"Not long ago I had the pleasure of partaking in another outstanding and informative sermon from Pastor Scott Brown at the Colts Neck, NJ, Reformed Church. The concept of shared knowledge was at the heart of his message to our flock. One of the primary aspects which I took away revolved around the fact that many times we run into situations we do not understand. They are new to us and we need someone to explain them to us."
This is not my personal experience. I did not have the pleasure of listening to what was probably a very good sermon. However, when I read the article this part struck me because this is at the heart of our philosophy here at opticXpress. You see, we try very hard to leverage the experiences of our clients when we perform their optometric billing. It is from this "shared knowledge" that we are able to better serve our optometric billing clients and our partners. We believe that by better understanding their experiences we can help others benefit as well.
Won't you join opticXpress today and help contribute to our ever expanding pool of knowledge? Won't you help opticXpress become the most knowledgeable optometric billing agency around? We hope to see you soon and we are thankful for each and every one of you this Holiday Season.
Happy Thanksgiving !
opticXpress is an optometric billing company that provides a clearinghouse, billing service and software strictly for optometrists.
Monday, November 21, 2011
OPTOMETRIC BILLING AND HOSPICE PATIENTS
YES! YOU CAN BILL AND BE PAID BY MEDICARE WHEN PERFROMING OPTOMETRIC/OPTOMETRIC BILLING SERVICES ON A HOSPICE ENROLLED PATIENT. READ THE ARTICLE BELOW TO FIND OUT HOW. AS ALWAYS, YOU MAY CONTACT opticXpress FOR HELP.
Part B Hospice Modifiers GV and GW
When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for
services that are related to the treatment and management of his terminal illness during the period his
hospice benefit election is in force, except for professional services of an “attending physician” who is
not an employee of the designated hospice and does not receive compensation from the hospice for
those services. Professional services of an “attending physician” are submitted with the GV modifier if
all conditions are met (description below). Any services provided to a patient enrolled in hospice that
are not related to the treatment and management of the patient’s terminal illness are submitted with
the GW modifier (description below).
For purposes of administering the hospice benefit provisions, an “attending physician” means an
individual who is a doctor of medicine, doctor of osteopathy or a nurse practitioner and is identified by
the individual at the time he elects hospice coverage as having the most significant role in the
determination and delivery of his medical care. The attending physician is not an employee of the
hospice and does not receive compensation from the hospice.
The following applicable modifiers should be used when billing for services of a patient enrolled in
hospice. The appropriate modifier usage will depend on who is providing the service, what services
are being provided and if the services are for/related to the reason the patient is enrolled in hospice.
GV Modifier
Attending physician not employed or paid under arrangement by the patient’s hospice
provider
This modifier should be used by the attending physician when the services are related to the patient’s
terminal condition and are not paid under arrangement by the patient’s hospice provider. Also, this
modifier must be submitted when a service meets the following conditions, regardless of the type of
provider:
The service was rendered to a patient enrolled in a hospice.
The service was provided by a physician or non-physician practitioner identified as the
patient’s attending physician at the time of that patient’s enrollment in the hospice program.
Do not submit the GV modifier in the following conditions:
The service was provided by a physician employed by the hospice.
The service was provided by a physician not employed by the hospice and the physician was
not identified by the beneficiary as his attending physician.
GW Modifier
Service not related to the hospice terminal condition
This modifier should be used when a service is rendered to a patient enrolled in a hospice, and the
service is unrelated to the patient’s terminal condition. All providers must submit this modifier when
this condition applies or when claims are submitted for treatment for a non-terminal condition to the
Part A contractor with condition code 07. http://www.trailblazerhealth.com/Publications/Job%20Aid/HospiceModifiersGVGW.pdf
Part B Hospice Modifiers GV and GW
When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for
services that are related to the treatment and management of his terminal illness during the period his
hospice benefit election is in force, except for professional services of an “attending physician” who is
not an employee of the designated hospice and does not receive compensation from the hospice for
those services. Professional services of an “attending physician” are submitted with the GV modifier if
all conditions are met (description below). Any services provided to a patient enrolled in hospice that
are not related to the treatment and management of the patient’s terminal illness are submitted with
the GW modifier (description below).
For purposes of administering the hospice benefit provisions, an “attending physician” means an
individual who is a doctor of medicine, doctor of osteopathy or a nurse practitioner and is identified by
the individual at the time he elects hospice coverage as having the most significant role in the
determination and delivery of his medical care. The attending physician is not an employee of the
hospice and does not receive compensation from the hospice.
The following applicable modifiers should be used when billing for services of a patient enrolled in
hospice. The appropriate modifier usage will depend on who is providing the service, what services
are being provided and if the services are for/related to the reason the patient is enrolled in hospice.
GV Modifier
Attending physician not employed or paid under arrangement by the patient’s hospice
provider
This modifier should be used by the attending physician when the services are related to the patient’s
terminal condition and are not paid under arrangement by the patient’s hospice provider. Also, this
modifier must be submitted when a service meets the following conditions, regardless of the type of
provider:
The service was rendered to a patient enrolled in a hospice.
The service was provided by a physician or non-physician practitioner identified as the
patient’s attending physician at the time of that patient’s enrollment in the hospice program.
Do not submit the GV modifier in the following conditions:
The service was provided by a physician employed by the hospice.
The service was provided by a physician not employed by the hospice and the physician was
not identified by the beneficiary as his attending physician.
GW Modifier
Service not related to the hospice terminal condition
This modifier should be used when a service is rendered to a patient enrolled in a hospice, and the
service is unrelated to the patient’s terminal condition. All providers must submit this modifier when
this condition applies or when claims are submitted for treatment for a non-terminal condition to the
Part A contractor with condition code 07. http://www.trailblazerhealth.com/Publications/Job%20Aid/HospiceModifiersGVGW.pdf
Friday, November 18, 2011
opticXpress is Coming Out With a New Optometric Billing Website!
opticXpress has been promising a new optometric billing website for a few weeks now. The time will be here soon! For customers and visitors alike, the new optometric billing website promises to be more immersive and more informative. You will now be able to get full sneak peaks of the opticXpress software package, clients will be able to watch online video tutorials, look up procedure and DX codes, and even link with social media! The new format is clean and simple to use and promises to be a rewarding experience for anyone looking for optometric billing help or information! Keep checking www.optometricbilling.rlrbillingsolutions.com for the update...it's coming faster than you can blink!
Thursday, November 17, 2011
Optometrists/opthalmologists beware!
For more info on optometric billing, visit www.opticXpress.com
REGULATORY/LEGISLATIVE
OCULAR SURGERY NEWS U.S. EDITION November 10, 2011
Ophthalmologists urged to fight efforts to expand scope of optometric practice
In the wake of the rapid passage of a law in Kentucky, a robust defense is needed to thwart future initiatives in other states.
Ophthalmologists should form a united front to resist powerful efforts being mounted by optometric groups to expand scope of practice privileges, a speaker said.
At the American Society of Retina Specialists meeting in Boston, David W. Parke II, MD, CEO and executive vice president of the American Academy of Ophthalmology, urged colleagues to participate in ongoing efforts to block the passage of state legislation designed to expand the scope of practice for optometry.
Since 1999, the AAO and various ophthalmic subspecialty societies have defeated scope of practice bills in 28 states. Two states, Kentucky and Oklahoma, have laws that expand scope of practice, Dr. Parke said.
Story continues below↓
“In the end, this is all really about principles,” Dr. Parke said. “We’ve got enough patients … but this is really about principles and it’s about quality of care and it’s about patient safety. It is a battle that is supported by your professional organizations.”
Ophthalmologists should be vigilant, Dr. Parke said.
“Recognize that your state may be next,” he said. “Recognize that this has direct implications for retina. Recognize that the legislative privileges that the American Optometric Association is requesting basically de-value your training and your expertise in the eyes of individuals and in the eyes of the public.”
Impetus for expanded privileges
Currently, there are about 16,500 practicing ophthalmologists and about 36,000 practicing optometrists in the United States. Optometrists provide about two-thirds of primary eye care. About 50% of optometrists are employed in practices that also employ ophthalmologists.
Approximately half of optometrists’ incomes derive from the sale of glasses and contact lenses. However, optometrists face stiff competition from various websites that sell contact lenses and glasses, Dr. Parke said.
The pool of practicing optometrists is expected to swell by about 25% in the next 10 years by virtue of five new optometry schools scheduled to open in the next few years.
Medical optometry, centered on expanded surgical privileges, is expected to account for a growing percentage of revenues in optometry in the next few years. This stems in part from the Harkin Amendment, which forbids discrimination based on licensure, Dr. Parke said.
“This opens up the potential for optometry to do surgery and get reimbursed for it,” he said.
Rapid passage of Kentucky law
The Oklahoma law was enacted in 1999. The Kentucky law was enacted in February. Proposed laws to expand optometrists’ privileges have failed in other states.
The Kentucky law allows optometrists to perform injections and some laser procedures. In addition, it gives the state optometric board of examiners free reign to further expand scope of practice without input from the State Board of Medicine, the American Medical Association or any other medical entity, Dr. Parke said.
The Kentucky law was signed into law only 13 days after being introduced in the state legislature, Dr. Parke said.
“It basically broke all records in Kentucky,” he said. “It was lubricated, as all things are, by money. The state optometrists contributed over $500,000, according to state records, within a matter of months preceding the introduction of this bill.”
Dr. Parke described the Kentucky bill’s passage as a “stealth operation” that was undertaken too quickly for ophthalmology to stage a timely resistance.
“It was not lost, as some people have said, because there was a lack of a coalition,” Dr. Parke said. “There just wasn’t time. There wasn’t money.”
Public opinion polls showed that about 78% of Kentucky residents opposed the bill, Dr. Parke said.
“The public is confused about training and professional labels in health care,” he said.
An American Medical Association poll showed that while 94% of respondents voiced a preference for a medical doctor to perform ocular surgical procedures requiring a scalpel, 71% knew that ophthalmologists were medical doctors and 54% believed that optometrists were medical doctors, Dr. Parke said.
“There’s tremendous confusion in the minds of the public,” he said.
Organization and funding
Organized ophthalmology needs substantial funding, organization and support to mount a robust counter-offensive against future scope of practice initiatives introduced into state legislatures, Dr. Parke said.
“Unfortunately, money is the mother’s milk of politics, and the [AAO’s] Surgical Scope Fund is our weapon,” he said.
Dr. Parke encouraged ophthalmologists to forge relationships with state legislators. Organized ophthalmology is also establishing relationships with the American College of Surgeons, AARP and several national consumer groups.
In addition, the AAO and subspecialty societies are sponsoring legislation to block potential scope of practice efforts in many states, Dr. Parke said.
“We have a number of such initiatives in different states. They’ve been effective. As they say, ‘A good offense is sometimes the best defense,’” Dr. Parke said. – by Matt Hasson and Michelle Pagnani
David W. Parke II, MD, can be reached at American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94109; 415-561-8510; fax: 415-561-8526; email: dparke@aao.org.
Disclosure: Dr. Parke has no relevant financial disclosures.
The OSN SuperSite is intended for physician use and all comments will be posted at the discretion of the editors. We reserve the right not to post any comments with unsolicited information about medical devices or other products. At no time will the OSN SuperSite be used for medical advice to patients.
Comment by Dominick M. Maino, OD, MEd -- November 14, 2011 10:26 PM
It is past the time for ophthalmology to stop fighting optometry. In case you haven''t noticed, you have not, will not and cannot win when you put your profession ahead of your patients'' needs. Optometry has been successful because what we do ...we do well...and no matter what ophthalmology says or does nothing will change that. Come work with us. Be the surgeons you are trained to be and let primary care optometry do what we are trained to do...yes, in some instances that means even some surgical procedures...your article is "wrong" in many ways....but I do not have enough space here to comment on these obviously biased...without merit..comments. Give it up and let''s get it together for our patients.
Comment by Eliot Milsky, O.D. -- November 12, 2011 10:32 AM
The story above is somewhat ironic, because optometrists are actually more likely to refer to a retina specialist than are general ophthalmologists, or even PCPs who may not understand ophthalmology sub-specialties. There is no reason for the American Society of Retina Specialists to be hostile to optometry. In fact it is counterproductive: ODs are actually retina specialists'' best friends. Eliot Milsky, O.D. Comprehensive Eye Care Professionals One Spring Street Unit 101, Paterson Street entrance New Brunswick , NJ 08901 Ph: (732) 202-0393 F: (732) 909-2147 eliotmilskyod@yahoo.com
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REGULATORY/LEGISLATIVE
OCULAR SURGERY NEWS U.S. EDITION November 10, 2011
Ophthalmologists urged to fight efforts to expand scope of optometric practice
In the wake of the rapid passage of a law in Kentucky, a robust defense is needed to thwart future initiatives in other states.
Ophthalmologists should form a united front to resist powerful efforts being mounted by optometric groups to expand scope of practice privileges, a speaker said.
At the American Society of Retina Specialists meeting in Boston, David W. Parke II, MD, CEO and executive vice president of the American Academy of Ophthalmology, urged colleagues to participate in ongoing efforts to block the passage of state legislation designed to expand the scope of practice for optometry.
Since 1999, the AAO and various ophthalmic subspecialty societies have defeated scope of practice bills in 28 states. Two states, Kentucky and Oklahoma, have laws that expand scope of practice, Dr. Parke said.
Story continues below↓
“In the end, this is all really about principles,” Dr. Parke said. “We’ve got enough patients … but this is really about principles and it’s about quality of care and it’s about patient safety. It is a battle that is supported by your professional organizations.”
Ophthalmologists should be vigilant, Dr. Parke said.
“Recognize that your state may be next,” he said. “Recognize that this has direct implications for retina. Recognize that the legislative privileges that the American Optometric Association is requesting basically de-value your training and your expertise in the eyes of individuals and in the eyes of the public.”
Impetus for expanded privileges
Currently, there are about 16,500 practicing ophthalmologists and about 36,000 practicing optometrists in the United States. Optometrists provide about two-thirds of primary eye care. About 50% of optometrists are employed in practices that also employ ophthalmologists.
Approximately half of optometrists’ incomes derive from the sale of glasses and contact lenses. However, optometrists face stiff competition from various websites that sell contact lenses and glasses, Dr. Parke said.
The pool of practicing optometrists is expected to swell by about 25% in the next 10 years by virtue of five new optometry schools scheduled to open in the next few years.
Medical optometry, centered on expanded surgical privileges, is expected to account for a growing percentage of revenues in optometry in the next few years. This stems in part from the Harkin Amendment, which forbids discrimination based on licensure, Dr. Parke said.
“This opens up the potential for optometry to do surgery and get reimbursed for it,” he said.
Rapid passage of Kentucky law
The Oklahoma law was enacted in 1999. The Kentucky law was enacted in February. Proposed laws to expand optometrists’ privileges have failed in other states.
The Kentucky law allows optometrists to perform injections and some laser procedures. In addition, it gives the state optometric board of examiners free reign to further expand scope of practice without input from the State Board of Medicine, the American Medical Association or any other medical entity, Dr. Parke said.
The Kentucky law was signed into law only 13 days after being introduced in the state legislature, Dr. Parke said.
“It basically broke all records in Kentucky,” he said. “It was lubricated, as all things are, by money. The state optometrists contributed over $500,000, according to state records, within a matter of months preceding the introduction of this bill.”
Dr. Parke described the Kentucky bill’s passage as a “stealth operation” that was undertaken too quickly for ophthalmology to stage a timely resistance.
“It was not lost, as some people have said, because there was a lack of a coalition,” Dr. Parke said. “There just wasn’t time. There wasn’t money.”
Public opinion polls showed that about 78% of Kentucky residents opposed the bill, Dr. Parke said.
“The public is confused about training and professional labels in health care,” he said.
An American Medical Association poll showed that while 94% of respondents voiced a preference for a medical doctor to perform ocular surgical procedures requiring a scalpel, 71% knew that ophthalmologists were medical doctors and 54% believed that optometrists were medical doctors, Dr. Parke said.
“There’s tremendous confusion in the minds of the public,” he said.
Organization and funding
Organized ophthalmology needs substantial funding, organization and support to mount a robust counter-offensive against future scope of practice initiatives introduced into state legislatures, Dr. Parke said.
“Unfortunately, money is the mother’s milk of politics, and the [AAO’s] Surgical Scope Fund is our weapon,” he said.
Dr. Parke encouraged ophthalmologists to forge relationships with state legislators. Organized ophthalmology is also establishing relationships with the American College of Surgeons, AARP and several national consumer groups.
In addition, the AAO and subspecialty societies are sponsoring legislation to block potential scope of practice efforts in many states, Dr. Parke said.
“We have a number of such initiatives in different states. They’ve been effective. As they say, ‘A good offense is sometimes the best defense,’” Dr. Parke said. – by Matt Hasson and Michelle Pagnani
David W. Parke II, MD, can be reached at American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94109; 415-561-8510; fax: 415-561-8526; email: dparke@aao.org.
Disclosure: Dr. Parke has no relevant financial disclosures.
The OSN SuperSite is intended for physician use and all comments will be posted at the discretion of the editors. We reserve the right not to post any comments with unsolicited information about medical devices or other products. At no time will the OSN SuperSite be used for medical advice to patients.
Comment by Dominick M. Maino, OD, MEd -- November 14, 2011 10:26 PM
It is past the time for ophthalmology to stop fighting optometry. In case you haven''t noticed, you have not, will not and cannot win when you put your profession ahead of your patients'' needs. Optometry has been successful because what we do ...we do well...and no matter what ophthalmology says or does nothing will change that. Come work with us. Be the surgeons you are trained to be and let primary care optometry do what we are trained to do...yes, in some instances that means even some surgical procedures...your article is "wrong" in many ways....but I do not have enough space here to comment on these obviously biased...without merit..comments. Give it up and let''s get it together for our patients.
Comment by Eliot Milsky, O.D. -- November 12, 2011 10:32 AM
The story above is somewhat ironic, because optometrists are actually more likely to refer to a retina specialist than are general ophthalmologists, or even PCPs who may not understand ophthalmology sub-specialties. There is no reason for the American Society of Retina Specialists to be hostile to optometry. In fact it is counterproductive: ODs are actually retina specialists'' best friends. Eliot Milsky, O.D. Comprehensive Eye Care Professionals One Spring Street Unit 101, Paterson Street entrance New Brunswick , NJ 08901 Ph: (732) 202-0393 F: (732) 909-2147 eliotmilskyod@yahoo.com
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