Office Polices and Procedures

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Office Policesand Procedures

• Dr. Lynn Hammonds
• EyeCare Associates, Inc.
• Hoover, Alabama
• lhammonds_at_webeca.com

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PRACTICE SETTINGS

• Solo Practice
• Associate - Individual or Group Practice
• Corporate Affiliate
• Referral Center
• Veterans Administration
• Academia

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WHY HAVE OFFICE POLICIES AND PROCEDURES?

• AVOIDS CONFUSION
• TO COMPLY WITH FEDERAL AND STATE LAWS
• REDUCES LIKELIHOOD OF LITIGATION

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Things To Remember

• IF IT IS IMPORTANT Write it down
• BE CONSISTENT
• BE OPEN TO CHANGE WHEN NEEDED

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THE EMPLOYEE
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EMPLOYEE RELATED POLICIES

• Employee Handbook
• Employee Training Introductory Period
• Office Meetings
• Documentation

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The Employee Handbook

• Purpose Mission Statement
• Employee Benefits
• Personnel Policies and Regulations
• Operation Policies and Regulations

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THE EMPLOYEE

• Employee Job Descriptions
• Employee Evaluations
• Employee Compensation
• Employee Warnings and Termination

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Office Policies not Addressed in Employee Handbook
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WHEN IN DOUBT SEEK LEGAL ADVISE FROM A
PROFESSIONAL!
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Patient ManagementPolicies and Procedures

• Dictated by Federal Law
• Dictated by State Law
• Dictated by Third Party Carriers
• Dictated by Surgeon
• Determined by Experience

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PATIENT SERVICES
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SCHEDULING PATIENTS

• SCHEDULE TEMPLATE
• LAST NEW PATIENT MORNING
• LAST NEW PATIENT AFTERNOON
• WHEN TO DOUBLE BOOK
• HOW TO BOOK EMERGENCY PATIENTS

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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.

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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.

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CELL PHONES
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PATIENTS LATE FOR THEIR APPOINTMENT

• or
• DOCTOR RUNNING LATE

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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.

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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

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DETERMINING IF FEES WILL BE REIMBURSED BY
INSURANCE

• INSURANCE MANUAL

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CASH PAYMENTS

• GIVE PATIENT A RECEIPT SHOWING PAYMENT OF CASH
• MAKE COPY OF RECEIPT AND PUT IN PATIENT FILE
• RANDOM AUDIT OF CASH DRAWER

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PATIENT REFUNDS

• Who has the authority to approve a patient
  refund?
• When to give the patients money back.

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CLINICAL SERVICES
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HARD COPY FILES OR ELECTORNIC MEDICAL RECORDS
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EXAM FORMS
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CHART DOCUMENTATION

• BLACK INK
• ADDITIONS/CORRECTIONS
• WRITING LEGIBLY
• ADEQUATE HISTORY
• OBJECTIVE FINDINGS

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WHAT ARE THE MINIMUM TESTING REQUIREMENTS FOR A
COMPREHENSIVE EXAM IN ALABAMA?
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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

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INSURANCE REIMBURSEMENT

• Documentation is the Basis for all Coding

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• 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

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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.

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Evaluation and Management (EM) 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 isnt in the record, it didnt happen

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CPT CODES

• 92XXX
• 99XXX
• 6XXXX
• 7XXXX

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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 -

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CATARACT PATIENTS

• INTRAOCULAR IMPLANT OPTIONS
• POST OPERATIVE CARE
• YAG CAPSULOTOMY

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REFRACTIVE SURGERY PATIENTS

• PRE-OPERATIVE VISITS
• POST-OPERATIVE VISITS

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DIABETIC PATIENTS

• Report Findings to Primary Care Physicians

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• 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
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• Contact Lens Fitting Policies and Procedures

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Contact Lens Fitting Fees

• Global Fees vs. Per Visit Fees
• Minors
• Unsuccessful Patients

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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

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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

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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.

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DRUG PRESCRIPTIONS
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PRESCRIPTIONS FOR MEDICATION

• DOCTOR SIGNATURE REQUIRED ON ANY Rx FOR
  PRESCRIPTION DRUGS
• DOCTOR APPROVAL FOR ANY Rx CALLED INTO THE
  PHARMACIST FOR PATIENT

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E-PRESCRIBEPQRI PHYSICIAN QUALITY REPORTING
INITIATIVE EARN 2 OF TOTAL ALLOWED CHARGES
in 2010
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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.

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OSHA STANDARDS

• PROPER STERILIZATION OF EQUIPMENT
• TONOMETER PROBE CLEANING
• PROPER DISPOSAL OF NEEDLES
• Employee Accidents

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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.

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RECORD RELEASE FORM SIGNED BY PATIENT FOR
RELEASE OF RECORDS
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Optical Services
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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

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WARRANTIES

• FRAMES
• ANTI-REFLECTIVE COATINGS
• SCRATCH COATINGS

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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

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SPECIAL OPTICAL SITUATIONS

• PUTTING NEW GLASSES PRESCRIPTION INTO PATIENTS
  OLD FRAME
• USING LENSOMETER READINGS OF OLD Rx TO DETERMINE
  GLASSES Rx TO BE USED IN NEW FRAME
• PATIENTS ORDERING GLASSES OVER THE INTERNET

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PATIENT ACCOUNTS
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ACCOUNT RECEIVABLES

• When to send bill to patient.
• When to send to collections.
• When to write off as bad debt.

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UNHAPPY PATIENTS

• WHEN TO GET DOCTOR INVOLVED
• EMPOWERING STAFF

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QUALITY CONTROL

• Chart Auditing
• Account Auditing
• Auditing Petty Cash
• Managing Contact Lens and Frame Inventory

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WHAT IF?

• Protocol for Office Emergencies

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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