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Wind(mills) of Change

This is not the time to take the Quixotic approach of trying to will the realities of healthcare reform away

in the famed Cervantes novel, Don Quixote was always fighting windmills. When it comes to healthcare reform, however, there is no bucking the system.

Instead, now is the time to buckle up. The optical profession is going to have a very bumpy, exciting, and busy year. With the healthcare exchanges going online and a projected 27 million Americans entering the already strained healthcare system in the next 10 years, it’s important to keep focused on those pieces of this massive puzzle that we can contain and control.

As you move through this new year, here are four of the items that should top your to-do list.

No. 1.
ATTITUDE ADJUSTMENT

The primary questions I get from practitioners I work with go something like this:

“Why do I have to care about whether this patient has already used their benefits; whether this service is covered under the their health plan; and whether they have to pay out-of-pocket amounts for it?”

It is imperative that you don’t lose focus amidst the constant evolution of the insurance game. Help your patients. Take care of the patient first, as always. If everyone focuses on the irritation of having to worry about insurance plan benefits versus actually taking care of the patient’s healthcare needs, the patient will be the loser.

It is a very frustrating process trying to mold your medical care into the insurance company’s benefit plan, so remember this: It’s healthcare reform, not insurance reform. The reason you have to be aware of the ins and outs of insurance is so you can function within healthcare.

So, in answer to the question, “Why do I have to care...,” you need to know these things so you can get paid for your services, pay your staff, and keep your lights on. It’s very frustrating—but it is also mandatory!

No. 2.
CODING CHANGES

ICD-10 is less than 10 months away. Have you started to learn this code set yet? If you have not reviewed ICD-10 code sets for reporting diagnoses with your practice, you are a little behind. ICD-10 will require your offices to revamp their intake strategies, scheduling strategies, and documentation requirements. ICD-10 is a much more specifically defined code set, so your documentation must also acclimate (see sidebar).

The good news? There is so much information available for ICD-10, both online (at cms.gov/ICD10, for example) and with your professional associations, that implementation should be a breeze come October 1.

No. 3.
SOFTWARE UPDATES

HIPAA-mandated transaction sets have already been put into place. Your job will be to make sure your EHR software vendor, as well as your claims clearinghouse, is ready for ICD-10 transactions to begin without fail on October 1. Software updates should be in place by midyear at the very latest, so testing can be done to make sure that you have very little interruption in revenue in October.

No. 4.
POINT PERSON

With the healthcare climate as it is now—and with ICD-10 coding coming this fall—your office needs to employ someone who can get to the bottom of every patient’s plan benefits and then be able to EXPLAIN them to your patient base (and to your staff).

So, whatever your sentiments about healthcare reform, you can’t afford to be like Don Quixote and will it all away. If you want to stay in business, that is.

Instead, heed these four steps; they will go a long way in working toward quality healthcare in 2014!

— Krystin Keller

Krystin Keller is an instructor and consultant with Cleinman Performance Partners, a business consultancy specializing in the development of high-performance optometry practices. © 2014 Cleinman Performance Partners.