OM answers billing questions submitted via reader survey

Every year, we send surveys to you, our readers, to find out what your pain points are in the practice, and then create content to help you navigate through those problems. Billing and coding issues consistently rise to the top of the FAQs. In this article, I would like to address some of those concerns, and share with you how to find the answers.

HOW DO I FIND THE RULES FOR BILLING FOR GLAUCOMA PATIENTS?

Medicare is the gold standard, however not every insurance plan abides by Medicare rules, so it is imperative to review the rules each plan lays out for us every new year by downloading the manual. To find Medicare guidance, look up your local coverage determination (LCD) by state and search for the procedure code you would like guidance on (https://go.cms.gov/2F6zthw ). In these LCDs, you will find what evidence is used to establish these guidelines and, in most cases, it is the American Academy of Ophthalmology Preferred Practice Patterns (PPP). To establish your practice protocols for any disease (but specifically for glaucoma, as it is our focus in this issue of Optometric Management) go to the LCD and then the PPP (https://www.aao.org/preferred-practice-pattern/primary-open-angle-glaucoma-ppp ) to determine the frequency of testing and documentation needed.

HOW DO I MAKE CERTAIN I ONLY BILL FOR WHAT WAS DONE AT EACH VISIT?

The best way to be certain you bill only for what was done is to have your billing team make certain they see (with their own eyes) the order for the test, the reason the test was ordered, and the results of the test, as well as the interpretation and report documented before submitting the claim. If any of these are not documented in the chart, then the billing team should send the chart back to the ordering doctor to document. All of us can benefit from a second set of eyes on the record. Let your team help you.

HOW DO WE MAKE SURE WE ARE ORDERING THE CORRECT TEST AT THE CORRECT VISIT?

A good way to be certain that the needed and ordered tests are completed, as instructed by the doctor, is to:

• Write the order for the next visit in today’s chart.
• Write the order in the appointment notes for the next visit.
• On the next visit, document the orders in the “reason for visit.”
• Document the test was completed with the interpretation and report.
• Order the test for the patient’s next visit. If this process is followed at each patient encounter and the tests are ordered by the doctor for reasons documented in the chart by the doctor (according to the PPP established, the insurance guidelines, and patient needs), you will find it easier to stay organized, and be sure everyone in the practice complies.

DON’T WAIT ON UPDATES

The most difficult part of all this is the time spent at the beginning of the year reviewing guidelines to make certain nothing has changed. Look now to see whether any guidelines or insurance rules have been altered, update your protocol, and make sure a process is in place to be consistent in testing, documentation, and patient care. Then, do the same with each disease process you manage in your practice. OM

DR. JASPER practices in West Palm Beach, Fla. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.