It’s been a very busy few weeks in the coding world. Now, you may not think that you’re affected by medical coding and compliance issues, but they touch every health care practice in the U.S. So, it’s vital that every health care provider develops a good offensive game plan for 2011, to better your clinical care, your coding and reimbursement knowledge, and medical compliance issues. Shoot for these goals:

• Goal #1: Analyze and develop your fees based on facts, not emotions.

One of the biggest changes came in the form of a one-year moratorium on Medicare physician payment cuts. This legislation, passed in mid-December, provides the new Congress with the opportunity to design a permanent fix to the Medicare reimbursement system once and for all. While on the surface the new CMS conversion factor appears to have decreased, physician reimbursements have remained stable from 2010 to 2011 because of the positive changes in the RVUs (Relative Value Units) and GPCIs (Geographic Practice Cost Indices).

• Goal #2: Understand opportunities to build your practice through better clinical care.

Optometrists often take for granted the clinical care we provide. We frequently give away our professional medical services (read: intellectual property) because we either don’t know how to code for what we provided, or we’re too frightened about losing a patient if we actually have to charge them for providing excellent care and solving their problem.

For example, management of dry eye or ocular surface disease is an area that has grown significantly in differential diagnosis, clinical testing, and management options. We now have a device (TearLab) that can actually measure osmolarity of the tear film, and we can code/bill for it: “83861–Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity” went into effect January 1. There are special rules for clinical lab tests, so be familiar with them before actually billing for it. Another growing area is diagnosis and management of meibomian gland disease/dysfunction.

These advances in clinical care also provide huge opportunities for revenue growth in your practice, if you follow appropriate coding guidelines and rules of medical necessity.

• Goal #3: Protect yourself and your practice from audits.

Chart compliance audits are on the rise by both refractive and medical carriers. The penalties are substantial, with recoupments easily reaching into six-figures.

Your best offense? Get up to speed with EMR and incorporate it into your practice. Consider one of the web-based coding systems (disk-based systems are generally not as current and need continual updating) to keep you and your practice up-to-date on all of the changes with rules, regulations, guidelines and policies.

As a new year begins, we have to be able to look back at our successes while looking forward to our opportunities and challenges. Providing the best care should always be about the patient, and not the money. In short, increased profitability is simply a byproduct of providing the standard of care to your patient, and then translating your medical record correctly in terms of the CPT.

Build a strong offense by treating your whole patient—refractively and medically. Build a strong defense by taking care of your medical record and learning how to translate your intellectual property into CPT codes that accurately reflect the care you provided.

To win the game, you have to have a proper balance of both offense and defense to come out on top. Embracing these realities will allow you to thrive and not just survive in today’s healthcare environment.

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