Paying Attention to Detail In Your Practice
Allan Barker, O.D., President
Eye Care Center
Paying attention to details is an important criterion for the delivery of quality eye care. A minute pigmentation of the retina can be differentiated by such a seemingly small detail as its appearance or disappearance under a red free filter during a photo documentation procedure. The differential diagnosis of a mucin ball versus a corneal ulcer can determine the success or failure of a silicon hydrogel extended wear candidate.
In business detail is also important, especially in the highly competitive, shrinking margin industry of eye care delivery. In our own large multi-disciplinary, multi-location eye care delivery system you can often distinguish between a highly successful and a marginal practice on details. One very important detail involves proper coding. Is a practice under coding or over coding? Based on my experience of having once served on the credentialing panel of a top 10 managed eye care company, optometrists are notorious under coders. Over coding is just plain wrong. However so is under coding. Why short change ourselves? It is quite simple; bill for what you do. If you do a comprehensive eye exam, bill for it. Most optometric eye examinations fulfill the criteria established by Medicare to qualify as "comprehensive". Yet, while an average optometric practice performs approximately 80% comprehensive and 20% intermediate examinations, we found outlyers within our own organization when we paid attention to detail. While many practices were billing and performing 4 of 5 examinations as comprehensive, we found one practice billing 1 of 3 examinations as comprehensive. What is worse is that the doctor billing for 1 of 3 exams as comprehensive was actually performing 4 of 5 examinations that qualified as comprehensive. The first question that comes to mind is obvious. Why? Were the doctors suffering from paranoia, fearing a life sentence in a maximum security facility with a psychotic cell mate? Is this the punishment for incorrect coding? Do they drive 30 miles per hour on the Interstate to avoid speeding? Like the example of driving 30 miles on the Interstate, which is illegal, under coding has its problems. When an insurance carrier does a review of a provider and finds that, for example, only 1 of 3 exams being delivered is comprehensive, they question the competence of the doctor and practice. They don't say, boy this doctor is great. He or she is blowing away our actuarial data and making us a ton of money. No! They are saying this provider is delivering inadequate care to our patients. Let's not recredential them or let's decredential them. The proper coding of eye examinations is a great place to start paying attention to detail in your practice. If, for example, an associate is billing 20% to 30% examinations as comprehensive and you know the average practice is doing 75% to 85% comprehensive, maybe it's time to re-evaluate what the associate is doing. Once you get your eye exams correct, you can expand your evaluation to include other areas of coding as well. Bill for what you do. Without getting into the debate of what constitutes a "comprehensive" eye examination, which can vary from State to State and insurance carrier to insurance carrier, let me suffice by simply stating that if you do the following elements you are performing a comprehensive eye exam. 1
- History
- General medical observation
- External and ophthalmoscopic examination
- Gross visual fields
- Basic sensorimotor examination
- Diagnosis and treatment
- Biomicroscopy, examination with cycloplegia or mydriasis and tonometry as indicated
A third attention to detail involves proper contact lens billing. In our practices, we have concentrated our margin increase toward our professional fees and away from materials. If you have not done this yet, you may be practicing in the previous millennium. There are two aspects of a contact lens procedure, fitting and evaluation, as defined by the American Medical Association CPT Manual. The manual describes code S0592 as a comprehensive contact lens evaluation and can be used to report the determination of suitability for contact lens candidacy, measuring K's, determining power and evaluating the fit of a contact lens. A separate code 92310 represents the prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation, and it can be used to report the service of determining the brand, base curve, and diameter of contact lens and providing insertion and removal training, if necessary. It might be reported only for new fits or re-fits with substantial change in lens modality and priced based on the complexity of fit and lens modality. Yet, if you are not paying attention to detail, you may be leaving out one of these areas in your billing procedure. In questioning doctors who short change themselves in this area I ask, how can you "fit" a lens on a patient without "evaluating" it? How can you "evaluate" a lens without "fitting" it? The AMA's CPT recognizes that both fitting and evaluation can be necessary and provides codes to report the services. By not charging for both a "fitting" and an "evaluation" you might be short changing yourself. If you and/or an associate are not doing both procedures you may be short changing the patient.
A fourth and final area of paying attention to detail involves the ophthalmic dispensary. 35% to 40% of multifocals dispensed in the U.S. are still straight tops. In successful optometry practices that number is 10% to 20%. We must give our patients the newest and the best to differentiate ourselves from the pack. That means 80% to 90% of the multifocals leaving your office should be progressive. You should also be tracking the percentage of polarized lenses leaving your dispensary as well as polycarbonates and anti-reflective coatings. Also, you should track the average dollars collected from eyewear leaving your dispensary. Those per patient statistics will teach you much about your practice and are all integral parts of the paying attention to detail process. Our own investigation has revealed an alarming deficiency of knowledge by optometrists in ophthalmic lens design. Doctors know all about contact lenses and treatment which are very important to our patient care. But what about lenses? We need to be more aware of what is available to our patients in the area of ophthalmic lens fabrication. We also need to not be afraid to make recommendations to patients that will make our prescriptions more optically effective. Isn't that what the patient depends on us to do?
Certainly, the four areas mentioned are only part of the process. This is a great place to start. First, perform and bill for comprehensive eye exams. Second, utilize and correctly charge for the instrumentation you have in your practice. Third, concentrate on contact lens professional fees to include both "fitting" and "evaluation." Finally, track your dispensary and learn about and then recommend for you patients the newest and best ophthalmic lenses available to hold your prescription. The more detail you know about your practice, the better you can thrive in today's competitive eye care environment. You wouldn't do a contact lens evaluation without a biomicroscope to help with the details. You shouldn't attempt to run your practice without looking at the details, as well.
Allan Barker, O.D. is President of Eye Care Center, with multiple offices in North Carolina . He can be contacted by eMail at abarker@EyeCareCenter.com.
Feature Articles Archives
- Optometric Practice Appraisals
- Transitioning
from Student to Doctor/Manager
- Developing
a Financial Strategy for your Practice
- Part
I: Why Rural Optometry?
- Part
II: What Not to do in a Rural Practice
- Paying
Attention to Detail In Your Practice by Allan Barker, O.D., President,
Eye Care Center
- Re-Think, Re-Tool, & Re-Engineer by Donna Suter, Suter Consulting Group
