Optometric Management

FEB 2017

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F E B R U A R Y 2 0 1 7 • O P T O M E T R I C M A N A G E M E N T . C O M 49 BUSINESS CODING STRATEGY T HERE IS no doubt that the financial corner- stone of almost every optometric practice is basic managed vi- sion care services and optical sales. From a percent- age of income basis, optical sales account for nearly 60% to 65% of the typical practice's gross in- come. Of the remaining service- side revenues, most are generated by managed vision care benefit examinations. Medical services, while grow- ing, 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 im- mense 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 re- fractive reimbursements • Increasing costs of running a practice, for example, technology costs, such as EMR, and person- nel 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 oph- thalmologists • Increasing responsibility of the patient for costs of services (deductibles, diagnostics, treat- ments and non-covered services) • Uptick in savvy and knowl- edgeable patients who may go else- where for medical eye care unless they are aware of our capabilities • Increase in practice consoli- dation is putting pressure on the individual practitioner • Coping with continual changes in the health care deliv- ery system (MIPS, ACOs, etc.) I have always been an advocate of practicing to the fullest extent of your individual license. I be- lieve 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 en- tities and to simply start provid- ing the very best total eye care! IDENTIFY THE DETAILS To prepare your practice for properly providing medical ser- vices, examine your internal pro- cesses. 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 proce- dures 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 re- cord became a mandate for prop- er compliance. Ensure a complete and accurate medical record by identifying the following: It is critical to properly note the rea- son 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.) is level of detail allows you to properly code these encounters and establish the medical neces- sity for supporting tests that you may perform. FILL THE GAP e 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 optom- etry's duty to fill this gap. OM OPTOMETRY'S HEARTBEAT SEIZE THE OPPORTUNITY FOR GROWTH IN MEDICAL SERVICES JOHN RUMPAKIS, O.D., M.B.A. DR. RUMPAKIS is founder, president and CEO of Practice Resource Management, Inc., a consult- ing, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/ OMcomment to comment on this article.

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