Article: Turning Wellness Exams into Medical Exams for Increased Reimbursement

[AdminWolf]

You can view the page at http://www.odwire.org/forum/content/...-Reimbursement

[AdminWolf]

Bob's coming back for another round! I hope to see everyone at this show, but if you can't make it feel free to ask questions in this thread.Thanksadam

[Mike Sandy]

Registered. Thanks Adam.

[Steven Nelson]

I hate the title. It sounds too much like you're changing the nature of the exam which is not only inappropriate, but fraud. It would be MUCH better stated as something like "Recognizing the difference between wellness and medical to increase reimbursements".

The biggest critics of medical billing insist that ODs fish for findings to "change" it to a medical visit. The title basically reinforces that it's what we do. That having been said, every OD should register because I'll bet the info is fantastic and will increase their bottom line significantly just by doing things correctly.

[AdminWolf]

I hate the title. It sounds too much like you're changing the nature of the exam which is not only inappropriate, but fraud. It would be MUCH better stated as something like "Recognizing the difference between wellness and medical to increase reimbursements".

The biggest critics of medical billing insist that ODs fish for findings to "change" it to a medical visit. The title basically reinforces that it's what we do. That having been said, every OD should register because I'll bet the info is fantastic and will increase their bottom line significantly just by doing things correctly.

The title sounds aggressive, but remember that the only people that can even see the webinar description are ODwire.org members (ie, your peers), so I think they all get what Bob is driving at.

This should be a good show -- he's always got tons of advice based on the very real data he obtains from eyecor users all over the country.

cheers
adam

[Steven Nelson]

The title sounds aggressive, but remember that the only people that can even see the webinar description are ODwire.org members (ie, your peers), so I think they all get what Bob is driving at.

This should be a good show -- he's always got tons of advice based on the very real data he obtains from eyecor users all over the country.

cheers
adam

My peers are the ones I was talking about

I'm sure it'll be great.

[James Harper]

When these screening procedures "uncover suspect or undiagnosed but established conditions", these can be treated medically. I also cringed when I read the title. Hopefully, while the title was probably successful in grabbing attention, the emphasis will be on uncovering medical problems that are otherwise missed and billing properly for what you do.Considering a medical cause of blurred vision first instead of considering medical only after a refraction does not correct vision as would be expected.

[AdminWolf]

When these screening procedures uncover suspect or undiagnosed but established conditions, these can be treated medically.I also cringed when I read the title. Hopefully, while the title was probably successful in grabbing attention, the emphasis will be on uncovering medical problems that are otherwise missed and billing properly for what you do.Considering a medical cause of blurred vision first instead of considering medical only after a refraction does not correct vision as would be expected.

Yes on all counts

I don't want to put words in Bob's mouth about the topics that he'll cover, but as you mentioned this is going to be about properly billing and coding for the work that you are already doing. With Eyecor he sees lots of practices leave $ on the table that they are legitimately entitled to.

And note that Oculus is the sponsor of this show, so I think there is going to be a heavy emphasis on how to get the best return from all the different high-tech instruments you've purchased for your practice.

I always like doing webinars like these, because the impact/ROI of attending is immediate and high.

cheers
adam

[Mike Cohen]

Yes on all counts

I don't want to put words in Bob's mouth about the topics that he'll cover, but as you mentioned this is going to be about properly billing and coding for the work that you are already doing. With Eyecor he sees lots of practices leave $ on the table that they are legitimately entitled to.

And note that Oculus is the sponsor of this show, so I think there is going to be a heavy emphasis on how to get the best return from all the different high-tech instruments you've purchased for your practice.

I always like doing webinars like these, because the impact/ROI of attending is immediate and high.

cheers
adam

Adam - you are far to bright for me to ever venture an opposing opinion and risk being brilliantly flayed.

You must know that Medicare is prime for cuts and optometry is under the looking glass; excessive diagnostic testing, unneeded instrumentation coding and nursing home mills.


I am just saying that the key word I have been hearing is "audit" and that future revenue should not be easily assumed as unchallenged ROI.

Possibility exists that retroactive refunds of Medicare/Medicaid reimbursements are in the offing.


Mike

[AdminWolf]

Adam - you are far to bright for me to ever venture an opposing opinion and risk being brilliantly flayed.

You must know that Medicare is prime for cuts and optometry is under the looking glass; excessive diagnostic testing, unneeded instrumentation coding and nursing home mills.


I am just saying that the key word I have been hearing is "audit" and that future revenue should not be easily assumed as unchallenged ROI.

Possibility exists that retroactive refunds of Medicare/Medicaid reimbursements are in the offing.


Mike

Mike -- I think you are bringing up a very important issue, we should talk about it at the show.

The reason I find Bob's webinars so useful is because he has direct access into practices all over the country through his software -- so he's seen exactly what sort of behavior gets people into trouble, and what is considered 'kosher'. If anyone can speak to the auditing process, it is him.

happy thanksgiving!
adam

[Steven Nelson]

Adam - you are far to bright for me to ever venture an opposing opinion and risk being brilliantly flayed.

You must know that Medicare is prime for cuts and optometry is under the looking glass; excessive diagnostic testing, unneeded instrumentation coding and nursing home mills.

I am just saying that the key word I have been hearing is "audit" and that future revenue should not be easily assumed as unchallenged ROI.

Possibility exists that retroactive refunds of Medicare/Medicaid reimbursements are in the offing.

Mike

I'm curious on what basis you're mentioning those areas of interest.

[Robert Rebello]

Since there is a reaction to the title of my webinar, I felt I should comment. The title expresses the goal of uncovering diagnoses during a wellness exam, then having the patient return for a Medical Exam. There is nothing wrong in this and should be utilized in every practice. A common example of this is taking wellness photos. We are going to address how to properly accomplish this as well as identifying other procedures that can be performed as part of a wellness exam. I will be showing case studies for these procedures which exposed diagnoses that otherwise would not have been picked up during a slit lamp examination. This is not as one comment stated “changing the nature of the exam which is not only inappropriate, but fraud.” It is not changing the nature of the exam. It is the process of identifying a problem and as the webinar will address how to properly and following NCCI standards, begin treatment for the patient. This is not fraudulent and should be encouraged in all practices.

I look forward to the webinar and your comments.

[Steven Nelson]

Since there is a reaction to the title of my webinar, I felt I should comment. The title expresses the goal of uncovering diagnoses during a wellness exam, then having the patient return for a Medical Exam. There is nothing wrong in this and should be utilized in every practice. A common example of this is taking wellness photos. We are going to address how to properly accomplish this as well as identifying other procedures that can be performed as part of a wellness exam. I will be showing case studies for these procedures which exposed diagnoses that otherwise would not have been picked up during a slit lamp examination. This is not as one comment stated “changing the nature of the exam which is not only inappropriate, but fraud.” It is not changing the nature of the exam. It is the process of identifying a problem and as the webinar will address how to properly and following NCCI standards, begin treatment for the patient. This is not fraudulent and should be encouraged in all practices.

I look forward to the webinar and your comments.

I would like to add one thing. One of my pet peeves is the concept that you can do a wellness exam first. I realize that patient expectation has to play a part, but in reality how can you do a wellness exam on someone you either haven't established is well or find conditions that show that they're clearly not (for example, finding ARMD during the exam or a history of DM).

My take on this issue is that you don't know it's a wellness exam until you're finished. They may come in with a complaint of blurry vision, but you don't know if the diagnosis is refractive (for reasons inexplicable to me, refractive error is considered "well") or medical until you're finished.

I'm not beating you up at all, but it's a very Rumpakis way to approach things and I think he's dead wrong on that. What I wonder is what happens when you dilate that diabetic and find hemes? They're already found, so what are you having them back for? Solely for an opportunity to bill for photos? You certainly won't be doing anything different than the first examination where you did a wellness exam on someone with retinopathy.

What I wish is that we would reserve judgement until the finding are in and then determine if the visit is wellness or medical based on the combination of findings, complaints and diagnoses. That both maximizes your reimbursements and saves the patient the time and expense of unnecessary secondary visits to repeat procedures for the purpose of billing to a better payor.

Just my two cents.

[Mike Sandy]

The title expresses the goal of uncovering diagnoses during a wellness exam, then having the patient return for a Medical Exam.

As soon as you begin the MDM, the exam becomes medical and ceases to be a wellness visit. Having them come back tomorrow to charge them another copay and bill another exam seems like gaming the system for a money grab.

Again, looking forward to your webinar. Thanks again.

[Steven Nelson]

As soon as you begin the MDM, the exam becomes medical and ceases to be a wellness visit.

Again, that's not converting one type of visit into another, but rather recognizing what they actually are. We don't make them medical or wellness...they are what they are when they walk in. Even in the description, it sounds a LOT like fishing for diagnoses so you can have the opportunity to bill their medical insurance. I've not seen the webinar, so I could be off base in my interpretation of what's going to be presented but that's what it SOUNDS like.

I'm all for making money, so you had me at hello when it comes to billing their medical.

[Mark Horwitz]

Again, that's not converting one type of visit into another, but rather recognizing what they actually are. We don't make them medical or wellness...they are what they are when they walk in. Even in the description, it sounds a LOT like fishing for diagnoses so you can have the opportunity to bill their medical insurance. I've not seen the webinar, so I could be off base in my interpretation of what's going to be presented but that's what it SOUNDS like.

I'm all for making money, so you had me at hello when it comes to billing their medical.

Steve,

I think you are arguing on symantics. When Bob Rubello says that you can "convert" a wellness exam to medical, I think he means one of two things. First, if you discover a medical dx that requires treatment at the initial visit, then you identify it as a medical exam, it is not routine and you have determined the nature of the visit after you get to the end of the exam, as you just suggested. Second, if you do uncover some signs of a medical condition that may require further testing that does not require immediate treatment, then you simply have them back for those tests as appropriate. In this case, the initial exam would be routine and the subsequent exams will be medical in nature.

Finally, if you want to do the extra testing at the time of the initial visit, there is no reason why you can't code the exam as routine and also bill the extra testing with a medical dx (ie. VF, phots, etc.) I am interested to see if Bob Rubello agrees at the webinar.

One thing for sure though, he is not suggesting you do fraud. He happens to employ some medical billing specialists. Furthermore, I doubt he would risk the success of Eyecor by suggesting ODs do something illegal.

[Steven Nelson]

Steve,

I think you are arguing on symantics. When Bob Rubello says that you can "convert" a wellness exam to medical, I think he means one of two things. First, if you discover a medical dx that requires treatment at the initial visit, then you identify it as a medical exam, it is not routine and you have determined the nature of the visit after you get to the end of the exam, as you just suggested. Second, if you do uncover some signs of a medical condition that may require further testing that does not require immediate treatment, then you simply have them back for those tests as appropriate. In this case, the initial exam would be routine and the subsequent exams will be medical in nature.

Finally, if you want to do the extra testing at the time of the initial visit, there is no reason why you can't code the exam as routine and also bill the extra testing with a medical dx (ie. VF, phots, etc.) I am interested to see if Bob Rubello agrees at the webinar.

One thing for sure though, he is not suggesting you do fraud. He happens to employ some medical billing specialists. Furthermore, I doubt he would risk the success of Eyecor by suggesting ODs do something illegal.

I never said he advocated fraud and I'm sure everything he says is consistent with the law. I just disagree with the implication of the title and explanation for the reasons I outlined. Everyone has their own style and I'd much rather people do it his way than how many ODs do. Erhapsmhe'll clear it up during the webinar.

[AdminWolf]

i sense this is going to be a really fun show -- close to 400 of y'all have signed up already, so the Q&A at the end should be... spirited

see you tonight!

Adam

[Steven Nelson]

I'm looking forward to it.

[Benjamin Bittner]

billing temp punctal plugs and silicone plugs with same codes insurance denied second claim saying it was a duplicate claim. how do you bill puctal plugs?

[mark botwin]

Good Webinar Bob,
I still disagree in a few areas.

Doc, I'm here for my wellness vision plan exam as I'm out of contacts but I am getting a lot more headaches recently. Medical necessity? Sure. Medical decision making, and recommendation and treatment plan done. Easy enough.

The medical plan is primary the vision plan for billing with a headache dx. Why not bill the scode exam for refraction and cl fitting to the vision plan?

[Wayne Goldschneider]

If a refraction is billed as well as the comprehensive to the medical insurance, and the refraction is denied, can you then bill the vision plan for the refraction?

[mark botwin]

billing temp punctal plugs and silicone plugs with same codes insurance denied second claim saying it was a duplicate claim. how do you bill puctal plugs?

Should not have been denied if you waited for the global 10 day period between procedures.

[mark botwin]

If a refraction is billed as well as the comprehensive to the medical insurance, and the refraction is denied, can you then bill the vision plan for the refraction?

Yes with a copy of the denied eob. You will only get a few dollars so make sure you collect both copays. Good question. In fact, you did more tests than just a "refraction" ie, phorias, near point tests, etc. that are not medically billed tests. Lets take the patient with vision coverage in for their wellness exam with headache complaints. You really did 2 different exams , a vision plan work up as well as a medical history, headache diagnosis and treatment plan. How you can split this visit and have the patient back for half of that exam I don't understand.

[tammy nguyen]

Thanks for such an informative webinar.Is there ANY ocular diagnosis that would increase a patient's medical premium? I heard you comment that its not like car insurance where a diagnosis will increase their fees, but don't people with certain health conditions (diabetes, hypertension, cancer...) have to pay more for medical insurance?

[Benjamin Bittner]

Should not have been denied if you waited for the global 10 day period between procedures.

claim was submitted after the 10 day global procedure. Is there anything else I can do different for the second claim?
insurance says this is a duplicate of the original claim even though it has a different date.

[mark botwin]

claim was submitted after the 10 day global procedure. Is there anything else I can do different for the second claim?
insurance says this is a duplicate of the original claim even though it has a different date.

Call them, speak to a supervisor, someone ignorant is handling the claim.

[AdminWolf]

Thanks everyone for coming to the show!

450+ members registered, so clearly there was major interest in this talk!

Perhaps we can persuade Robert to give another one in 2012.

I've uploaded a copy of the slides at the top of the thread (underneath the Oculus logo).

Thanks again
Adam

[Fred Soto, O.D.]

Hi Bob,When I perform an OCT on a plaquenil patient, I use the diagnosis code V58.69 and it is denied. I get paid if I use the same code for visual fields. What am I doing wrong?

[Robert Rebello]

Good Webinar Bob,
I still disagree in a few areas.

Doc, I'm here for my wellness vision plan exam as I'm out of contacts but I am getting a lot more headaches recently. Medical necessity? Sure. Medical decision making, and recommendation and treatment plan done. Easy enough.

The medical plan is primary the vision plan for billing with a headache dx. Why not bill the scode exam for refraction and cl fitting to the vision plan?

Mark: Yes that is exactly what you can do. I said the cleanest method was to have the patient return and bill both. But you can bill the exam to wellness and the procedures fro whatever the Dx is to Medical.

PS: I was looking for you at Vision West.