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Technician’s Role in Medicare Compliance

Technician’s Role in Medicare Compliance. Jill J Luebbert , CPOT, ABOC. Eye care can be more than vision care. Medical Codes vs Refractive Codes. 99000’s 92000’s. Technician’s play a key role. How you document determines the billing level. Let’s see what your role is.

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Technician’s Role in Medicare Compliance

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  1. Technician’s Role in Medicare Compliance Jill J Luebbert, CPOT, ABOC

  2. Eye care can be more than vision care Luebbert Consulting & Training

  3. Medical Codes vs Refractive Codes • 99000’s • 92000’s Luebbert Consulting & Training

  4. Technician’s play a key role • How you document determines the billing level Luebbert Consulting & Training

  5. Let’s see what your role is Luebbert Consulting & Training

  6. Documentation is the key Luebbert Consulting & Training

  7. Pretest • Chairside documentation Luebbert Consulting & Training

  8. If it isn’t written down • It never happened Xxxxxxxx Xxxxxxxxxxx xxxxxxxxxxxx Luebbert Consulting & Training

  9. Parts of the examination • S • O • A • P Luebbert Consulting & Training

  10. Update from SOAP • S = Subjective Data • NOW PFSH and ROS • O = Objective • NOW Physical Examination • A = Assessment • Remains Assessment • P = Plan • NOW Medical Decision Making & Management Luebbert Consulting & Training

  11. Where do we start? Luebbert Consulting & Training

  12. We start at the beginning • Subjective Data • HPI • History of Present Illness • PFSH • Past, Family, and Social History Luebbert Consulting & Training

  13. Chief Complaint • ‘What brings you here today?’ Luebbert Consulting & Training

  14. Why is this important? • Determines what happens next • Is the chief complaint medically oriented? Refractive - 92000 Medical - 99000 Luebbert Consulting & Training

  15. Examples of ‘medically oriented’ • Vision cloudy • Feel itchy • Teary • Vision fluctuates • Shadows • Headaches • Red Luebbert Consulting & Training

  16. Medically oriented….. • NOW…………. • 99000 CODES Luebbert Consulting & Training

  17. If you ask or observe • DOCUMENT!!!!!!!!! Luebbert Consulting & Training

  18. History of Present Illness (HPI) • Location (where) • Quality (sharp, dull, hazy) • Severity (mild, severe, bothersome) • Duration (constant, off & on) • Timing ( mornings, mid-day) • Context (driving, reading) • Modifying Factors (bright light, close eyes) • Associated Signs & Symptoms(itch, headache) Luebbert Consulting & Training

  19. HPI catagories • If you investigate and document 1 – 3 items • Brief • If you investigate and document 4+ items • Extended Location (where) Quality (sharp, dull, hazy) Severity (mild, severe, bothersome) Duration Timing Context Modifying Factors Associated Signs & Symptoms Luebbert Consulting & Training

  20. Review of Systems (ROS) • Allergies (environmental, drug) • Cardiovascular (hypertension, stroke) • Constitutional ( weight loss, fevers) • Ears, Nose, Mouth, Throat (upper respiratory) • Endocrine (NID, ID, thyroid, hormonal) • Eyes (GLC, AMD, Surgery) • Gastrointestinal (ulcers, colitis) • Genitourinary (STD) Luebbert Consulting & Training

  21. ROS • Hematologic/Lymphatic (anemia, leukemia) • Integumentary (psoriasis, eczema, rosacea) • Musculo-skeletal(osteoarthritis, fibromyalgia) • Neurological (MS, epilepsy) • Psychiatric (depression, panic disorders) • Respiratory (cigarette smoker, asthma) Luebbert Consulting & Training

  22. ROS • If you investigate and document 1 area • Problem Pertinent • If you investigate and document 2 – 9 areas • Extended • If you investigate and document • Complete (Can say all others are negative) Luebbert Consulting & Training

  23. Past, Family, and Social History(PFSH) • Past • Ocular – cataract, AMD, GLC, surgery • Medical – diabetes, hypertension • Family History • Ocular – cataract, AMD, GLC, surgery • Medical – diabetes, hypertension • Medication • OTC and pharmaceutical • Social • Smoking, alcohol, hobbies Luebbert Consulting & Training

  24. PFSH • If you investigate and document 1 area • Pertinent • If you investigate and document 2 – 3 areas • Complete • Required • if new patient Luebbert Consulting & Training

  25. At this point, • Billing level groundwork is laid Luebbert Consulting & Training

  26. Will this visit be…. • Problem Focused • Extended Problem Focused • Detailed • Comprehensive Luebbert Consulting & Training

  27. Luebbert Consulting & Training

  28. Physical Examination • If you looked at it • DOCUMENT IT!!!!! • If the doctor looks at it • DOCUMENT IT!!!!! Luebbert Consulting & Training

  29. If you are chairside assisting • Be observant • The doctor may not follow the ‘traditional’ sequence • Document Luebbert Consulting & Training

  30. Eye Elements • Acuity • Visual Fields (confrontation) • Tonometry • Ocular Motility (cover tests, EOM) Luebbert Consulting & Training

  31. Eye Elements • Adnexae (lids, lashes, puncta, orbit) • Conjunctiva (palpebral, bulbar) • Anterior Chamber • Pupil / Iris • Cornea • Anterior Chamber • Crystalline lens • Retina (macula, foveal reflex, a/v ratio) • Cup/Disc Luebbert Consulting & Training

  32. Systemic Element • Orientation to time, place, person • General Constitution (mood) Luebbert Consulting & Training

  33. At this point…… • Determine if additional groundwork is laid Luebbert Consulting & Training

  34. Investigated and Documented • 1- 5 eye elements • Problem Focused • 6 – 8 eye elements • Extended Problem Focused • 9 – 11 eye elements • Detailed • Comprehensive • 12 eye elements & 1 systemic element Luebbert Consulting & Training

  35. Luebbert Consulting & Training

  36. Billing levels • Are determined by the number of areas of the examination process investigated Luebbert Consulting & Training

  37. What about the refraction? Luebbert Consulting & Training

  38. Refraction • May be a routine portion of the examination • However • Is not a medical test • IS refractive (92000) • Is to be separated from medical procedures Luebbert Consulting & Training

  39. How do we get to the coding • Diagnosis & Management Options • Data Complexity • Risk Luebbert Consulting & Training

  40. Diagnosis & Management Options • Straight forward • Low complexity • Moderate complexity • High Luebbert Consulting & Training

  41. Data Complexity • The doctor determines • Levels • Minimum • Limited • Moderate • Extensive Luebbert Consulting & Training

  42. Risk • Presenting Problem • Diagnostic Procedure • Management Options Minimal – Low – Moderate - High Luebbert Consulting & Training

  43. Decision Making Luebbert Consulting & Training

  44. New Patient Luebbert Consulting & Training

  45. Established Patient Luebbert Consulting & Training

  46. What if you did not document • Lower coding • Lower billing level Luebbert Consulting & Training

  47. You play an important role • Documentation • Follow through Luebbert Consulting & Training

  48. Efficient Recording of Procedures • Leads to • Higher levels of procedure levels • Higher billing levels Luebbert Consulting & Training

  49. You can and do make a difference Luebbert Consulting & Training

  50. Enjoy Nebraska Optometric Conference Experience Jill J Luebbert, CPOT, ABOC jill@jjlconsulting.com www.jjlconsulting.com Luebbert Consulting & Training

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