A number of ophthalmologists have contracted with PHSI and other companies who either totally or partially provide turnkey operations where hearing services and subsequent sales of hearing aids are provided to patients. Some say it’s not ethical, but I disagree. the question is whether it’s appropriate. In other words, would it not be better to send these patients to hearing professionals or ENT?

Hurray! Congress has voted to schedule a vote later this week to delay the 20% fee cut til May 1. They are also drafting legislation to ‘fix” this annual problem of reversing Medicare fee cuts, by freezing the fees for five years. Great idea, guys! Keep up the good work! I am seriously considering dropping Medicare, or, charging a mandatory $40 refraction fee for every visit. Otherwise, I really don’t see how my practice can be profitable with these fees.

Medicare has now eliminated the use of consult codes in the office. You have to use the 92o04 or 992o4 codes (ophthalmology and E/M), but not that 99244 (consult). The difference is around $30-40. Of course, you’re going to end up treating the patient as a consult and writing a letter to the referring doctor like in any other consult, except you’re getting paid less, for no good reason. Yay!

When (and it certainly seems like when and not if) phaco goes down to around $500, I will probably limit myself to straightforward cases, or maybe only those where I can implant a premium lens, and I will try to squeeze all my cases in 1 or 2 days a month. Otherwise, it makes no economic sense. I would imagine this is exactly what Medicare has in mind as a way to decrease reimbursements for the #1 procedure by volume. Yay for ObamaCare!

If you are in private practice, you MUST be familiar with the following three modifiers- otherwise, you are losing lots of money:

-24: This is added to the EXAM code (ie, 92012) during the post-op period (often 90 days after the procedure), when you are examining someone for a different diagnosis (i.e., conjunctivitis 1 month after cataract surgery). Without this modifier, the exam will be denied, as it will be assumed it’s a post-op visit.

-25: Add this to the EXAM code when you do a procedure on the same day- otherwise, you’ll be paid for the procedure only and the exam will be denied (ie, 92014-25  for cataract when you bill for insertion of collagen plugs for dry eye, too, on same day).

-79: Add this to any PROCEDURE CODE you do during the post-op period when it’s unrelated to the original procedure. Otherwise, it will be denied as part of the global fee for the original procedure (ie, removal of chalazion 1 month after cataract surgery).

There are other modifiers, but these three are the most important and come up very often. Make sure your biller understands what you are doing, and that each exam and procedure MUST be attached to a different diagnosis on separate lines.

In general- sure! But I typically go to hang out with my friends. Let’s face it- if you read the big three journals on a regular basis, and you check out websites to see the latest in surgical maneuvers, there’s not much you’re going to learn at the Academy. But if you go to make connections (i.e., you’re looking to move your practice), want to try LRI’s in a wet lab, or want to “test drive” new equipment, then it might be worthwhile. And getting 32 CME credits always comes in handy. But times are tough today- maybe spending a few thousand dollars (in expenses and lost income) is not high on your list this year- can’t blame you. For sure, someone needs to tell the Academy that Anaheim and Houston are not the most interesting cities and should be scratched! (no insult to those who live there!) I wonder if the ASCRS meeting is stealing a significant number from the Academy.

In a study published in the July issue of the Archives of Ophthalmology, researchers reviewed the closed retinopathy of prematurity (ROP) malpractice claims filed with the Ophthalmic Mutual Insurance Company (OMIC) to classify the reasons for the claims. Eight cases involved a failure of transfer of care after discharge of the patient from the hospital, 3 cases demonstrated long periods between follow-up exams, 1 case was due to a failure of outpatient referral to the treating ophthalmologist, and 1 case involved unsupervised ROP care by a resident.

The authors note that the management of ROP is very complex and that there needs to be a systematic process or checklist that is activated when the screening for ROP begins. The following is a summary of  the recommendations from OMIC reviewed in the article and designed to ensure appropriate ROP screening practices and treatment for both inpatients and outpatients:

1. Update and review current ROP screening and treatment guidelines with all parties involved in the care of premature infants including neonatologists, ophthalmologists, pediatricians and parents.
2. Activate a hospital ROP tracking system on the birth of infants who meet the age and weight requirements for ROP screening.
3. Designate an ROP coordinator to follow up with patients identified by the tracking system, ensure appropriate timing of screening examinations while patients are in the hospital, and coordinate the initial follow-up appointments once patients leave the hospital.
4. Make written follow-up appointments before discharge for any patient who has not met the criteria for the conclusion of ROP screening.
5. Attending physicians must supervise residents who participate in any ROP examinations.
6. Assume primary responsibility for ensuring further follow-up and managing the transfer of care between different ophthalmic specialists after the patient is discharged from the hospital.
7. Create and implement an office-based ROP tracking system for outpatients. Institute a follow-up protocol for all changed or missed appointments.

For more detailed guidelines and forms about ROP screening and management, please refer to “ROP: Creating a Safety Net” by Menke AM, available on the OMIC Web site.

Read the abstract or article here (log in required).

The advantage of having, say, two p/t workers instead of one f/t is that a p/t worker does not get or expect benefits, and when one cannot come to work, the other one can fill in. I have 1 f/t office manager and 2 p/t workers who do reception/clerical work. I find this to be much better than having 2 f/t workers. Also, I have found it very difficult to keep f/t workers as receptionists- the good ones, ultimately, look for more challenging work elsewhere. A good employee who is only interested in p/t reception work are often stay-at-home moms or retired women- they are not ambitious, but they are smart and educated. Those are the ideal receptionists.

Over the years, I have received several requests from insurance companies for refunds, based on the fact that the patient’s subscription had expired. Problem is, of course, is that these requests come many months after the fact, making it too late to bill the correct insurance company. When I called and complained, surprise!- I got nowhere. Anyway, I read a piece in one of the throwaways that this practice is really illegal. The article included all kinds of legal arguments you can put in a letter fighting these requests. I recommend you call your local ophthalmology society for help in drafting this kind of letter and fight these unfair requests.

Today, one has cut overhead wherever possible. If you have a relatively small practice, I would advise using Quickbooks instead of a bookkeeper. QB automatically tracks all your checks by category, so when you run a report, you can see exactly where your money is going. For a small fee, you can sign up for payroll services, so you can write your own payroll checks with just a few clicks. You get automatic updates, so you’re always current with all the new payroll changes your friendly government makes. You can do your own quarterly reports, or QB will do that for you, too, for an extra fee. If you’re writing most of your checks using online banking (which you should be), downloading your bank statement to QB is also easy.