business of contact lenses
Recognize the Value of Your Services
BY CARLA J. MACK, OD, FAAO
The Business of Contact Lenses
is a new column for Contact Lens Spectrum this year. Gary Gerber, OD,
will continue to offer his insights on all topics relating to patient and practice
management from communication to
marketing and office flow. My columns will alternate with Dr. Gerber's and will
focus on coding and billing issues as they relate to your patients, practice and
business. I will review columns and case reports from prior issues and discuss the
important coding dilemmas that may accompany those topics.
Proper Coding is Essential
I've developed a passion
for educating our peers about correct coding and billing for services, procedures
and products for two reasons. First, there's value in the services that you provide
to your patients. When you fit a contact lens, remove a foreign body or diagnose
a patient with glaucoma, you're the expert. There's value in your ability to diagnose
and to treat patients who have come to your practice for your expertise and care.
Second, correct coding isn't something
you should do; legally, it's something you must do.
I've discovered that many
eyecare practitioners are very generous people. While this is inherently a good
attribute, it's not so good for your bottom line when you consistently say "No charge,"
or "Don't worry about it." In Dr. Gerber's January column "Can Administrative Red
Tape Keep Patients Out of Lenses?" I was somewhat surprised to read that it's not
just eyecare practitioners providing services at no charge: Occasionally orthodontists
never consider payment as an administrative road block. Your billing practices should
be consistent and shouldn't vary based on a patient's insurance or lack thereof.
Who is Responsible?
Many of us believe that
our involvement with patients begins with a patient history and ends with a discussion
of the treatment plan. I'd add two more layers of patient care that fall under practitioners'
responsibilities: medical record documentation and correct coding and billing (Figure
1). It's imperative that you have a complete medical record before determining the
appropriate procedure and diagnosis codes. Allowing your staff to choose the codes
for the visit or to change the codes that you've chosen puts you at risk during
an audit. Appropriate coding is the responsibility of the practitioner.
Practitioners often under-code thinking
this will protect them in an audit. A 2004 survey by Cleinman Performance Partners,
Inc. reported that the average optometrist leaves $100,000 of medically necessary
and legitimate charges on the table each year. You can bet that amount has grown
in the ensuing two years. Don't be fooled. Under-coding is no safer than over-coding.
You could reinvest that money back
into your practice for new instrumentation, additional marketing or building renovations
to name a few. In addition, appropriate coding and billing will improve patients'
perception of you and your practice.
Dr. Mack is a
Diplomate in the Cornea and Contact Lens Section of the American Academy of Optometry
and the director of clinics at The Ohio State University College of Optometry.
Contact Lens Spectrum, Issue: February 2007