9Office Policies not Addressed in Employee Handbook
10WHEN IN DOUBT SEEK LEGAL ADVISE FROM A PROFESSIONAL!
11Patient Management Policies and Procedures Dictated by Federal LawDictated by State LawDictated by Third Party CarriersDictated by SurgeonDetermined by ExperiencePatient Management Policies and Procedures
13SCHEDULING PATIENTS SCHEDULE TEMPLATE LAST NEW PATIENT – MORNING LAST NEW PATIENT –AFTERNOONWHEN TO DOUBLE BOOKHOW TO BOOK EMERGENCY PATIENTS
14Administrative Code- Alabama Law 630-X Emergency Services Outside ofNormal 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.
15Emergency 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.
17PATIENTS LATE FOR THEIR APPOINTMENT DOCTOR RUNNING LATE
18HEALTH 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.
19POLICIES REGARDING FEES ALL PROFESSIONAL FEES MUST BE PAID AT TIME OF SERVICEALL CONTACT LENSES MUST BE PAID IN FULL BEFORE DISPENSINGHALF MUST BE PAID BEFORE GLASSES ARE ORDEREDFULL AMOUNT PAID BEFORE GLASSES ARE DISPENSED
20DETERMINING IF FEES WILL BE REIMBURSED BY INSURANCE INSURANCE MANUAL
21CASH PAYMENTS GIVE PATIENT A RECEIPT SHOWING PAYMENT OF CASH MAKE COPY OF RECEIPT AND PUT IN PATIENT FILERANDOM AUDIT OF CASH DRAWER
22PATIENT REFUNDS Who has the authority to approve a patient refund? When to give the patient’s money back.
26CHART DOCUMENTATION BLACK INK ADDITIONS/CORRECTIONS WRITING LEGIBLY ADEQUATE HISTORYOBJECTIVE FINDINGS
27WHAT ARE THE MINIMUM TESTING REQUIREMENTS FOR A COMPREHENSIVE EXAM IN ALABAMA?
28Administrative Code- Alabama Law 630-X Failure to Meet Standard of CareMinimum Testing for a Comprehensive Eye ExamCase HistoryDetermination of Refractive ErrorBinocular Vision EvaluationOphthalmoscopyEvaluation of Health of External Eye & Adjacent StructuresTonometry or Other Appropriate Glaucoma TestingOther Test Necessary under the Circumstances
29INSURANCE REIMBURSEMENT Documentation is the Basis for all Coding
30Claims are transmitted to insurance companies with codes that reflect professional services rendered to patientsThese codes consist ofE/M codes to document and support charges submittedCPT codes to delineate charges and to further document services, and,ICD codes to specify the diagnosis
31CPT and HCPCS Codes Current Procedural Terminology - CPT Healthcare Common Procedure Coding System - HCPCSDeveloped by the American Medical Association and Centers for Medicare and Medicaid ServicesNumbers 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.
32Evaluation 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 reducedIf it isn’t in the record, it didn’t happen
34GLAUCOMA PATIENTS Comprehensive Exam - 92004 or 92014 every year IOPS every 3-4 monthsVISUAL FIELDS every yearDIGITAL IMAGING every yearFUNDUS PHOTOS every yearPACHYMETRY onceGONIOSCOPY every 1 to 2 yearsSerial Tonometry
35INTRAOCULAR IMPLANT OPTIONS POST OPERATIVE CARE YAG CAPSULOTOMY CATARACT PATIENTSINTRAOCULAR IMPLANT OPTIONSPOST OPERATIVE CAREYAG CAPSULOTOMY
36REFRACTIVE SURGERY PATIENTS PRE-OPERATIVE VISITSPOST-OPERATIVE VISITS
37Report Findings to Primary Care Physicians DIABETIC PATIENTSReport Findings to Primary Care Physicians
38One-time no-cost public health program provides eye care for infants for babies 6-12 months of agecomplements pediatrician well-baby vision screeningsno cost regardless of income
40Contact Lens Fitting Fees Global Fees vs. Per Visit FeesMinorsUnsuccessful Patients
41Procedures 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 LENSESCARE AND WEARING SCHEDULE FORMS
42PATIENT FOLLOW-UPCONTACT LENS FOLLOW-UP VISIT MADE FOR 1-2 WEEKS AFTER INSERTION AND REMOVAL TRAININGTECHNICIAN THAT DID CONTACT LENS TRAINING CALLS PATIENTS 1-2 DAYS AFTER TRAINING TO ANSWER ANY QUESTIONS THEY MAY HAVE
43FAIRNESS 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.
45PRESCRIPTIONS FOR MEDICATION DOCTOR SIGNATURE REQUIRED ON ANY Rx FOR PRESCRIPTION DRUGSDOCTOR APPROVAL FOR ANY Rx CALLED INTO THE PHARMACIST FOR PATIENT
46E-PRESCRIBE PQRI – PHYSICIAN QUALITY REPORTING INITIATIVE – EARN 2% OF TOTAL ALLOWED CHARGES in 2010
47MEDICAID PRESCRIPTIONS The US Troop Readiness, Veterans’ Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007Act contains a provision that requires all written Rxs for Medicaid patients to be written on “tamper-resistant” Rx pads.
48OSHA STANDARDS PROPER STERILIZATION OF EQUIPMENT TONOMETER PROBE CLEANINGPROPER DISPOSAL OF NEEDLESEmployee Accidents
49PATIENT 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.
50RECORD RELEASE FORM SIGNED BY PATIENT FOR RELEASE OF RECORDS
52PRESCRIPTION RELEASE RULE EYEGLASSES 1 – 1980Federal Trade Commission Rule requiring eye doctors to give patient a copy of the glasses prescription immediately after an eye exam that includes a refraction
54MEDICARE FEES NOT COVERED BY INSURANCE PATIENTS MUST BE INFORMED THAT THE SERVICE IS NOT COVERED BY MEDICAREPATIENTS MUST SIGN A FORM STATING THAT THEY ARE LIABLE FOR THE AMOUNT NOT COVERED BY MEDICARE
55SPECIAL OPTICAL SITUATIONS PUTTING NEW GLASSES PRESCRIPTION INTO PATIENT’S OLD FRAMEUSING LENSOMETER READINGS OF OLD Rx TO DETERMINE GLASSES Rx TO BE USED IN NEW FRAMEPATIENTS ORDERING GLASSES OVER THE INTERNET