PaperlessContinued from page 1

ALLDocsALLDocsThe

Newsletter

Get JazzedYour board of directors is jazzed

for the annual meeting. Sure, ithelps that we’ll be meeting in NewOrleans in a beautiful Ritz Carltonthat backs right up to the famed French Quarter.But we’re just as excited about the program that istaking shape.

Our theme this year is medical billing—andeven if you arrive knowing very little, you’ll leaveready to implement it into your practice. One dayof the meeting will be devoted to a six-hour semi-

nar on medical billing, presented by a panel of experts, including Dr.John Rumpakis whose column is featured on page 3. We’re hopingto add a session for your staff members who handle the billing.Please email or fax me to let me know if you’re interested in invitingstaff members along for this session so we can increase our reservedblock of rooms, if necessary.

You’ll notice that this newsletter will also be taking on more of a“how to” approach. In this issue, Dr. John Magalhaes shares somestrategies for starting with medical billing, while Dr. Rumpakis remindsus that what we say is equally important to what we do. And Dr.Dawn Bearden shares how she is moving her offices toward paperless.

Throughout the year, this newsletter, sponsored by Alcon, will intro-duce the concepts we’ll be sharing at the annual meeting. We are luckyto have several ways in which we can exchange information that helpsour practices, our patients, the LensCrafters locations next door and ourprofits. While that should be plenty of incentive to come to the annualmeeting, the board extends one other attractive incentive: stay for theentire session and we’ll pay for your first night in the hotel. We’ll havemore details in the next issue, but I ask that you contact me as soon aspossible if you’re interested in our billing staff session. ■

Dr. Kerry Gelbdrkmg@comcast.net or 732.726.1735

A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

Dr. Gelb

2

Provide Patients Direction on Solution

Mark Steadman, O.D.,Nashua, NH, understands whyso many patients are indiffer-

ent to their contact lens solutions. “Ifpractitioners don’t stress the importance,patients will treat solutions like they’reall the same,” he says. To counter that,he makes a strong recommendation inthe exam room about using—and stay-ing with—a specific solution. For many

patients, he recommends OPTI-FREE®

EXPRESS® MPDS NO RUB™ Lasting Com-fort Formula. He tells patients he used ithimself when he wore contacts. “I foundit a nice, clean, easy solution to use. Itdoesn’t leave a residue on the lens. I tellthem it’s good for their eyes and goodfor their contacts.”

To keep patients from buyingwhat’s on sale, he and the techs tell pa-

tients: “This is your so-lution. Check with usif you’re thinking ofchanging brands.” Inthis way, Dr. Steadmanlets patients know thatthe choice of solutionis one of the factors inoverall contact lenscomfort. ■

they could move the examination formatto mirror the way these O.D.s movedthrough the exam process. They cus-tomized responses in the drop-downmenus so that common responses werenear the top. They created commonlyused sentences so that the computerrecognized and offered those as an op-tion after just a few keystrokes or in amenu. That saves them from typingthe same responses on most charts.

She compares herself and the staffon the day the trainer left to sadpreschoolers watching their mom walkout the door. But they followed the pre-dictable pattern of learning to crawl,walk and then run as their confidencegrew. MaximEyes support techs havethe ability to make modifications re-motely, so even in between visits fromthe trainer, they were able to continueto customize and modify the system.

Trial and ErrorsWhile the transition went smoothly

when patient flow was minimal, whenvolume picked up so did the tensionlevel. “My techs were ready to mutinywhen we started to see a regular patientload. If we had 10 charts that were aninch thick that day, the techs weren’ttech-ing, they were scanning.” So thestaff and O.D.s began looking carefullyat what really needs to be in the com-puter record and how much of whatthey were scanning was redundant.

In the next issue: Dr. Bearden details thebenefits of the system and the tremendous pa-tient response. ■

FROM THE PRESIDENT’S DESK

3ALLDocsALLDocsThe

Newsletter

forming a comprehensive exam that in-volved medical decision-making, theO.D. billed the following:

92004 - Comprehensive exam, re-imbursed at $122.11.

92015 - Refraction, billed and denied.99212 (modifier 59) - E/M, reim-

bursed at $36.16.Dr. Magalhaes comments: “Note that

the two entering medical complaints wereworked up separately and billed appropri-ately. Review the definition of 92004 andits attendant requirements and the newglaucoma screening codes G0117 andG0118, which could apply here as well.Medicare will deny refractions, but the feecan be collected from the patient if an Ad-vanced Beneficiary Notice is presentedand signed by the patient. Modifier 59 isused to indicate ‘distinct and separate’ andis tied to a diagnosis of SPK, while the

“Don’t be afraid to bill for thereimbursement to whichyou are entitled,” says John

Magalhaes, O.D., F.A.A.O., North An-dover, MA. Just be sure to “bill for whatis done, well-documented and what willstand up to a medical review (audit).”

To illustrate, Dr. Magalhaes provid-ed the following three case examplesfrom his offices. He notes that each lo-cal Medicare carrier may have differentregulations and should be consulted.

Example #1A 68-year-old African American male

with a history of IDDM, family history ofglaucoma, and a past eye history of asy-metric cupping and consistently high eyepressures presents with reported concernfor glaucoma and itchy, tearing eyes. Af-ter taking an extensive history and per-

92004 is linked toOAG suspect.”

Example #2The same patient

returns for a full glau-coma work-up to in-clude extensive diagnostic testing, forwhich the O.D. billed the following:

92083 - Visual field, reimbursed at$68.10.

92135 (modifier 50) - Scanninglaser, reimbursed at $81.26.

92020 - Gonioscopy, reimbursed at$25.83.

Dr. Magalhaes comments: “Thesemay all be attached to diagnoses such asOAG suspect, PXS and OHT as appropri-ate. Other billable services could have in-cluded pachometry 76514, serial tonome-

Getting Started with Medical Billing

Continued on page 4

Dr. Magalhaes

THE MEDICAL MODEL

A Little Explanation Goes a Long WayBy John Rumpakis, O.D., M.B.A.

One of the tenets of medical billing is to documentwell. But in making sure that your documentation

supports your claim for the payer, don’t overlook whatyou’re telling the patient. Here’s why. I recentlyheard of a case where a patient, receiving aMedicare statement showing $250 in charges,complained that the practitioner was committinginsurance fraud. In fact, the charges were com-pletely appropriate; the O.D. suspected a medicalproblem, performed the additional tests andbilled Medicare on the patient’s behalf.

But place yourself in the patient’s position.You’ve been quoted a fixed price for a procedure,and during the exam, the doctor performs some additionaltests but doesn’t fully explain them. Then he or she tells younot to worry because the insurance company will be billedfor the visit. Three weeks later you get a report from the in-surance carrier showing charges far greater than what youwere expecting. It’s not entirely surprising the patientthought the O.D. was ripping off the insurance company.

Our goal in practice is to have the satisfaction of being

able to practice full-scope eye care and take care of ourpatients in a manner that exceeds their expectations. Thatdemands proper and appropriate communication with ourpatients. If a patient’s signs, symptoms or chief complaintsrequire you to perform an examination or order additional

procedures, explain that the examination is nolonger considered to be a basic vision examina-tion and that while the visit can be billed to thepatient’s medical carrier, the charges and feeswill be different than the stated vision examfee. Then there are no surprises when the insur-ance carrier’s statement shows up. Take thetime to properly set the patients’ expectations.

While communicating what we’re doingduring a medical examination process may be

second nature to many of us, simply imparting the clini-cal value and findings isn’t enough. We also have a re-sponsibility to communicate our fees and the process ofthird-party medical billing. Be your patients’ advocate,provide the best care you are trained to provide, getpaid properly for the services provided and continuallycommunicate with your patients. In so doing, you’llmake the patient your advocate for life. ■

Dr. Rumpakis

Supported by an unrestricted educational grant from Alcon Laboratories

4 ALLDocsALLDocsThe

Newsletter

By Jeff McLean, President of CooperVision, U.S.

In the vast landscape of American business today, itis commonplace for mergers and acquisitions to

take place on a daily basis. What is rare, however, iswhen two companies unite bringing together astrategic fit of both product and personnel to bring awinning combination for each company as well asfor you—our customers. This is precisely what we be-lieve we’ve accomplished bybringing CooperVision and Oc-ular Sciences together!

Our new CooperVision will allow us to enhance ouralready outstanding product portfolio, improve our serv-ice to you with an expanded sales force and add exten-sive Research and Development resources to deliver toyou the next generation of silicone hydrogel material lenstechnology. We are committed to maintaining and im-proving the level of service and attention you enjoy fromOSI and CooperVision, and to ensuring that you can con-tinue to fit either company’s products with confidence.

We consider LensCrafters Leaseholding Doctors

very special customers, and Cooper and OSI havefiercely competed for your business for years. Hopeful-ly, you can appreciate my excitement and enthusiasmas we now will be working together as a single com-pany to partner with you to grow your business. Forthe time being, it’s “business as usual” and you neednot change the way you do business with either com-pany. Let me assure you, however, that we will bemoving quickly to integrate and improve the service,

support and product offeringsfrom our combined companies.

You’ll also be seeing exciting new promotions, pro-grams and product enhancements that will activelydemonstrate our support for you. Watch for informationon the French River Cruise Contest for ALLDocs membersand please keep your eyes open for further news andcompany updates. Please be sure to visit our website—www.CooperVisionOSI.com—for additional informa-tion and answers to your questions.

Thank you for your continued support. Welook forward to an especially exciting year withLensCrafters Leaseholding Doctors. ■

Seeing Beyond the Ordinary

try 92100, and glaucoma provocative test-ing 92140. These services were not per-formed on this particular patient. Visualfield is a bilateral procedure reported onone line. Scanning laser is a unilateral pro-cedure, so use modifier 50 if done on botheyes. For gonioscopy, report bilateral pro-cedures on one line; if only one eye isdone, use modifier 52 for reduced services.”

Example #3A 67-year-old female with a history of

psychotropic drug use and eyelid surgerypresents with a complaint of light sensi-tivity, pain in the eye and intractable for-eign body sensation, OU. After a thor-ough history, review of systems and diag-nostic testing to try to uncover the causeof the eye pain as well as the etiology ofthe FBS, the O.D. billed the following:

99213 (25) - E/M code, reimbursed

at $49.60.67820 (RT) - Epilation to correct

trichiasis, reimbursed at $53.75.68720 (LT) - Epilation to correct

trichiasis, reimbursed at $53.75.Dr. Magalhaes notes: “Remember

that many surgical services carry withthem global surgical periods in whichany follow-ups are included in the globalfee. The office billed the E/M code withthe modifier 25, relating to diagnosis ofeye pain, to indicate that there was signif-icant effort that was ‘separately identifi-able,’ and ‘not part of the surgery or pro-cedure.’ Documentation must indicatethat the complaint of pain was workedup independently and extensively, per-haps with additional intraocular testingto rule out uveitis, vitritis, retinitis, etc.”

Dr. Magalhaes adds, “Just code accord-ing to levels of history, exam componentsand how complicated the diagnosis is.”

In a later issue, Dr. Magalhaes will reviewsome common reasons for denial of claims. ■

Medical BillingContinued from page 3

Allergy SeasonContinued from page 1

contact lens wear. Patients who havered and itchy eyes may choose to dis-continue lens wear without consultingtheir doctor. They may blame their con-tact lenses or solutions for the discom-fort—even if it continues once they’veremoved their lenses.

By writing a PATANOL prescriptionthat the patient can fill throughout theyear, Dr. Mulgrew knows his patients canget the right treatment for their symptomsquickly. Simply by discussing allergies, heopens the door to let patients know hecan treat most ocular problems and condi-tions. Dr. Mulgrew says, “Treating allergieshas been a tremendous practice builder.Not only do our patients now seek ourcounsel on therapeutic matters, buttreating allergies has been an excellentgateway into medical billing, which fur-ther develops loyal patients.” ■

GUEST COLUMN FROM COOPERVISION

A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

ALLDocsALLDocsThe

NewsletterRx Therapeutics for Practice Growth

First Quarter 2005

ond office located in theSawgrass Mall to a practi-cally paperless system.That office only got high-speed Internet access thiswinter—a necessity fornetworking her two of-fices and home computer.

She started down thepaperless path two yearsago by computerizing heraccounting system. “Thatwas my training groundfor computerizing the whole office,” she says.

Going Cold TurkeyWhen Dr. Bearden selected the

MaximEyes software, it involved bring-

Paperless Efficiency

Dr. Bearden at her computer

Robert Mulgrew, O.D., knows thatallergies aren’t just a seasonal prob-lem for his patients. In his Tucson

practice, he sees patients who suffer fromallergy symp-toms year-round. Evenwith those pa-tients who arecurrentlyasymptomatic,Dr. Mulgrewdiscusses theavailability ofprescription oc-

ular allergy medication like PATANOL®.Dr. Mulgrew states there are several

good reasons for talking about allergiesyear-round. Patients want immediate andeffective relief. If he hasn’t provided themwith a PATANOL prescription, they will ei-ther call their primary care physician, orbuy an OTC product. OTC products are

Mark YourCalendar

The ALLDocs annual meeting will beheld on Sunday, October 16, to Thurs-

day, October 20, in New Orleans at theRitz Carlton in the famous French Quar-ter, shown at right. ■

Allergy Season Isn’t Only in Springless efficacious, requiring more frequentdosing, which is difficult for contact lenswearers. Patients can put a drop ofPATANOL in their eyes in the morning,insert their contact lenses soon after andhave all-day relief.

Allergy symptoms are a significantfactor in many patients dropping out of

Continued on page 4

Editor’s Note: This is the first ina two-part series on the experience of Dr.Dawn Bearden, whose practice epito-mizes the paperless office.

When Dawn Bearden, O.D.,took over the lease at thePembroke Pines, FL, office in

1997, she knew she wanted to go paper-less. There were other purchases to makefirst—a visual field machine, topographerand a digital retinal camera, for example.But in 2002, during the slow month ofDecember, the practice put away the pa-per and switched to MaximEyes practicemanagement software.

Dr. Bearden’s experience will prove in-valuable as she prepares to move her sec-

ing a trainer into the office to help withthe transition. She closed the office formost of one day so the trainer couldwork with the technicians and the doc-tors. During the first day of the live sys-tem, Dr. Bearden and the trainer workedtogether adding last-minute customiza-tion while Michelle Leal, O.D., sawthe day’s few patients. That way, theycould see how easily Dr. Leal could ma-neuver through the system during thepatient exam. “We could say, ‘That’sworking’ or ‘This needs to be moved.’We did that for a day or two, keeping apad of paper near the computer so wecould keep notes about the changesneeded,” Dr. Bearden says.

The program is fully customizable, soContinued on page 2