Office Policesand Procedures

Dr. Lynn Hammonds

EyeCare Associates, Inc.

Hoover, Alabama

lhammonds@webeca.com

PRACTICE SETTINGS

• Solo Practice

• Associate - Individual or Group Practice

• Corporate Affiliate

• Referral Center

• Veterans Administration

• Academia

WHY HAVE OFFICE POLICIES AND PROCEDURES?

• AVOIDS CONFUSION

• TO COMPLY WITH FEDERAL AND STATE LAWS

• REDUCES LIKELIHOOD OF LITIGATION

Things To Remember

• IF IT IS IMPORTANT – Write it down

• BE CONSISTENT

• BE OPEN TO CHANGE WHEN NEEDED

THE EMPLOYEE

EMPLOYEE RELATED POLICIES

• Employee Handbook

• Employee Training – Introductory Period

• Office Meetings

• Documentation

The Employee Handbook

• Purpose – Mission Statement

• Employee Benefits

• Personnel Policies and Regulations

• Operation Policies and Regulations

THE EMPLOYEE

• Employee Job Descriptions

• Employee Evaluations

• Employee Compensation

• Employee Warnings and Termination

Office Policies not Addressed in Employee Handbook

WHEN IN DOUBT

SEEK LEGAL ADVISE FROM A PROFESSIONAL!

Patient ManagementPolicies and Procedures

• Dictated by Federal Law

• Dictated by State Law

• Dictated by Third Party Carriers

• Dictated by Surgeon

• Determined by Experience

PATIENT SERVICES

SCHEDULING PATIENTS

SCHEDULE TEMPLATE

LAST NEW PATIENT – MORNING

LAST NEW PATIENT –AFTERNOON

WHEN TO DOUBLE BOOK

HOW TO BOOK EMERGENCY PATIENTS

Administrative Code- Alabama Law

• 630-X-12-.08 Emergency Services Outside of

Normal Practice Hours.

The optometrist shall have an established and appropriate procedure for the provision of services to patients in the event of an emergency outside of the normal practice hours, or when the licensee is not available due to vacation, illness, attendance at professional meetings or continuing education programs, or other absences of a similar nature.

Emergency Services Outside of Normal Practice Hours

• The procedure referred to herein may include, but is not limited to, cooperative arrangements with another licensed optometrist or licensed physician, a telephone answering system or pager through which the patient can obtain access to services, or written instructions to patients setting out how reasonable access to services may be obtained.

CELL PHONES

PATIENTS LATE FOR THEIR APPOINTMENT

or

DOCTOR RUNNING LATE

HEALTH INSURANCE PORTABILITY AND

ACCOUNTABILITY ACT (HIPAA)

• Enacted by the US Congress in 1996 - Protection of confidentiality and security of health data through setting and enforcing standards.

POLICIES REGARDING FEES

• ALL PROFESSIONAL FEES MUST BE PAID AT TIME OF SERVICE

• ALL CONTACT LENSES MUST BE PAID IN FULL BEFORE DISPENSING

• HALF MUST BE PAID BEFORE GLASSES ARE ORDERED

• FULL AMOUNT PAID BEFORE GLASSES ARE DISPENSED

DETERMINING IF FEES WILL BE REIMBURSED BY

INSURANCE

INSURANCE MANUAL

CASH PAYMENTS

• GIVE PATIENT A RECEIPT SHOWING PAYMENT OF CASH

• MAKE COPY OF RECEIPT AND PUT IN PATIENT FILE

• RANDOM AUDIT OF CASH DRAWER

PATIENT REFUNDS

• Who has the authority to approve a patient refund?

• When to give the patient’s money back.

CLINICAL SERVICES

HARD COPY FILES OR ELECTORNIC MEDICAL

RECORDS

EXAM FORMS

CHART DOCUMENTATION

• BLACK INK

• ADDITIONS/CORRECTIONS

• WRITING LEGIBLY

• ADEQUATE HISTORY

• OBJECTIVE FINDINGS

WHAT ARE THE MINIMUM TESTING REQUIREMENTS FOR A COMPREHENSIVE

EXAM IN ALABAMA?

Administrative Code- Alabama Law

630-X-12-.06 Failure to Meet Standard of Care

Minimum Testing for a Comprehensive Eye Exam

• Case History• Determination of Refractive Error• Binocular Vision Evaluation • Ophthalmoscopy• Evaluation of Health of External Eye & Adjacent Structures• Tonometry or Other Appropriate Glaucoma Testing• Other Test Necessary under the Circumstances

INSURANCE REIMBURSEMENT

Documentation is the Basis for all Coding

• Claims are transmitted to insurance companies with codes that reflect professional services rendered to patients

– These codes consist of• E/M codes to document and support charges

submitted• CPT codes to delineate charges and to further

document services, and,• ICD codes to specify the diagnosis

CPT and HCPCS Codes

• Current Procedural Terminology - CPT• Healthcare Common Procedure Coding System -

HCPCS

• Developed by the American Medical Association and Centers for Medicare and Medicaid Services

• Numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services.

• Insurance companies use procedure codes to determine the amount of reimbursement that a practitioner will receive by an insurer.

Evaluation and Management (E&M) Coding

• 1995 Guidelines issued by the AMA and the Centers for Medicare and Medicaid Services (CMS)

• Information in the record must substantiate coding or payment is denied or reduced

• If it isn’t in the record, it didn’t happen

CPT CODES

• 92XXX

• 99XXX

• 6XXXX

• 7XXXX

GLAUCOMA PATIENTS

• Comprehensive Exam - 92004 or 92014 every year

• IOPS - 99213 - every 3-4 months• VISUAL FIELDS - 92083 - every year• DIGITAL IMAGING - 92135 - every year• FUNDUS PHOTOS - 92250 - every year• PACHYMETRY - 76514 - once • GONIOSCOPY - 92020 - every 1 to 2 years• Serial Tonometry - 92100 -

CATARACT PATIENTS

INTRAOCULAR IMPLANT OPTIONS

POST OPERATIVE CARE

YAG CAPSULOTOMY

REFRACTIVE SURGERY PATIENTS

PRE-OPERATIVE VISITS

POST-OPERATIVE VISITS

DIABETIC PATIENTS

Report Findings to Primary Care Physicians

• One-time no-cost public health program provides eye care for infants

─for babies 6-12 months of age

─complements pediatrician well-baby vision screenings

no cost regardless of income

Contact Lens Fitting Policies and Procedures

Contact Lens Fitting Fees

• Global Fees vs. Per Visit Fees

• Minors

• Unsuccessful Patients

Procedures for Contact Lens Insertion and Removal Training

• PATIENTS MUST BE ABLE TO INSERT AND REMOVE CONTACT LENSES BEFORE THEY ARE ALLOWED TO LEAVE OFFICE WITH THE LENSES

• CARE AND WEARING SCHEDULE FORMS

PATIENT FOLLOW-UP

• CONTACT LENS FOLLOW-UP VISIT MADE FOR 1-2 WEEKS AFTER INSERTION AND REMOVAL TRAINING

• TECHNICIAN THAT DID CONTACT LENS TRAINING CALLS PATIENTS 1-2 DAYS AFTER TRAINING TO ANSWER ANY QUESTIONS THEY MAY HAVE

FAIRNESS TO CONTACT LENS CONSUMERS ACT - 2004

Act Requires that contact lens prescribers provide patients with a copy of their contact lens prescriptions after a contact lens fitting and verify prescriptions to any third party designated by a patient, such as an online seller.

DRUG PRESCRIPTIONS

PRESCRIPTIONS FOR MEDICATION

• DOCTOR SIGNATURE REQUIRED ON ANY Rx FOR PRESCRIPTION DRUGS

• DOCTOR APPROVAL FOR ANY Rx CALLED INTO THE PHARMACIST FOR PATIENT

E-PRESCRIBE

PQRI – PHYSICIAN QUALITY REPORTING INITIATIVE –

EARN 2% OF TOTAL ALLOWED CHARGES in 2010

MEDICAID PRESCRIPTIONS

• The US Troop Readiness, Veterans’ Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007

• Act contains a provision that requires all written Rxs for Medicaid patients to be written on “tamper-resistant” Rx pads.

OSHA STANDARDS

• PROPER STERILIZATION OF EQUIPMENT

• TONOMETER PROBE CLEANING

• PROPER DISPOSAL OF NEEDLES

• Employee Accidents

PATIENT RECORDS

• 630-x-12.03 Release of Patient Records.

• ….The board shall deem it unprofessional conduct for a licensee to fail to maintain, in his or her possession, all records pertaining to a patient for a period of not less than seven years from the date of the last service provided to that patient.

RECORD RELEASE FORM SIGNED BY PATIENT FOR RELEASE OF RECORDS

Optical Services

PRESCRIPTION RELEASE RULE

• EYEGLASSES 1 – 1980

• Federal Trade Commission Rule requiring eye doctors to give patient a copy of the glasses prescription immediately after an eye exam that includes a refraction

WARRANTIES

• FRAMES

• ANTI-REFLECTIVE COATINGS

• SCRATCH COATINGS

MEDICARE FEES NOT COVERED BY INSURANCE

• PATIENTS MUST BE INFORMED THAT THE SERVICE IS NOT COVERED BY MEDICARE

• PATIENTS MUST SIGN A FORM STATING THAT THEY ARE LIABLE FOR THE AMOUNT NOT COVERED BY MEDICARE

SPECIAL OPTICAL SITUATIONS

• PUTTING NEW GLASSES PRESCRIPTION INTO PATIENT’S OLD FRAME

• USING LENSOMETER READINGS OF OLD Rx TO DETERMINE GLASSES Rx TO BE USED IN NEW FRAME

• PATIENTS ORDERING GLASSES OVER THE INTERNET

PATIENT ACCOUNTS

ACCOUNT RECEIVABLES

• When to send bill to patient.

• When to send to collections.

• When to write off as bad debt.

UNHAPPY PATIENTS

• WHEN TO GET DOCTOR INVOLVED

• EMPOWERING STAFF

QUALITY CONTROL

• Chart Auditing

• Account Auditing

• Auditing Petty Cash

• Managing Contact Lens and Frame Inventory

WHAT IF?

Protocol for Office Emergencies

Protecting Yourself and Your Future

• Membership in the AOA

• Membership in your State Optometry Association

• Membership in your Local Optometry Group

• Membership in the UABSO Alumni Association