Will 2014 Be the Light at End of the Tunnel or the Headlight on an Approaching Train?

By Charles B. Brownlow, OD

Now is the time for health care providers to make New Year’s resolutions. The key, however, is following through on those resolutions. Make 2014 the year that you not only keep your resolutions, but also complete them before the new year begins.

Here are four suggested resolutions I have for you:

1. Look at your current fee schedule. Decide whether your current fees match your feelings of the values of your services. It will be difficult, if not impossible, to negotiate with an insurance company for better fees if you’re not confident that your fees are appropriate to their value to your patients.

2. Review your internal protocols for providing care, including the way you collect data, how you decide which tests to do for each patient, how you keep records of each visit and each procedure, how you record your diagnoses and management options – such as writing orders for returns to office, additional testing, creating interpretations and reports for procedures, choosing diagnosis, office visit, and procedure codes to accurately tell the patient and payer exactly what you did. If you haven’t already created such guidelines for doctors and staff in your practice, do so now.

3. Realize that many doctors are being audited and you will be, too. An audit consists of a review of a doctor’s compliance with the national rules relative to medical record keeping. Each of you should review the definitions for the 20 CPT codes you use most frequently, as well as the Documentation Guidelines for the Evaluation and Management Services, 1997. You might want to do an internal audit of your charts and choices of codes. PMI can provide you with the tools you need (or you can email me at: brownlowod@aol.com) or PMI can do the audit for you. Good medical records begin with good patient care. Begin by following these caveats with each patient encounter:

  • Carefully interview the patient to learn why they are in the office (chief complaint/reason for visit). Many audits come out badly because no reason for visit is recorded or it doesn’t match the complexity of the record.
  • Choose the questions in each case history and the tests in each physical examination to match the needs of the patient, customizing each as you gain more information throughout the history and examination.
  • Provide the care the patient needs that day, no more and no less.
  • Keep a detailed, accurate record of all that is done during the visit, being careful to do only the tests that are necessary for that patient, that day, and to record only data that was actually done that day. Avoid automatically populating fields of the medical record from data gathered at an earlier visit.
  • Choose the diagnosis codes (ICD-9)  that are germane to the visit, not a list of all diagnoses the patient has (related to the visit or not) or every diagnosis the patient has ever had.
  • Choose office visit and procedure codes according to the rules and definitions in Current Procedural Terminology (CPT).

4. Review your provider agreements for all the insurers that you are contracted with. Review them with all the doctors and key staff in your practice to see which you want to renew, which you want to cancel, and which may be worth the effort to negotiate improvements. Don’t wait for a neighboring OD to tell you about the results of her or his negotiations. Enlist the help of your accountant or practice consultant in analyzing the contracts. Take action on your own and see how good it feels to tell a bad insurance plan that you won’t accept their meager payments any longer, or how good it feels when they actually make favorable changes to keep you as a provider.

These actions are not painful. However, it’s up to you to ensure that 2014 truly does represent the light at the end of the tunnel and not the headlight on a fast-approaching train.

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OHIP Will Help ODs SOAR

At OOA Leadership Day Dan Paoletti, CEO of Clinisync, explained that Clinisync will employ HealtheWay as the simple web-based solution to help providers accomplish Stage 2 Meaningful Use.  The program, to be available by April 2014, is free to providers unless they want to access public health reporting or community health records.  Using HealtheWay, ODs will be able to search for PCPs and see a data list they require for electronic referrals. For additional information go to http://www.healthewayinc.org/Dan Paoletti, OHIP

Memorandum of Membership

It is Autumn in Ohio.  My favorite time of the year.  The month of November brings to mind falling leaves, the OSU-Michigan game, and Thanksgiving.  Traditionally at the OOA, November marks the start of the annual membership drive.  The OOA Staff,  Board, and Membership Commitee are counting on you to renew your commitment to the profession by continuing your membership in the OOA.  If you are not a member, we invite you to be a part of  the group that represents Ohio optometry.

I frequently get asked, “what do I get as a member?”  Many benefits are not always tangible.  The OOA promotes and advances the practice of optometry by:

1)      Serving as a Resource for Information– The OOA provides members prompt information about issues that affect optometry so we can make good practice decisions.

2)      Advocating for Optometry- The OOA effectively represents our interests within the government, the insurance industry, other health professionals, and the media.

3)      Promoting Optometry to the Public- The OOA actively markets to the general public and referring healthcare providers on a regular and consistent basis, delivering our message that we are the primary eye care providers.  It also counters negative press that may harm our profession.

4)       Providing Intraprofessional Networking Opportunities- The OOA is a place where we can connect with our peers, learn best practice protocols, find career resources, share ideas, and mentor each other.  The East West Eye Conference, Practice Management Institute, and local Zone Meetings provide means for educational and career growth.

I’d like to also challenge you to make your membership meaningful.  Membership is a two-way street.  You only get out what you put into it.  Stay involved by opening emails, visiting social media outlets, and reading the quarterly Perspectives newsletter.  Attend a zone meeting and East West.  Provide VisionUSA or Infantsee exams.  Donate to the OOA Foundation or contribute to PAC.  It can be as simple as that.  Don’t like something that is happening to optometry?  Volunteer on a committee or serve as a legislative liaison.  You have the power to change and influence the direction of our profession.

There are many opportunities to enhance your membership experience.  We look forward to having you be a part of such an active and important organization.  You worked hard to become an optometrist.  Membership in the OOA is your insurance policy to keep Ohio optometry strong for generations to come.  Please renew your membership for the 2014 year.

Elizabeth Muckley, OD

Trustee