The Optical Vision Site

Making the Most of Optical Managed Care

This post on Making the Most of Optical Managed Care was submitted by ClearVision Optical:

Independent optical dispensers are often reluctant to embrace the world of managed care, but the reality is: managed care is here to stay. Fortunately, there are a number of ways to make managed care work for you and your optical practice.

Junction City Frames by ClearVision Optical

For starters, you need to choose which plans to partner with. This should be a case of choosing the RIGHT plans, not the MOST. That’s because for each insurance provider you partner with, your office will have an equal number of provider policies to manage. Ultimately, this could result in you and your staff spending more time on paperwork – and less time with patients.

Instead, be selective in choosing managed care partners. Study what each partnership will mean to your practice. If a plan won’t provide you with an increase in sales that is in proportion to the amount of work entailed in partnering with it, cross it off your list. It’s also important to consider which plans local companies or unions in your area offer.

Once you’ve selected your managed care partners (and your staff has mastered the practices and policies of each), it’s time to work with your customers. Be sure to position yourself as an expert on eyecare with your customers. Sell what looks good on your customer and what is medically necessary – not what is the cheapest frame. To this end, you can encourage your customer to use their managed care funds as a discount toward better frames. Stress the benefits of quality products in medical terms and the importance of a well-warranted frame.

Despite your effort to up-sell, many managed care customers may simply want inexpensive frames that are 100% covered by their plans. While this audience wants a veritable bargain, they do not want to look cheap. Fortunately, house brands such as ClearVision Collection, Junction City and Koodles from ClearVision Optical offer current styles at managed care-friendly prices.

You also can use managed care to help freshen up your frame board. Take your slower-moving frames off your main board and replace them with new product. Move the old product to a separate area and label it as a specially-priced “Managed Care Collection.” This way, you can offer your managed-care customers name brands at lower prices, while reaping the rewards of having fresh, new product on display.

If you select the right plan partners, educate your staff and offer good value to your customers, you will ultimately reap the many rewards of managed care.

Health Reform Bill Update

Health Care Reform Bill Moves to Senate Floor for Debate

Senate Democrats managed to push health care reform legislation past a key hurdle on Saturday night, with a close vote that will lead to a debate on the Senate floor later this month, the Associated Press reported.

U.S. Sen. Christopher Dodd

The Senate bill roughly mirrors a health care reform bill that has already been passed by the U.S. House of Representatives, although some major differences would have to be ironed out before a bill could reach the desk of President Barack Obama. U.S. Sen. Christopher Dodd (D-Conn.) announced the vote Saturday night.

“On this vote, the yays are 60, the nays are 39, three-fifths of the senators duly chosen and sworn having voted in the affirmative, the motion is agreed to,” Dodd told reporters.

Prior to the vote, all 40 Republicans were on record as opposing the bill, and the Democrats did not have a single vote to spare, needing every Democrat and Independent who normally votes with Democrats to vote in favor of the motion. Two key Democrat votes were secured on Saturday.

U.S. Sen. Max Baucus

President Barack Obama has made health care reform a top priority of his administration.

“Tonight we have the opportunity, the historic opportunity to reform health care once and for all,” Sen. Max Baucus (D.-Mont.), a chief architect of the legislation, said, according to the Times. “History is knocking on the door. Let’s open it. Let’s begin the debate.”

House Passes Health Care Bill – What about Vision Care?

The House health care bill passed Saturday 11/7/09  would:

• Require most Americans to buy health insurance or pay a fine.
• Expand health care coverage to 36 million more people over the next decade.
• Require employers with payrolls above $500,000 to provide insurance to their employees or pay a fine.
• Prohibit insurance companies from denying coverage because of pre-existing medical conditions.
• End premium disparities between men and women.
• Impose a 5.4% income tax surcharge on income above $500,000 annually for individuals and above $1 million annually for households.
• Establish a government-run insurance plan to compete with private insurers beginning in 2013.
• Cost $1.2 billion over 10 years.
• Cut Medicare spending by more than $400 billion over 10 years.

How this will the fact that the House Passes Health Care Bill effect the Vision Care industry? Much more to come on that question but this is a big step towards change that we will all need to embrace whether you support the bill or not!

Source: NCTimes.com

Health Care Reform Package and Vision Care

We are receiving  a lot of correspondence from our readers about Health Care Reform and Vision Care. For example, Eric White, OD has some major concerns about what is happening with the Health Care Reform Package and Vision Care. We are sharing Eric’s concerns with you in case you want to take some action, get involved:

“AOA’s executive board last week was granted the removal of eyecare from the Health Reform to the Finance Committee. Their thoughts were if VSP did not exist that the medical insurance companies would be forced to pay higher reimbursements. This is a scary thought since my practice is 50% VSP and most doctors in California is much higher. What would stop medical insurance companies to just eliminate private practice and go directly to the Costco’s of the world?

We had our VSP meeting last weekend and almost all if not all of us signed a letter asking the Finance Committee to put eyecare back in the bill. It was voted on a few days ago but I do not know if this was added. We need to let all of our colleagues know what is going on and find out what AOA executive board is trying to do. Many people at the meeting last weekend are on different AOA boards and not one of us knew this was happening.

I wanted everybody to hear about this to become involved in saving private practice. Please consider sending a email blast to all PEN members.

Thank you,

Eric White, OD”

Health Care Reform Updates for the Optical Industry

How will Health Care Reform affect all of us in the optical industry? This will be an ongoing question for some time to come. The Vision Council has developed a memorandum to update their optical vision company members on the process and how the legislation may affect us as individuals and as optical business participants. We will be making sure that we review the updates and pass on as much information as possible.

Today, October 13, the Senate voted on health care reform legislation. The Senate Finance Committee approved comprehensive health reform legislation by a 14 to 9 vote, bringing to a close an extended, multi-day markup of the bill. The Finance Committee bill must now be melded with health reform legislation approved by the Senate Health, Education, Labor and Pensions Committee in July. This process will be driven primarily by the Senate Democratic Leadership. Floor action is expected within the next two weeks and debate could require at least three weeks.

Thank you to The Vision Council for providing us access to these timely Health Care Reform Updates for the Optical Vision Industry.

Important Legislative Updates From OAA- Red Flags and Surety Bonds

DMEPOS Surety Bond- Opticians Are Not Exempt

DMEPOS Surety Bond and Accreditation Requirement for Medicare Billing Privileges

Per final regulations implemented by CMS, DMEPOS suppliers will be required to become accredited to obtain and maintain Medicare billing privileges by October 1st of this year, others may be required to post a surety bond by October 2nd to secure Medicare billing privileges and most will be required to provide both.

Frank Whelan, the CMS agency administrator for the new requirements, informed the Opticians Association of America on September 9, 2009 that opticians are not exempt from the Medicare suppliers’ surety bond requirement due Oct. 1st for DMEPOS.  However, opticians are exempt from accreditation.

What you need to do if you are in the process of being accredited or obtaining a surety bond:

The Centers for Medicare & Medicaid Services (CMS) encourages all DMEPOS suppliers currently in the midst of the accreditation process to correct all outstanding deficiencies on your accreditation report, so that a site visit or accreditation decision can be rendered by the October 1, 2009 deadline.  CMS also encourages all DMEPOS suppliers, subject to the bonding requirements, to obtain a surety bond.

While the DMEPOS Accrediting Organization will notify the National Supplier Clearinghouse (NSC) that you are accredited, you will need to notify the NSC that you have obtained your surety bond.  When submitting your DMEPOS surety bond to the NSC, you should submit sections 1, 2A1, 12, and either 15 (if you are the authorized official) or 16 (if you are the delegated official) of the Medicare enrollment application (CMS-855S).  By submitting the required sections of the CMS-855S, you will help to ensure that NSC is able to correctly associate your DMEPOS surety bond to your enrollment record.

For additional information regarding DMEPOS accreditation or the provisions associated with a surety bond, go to www.cms.hhs.gov/MedicareProviderSupEnroll.

Frequently Asked Questions (FAQs) on the surety bond requirement can be found on the NSC’s FAQ page at www.palmettogba.com/ns

RED FLAG RULE

Know Your Billing Codes by Eye Doc News Blog

One of the Blogs we subscribe to is EyeDocNewsBlog: Here is their update about billing codes:

Modifiers Your New Friend-

By Dr. Ari Weitzner

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.

Don’t Refund Money to Insurance Plans

One of the newsletters we subscribe to is Eye Doc News, Ophthalmology Online- the following was a post  by Dr. Ari Weitzner:

“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 calfile:///Users/cathyives/Desktop/Link%20Revenue%20/led 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.”