge of Medical BillingO.D. tackles learning curve and practice benefits

Dr. Malara

The ALLDocs annual meeting will be held from Sunday, October19, to Thursday, October 23, at The Breakers in Palm Beach, FL.

The meeting offers many opportunities for CE and practice man-agement discussions with colleagues in the same practice setting.

The focus of this year’s meeting is on health: personal healthand wellness, the health of our patients and the health and prof-itability of our practices.

After making your hotel reservations (The Breakers can bereached at 888.273.2537), register for the meeting with ALLDocsdirectly by downloading the registration form on alldocsod.comand mailing it to Dr. Richard Hults.

Need help with travel? Call Kim Collings at 800.218.9097 oremail her at [email protected]. �

for the M.D.s, but if a patient has towait to get on an M.D.’s schedule, or ifthe family physician is prescribing anold-school solution, it behooves thepatient to come here.”Dr. Malara introducedmedical coding

into the practice about eight years ago. ItContinued on page 4

Make Recommendations

Dr. Richard Malara recommendsOPTI-FREE® RepleniSH® MPDS. “I ex-

plain, and the staff reiterates, that not allbrands are the same. Store brand formu-lations can change. OPTI-FREE RepleniSHis not sold as a store brand disinfectant.Most patients don’t know that,” he says.“It’s particularly important for siliconehydrogel lens wearers to use the ap-propriate lens/solution combination.”Based on the clinical research on corneal staining,he recommends OPTI-FREE RepleniSH MPDS. �

Last Chanceto Get in Shape

New activity pool at The Breakers

ALLDocsALLDocsThe

Newsletter2

FROM THE PRESIDENT’S DESK

Strength Training

Maintaining a healthy body takes effort. A gooddiet and exercise are part of the preventive care

required. So are visits to doctors. Maintaining a healthypractice requires similar steps. Wefeed our practices with a steady diet of new pa-tients and new practice opportunities. Using thatanalogy, I encourage everyone to make an ap-pointment for one of the most important check-upsof the year—the ALLDocs annual meeting.

This meeting represents a unique opportunityto spend relaxed time with other O.D.s who arecultivating successful practices in similar practicesettings. We hear routinely from LensCrafters

leaseholders who say they get more out an ALLDocs meeting thanthey do from any other meeting they attend.

This year’s meeting is no different. With a focus on the healthybody, we will examine the ways we can keep our patientshealthier by understanding more about the diagnosis and man-agement of ocular conditions. By expanding our focus into thesemedical conditions, we can also ensure the health of our practices.

Your ALLDocs board has also been working on other ways tohelp ALLDocs members improve their practice communications. Afterextensive negotiations, we have contracted with LogicalSolutions.netto provide web site hosting and development services for individualpractice web sites. Our estimate is that only about half of ALLDocsmembers currently maintain a practice web site. Yet as patientslook to the Internet for more health information, it’s critically impor-tant that you be there—on the web—so they can find you and un-derstand the range of services you offer.

We’ll have more information on this exciting offer for you atthe annual meeting. �

Kerry Gelb, [email protected]

Dr. Gelb

A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

O.D. DiscussesSolutions

with Patients

More information about web site optionswill be presented at the annual meeting.

Upgrade Your ImageALLDocs board develops vendor relationship

with web site hosting company

Tired of your old web site or con-fused by the process of creatingone? The ALLDocs board has con-

tracted with LogicalSolutions.net, aweb site developer with experience inthe eye care industry. Company repre-sentatives will present a session at the

annual meeting of the ease of creatinga web site and array of functionality.

Shawn Ryan, the company’sInternet consultant, says ALLDocsmembers can select from several tem-plates and color schemes for an easilycustomized look. O.D.s can upload

photos or logos, or the system willwalk a user through the creation of abasic logo.Some pages available to ALLDocs

members will have material providedby the O.D. directly, and some in-formation will be provided by theALLDocs network or from other eyehealth resources.The web sites can include map

locators, contact lens reordering, aswell as online appointment schedul-ing or requests for appointments. Forpractices already using the Lens-Crafters online scheduling, the newweb sites can link to that.Alcon and CooperVision are spon-

soring the service, significantly lower-ing the cost for individual O.D.s. �

Dr. Bill Fox, with four Lens-Crafters leases in North Caroli-na, is featured in the fall issue of

Contact Lens Profit Advisor. Dr. Fox says,“I’ve changed my philosophy in thepast few years. I used to not worryabout solutions, but I realize now thatthey do make a difference.” He nowrecommends OPTI-FREE® RepleniSH®

MPDS, telling patients, “Stay on thissolution.” He also appreciates that thebox reminds patients to see their doc-tor yearly for healthy vision. �

3ALLDocsALLDocsThe

Newsletter

By Tom Nicholson

CooperVision has a reputation for establishing ex-cellent business relationships with O.D.s and

continues that effort by offering two new, free edu-cational resources for your practice.

CooperVision TV (coopervision.tv) has six in-structional videos that patients can watch at homeor in the office. The videos cover insertion and re-moval tips, wear and care of contact lenses, as wellas the advantages of technology such as Biofinity®,Proclear® and multifocal lenses.

The CooperVision Online Learning Center pro-vides high-quality contact lens training and support.Classes support new product introductions, covermaterial technology and address topics through 23courses organized into seven tracks:

� New to Eye Care—seven courses designedfor staff training on optics, ocular anatomy, instru-mentation and more

� Contact Lens Fundamentals—five courses ap-propriate for staff, whether or not they fit contacts

� Intermediate Contact Lens—five courses ap-propriate for fitters and trained office support staff

� Advanced Soft ContactLens Studies—five applied sciencecourses for the professional

� Multifocal Technology—fourcourses on advanced contact lenstechnology for correcting presbyopia

� Material Technology—fourcourses on the technologies behindCooperVision’s Aquaform and PC Hydrogel lens materials

� Toric Technology—three courses on the ba-sics of fitting soft toric lenses

Courses within each curriculum can be taken atany time and in any order, and when staff memberscomplete a track, they receive a framed certificate. TheCooperVision Online Learning Center also links to accred-ited prepaid courses from the Contact Lens Society ofAmerica and the American Optometric Association,partners of this CooperVision educational program.

Enroll at learning.coopervision.com. First-timeusers need to register via the “Don’t have an ac-count?” button. If you have problems registering,contact Jennifer Knab, CooperVision’s web supportat 800.341.2020 ext. 3515 or via email [email protected]. �

GUEST COLUMN FROM COOPERVISION

Tom Nicholson

Eyes on HealthMeeting to focus on health, practice growth

This is a tentative schedule for theannual meeting to be held at TheBreakers in Palm Beach, FL. This

agenda is subject to change, and up-dates will be posted on alldocsod.com.

Sunday, October 19th� Lunch and golf at The BreakersGolf Course� Evening welcome reception

Monday, October 20th�Welcome and presentations by GoldSponsors, Alcon and CooperVision� CE sessions, including two hours onthe Healthy Body by Steven Newman,O.D., followed by a session on ARMDby Jerry Sherman, O.D.

� Afternoon CE session oncorneal microscopy byMichael Burton, O.D.� Vendor presentation� Focus groups� Ragtops off-site dinner event

Tuesday, October 21st� Vendor presentation on Internetcontact lens business� Vendor presentations� Jack McIntyre, O.D., presentsBulletproof Your Contact Lens Busi-ness on practice management� EMR lunch, moderated byMichael Sherman� Second golfing event� Vendor fair

Wednesday, October 22nd� Vendor presentations� Gabe Mirkin, M.D., speaks onHealth Update Diabetes/CVA� Charles Brownlow, O.D., presentstwo-hour session on Medical Billingand Coding, sponsored by Alcon� Vendor fair� Gala evening event at The Breakers

Thursday, October 23rd� Business meeting, followed bypractice management CE with GaryGerber, O.D.� LensCrafters presentation �

Online Resources for O.D.s, Staff and Patients

The Breakers

that you perform on a patient. Ifyou fail to meet this standard, thatpayment you received for the partic-ular service/procedure is at risk.

Secondly, some services are tobe performed together. Breakingthem apart to gain a higher reim-bursement is verboten. Make surethat you adhere every day to the CPT guidelines,the CCI guidelines and the rules of your local carri-ers. These rules and guidelines change constantly,so you must stay on top of these issues to ensurecompliance of your practice.

The third area, one where O.D.s need to be vigilantand careful, is in only having a covered diagnosis for aprocedure. Having a covered diagnosis solely is notenough to pass muster on an audit. I have seen manyO.D.s who manufacture a diagnosis just to get a servicecovered. Let me be clear. Don’t do that. According to theICD-9 guidelines, you cannot use the patient’s chiefcomplaint or symptom as the diagnosis when youknow the cause of that chief complaint or symptom.

Simply stated, just because you submit a claim and itgets paid does not mean that you submitted the claimproperly. Carriers do not audit on a claim-by-claim basis,but they recover their money on post-payment reviews.

There are many resources to help keep you up-dated. The ReimbursementPLUS suite (Reimburse-mentPLUS.com), which contains the local carrier poli-cies, the CCI guidelines, CPT code properties, and allCPT and ICD-9 manuals all in one online resource, isone such source. Tools like these are invaluable be-cause they can help you stay profitable and, moreimportantly, safe in the knowledge that your claimsare being filed correctly…the first time. �

The High Cost of Complacency

IMPLEMENTING THE TOTAL PATIENT CARE MODEL

Dr. Rumpakis

ALLDocsALLDocsThe

Newsletter4

Supported by an unrestricted educational grant from Alcon Laboratories

By John Rumpakis, O.D., M.B.A.

“New Report Shows CMS Pilot Program SavingNearly $700 Million in Improper Medicare

Payments” screams the headline. There’s a temptationto read it casually and think it doesn’t apply to yourpractice. If you think you’re not at risk for an auditbecause optometry is small potatoes, you’re wrong;that kind of complacency is a dangerous thing.

Getting paid for an improperly filed claim oftencreates a false sense of confidence. Payment doesn’tnecessarily mean CMS determined the accuracy ofthat particular claim or that it cannot be reviewedagain. So don’t develop a false sense of confidence;be vigilant continually for proper coding, using allof the resources available to you.

I have identified five common billing errors thatO.D.s commit every day, so you can double-checkyour billing practices.

The Top Five Mistakes O.D.s Make1. Failing to establish medical necessity2. Unbundling services3. Billing for non-covered services4. Filing duplicate claims5. Filing claims with incomplete or invalid

group number

In this section, I’ll address the top three.Failing to establish medical necessity properly in

the medical record is far and away one of the biggestissues O.D.s face. There is a very specific definition ofmedical necessity (available at medicare.gov) that mustbe met for each and every examination/procedure

is continuing to pick up momentum—especially in glaucoma management—now that he has added more diagnosticinstrumentation, including a visual fieldanalyzer and laser scanner. He antici-pates a quick return on the investmentas he gains more glaucoma patients.Letting patients know what servic-

es he can provide “starts in the exam

Medical BillingContinued from page 1

room,” he says. “At the first visit, I ex-plain to patients what is within myability and legal scope of practice. TheAmerican Optometric Association’sStatement of Practice, which definesour abilities to treat and manage ocu-lar disease, is posted in the office.”Dr. Malara notes that incorporat-

ing medical billing doesn’t require alarge financial investment. “Ocular al-lergies, dry eyes and most eye infec-tions are easy places to start. Op-

tometrists are already treating thoseconditions, and the coding is relativelysimple. Plus, Alcon has developed ef-fective products for those conditions. Iuse TRAVATAN® and TRAVATAN Z® so-lutions for my patients with elevatedIOP, VIGAMOX® solution for bacterialconjunctivitis, SYSTANE® LubricantEye Drops for dry eyes and PATANOL®

and PATADAY™ Ophthalmic Solutionsas my drops of choice for ocular aller-gy patients.” �