Article

BUSINESS: CODING STRATEGY

OPTOMETRY’S HEARTBEAT

SEIZE THE OPPORTUNITY FOR GROWTH IN MEDICAL SERVICES

THERE IS no doubt that the financial cornerstone of almost every optometric practice is basic managed vision care services and optical sales. From a percentage of income basis, optical sales account for nearly 60% to 65% of the typical practice’s gross income. Of the remaining service-side revenues, most are generated by managed vision care benefit examinations.

Medical services, while growing, are still in the minority from an income basis. Is this a bad thing? Absolutely not! What it tells me is that there is an immense opportunity for growth within optometry for providing medical services.

PRACTICE TRENDS

Trends in practice point to O.D.s’ need to take on medical services:

  • Downward pressure on refractive reimbursements
  • Increasing costs of running a practice, for example, technology costs, such as EMR, and personnel costs, in well-trained staff
  • Increasing demand for care as 10,000 baby boomers turn 65 each day and the midpoint of the boomers entering Medicare won’t occur until the year 2020
  • Contracting supply of ophthalmologists
  • Increasing responsibility of the patient for costs of services (deductibles, diagnostics, treatments and non-covered services)
  • Uptick in savvy and knowledgeable patients who may go elsewhere for medical eye care unless they are aware of our capabilities
  • Increase in practice consolidation is putting pressure on the individual practitioner
  • Coping with continual changes in the health care delivery system (MIPS, ACOs, etc.)

I have always been an advocate of practicing to the fullest extent of your individual license. I believe providing the best in vision care and optical solutions is not mutually exclusive of providing the very best medical eye care. I think the time is now to quit treating these as two separate entities and to simply start providing the very best total eye care!

IDENTIFY THE DETAILS

To prepare your practice for properly providing medical services, examine your internal processes. Your front desk protocol should include: getting the reason for visit when the patient makes the appointment and capturing all insurance information from the patient at the time he or she makes the appointment. Also, accept that many, if not most, medical procedures you perform, while covered services, will be paid for out of pocket by the patient due to the rise of medical insurance deductibles.

With the implementation of the ICD-10 in Oct. 2015, the need for a much more detailed medical record became a mandate for proper compliance. Ensure a complete and accurate medical record by identifying the following: It is critical to properly note the reason for the visit, laterality of signs and symptoms and, in the case of an injury, what caused it, where it occurred and what the activity being performed was when the injury was sustained. (Keep in mind that the laterality of your CPT procedures must match with the laterality of the ICD-10 codes used to submit a clean claim.) This level of detail allows you to properly code these encounters and establish the medical necessity for supporting tests that you may perform.

FILL THE GAP

The potential for growth in providing medical services in an optometric practice is huge and, as a profession, should be a clear focus for our future. It is optometry’s duty to fill this gap. OM