Important core concepts.pdf

Important Core Concepts The first and probably most important clinical concept is that there is no such thing as an "eye exam” or at least in the way ODs have conventionally defined it or classified it. Forced upon us is the dichotomy of medical eye care vs. wellness/refractive eye care and all "ex...

Important Core Concepts The first and probably most important clinical concept is that there is no such thing as an "eye exam” or at least in the way ODs have conventionally defined it or classified it. Forced upon us is the dichotomy of medical eye care vs. wellness/refractive eye care and all "exams'' fall into one of those classifications. Very little about the "stuff" you do in those exams (exam elements) will change, but most everything else will require some modification - especially your documentation. ”* It's hugely important that you share all of this with your staff as not only do they have to be well-versed, but will most likely be the first and last point of contact for your patients so it's supremely important that they understand and are able to articulate these concepts. The dichotomy between the medical vs. the refractive eye exam was invented by the insurance industry because they've never been terribly good at making a distinction between wellness and pathology-oriented examinations. The reason we're saying this is that there is always a discussion out there between whether patients are coming in for a "glasses exam” or a medical exam and the answer is simple: They're coming in for neither. Patients come in for eye examinations with no regard for the type. This ties in hugely with the chief complaint because there are those folks that will say the chief complaint is a quote of the first thing out of the patient's mouth and ultimately controls the coding. The argument is that you're not supposed to infer from their description what their real complaints are - that you are bound to the letter of their words - which is ñawed. We don't refer patients with complaints of “arms are too short” for an orthopedic evaluation. We infer that they are entering presbyopia. (Helpful Hint: altering a patient's arm Length is outside of the scope of optometric care) It seems silly, but the reality is when someone says that, our brain changes their wording to "near blur" and often patients don't word thing: precisely the way their insurance requires. The overarching point is that there's a difference between what they say and what they're "saying”. It's your job to document that difference. Another biggie is that a refraction is just a test. That's it. It's just like fields or gonio or photography or OCT. It's not what you're doing for the exam. It's merely a data point. It's an important data point, but that’s all it is and its purpose is meant to be kept in the context of the health of the eye. Yot no longer do an exam to prescribe glasses (although that certainly will happen at the conclusion of most of your exams), you order a refraction as an additional part of an exam for the purpose of determining their best corrected acuity as a metric for gauging the severity of whatever medical conditions are present. In other words, how bad is that cataract, spk, cornea edema or headaches? How are they affecting the patient's BVA? Are the headaches a result of uncorrected refractive error or intracranial hypertension? It may seem simple to say, but it's a very implant mindset when approaching coding your examinations. Medical eye care brings significant benefits: Patients without a routine annual wellness benefit through a vision care plan (VCP) are more likely to rome pin sooner if they're aware that it will only cost them a specialist copay or that the eye exam they were planning to get anyway will be medical deductible. It is more professional to be a medical specialist capable of utilizing the patient's specialist benefits on their medical plan. Patients don't know they can use their major medical insurance because they don't know you're a specialist. This is a view of optometry that you will help change with every patient you see. There is tremendous professional satisfaction in using your education and experience and receiving appropriate payment for your services as medical plans, for the most part, pay significantly better than routine wellness plans. Billing medical will make you a better clinician with better, cleaner, and more appropriately documented records. You will become proficient at recognizing what documentation is required as it relates to your patient's presentation, examination, and diagnoses. Let's take a step-by step approach In beginning the