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Office Polices and Procedures

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Presentation on theme: "Office Polices and Procedures"— Presentation transcript:

1 Office Polices and Procedures
Dr. Lynn Hammonds EyeCare Associates, Inc. Hoover, Alabama

2 PRACTICE SETTINGS Solo Practice
Associate - Individual or Group Practice Corporate Affiliate Referral Center Veterans Administration Academia

3 WHY HAVE OFFICE POLICIES AND PROCEDURES?
AVOIDS CONFUSION TO COMPLY WITH FEDERAL AND STATE LAWS REDUCES LIKELIHOOD OF LITIGATION

4 Things To Remember IF IT IS IMPORTANT – Write it down BE CONSISTENT
BE OPEN TO CHANGE WHEN NEEDED

5 THE EMPLOYEE

6 EMPLOYEE RELATED POLICIES
Employee Handbook Employee Training – Introductory Period Office Meetings Documentation

7 The Employee Handbook Purpose – Mission Statement Employee Benefits
Personnel Policies and Regulations Operation Policies and Regulations

8 THE EMPLOYEE Employee Job Descriptions Employee Evaluations
Employee Compensation Employee Warnings and Termination

9 Office Policies not Addressed in Employee Handbook

10 WHEN IN DOUBT SEEK LEGAL ADVISE FROM A PROFESSIONAL!

11 Patient Management Policies and Procedures
Dictated by Federal Law Dictated by State Law Dictated by Third Party Carriers Dictated by Surgeon Determined by Experience Patient Management Policies and Procedures

12 PATIENT SERVICES

13 SCHEDULING PATIENTS SCHEDULE TEMPLATE LAST NEW PATIENT – MORNING
LAST NEW PATIENT –AFTERNOON WHEN TO DOUBLE BOOK HOW TO BOOK EMERGENCY PATIENTS

14 Administrative Code- Alabama Law
630-X 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.

15 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.

16 CELL PHONES

17 PATIENTS LATE FOR THEIR APPOINTMENT
DOCTOR RUNNING LATE

18 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Enacted by the US Congress in Protection of confidentiality and security of health data through setting and enforcing standards.

19 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

20 DETERMINING IF FEES WILL BE REIMBURSED BY INSURANCE
INSURANCE MANUAL

21 CASH PAYMENTS GIVE PATIENT A RECEIPT SHOWING PAYMENT OF CASH
MAKE COPY OF RECEIPT AND PUT IN PATIENT FILE RANDOM AUDIT OF CASH DRAWER

22 PATIENT REFUNDS Who has the authority to approve a patient refund?
When to give the patient’s money back.

23 CLINICAL SERVICES

24 HARD COPY FILES OR ELECTORNIC MEDICAL RECORDS

25 EXAM FORMS

26 CHART DOCUMENTATION BLACK INK ADDITIONS/CORRECTIONS WRITING LEGIBLY
ADEQUATE HISTORY OBJECTIVE FINDINGS

27 WHAT ARE THE MINIMUM TESTING REQUIREMENTS FOR A COMPREHENSIVE EXAM IN ALABAMA?

28 Administrative Code- Alabama Law
630-X 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

29 INSURANCE REIMBURSEMENT
Documentation is the Basis for all Coding

30 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

31 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.

32 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

33 CPT CODES 92XXX 99XXX 6XXXX 7XXXX

34 GLAUCOMA PATIENTS Comprehensive Exam - 92004 or 92014 every year
IOPS every 3-4 months VISUAL FIELDS every year DIGITAL IMAGING every year FUNDUS PHOTOS every year PACHYMETRY once GONIOSCOPY every 1 to 2 years Serial Tonometry

35 INTRAOCULAR IMPLANT OPTIONS POST OPERATIVE CARE YAG CAPSULOTOMY
CATARACT PATIENTS INTRAOCULAR IMPLANT OPTIONS POST OPERATIVE CARE YAG CAPSULOTOMY

36 REFRACTIVE SURGERY PATIENTS
PRE-OPERATIVE VISITS POST-OPERATIVE VISITS

37 Report Findings to Primary Care Physicians
DIABETIC PATIENTS Report Findings to Primary Care Physicians

38 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

39 Contact Lens Fitting Policies and Procedures

40 Contact Lens Fitting Fees
Global Fees vs. Per Visit Fees Minors Unsuccessful Patients

41 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

42 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

43 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.

44 DRUG PRESCRIPTIONS

45 PRESCRIPTIONS FOR MEDICATION
DOCTOR SIGNATURE REQUIRED ON ANY Rx FOR PRESCRIPTION DRUGS DOCTOR APPROVAL FOR ANY Rx CALLED INTO THE PHARMACIST FOR PATIENT

46 E-PRESCRIBE PQRI – PHYSICIAN QUALITY REPORTING INITIATIVE – EARN 2% OF TOTAL ALLOWED CHARGES in 2010

47 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.

48 OSHA STANDARDS PROPER STERILIZATION OF EQUIPMENT
TONOMETER PROBE CLEANING PROPER DISPOSAL OF NEEDLES Employee Accidents

49 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.

50 RECORD RELEASE FORM SIGNED BY PATIENT FOR RELEASE OF RECORDS

51 Optical Services

52 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

53 WARRANTIES FRAMES ANTI-REFLECTIVE COATINGS SCRATCH COATINGS

54 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

55 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

56 PATIENT ACCOUNTS

57 ACCOUNT RECEIVABLES When to send bill to patient.
When to send to collections. When to write off as bad debt.

58 UNHAPPY PATIENTS WHEN TO GET DOCTOR INVOLVED EMPOWERING STAFF

59 QUALITY CONTROL Chart Auditing Account Auditing Auditing Petty Cash
Managing Contact Lens and Frame Inventory

60 Protocol for Office Emergencies
WHAT IF? Protocol for Office Emergencies

61 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


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