Rick Cornett, OSU Optometry students met key U.S. Congressmen

OOA Executive Director and OSU College of Optometry students met with key U.S. Congressmen on March 27 at an event Congressman Pat Tiberi hosted in honor of Congressman Bill Johnson.

Congressman Johnson is a co-sponsor on H.R. 920 and H.R. 855.

H.R. 920: National Health Service Corps Improvement Act of 2013 aims to bring doctors of optometry into more underserved urban and rural communities by ending the misguided exclusion of optometrists from the National Health Service Corps (NHSC) student loan repayment and scholarship programs.

H.R. 855: Optometric Equity in Medicaid Act seeks to avert a potential crisis in access to primary eye care for Medicaid patients by amending the federal Medicaid statute to fully recognize optometrists.

These bills are continuations of bills that have been introduced in previous congressional sessions.

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OSU Corneal Classic Golf Tournament

All are invited to participate in the OSU “Corneal Classic” Golf Scramble.  This tournament is to raise funds for students to travel to AOSA Optometry’s Meeting, in San Diego, CA in June.  The tournament will be held Saturday, April 13th, 2013 (1:00pm shotgun start) at Royal American Golf Links in Galena.  The cost is $65.00 per person and includes greens fee, cart, range balls, a meal after the tournament and the opportunity to win prizes.  Come early to make use of the practice facilities and meet other participants.

In addition to having an enjoyable day on the golf course, you may use this opportunity to make connections with our students and faculty as well as other area doctors. If you are unable to attend, but would like to contribute to AOSA, any donations are greatly appreciated.

Please note any special requests on the registration form below.  If you have other questions contact Mpipitone@optometry.osu.edu or (330) 618-1817.

Corneal Classic Registration

Organization: Remember the Milk

milk

by Greg Hopkins, OD

Generations X and Y tend to use standard goal setting and priority-based systems of personal organization, which are tried and true. However, a new trend towards “Getting Things Done” has led to a more flexible bottom-up approach (vs. top-down), along with the development of a concept called the peripheral brain.

One of the best types of peripheral brains out there (besides good old pen and paper) are online task-management and reminder systems like the popular “Remember The Milk” web application.

We can all encourage good contact lens adherence by recommending solutions that integrate conveniently with our patient’s current systems of personal organization.

http://www.rememberthemilk.com/help/guide/

InfantSEE Helps Pediatric Focus of Practice

by Dr. Cara Frasco

InfantSEE 1

I signed up to be an InfantSEE provider when the program started in 2005. I had finished my residency in Pediatric Optometry one year prior. InfantSEE examinations were a logical way to help grow the pediatric focus of my practice and promote the importance of lifelong eye care.

The InfantSEE assessment allows me to identify children at risk for visual problems and intervene before severe impairment develops. I am able to follow-up on these babies between 3 and 4 years of age to make sure their eyes are free of amblyopia and strabismus.

InfantSEE 3

InfantSEE examinations have also helped to strengthen the relationship I have with my local pediatricians. I send a letter to every baby’s pediatrician informing them about the InfantSEE program and of my findings. Now almost eight years later, several pediatricians have recognized the value of InfantSEE and recommend an InfantSEE examination to parents during the child’s 9-month well-visit.

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InfantSEE Week is May 13-18, 2013. Make sure you know the events for the week – contact your zone coordinator for more information.

Congratulations to Dr. Frasco who practices in Springboro and Middletown. She submitted the most InfantSEE forms online in 2012 of any doctor in the United States. Doctors are asked to submit online a form for each InfantSEE exam they complete. The forms can be accessed at http://www.infantsee.org. There will be a special recognition for the Ohio doctor who submits the most forms in 2013; in addition, doctors who submit 25 forms online before September 1, 2013 are eligible for complimentary registration to the EastWest Eye Conference.

AOA-Backed Medicaid, NHSC Improvement Bills Introduced; ODs Encouraged to Contact Elected Officials for Support

AOA doctor and student advocates helped secure record levels of support for optometry-specific legislation in the last Congress. Thanks to their efforts, the National Health Service Corps Improvement Act (HR 920) and the Optometric Equity in Medicaid Act (HR 855) have been introduced into the new 113th Congress with broad bipartisan support.

Sponsored by Reps. Cathy McMorris-Rodgers (R-Wash.) and Kathy Castor (D-Fla.), the AOA-backed National Health Service Corps Improvement Act (HR 920) aims to bring doctors of optometry into more underserved urban and rural communities by ending the misguided exclusion of optometrists from the NHSC student loan repayment and scholarship programs. Reps. Bruce Braley (D-Iowa), Bill Cassidy (R-La.), Raul Grijalva (D-Ariz.), Brett Guthrie (R-Ky.), Jerry McNerney (D-Calif.), and Peter Welch (D-Vt.) have joined as original co-sponsors.

Sponsored by Reps.  Ralph Hall (R-Texas) and Jan Schakowsky (D-Ill.), the AOA-backed Optometric Equity in Medicaid Act (HR 855) seeks to avert a potential crisis in access to primary eye care for Medicaid patients by amending the federal Medicaid statute to fully recognize optometrists.

Reps. Earl Blumenauer (D-Ore.), Suzanne Bonamici (D-Wash.), David Cicilline (D-RI),  Lloyd Doggett (D-Texas), Keith Ellison (D-Minn.), William Keating (D-Mass.), Dave Loebsack (D-Iowa), Zoe Lofgren (D-Calif.), Jerry McNerney (D-Calif.), Eleanor Holmes Norton (D-DC), Tim Ryan (D-Ohio), Lee Terry (R-Neb.), and Ed Whitfield (R-Ky.) have joined as original co-sponsors.

2013 EastWest Education is Set

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The speakers for the 2013 EastWest Eye Conference have been announced.

EastWest has an incredible faculty for OD education,” said Dr. Brian Mathie, chair of EastWest education. “Speakers include Dr. Larry Alexander, Dr. Jill Autry, Dr. Charles Brownlow, Dr. Paul Karpecki, Dr. John McGreal, Dr. Bruce Onofrey, Dr. Carlo Pelino, Dr. Joe Pizzimenti, Dr. Sherrol Reynolds, Dr. Stuart Richer, and Dr. Jim Thimons.“

The Neuro-optometric Rehabilitation speakers are Dr. Stan Appelbaum, Dr. Brandon Begotka, Dr. Rob Fox, Dr. Kellye Knueppel, Dr. John Pulaski, and Dr. Maximillian Riesenhuber.

Faculty for the Allied Eye Professional education include Lynn Lawrence, Jackie O’Keefe, Mary Schmidt, Phernell Walker and Dr. Mark Yoder.

EastWest Eye Conference – October 3-6, 2013 – Cleveland, Ohio

Be A Hero to Your Patients

By Lauren Grillot, OD, MS – Troy, Ohio

If you knew your child was smart but was struggling in school wouldn’t you want to know why and “fix” it?

Many people don’t realize that vision is much more than 20/20 and healthy eyes.  Vision is a complex process that involves over 20 visual abilities and more than 65% of all the pathways to the brain. One in four children has an undiagnosed vision problem which can interfere with learning and lead to academic and/or behavioral problems. However, it is important to know that these children frequently do not report symptoms because they think everyone sees the same way they do.

Often a child with a vision-based learning problem has excellent verbal skills, causing parents and educators to think the child must be lazy, have ADD/ADHD, or is learning disabled. The possible misdiagnosis can be due to similar symptoms, but the causes are not the same.

Vision problems may be just a piece of the puzzle or the whole piece, but they should not be ignored.

You, as an optometrist, are in the perfect position to help identify those children who are struggling to achieve as the result of a vision related learning problem. You can start by asking 3 basic questions: 1. is your child working up to his/her potential?  2.  do they like to read?  3.  do they experience double vision, tired eyes, blurred vision or headaches when doing near work?

If the answer is “no” to #1 or #2 or “yes” to #3 then either refer the child to someone who works w/ visual problems that interfere w/ learning or treat the child yourself.  You can be a HERO by helping to identify these children.  The benefit of treatment lasts forever and can be life changing!

Two Updates from CMS

Mandatory Payment Reductions in the Medicare Fee-for-Service (FFS) Program – “Sequestration”

The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration.

This listserv message is directed at the Medicare FFS program (i.e., Part A and Part B). In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.

Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction. The Centers for Medicare & Medicaid Services encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare’s reimbursement.

Questions about reimbursement should be directed to your Medicare claims administration contractor. As indicated above, we are hopeful that Congress will take action to eliminate the mandatory payment reductions.

Problem Impacting Crossover of Medicare Part B Outpatient Therapy Claims

Parties that bill for Medicare participating outpatient therapists, physicians, and non-physician practitioners (NPPs) may have recently noticed an increase in the incidence of the Health Insurance Portability and Accountability Act (HIPAA) rejection codes denoted below on their provider notification letters.  Medicare routinely mails these letters out to providers, physicians/practitioners, and suppliers when various identified claims cannot be successfully crossed over to their patients’ supplemental insurance companies.

  • H51000: The Procedure Code ____ is not a valid CPT or HCPCS Code for this Date of Service
  • H51061: ‘Procedure Modifier 1’ ___ is not a valid CPT or HCPCS Modifier Code
  • H51062: ‘Procedure Modifier 2’____ is not a valid CPT or HCPCS Modifier Code
  • H51063: ‘Procedure Modifier 3’ ____ is not a valid CPT or HCPCS Modifier Code
  • H51064: ‘Procedure Modifier 4’ ____ is not a valid CPT or HCPCS Modifier Code
  • H51108:  _______ is not a valid ‘Line Level Adjustment Reason Code.’

Note:  Where you see “_____” directly above, the value (for example, G8978; modifier CH; or CARC 246) was reported, when applicable, on the outbound provider notification letter that billing offices would have received.

Unfortunately, the new functional G-codes, new severity/complexity modifiers, and new Claim Adjustment Reason Code (CARC) 246 for the January 2013 Healthcare Common Procedure Coding System (HCPCS) and CARC updates were inadvertently not loaded. As a result, a moderate number of Part B outpatient therapy claims (claims for physical, speech, and occupational therapy) were rejected in error. The newly added severity/complexity modifiers were as follows:  CH, CI, CJ, CK, CL, CM, and CN.  The new functional G-codes fall within the following ranges:

  • G8978—G8999
  • G9158—G9176
  • G9186

Actions Taken To Remedy the Issue

The Coordination of Benefits Contractor (COBC) HIPAA validation vendor added the new G-codes to its HCPCS table as of January 28, 2013. The vendor then added the new severity/complexity modifiers to its HCPCS table as of February 11. Lastly, the vendor added the new CARC 246 to its table as of February 25. Thus, Medicare participating therapists, physicians, and NPPs should now see a drastic decrease in the incidence of error codes H51000, H51061—H51064, and H51108 reflected on their provider notification letters.

Affected Claims Need to be Billed Directly to Supplemental Insurers

If your billing office received a provider notification letter from Medicare indicating that claims could not be crossed over due to one of the H-series error messages described above, there unfortunately is not a way for Medicare to re-transmit the affected claims to your patients’ supplemental insurers. Therefore, you will need to bill your patients’ supplemental insurers directly. CMS regrets that this is necessary.

Please know that to help mitigate this kind of problem in the future, CMS will implement a fail-safe strategy well in advance of the scheduled installation of new HCPCS or other code updates. This will ensure that any incorrectly rejected Medicare crossover claims will be repaired by all A/B MACs, thus appropriately minimizing the impact to the provider community.

Vision Center Making a Difference

From the OneSight Vision Center at Oyler school:

There is a little second grade Oyler student named Sadie.   She was wearing glasses her uncle purchased over the counter for her.  Sadie was being mentored for her reading and handwriting.  She did not read well and her handwriting was so bad that the letters were giant scrolls that went up the side and off of the paper.  She could not see the lines on the page.

She was referred for an exam.  Unfortunately she had Amerigroup insurance which we were not contracted with at that time.  But due to her high prescription and problems, we ordered her glasses from OneSight.   Her prescription was a +7.50 sphere in the right eye and +8.00 sphere in the left eye.  The little red head selected pink frames and she looks beautiful in them.

Today the Mentoring Director came into our Vision Center.  Sadie, who could not write very well, was so happy with her glasses, she wrote a letter to her Mentor thanking her for all her help with her reading and handwriting.  The letter was written very well for a second grader, the letters were all on the lines, and the Mentor is delighted with Sadie’s progress.

The Mentoring Director wanted to share the story and is in awe of Sadie’s progress with her new glasses.  She wanted us to be aware of the difference the OneSight Vision Center is making in some of the student’s lives.

As a side note, I was delivering consent forms to some the rooms today and met Sadie in the hallway.  With her teacher’s permission, she volunteered to help me find the rooms since she can now see the room numbers on the walls.  We don’t know what her confidence level was before, but she certainly has it in full now.

Watch world, Sadie’s coming.