the 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 do to!
You should 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.