BUSINESS MANAGEMENT

Are You GIVING IT AWAY?

2 OD experts dig into 9 ways that ECPs are losing pure profit—and putting themselves at risk

BY ALLAN BARKER, O.D., and GREG STOCKBRIDGE, O.D., MBA

Eyecare professionals are notorious for giving things away to patients.

Whether we’re talking about free contact lens samples, free prescription and nonprescription samples of pharmaceuticals, or even free adjustments in their dispensary, eyecare practitioners just can’t seem to get enough of giving things away for free.

Never mind the old adage that people don’t appreciate value in something that’s free. Surely that doesn’t apply to eyecare professionals. Let’s consider the following examples of benevolent eyecare professional behavior that may hold hidden negative outcomes.

1. Under-Coding

Any insurance executive will tell you that under-coding can be as detrimental to an insurance audit as over-coding. Often eyecare professionals will under-code because they are paranoid that an insurance audit will put their life and career in jeopardy.

In reality, under-coding can lead an insurer to conclude that the provider is not performing adequate eyecare testing to its insurance customers (who are your patients). And it can only lead to the conclusion that you are a substandard provider who does not do adequate tests required by the diagnosis code.

2. Not Performing a Test Due to Fear of Patient Expense

Eyecare practitioners are known to not run a visual field on a patient with a headache because the patient did not have insurance or, better yet, because they have a high copay or an HSA plan with a high deductible that has not been met.

All it takes is just one missed brain tumor to learn a valuable lesson, and that is to order a test if it is medically warranted regardless of whether or not the patient has insurance. The patient is coming for help, and the eyecare practitioner needs to do what is in the patient’s best medical interest, period.

3. Failure to Convert to Medical

Vision and medical plans can be confusing for the doctor, the staff, and the patients. It is vital that you learn when to bill a patient’s medical insurance and when to bill the patient’s vision plan. We have seen, time and time again, doctors billing the patient’s vision insurance when actually the patient’s intent of the visit was more medical. If a patient comes in with a complaint of lost vision in his right eye and you diagnose a retinal vein occlusion, you don’t need to feel ashamed at billing his medical insurance for this visit. It was not routine.

Too often, patients don’t even know that they can use their medical insurance for the visit. That is where a well-trained staff can educate the patient about the difference between routine vision and medical insurance.

4. Not Billing for Professional Care

Obviously, there is a loss of income when a patient is not billed for any professional service. Also, there may be a long-term impact when the Office of Inspector General (OIG) calculates your usual and customary fees in analyzing your Medicare and/or Medicaid reimbursement profile. “Free” can have longtime damage to your bottom line via reduced reimbursements.

You may even be setting yourself up for a fraud charge with your benevolent behavior. Medicare will let you waive fees for specific financial hardships that are well documented. However, when you don’t charge a patient a fee only because he or she doesn’t have insurance and then you charge a Medicare patient for the same service, you are committing fraud.

5. Failure to Charge for Follow-Up Visits

If you are treating a patient’s medical condition and you need to see him for a follow-up—whether it’s one day later or six months later—those visits should be treated the same way.

We have seen time and time again where eyecare practitioners feel guilty that they must charge for their service if they need to see the patient back one day later. Why someone feels that a one-day follow-up for a corneal ulcer does not justify another office visit makes no sense. The time between visits does not justify not charging for a visit.

6. Waiving Refraction, Copay, and Deductible Fees

Many eyecare providers waive these fees. Again, this constitutes fraud. CMS considers this an inducement for the patient to visit your office—and such inducements are illegal.

7. Free Drug Samples

Let’s say that two patients come to two different offices with an iritis. Both doctors prescribe the same care regimen, but one provider gives an Rx and the other gives a free sample.

Assume that, unfortunately, both cases have a very bad identical outcome. The case winds up in court. The only difference is Dr. A wrote a prescription while Dr. B gave a free sample of the same drug.

Dr. A had the total backup of his records, the prescription, the drug company, the pharmacist, and his malpractice insurance provider.

What does Dr. B have? Not much. Maybe it’s in his record and maybe not. The lawyer asks, “Was the bottle expired?” Who knows? “Was the bottle tampered with?” Who knows?

Which doctor has the best chance of prevailing? Certainly Dr. A, the one who did not give out the free sample to the patient.

8. Free Contact Lens Samples

Surely there are times when in an emergency situation an eyecare professional may want to give a contact lens sample to a patient who can’t see and has no backup eyewear. However, what if the sample is an approximate lens to the patient’s true Rx and the patient is subsequently involved in a tragic accident?

Also, what about the eyecare professional who hands the patient three different samples to try? These eyecare professionals are turning patients into their own doctors rather than using their own professional expertise. Here again, benevolence can create unexpected havoc.

The patient becomes his own doctor and often cannot remember which lens he actually preferred. Rather than professional care, the ECP creates professional confusion.

9. Under-Charging for a Contact Lens Fitting

Eyecare practitioners are often guilty of not charging appropriately for contact lens fittings. When an office has a fee schedule for fitting based on simple and complex fits, and new and established patient visits, then the fee schedule should be followed—for a few reasons.

One is to get paid appropriately for your services. Second is maintaining consistency in your office to avoid staff confusion of charges. Third is to avoid patient confusion.

Remember, a fee schedule was set in place for a reason. Complex fits are complex fits for a reason, whether it takes one visit or three visits. They require more thought and more clinical expertise. Even if the complex fits take no more time than the simple fits, you should be paid for your knowledge and expertise.

Eyecare professionals have invested many years in obtaining their education and licenses. There is no reason to be benevolent to any patient when the outcome can be quite negative to one’s professional career.

If there is a legitimate patient hardship that can be substantiated, of course you want to be benevolent. However, these circumstances are few and far between. Benevolence should not be extended to patients in a cavalier, routine manner—the results can lead to lost income, lost malpractice cases, confused patients, and even fraud convictions.

Allan Barker, O.D., and Greg Stockbridge, O.D., MBA, are practicing optometrists in North Carolina. They have written extensively about practice growth and business management.