PROVIDE ELEVATED CARE, WHILE MAKING UP FOR MANAGED CARE PLAN DISCOUNTS
AS IS the case with the managed care plans that private practice optometrists accept, corporate O.D.s must also honor discounts that can affect their bottom lines. To offset these discounts and provide a higher level of care, I advocate embracing the medical model. The first step in doing so is the appropriate classification of patients prior to the exam. (This may require some staff training, see below.) Diligence in monitoring the patient’s chief complaint and medical history will not only provide the highest standard of care for the patient, but also secure accurate reimbursements.
Here are some action points to start with the medical model.
1 TRAIN STAFF
Staff members should be able to identify the patients’ reason for visit, prior to the exam. One way to achieve this is by providing them with a list of questions. Once the reason for the visit is identified, the staff member can inform the patient whether his or her medical plan or managed vision care plan will be applied to the visit, setting clear expectations for services rendered and payment.
2 INVEST IN DIAGNOSTIC EQUIPMENT
When embracing the medical model, diagnostic equipment, such as an OCT, can elevate your standard of care and provide a return on investment. For example, a medically necessary retinal photo for a diabetic or glaucoma patient, code 92250, can reimburse as much as $80.
3 REVIEW PRE-TEST PROTOCOLS
Embracing the medical model does not increase chair time. Review protocols so staff takes retinal photos and visual fields, leaving the O.D. to evaluate the results and provide treatment.
4 SCHEDULE FOLLOW-UP VISITS
Medical model patients typically need to be seen more often than annually. These appointments can be short visits; create time in your schedule for them. Typically, schedule these as first patients in the morning or during the week during non-peak hours.
5 MONITOR FEES
Medical service fees should be adjusted according to the standard. Check your explanation of benefits (EOBs) to determine the standard for these procedures.
Average Transaction Per Patient
O.D.s should be aware of their average transaction per patient. To calculate this:
Average transaction = Total visit fees collected/number of patients
You may also separate this calculation into medical and non-medical visits. The average transaction for a routine eye exam can range from $55 to $75. The average transaction for a medical exam can range from $100 to $200. If you are not falling into this range in either category, the seriously evaluate your exam, insurances taken and billing.
6 PERFORM A CHART AUDIT
Review charts to see what was wrongly billed as vision care plan vs. medical, and discuss these with your staff to ensure better management in the future.
Embracing the medical model in a corporate setting differentiates your practice and keeps patients coming back to your office for all their eye care needs! OM