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Excellence in Optometric Education John A. McGreal Jr., O.D. Missouri Eye Associates McGreal Educational Institute Understanding Medicare Guidelines -

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Presentation on theme: "Excellence in Optometric Education John A. McGreal Jr., O.D. Missouri Eye Associates McGreal Educational Institute Understanding Medicare Guidelines -"— Presentation transcript:

1 Excellence in Optometric Education John A. McGreal Jr., O.D. Missouri Eye Associates McGreal Educational Institute Understanding Medicare Guidelines

2 JAM John A. McGreal Jr., O.D. n Missouri Eye Associates n Old Ballas Rd. n St. Louis, MO n n FAX n

3 JAM 2008 Medicare E/M Guidelines n Compliance – How To Document the Medical Record – How To Select an E/M Codes, eye codes, “S” codes – How To Evaluate your Fees – How To Effectively Co-manage Surgical Cases – How To Increase Revenues – How To Survive an Audit – How To Understand HIPPA Privacy Rules – How To Implement a Compliance Plan

4 JAM Health Insurance Portability and Accountability Act of 1996 n President Clinton & USAG J. Reno – #2 priority: prosecution of health care fraud – $104 Million: Appropriations to HHS – $70 Million: OIG – $47 Million: FBI fraud investigation unit – Criminal offenses expanded – $10,000 fine / line item violation – suspension of payment and participation from program – Yielded $23 return on every $1 spent in 1997

5 JAM Qui Tam Relaters n Amendment to False Claims Act of 1986 n Encourages private individuals to sue in the government’s behalf n Whistleblowers - 30% of recoveries – $1 Billion paid since 1987 in Qui Tam actions n Compliance Plan – Eliminates aggressive or conservative billing philosophies – Removes incentives for whistleblowers – Improves collections while reducing audit risks

6 JAM Medicare Review Strategies n Error rates at below 7% nationally n E/M codes represent 75% of errors (highest for Part B) – 10-1 overpayment –underpayment – Insufficient documentation and incorrect coding n OB/GYN specialty highest error rate nationally at 35.75% n Diagnostic radiology specialty highest projected dollars paid incorrectly at 48 million

7 JAM Top 5 Errors by Profession n OB/GYN n Neurology n Chiropractic n Optometry – 11.6% n Nephrology

8 JAM Medicare Review Strategies n E/M established codes n Laboratory n Hospital E/M, subsequent n Consultation codes n E/M new codes n Electrocardiograms n Chiropractic n Rituximab n Hospital E/M, initial

9 JAM HIPAA in Bite Sized Chunks n Standards for transactions conducted electronically n Standards to protect privacy of personal health information n Standards to protect security of personal health information when stored electronically n Uniform federal identifiers of providers, health plan, employers and individuals

10 JAM NPI Identifier n Enumerator / National Provider System / ANSI – Must be used by May 23, 2007 – Providers need to apply online at CMS website n Identifiers for providers, health plans, employers and individuals n National Provider Identifier (NPI) – 10 digit string of alphanumeric characters, includes check digit – Format allows 200 billion identifiers without re-using values n Benefits of NPI identifiers – All transactions for ALL health plans – NPI will never change – Facilitates coordination of benefits – Facilitates tracking claims and payments – Facilitates identifying and prosecuting fraud n Start sharing NPIs NOW with consultants & Specialists!!

11 JAM Code Set Adoption in HIPAA n CPT-4: Current Procedure Terminology n CDT: Code on Dental Procedures and Nomenclature (Proposal to implement ICD-10) n ICD-9-CM (Volume 1,2): International Classification of Diseases (Proposal to implement ICD-10) n ICD-9-CM (Volume 3): inpatient disease codes n NDC: National Drug Code n HCPCS: Healthcare Common Procedure Coding System

12 JAMINTRODUCTION n CMS = Center for Medicare & Medicaid Services (formerly HCFA) - announced June 14, 2001 – Center for Medicare Management - traditional fee- for-service programs – Center for Beneficiary Choices - provide beneficiaries with information on Medicare, MedicareSelect, Medicare+Choice, and Medigap options – Center for Medicaid and State Operations - focus on Medicaid and state administered services

13 JAMINTRODUCTION n CMS n CPT n ICD – n Medicare n Major Medical n E/M Coding (99XXX) n Eye Coding (92XXX) n Special Ophthalmic Codes

14 JAM E/M GUIDELINES n New/Established Patient n Chief Complaint n History of Present Illness n Family History n Past History n Social History n Review of Systems

15 JAM E/M DESCRIPTORS n History * n Examination* n Medical Decision Making* n Counseling n Coordination of Care n Nature of the Presenting Problem n Time

16 JAM CATEGORIES OF SERVICE CATEGORIES OF SERVICE n Office Visits (E/M Codes) – New – Estab n Office Visits (Eye Codes) – New – Estab n Consultations (E/M Codes) – Office

17 JAM E/M Coding - Consultation E/M Coding - Consultation n Office Consultations – Opinion / Advice – Not Referral n Duration - short n Continuity - expect patient back n Documentation - required

18 JAM E/M Coding - Referral E/M Coding - Referral n Referral – Treatment or Care n Duration - long n Continuity - Do not expect patient back n Documentation - not required, but courtesy n Warning! - carefully consider the language used in the correspondence to your consulting specialists – avoid the term referral, unless that is what you mean!

19 JAM SELECTING AN E/M LEVEL SELECTING AN E/M LEVEL n Identify Category of Service n Identify Extent of History Taking n Identify Extent of Examination n Identify Complexity of Medical Decision Making n Review E/M Descriptors

20 JAM E/M CODING - OFFICE VISITS n New Patient (3 of 3) – PFH / PFE / SDM / 10 – EFH / DFE / SDM / 20 – DH / DE / LDM / 30 – CH / CE / MDM / 45 – CD /CE / HDM / 60

21 JAM E/M Coding - Office Visits E/M Coding - Office Visits n Established Patient (2 of 3) – Minimal / 5 – PFH / PFE / SDM / 10 – EFH / EFE / LDM / 15 – DH / DE / MDM / 25 – CH / CE / HDM / 40

22 JAM DOCUMENTATION OF HISTORY DOCUMENTATION OF HISTORY n Problem Focused History (PFH) – CC / 1-3 HPI n Expanded Problem Focused History (EPF) – CC / 1-3 HPI / Ocular ROS n Detailed History (DH) – CC / 4 HPI / Ocular ROS / ROS-2 / 1 OF 3 PFSH n Comprehensive History (CH) – CC / 4 HPI / Ocular ROS / ROS-10 / 3 OF 3 PFSH (NEW) OR 2 OF 3 PFSH (ESTAB)

23 JAM Eye Examination Documentation n VA / CVF / Pupils & Iris / Adnexa n Bulbar & Palp Conjunctiva n EOM n SLE: Cornea / Lens /AC n IOP / Optic Nerve / Posterior Segment n Neurologic: Orientation (Time / Place / Person) n Psychiatric: Mood & Affect (Depression /Anxiety /Agitation)

24 JAM DOCUMENTATION OF EXAMINATION DOCUMENTATION OF EXAMINATION n Problem Focused Exam (PFE) – Limited Exam / l - 5 Elements n Expanded Problem Focused Exam (EPF) – Limited Exam / 6 Elements n Detailed Exam (DE) – Extended Exam / 9 Elements n Comprehensive Exam (CE) – Complete Single System Exam – All Elements

25 JAM Medical Decision Making Medical Decision Making n Straightforward (SF) – # Dx / Rx Options - Min / Data - Min / Risk - Min n Low Complexity (LC) – # Dx / Rx Options - Lim / Data - Lim / Risk - Low n Moderate Complexity (MC) – # Dx / Rx Options - Mult / Data - Mod / Risk -Mod n High Complexity (HC) – # Dx / Rx Options - Ext / Data - Ext / Risk - High

26 Comprehensive Ophthalmological Service / n Complete system evaluation, 8 or more elements n Need not be performed at one session n Integrated services where med decision making cannot be separated from examination methods n Includes history, medical observation, external & ophthalmoscopic, gross visual fields, sensorimotor, biomicroscopy, consultations, dilation (cycloplegia), mydriasis, tonometry, initiation of diagnosis and treatment programs, prescription of medication

27 JAM Comprehensive Ophthalmological Service 92004/92014 n Always includes initiation of diagnosis and treatment programs – includes the prescription of medication, and arranging for special ophthalmological diagnostic / treatment services, consultations, laboratory procedures and radiological services

28 JAM Intermediate Ophthalmological Service / Intermediate Ophthalmological Service / n Evaluation of new / existing condition, complicated with a new diagnostic or management problem n Integrated services where med decision making cannot be separated from examination methods n Includes history, medical observation, external & adnexal, & other diagnostic procedures, biomicroscopy, mydriasis ophthalmoscopy and tonometry

29 JAM Intermediate Ophthalmological Service / n Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient n 7 or less elements

30 JAM 2004 New HCPCS Codes n “S” codes are useful for some private insurers n Medicare and other federal payers do not recognize them n They are useful when CPT does not have a code to accurately describe the service (i.e. LASIK, PTK, PRK, corneal topography) or for invoicing self-pay patients. n They specifically describe “routine exams” including refractions and permit a different charge

31 JAM HCPCS “S” Codes HCPCS “S” Codes n S0592 Complicated contact lens evaluation n S0620 Routine ophthalmologic exam including refraction; new patient n S0621 Routine ophthalmologic exam including refraction; established patient

32 JAM 2006 Medicare Fee Schedule Office Visits n 99201$ $ n 99202$ $ n 99203$ $ n 99204$ $ n 99205$ $ n 92002$ $ n 92004$ $89.53-

33 JAM 2006 Medicare Fee Schedule Consultations n 99241$ n 99242$ n 99243$ n 99244$ n 99245$

34 JAM Refraction Refraction n Non-covered service n Can be billed to beneficiary – failure to do so results in lost revenues n Reminders – Charge only for “Rx-able” refractions – Do not forget to charge for the final refraction when changing spectacles in a post-operative cataract patient

35 JAM Gonioscopy n Bilateral n Requires documentation – describe visible angle structures n No limitations to diagnostic groups in most states n Fee$ / $25.47

36 JAM Visual Field 9208x n Bilateral n Requires Interpretation – separate report form – narrative in body of medical record, on date of service n Fee $ (-81) / $46.18 n Fee $ (-82) / $59.09 n Fee $ (-83) / $68.17

37 Oculus Easy Field Perimeter n Screening AND Threshold fields n Color LCD-Display n Fixation monitoring – CCD camera n Stores up to 40,000 exams n Built-in printer

38 JAM Extended Ophthalmoscopy / n Unilateral n Initial (-225) vs. Subsequent (-226) n Implies detailed, extra ophthalmoscopy – document fundus lenses used n Modifiers RT /LT n Requires retinal drawings & interpretation – sizes, colors and dimensions carrier specific n Fee ($20.38-/$21.69) ($ /$19.53)

39 JAM Fundus Photography n Bilateral n Not Bundled n Requires Interpretation n Fee$65.86-/$69.46

40 Fundus Retinal Photos ROI n Synemed (Canon 8+MP) n Cost $22, n Lease $ n Breakeven 2 photos / wk n 8-10 MP digital non- mydriatic n 10 images / wk – lease = $22, annual revenue

41 JAM 2006 New ICD-9 Codes n Must report with n Nonproliferative diabetic retinopathy NOS n Mild nonproliferative diabetic retinopathy n Moderate nonproliferative diabetic retinopathy n Severe nonproliferative diabetic retinopathy n Diabetic macular edema – Must report with ICD code for diabetic retinopathy n = background diabetic retinopathy n = proliferative diabetic retinopathy n –

42 JAM External Ocular Photography n Report for documentation of medical progress – Ex.: close-up photography, slit lamp photography, goniophotography, stereo-photography n Bilateral n Not Bundled n Requires Interpretation and report n Fee$39.77-/$42.12

43 JAM RPS AdenoDetector n Bilateral n Infectious agent detection by immunoassay with direct observation, not otherwise specified n Modifier: QW for CLIA waived products n ICD-9 Positive test result – other adenoviral conjunctivitis; acute follicular conj – other diseases of conjunctiva due to viruses n ICD-9 Negative test result – Acute follicular conjunctivitis, excludes EKC, PCF – Acute atopic conjunctivitis n Fee$16.76

44 JAM Serial Tonometry n Bilateral n Requires Interpretation & Report – Example: Angle closure glaucoma – multiple measurements over time n Fee$76.05-/80.60

45 JAM Scanning Computerized Ophthalmic Diagnostic Imaging n Unilateral n Applies to glaucoma and retinal evaluations – Heidelberg / Heidelberg Retinal Topography (HRT III) – Carl Zeiss / Optical Coherence Tomography (OCT) – Carl Zeiss / Laser Diagnostic Technology (GDX) – Marco / Retinal Thickness Analyzer (RTA) – Optovue / RTVue n Requires Interpretation & report n Fee$38.91-/$40.64

46 JAM Scanning Laser Covered Diagnosis List n retinal nerve fiber bundle defects n glaucomatocyclitic crisisPapilledema n pigmentary iris degeneration n goniosynechiae n pupillary membranes n recession of the angle n glaucoma n visual field defects n unspecified disorder of optic nerve or pathways

47 JAM Scanning Laser n Moderate Damage - payable once or twice per year, not with a field – Visual field examples n moderate reduction in retinal sensitivity n temporal wedge – Optic Nerve examples n enlarged cup with sloped or pale rim n focal notch n rim/disc >0.1 but <0.2 n prominent lamina cribrosa

48 JAM Scanning Laser n Advanced Damage - rarely payable, fields more valuable – Visual field examples n loss of central vision n temporal island remains n severe reduction in retinal sensitivity n absolute defects to within 3 degrees of fixation – Optic Nerve examples n rim destroyed n rim/disc ratio<0.1

49 JAM Pachymetry n Bilateral n Measurement of central corneal thickness (CCT) proven by Ocular Hypertension Treatment Study (OHTS) to be standard of care in diagnosis and management of glaucoma, glaucoma suspect and ocular hypertension n Also billable for keratoconus, corneal transplants, cataracts with corneal dystrophies, guttata, edema n Requires Interpretation & Report n Fee$11.18-/$11.42

50 Reichert IOPac n Portable n Battery operated n Stores up to 1000 pts. n USB and infrared interface n Down load to PC and printer n Detachable probe – Easily replaced if necessary –

51 JAM Computerized Corneal Topography n Bilateral or unilateral n Requires interpretation & report n No limitations to diagnostic groups in most states n Fee$ / $28.47

52 JAM Corneal Topography n ICD-9 Codes that Support Medical Necessity – * Irregular astigmatism – Corneal Opacity Unspecified – Bullous Keratopathy – Hereditary Corneal Dystrophy Unspecified – Other Anterior Corneal Dystrophy – Endothelial Corneal Dystrophy – Keratoconus Unspecified – Keratoconus Stable Condition

53 JAM Corneal Topography n ICD-9 Codes that Support Medical Necessity – Keratoconus Acute Hydrops – Pterygium Unspecified – Mechanical Complication Prosthetic Corneal Graft – V42.5 Cornea Replaced by Transplant – V45.61* Cataract Extraction Status – V45.69* Other States Following Surgery of Eye /Adnexa – * must be accompanied by V45.61 or V45.69 – *V45.61 must be accompanied by – *V45.69 must be accompanied by

54 JAM Therapeutic Contact Lens n Unilateral n Bundled with 92xxx, includes supply of lens n Recommendations – use disposable lenses – accept a less than optimum cosmetic fit – tolerate debris on and beneath lens – remove only once and do not replace – liberally hydrate prior to removal n Fee$58.93-/62.97

55 JAM Correction Trichiasis 67820* n Epilation n By forceps n ICD-9 – Trichiasis without entropion – Senile entropion n Fee$43.79-/$54.29

56 JAM Removal of Foreign Body 65205* n External Eye, Conjunctiva – superficial – scleral, non-perforating n ICD-9 – FB in cul-de-sac n Fee$45.52-$48.82

57 JAM Removal of Foreign Body 65210* n External Eye, Conjunctiva – embedded (includes concretions) – subconjunctival – scleral, non-perforating n ICD-9 – FB in other sites or combined sites n Fee$55.64-$59.74

58 JAM Removal of Foreign Body 65222* n External Eye, Corneal – with Slit Lamp n ICD-9 – FB in cornea n Fee$61.25-/$65.75

59 JAM Sensorimotor Examination n Quantitative measurement of ocular deviation – document all major fields of gaze n Bilateral n Requires interpretation and report n Fee$ n – Orthoptic and / or pleoptic training, with continuing medical direction and evaluation n Fee$33.78+/$32.38

60 JAM Dilation of Lacrimal Puncta 68801* n With or Without Irrigation n ICD-9 – Epiphora, insufficiency of drainage – Chronic Dacryocystitis – Stenosis, Lacrimal Punctum – Nasolacrimal Duct Obstruction n Fee $98.07-/$103.08

61 JAM Punctal Occlusion By Plug n Temporary (collagen) or Permanent (Silicone) n Payment is per puncta (modifiers required) – E1=left upperE3=right upper – E2=left lowerE4=right lower n Global period - 10 days n Supply code-included in procedure code, not separately billable n Fee$ /$130.02

62 JAM n ICD-9 – Punctate Keratitis – Filamentary Keratitis – Exposure Keratitis – Other forms of Keratitis – Unspecified Keratitis – Recurrent Corneal Erosion – Eyelid Retraction – Unspecified Tear Film Insufficiency – Sicca Syndrome; use additional systemic manif. code Punctal Occlusion By Plug 68761

63 JAMModifiers – 32 Mandated Services – 50 Bilateral Procedure – 24 Unrelated Service / Same Doctor – 25 Separate Service / Same Doctor / Same Day – 52 Reduced Service / Informational / Not Reduced Fee – 54 Surgical Care Only – 55 Post-Op Care Only – 51 Multiple Procedures – RT / LT Right / Left – E 1- E4 Identifies Puncta

64 JAM Comanagement of Surgery n Procedures / / $ /$ n Global Periods - usually 90 days n Value - up to 20% n Modifiers (-54,-55) n Range Dates n Rules - Medicare Transfer Agreement in MD record n Correspondence n Legal/Political/Inter-professional Issues

65 JAM Complicated Cataract Surgery n New CPT code for 2001 / $ /$ n Extracapsular cataract extraction with insertion of IOL, complex, requiring devices or techniques not generally used in routine cataract surgery – 2% of all cataract surgeries involve extraordinary work n iris expansion devices, suture support for IOL, posterior capsulorrhexis, small pupil, subluxed lens, Pseudoexfoliation, trauma, Marfan’s, glaucoma, uveitis n pediatric population n Advanced, white, hard cataract

66 JAM CASE 1: Cataract n CPT / ICD – / Myopia (367.1) = $20.00 – / Cataract (366.16) = $95.00 – Total $ n Rx: Spectacles n RTO: 1YR n CPT / ICD – / Myopia (367.1) = $20.00 – / Cataract (366.16) = $80.00 – Total $100.00

67 JAM CASE 2: Blepharoconjunctivitis n CPT / ICD – or / Blepharitis (373.00) = $50.00 or $63.00 n Rx: Bacitracin Oint hs / Tobradex qid / Lid Hygiene / AFTs n RTO: 1 WK n CPT / ICD – / Blepharitis (373.00) = $$45.00 – Total $95.00 or $108.00

68 JAM CASE 3: Allergic Conjunctivitis n CPT / ICD – or / Conjunctivitis allergic (372.14) – $50.00 or $63.00 n Rx: Pataday QD / Cold Packs / AFTs n RTO: 1 WK n CPT / ICD – or / Conjunctivitis, allergic (372.14) = $$45.00 or $63.00 – Total $95.00 or $126.00

69 JAM CASE 4: Rosacea (Skin & Eye) n CPT / ICD – or Meibomianitis (373.12) / Acne Rosacea (695.30) = $50.00 or $63.00 – / (370.01) Marginal keratitis = $45.00 – Total $ or $ n Rx: Zylet QID / Lid Hygiene / Minocycline 50mg BID / MetroCream 0.75% BID RTO: 2 D n CPT / ICD – or / Meimbomianitis (373.12) = $50.00 or$63.00 – Total $ or

70 JAM CASE 5: Corneal Foreign Body n CPT / ICD – / Abrasion (918.1) = $50.00 – / Abrasion (918.1) = $45.00 – / Corneal Foreign Body (930.00) = $65.00 – Total $ n Rx: Acular LS QID / Zymar QID / Patch +/- Ibuprofen 400mg n RTO: 1 Day

71 JAM CASE 6: Misdirected Lashes n CPT / ICD – / SPK (370.21) = $50.00 – / SPK (370.21) = $45.00 – 67820/ Trichiasis (374.05) = $45.00 – Total $ n Rx: Xibrom BID / AFTs n RTO: 1 Day / PRN

72 JAM CASE 7: Corneal Erosion n CPT / ICD – / Recurrent Corneal Erosion (371.42) = $50.00 – / Recurrent Corneal Erosion (371.42) = $70.00 – Total $ n Rx: Vigamox TID / Nevanac TID / Bandage SCL n RTO: 1 Day n CPT / ICD – or / Recurrent Corneal Erosion (371.42) = $45.00 or $63.00 – Total $ or $183.00

73 JAM CASE 8: Bacterial Keratitis n CPT / ICD – or / Bacterial Keratitis (370.03) = $50.00 or $63.00 – / Bacterial Keratitis (370.03) = $45.00 – Total $95.00 or $ n Rx: Zymar q2h n RTO: 1 Day n E/M: or or…..? – Total $ and up

74 JAM CASE 9: Central Serous Retinopathy n CPT / ICD – / Central serous retinopathy (362.41) = $50.00 – LT / Central serous retinopathy (362.41) = $20.00 – / Central serous retinopathy (362.41) = $70.00 – Total $ n Rx: Observation RTO: 1 Mos n CPT / ICD – / Central serous retinopathy (362.41) = $50.00 – LT / Central serous retinopathy (362.41) = $20.00 – LT / Central serous retinopathy (362.41) = $45.00 – Total $255.00

75 JAM CASE 10: Macular Degeneration n CPT / ICD – / Age Related Macular Degeneration (362.51) = $95. – RT, LT / (362.51) = $40.00 – / (362.51) = $70.00 – Total $ n Rx: Amsler Grid / Vitamins n RTO: 6 Mos n CPT / ICD – / RT, LT / (362.51) = $ – Total $340.00

76 JAM CASE 11: High Risk Medication n CPT / ICD – / Rheumatoid Arthritis (714.0), High Risk Medical Treatment (V58.69) = $50.00 – RT, LT / (714.0, V58.69) = $40.00 – / (714.0, V58.69) = $70.00 – Total $ n Rx: Observation n RTO: 6 Mos n CPT / ICD – Same as above = $ – Total $320.00

77 JAM CASE 12: Dermatitis n CPT / ICD – or / Dermatitis (373.32) = $50.00 or $63.00 – / (373.32) = $45.00 – Total $95.00 or $108 n Hydrocortisone 1.0% QID / Cold Packs n RTO: 1 WK n CPT / ICD – / (373.32) = $45.00 – Total $ – $153.00

78 JAM CASE 13: Glaucoma Suspect n CPT / ICD – / Glaucoma Suspect (365.01) = $80.00 – / (365.01) = $25.00 – / (365.01) = $15.00 – / (365.01) = $70.00 – / (365.01) = $70.00 n CPT / ICD – or / (365.01) = $50.00 or $63.00 – RT, LT / (365.01) = $90.00 – Total $ or $ n Rx: Initiate or continue treatment or consultation- MD

79 JAM CASE 14: Dry Eye n Dx: Documentation: Narrative & Shirmer Strips n CPT / ICD Temporary Collagen Plugs – / Dry Eye Syndrome (370.33) = $80.00 – E2 / (370.33) = $ – E4 / (370.33) = $ (Paid at 50% allowable) – Total $ n E/M: Permanent Silicone Plugs – , E2, E4 / (370.33) = $ n RTO: >10 Days global period n Total $494.00

80 JAM CASE 15: Cataract Co-Management n CPT / ICD – , RT / – Date of Service-is date of surgery – Range Dates-starts on date of transfer of care from MD to OD, ends 90 days from date of surgery n Rx: Post-Operative Care n RTO: Outcome dependant n E/M: and Material/Hardware Codes (DME)

81 Monitor Compliance with Audits n Develop a “Documentation” team n Monthly Assessment – 10 charts/Provider n Report your Results – All staff, residents, students n Acknowledge positive & negative variances – RETRAIN, RETRAIN..

82 JAM THANK YOU! n Primary Eyecare Network – – Medicare Compliance Kit n Health History Questionnaire n Examination Forms n E/M Worksheets n ICD-9 Codes n Interpretation/Report form – Medicare A-Z Manual – Superbills / Signature on File stickers / Electronic Claims – HIPAA Compliance Manual

83 Thank you Excellence in Optometric Education Missouri Eye Associates McGreal Educational Institute Missouri Eye Associates McGreal Educational Institute


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