Retinal Physician

JAN-FEB 2017

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R E T I N A L P H Y S I C I A N | J A N U A R Y / F E B R U A R Y 2 0 1 7 37 37 R E T I N A L P H Y S I C I A N . C O M | J A N U A R Y / F E B R U A R Y 2 0 1 7 ere is a growing array of off-the-shelf electronic products that provide tremendous assistance. For example, using an HDMI cable and a 32-inch TV as a computer monitor will cost less than $200. Using a Kindle app (Amazon.com, Seattle) on an 18.5-inch tablet is possible for about $500. It might be wise to ask vendors of higher priced devices if you can have one unit as a demo. PERSONNEL Utilizing the right personnel is a key to success in this discipline. Low vision is not cured with optics — train- ing is the secret to success. Rehabilitation requires adaptive skills that take time and practice to develop. For example, eccentric fixation with a macular scar is necessary in many patients, but only with considerable practice does it become effective. An optometrist or ophthalmologist with a special interest in LVR is the first professional that low vision patients will see for an evaluation. It is also essential that specially trained occupational therapists (OTs) be part of the program. ese OTs can work in the office or for a home health agency; the latter will let them visit patients in their home environments. BILLING AND FINANCIAL CONSIDERATIONS Medicare reimbursement is available for LVR services, so while CMS is not a huge source of revenue, LVR can be self-supporting. Since 2004, CMS has had a national policy in place that allows CPT rehabilitation codes to be used for the ICD diagnoses of visual impairment. Most low vision doctors use an E&M office visit code, a visual field test code, and perhaps a prolonged service code for the initial evaluation. e OT working in the retinal practice can bill under Part B of Medicare in the retinal office or can use appropri- ate Part A charges if they work in other types of settings. Part B reimbursement for OTs pays more than $100 per hour for face-to-face treatment (eg, 97534 in 15-minute increments). Payer coverage and documentation guidelines for low vision services should be researched thoroughly. Review of CMS Online Coverage Manuals, NCD, and your local MAC LCD guidelines for erapy Services should be completed before any decision is made. While traditional Medicare will allow coverage for LVR, and Medicare Advantage plans should follow Medicare guidelines, confirming benefits is strongly rec- ommended. Commercial plans may or may not have poli- cies in place for LVR. Benefit calls should include CPT and ICD-10 code specific questions to ensure proper cov- erage data is obtained. Compensation for the professionals providing the LVR service is an important consideration. We have found that a productivity-based model of compensation has great merit. Everyone involved should have some "skin in the game" to achieve a financially successful LVR practice. A fair percentage of collections can be ascertained, taking into consideration the projected revenue and direct costs. A percentage of practice overhead should be assigned based on the services to be utilized, such as front office (scheduling and check-in/out) and billing. Don't forget to include the sale of LVR devices in the compensation model. is is an area where you have more flexibility to determine the percentage of the profits that should be allo- cated to the physician. A CASE IN POINT We recently had a delightful woman referred by one of our retinal physicians to the low vision rehab service. She was in her late 90s and had been receiving anti-VEGF injec- tions for more than a year. e first words out of her mouth were delightfully disarming: "You know, sonny, when you are nearly 100, you slow down a little bit. I am not running races any longer, and that gives me more time for reading now. But darn it, I don't see well enough to read any longer. You've got to do something about that!" Like many posttreatment exudative maculopathy patients, she had a moderate reduction in VA (20/80) with a relative scotoma present centrally. With 4X magnifica- tion, optimal illumination, and some simple OT instruc- tion, she was back to reading in no time and happy about it! She was a political junkie and wanted to keep up on the mudslinging taking place in the primaries. When I asked her how long she planned to live, she replied, "At least until November. I want to see who wins the election. After that though, I may want to die!" LVR is really the bottom line in what we do as reti- nal doctors. It is where the retinal rubber meets the road. Ignore it, and you won't be truly getting full traction in helping your patients. RP "Sonny, when you are nearly 100, you slow down...that gives me more time for reading...[but] I don't see well enough..."

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