Optometric Management Tip # 375   -   Wednesday, April 15, 2009
Emergency Office Visits

If your practice is like mine, you see a fairly high number of patients with emergency eye problems. We can debate how we define emergency, but for this article let's consider it to be an urgent eye health problem that is seen during normal business hours without an advance appointment. This could be for a red eye, pain, flashes and floaters, an injury, a foreign body or something similar. The patient calls the office and wants to come in right away, or your staff determines the patient should come in right away. How does your office handle these cases?

Intermediate or brief visit?

I see many practitioners who consider many of these urgent exams as intermediate or even brief office visits. I almost always classify them as comprehensive exams. This classification has nothing to do with insurance coverage because the type of exam and the fee is the same regardless if it's private pay or billed to medical insurance. I think they are comprehensive because I do all the tests that I would do during any full eye exam. For example, I need to do a retinal examination and measure IOP for a red eye complaint.

I often do a refraction at this type of exam as well and, if so, a refraction fee is charged. Of course, this depends on the case and it is not always possible to do a refraction, but there are other times when knowing the current best visual acuity is very helpful.

Furthermore, I find that these urgent exams are more time consuming and more demanding than routine annual eye exams, so it makes no sense to bill them as a lesser exam at a lower fee.

I find no resistance to the exam fee from the patient because we quote it in advance over the phone. We also discuss insurance plans and we inform the patient if we accept his plan or not.

Insurance assignment

Just because the patient has a medical eye problem does not mean you must accept his medical insurance. I recommend you print a list of accepted insurance plans for your staff and stick to it. And there are many different plans within one company, so be specific. Maybe you accept Blue Cross Blue Shield plans, but not if they're out-of-state. There are many different Medicare plans these days and you may not want all of them. Perhaps a plan from a certain employer is ERISA based and you are not on the panel. Always follow the terms in your provider agreement when it comes to billing and accepting assignment.

Once your staff has the insurance list, you can advise the urgent caller about your office policy for his insurance. If you don't accept his insurance simply quote the exact exam fee and advise that payment is due at the time of the visit, while reminding the patient that he may be able to file his own claim for reimbursement. Your office can assist that process by supplying a fee slip with all the proper codes and identification numbers. There is no need to be shy about quoting fees, patients accept them quite well and they like to know the rules in advance.

Staff response to emergencies

The best response to a call from a patient with an eye emergency is “How soon can you get here?” This approach has proven to be a great practice builder because you are helping someone in great need. Train your staff and design your office schedule to accommodate these urgent calls in a caring and compassionate way.

In spite of the sentiment above, it's a good idea for your staff to be trained in differentiating serious eye emergencies from the not so serious. Here is a link to a previous tip that provides a list of emergency eye symptoms for front desk personnel: http://www.optometric.com/mtotw/tip.asp?tip=143

Handling the extra patients

While you can't predict the number of urgent calls you'll receive each day, you can determine the average. Based on that, you may want to block out one or more appointment slots in the morning and afternoon to allow your office to work in emergency visits and also to provide a general catch-up period.

We use a 15 minute slot for every type of exam so it's very easy for my staff to fill the schedule.

Being able to handle some unexpected patients is one of the prime benefits of a highly delegated practice. Using clinical technicians to reduce the doctor time spent with each patient makes it easier to stay on schedule and that reduces stress in the office.

Choice of doctors?

Urgent visits can be a great way to increase the number of patients seen by a new associate doctor who has not developed a following yet. My office generally asks patients if they have a preference for which doctor they see, but in most cases with eye emergencies, the staff simply does not offer a choice.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management