BUSINESS

  CODING STRATEGY

KEEPING THE BUCKET FULL

COMPLIANCE IS THE KEY TO YOUR BUSINESS’ SUCCESS

RUNNING AN independent optometric practice today is a difficult thing to do. In building a better business, there are many different aspects to keeping your practice profitable, so you can reinvest in technologies, staff and facilities to provide the highest level of care to your patients.

So often the focus of practice profitability is on the side of generating more revenues, be it from incorporating “the medical model”or increasing optical sales. And, as important as that may be, the other side of the equation is keeping more of the money that you earn.

GENERATING MORE REVENUE

Too often, practitioners improperly boost their revenues by providing services that are not necessary to provide for the patient. That might be billing a higher level of E/M (evaluation/management) service when a lower one would have been warranted, or performing a comprehensive exam on someone when a lesser, more appropriate level of service would have been correct. Another area of exposure is in ordering or performing special ophthalmic procedures on patients where the medical necessity of the procedure hasn’t been properly established, or the test is done primarily for the convenience of the patient or the provider.

As an example, say a physician orders a fundus photograph for a diabetic patient who is asymptomatic and has no signs of retinopathy just to document a baseline “normal” retina. There is no medical necessity to do this, as the doctor’s chart notes from his retinal examination is sufficient.

Though this concept may be appealing, keep in mind, audit risk is significant. As primary providers of eye care for the U.S. population, we must understand that optometric practices are targets of carrier audits, whether they be from a managed vision care plan, Medicare or other medical insurance carriers. Fulfilling the professional mandate of providing care that is appropriate and proper for the patient presentation — and coding it correctly — are legal requirements that many take far too casually; the temptation of increased revenues are far too great.

SAVING YOUR EARNINGS

Keeping more of your money means that you have to be compliant. This entails coding properly with the CPT, the ICD-9 and ICD-10, and being compliant with HIPAA and OSHA as well. Yes, these are things that take time to do properly and can be very costly if not done well. A number of resources exist for assisting you in becoming compliant and maintaining compliance, whether it be in proper charting and coding, HIPAA or OSHA — so use them! Ignorance of these requirements is not a defense, and these authoritative bodies do enforce these rules and regulations.

SUCCESS THROUGH COMPLIANCE

Keeping your bucket full is critical to your success. The ability to keep your practice growing, in terms of both patients and profitability, means that you need to be able to provide state-of-the-art care that your patients deserve, and maintaining compliance by being knowledgeable in successfully navigating the world of healthcare compliance.

Building a better business means embracing this concept not as a “want to do,” but rather a “need to do,” for keeping your hard-earned dollars in your pocket. OM

JOHN RUMPAKIS, O.D., M.B.A. is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/OMcomment to comment on this article.