Providing Retina Services in a General Ophthalmology Practice
Cli
Financial Disclosure
Warren Laurita – Speaker for Regeneron and Allergan American Society of Ophthalmic Administrators May 10, 2016
New Orleans, LA Mary Pat Johnson, COMT, COE, CPC, CPMA Warren E. Laurita, MBA
Financial Disclosure
Need vs Desire
Mary Pat Johnson is a consultant for Corcoran Consulting Group and acknowledges a financial interest in the subject matter of this presentation.
A.
Need 1. 2.
a. 2 to 5 new patients per half day b. 15 to 20 established patients per half day
B.
Desire – 1. 2.
Types of Arrangements A.
2.
Types of Arrangements
Includes a. Space b. Equipment c. Some Staff Functions as a Retina Group Office – retina bills
A.
Leased Employee Physician is leased to General Group 1.
2. 3.
C.
Provide total ophthalmic care One stop care - marketing
Rental Pre-established rent 1.
B.
Is there a lack of retina services in the community Is there significant patient volume
Governmental Regulations 1. Fair Market Value 2. The contract must be for a minimum of one year 3. The contract cannot be ‘evergreen’ a. The contract must be reviewed / negociated annually b. The fair market value must be re-determined annually
Payment is made to Retina Practice a. Flat Fee b. Percentage May or may not include leased staff Functions as general with retina service – general bills
Hired Physician (part time) Physician becomes employee of General Practice – general bills
1
Space A.
Appropriate space must be available on a consistent basis 1. 2. 3. 4.
B.
Waiting room and sub waiting room Work-up rooms Exam rooms Procedure / injection rooms
Fluorescein Intraocular drugs for injection a. b. c.
Ordering of Drugs 1. Receiving and refrigerating 2. Logging into system Tracking utilization a. Patient b. Drug
Argon PDT
Indirect Refrigerator
B. Supplies 1. 2.
Drug inventory System 1.
OCT Laser a. b.
5. 6.
A.
Slit lamps Camera
Electronic Medical Records System 1. 2.
Avastin Lucentis Eylea
Eye Lot number
Payments 1. Match payments received to each drug 2. Tracking payment of Invoices Retina Physician must learn new EMR system (leased or employed) Retina staff must learn new EMR system (leased)
Staff
Staff
Reception Technicians
Typically provided by General Practice 1. Always present to make appointments 2. Require proper training for scheduling retina patients a. b. c.
3.
5.
When Where By whom
2. Followers (Scribes) If from general a.Must be trained for following in retina
When Where By whom
i. ii. iii.
Benefit Investigation for Injectable a. b.
Work-up technicians typically provided by general practice a.Require training to perform retina work-ups i. ii. iii.
Proper spacing for new and established patients Direct injection patients Patients receiving procedures
Providing training a. b. c.
4.
1.
When Where By whom
b.Must learn all retina terminology c.Must learn injection preparation and assistance
prior authorization requirements Drug co-pays and deductibles
Confirmation of patients
3. Followers (Scribes) If from retina a.Must learn general EMR b.Must adopt to environment
2
Staff cont..
Goals and Expectations
A. Work Place Culture 1. 2. 3. 4.
A. General Practice
Who is in charge? Pace of work Responsibilities Expectations a. b.
1. Provide retina care a. Better service to patients b. Better marketing position
By general staff (retina staff if present) By retina physician
2. Utilize vacant space a. Use office space when vacant (i.e. in surgery) b. Offset cost
B. Staff Cooperation
3. Generate additional revenue
1. With retina physician 2. With retina group staff (if present) 3. General physicians with retina physician
B. Retina Practice 1. Expand patient catchment area 2. Maximize available treatment time 3. Protect referral base
Thank You for your attention
3
Objectives Coding and Billing for Retina Services
• • • •
Mary Pat Johnson, COMT, COE, CPC, CPMA Senior Consultant Corcoran Consulting Group
