July 2023

You Don’t Want to Miss This

From the SNAPP Board

Trust us on this.

You don’t want to miss the 2023 SNAPP Las Vegas Meeting, Sept. 26-28 at The Palms Casino Resort.

Each day features unique programming, from a relaxed welcome at the Laguna Pool House on Tuesday, Sept. 26, to an information-packed day Wednesday with a general session, breakout groups and a compliance update. The day ends with a sponsor trade show that provides members with time they need and want to dive into the sponsors’ offerings.

The meeting concludes Thursday after another full day of valuable information, including five hours of COPE- and ABO-approved continuing education and a three-hour workshop on how to improve conversions, topline sales and profitability.

Plus, it’s fun. As board members, we can each tell you about friends we’ve made and ideas we’ve gained at these meetings. The final nudge to you is that you can get paid to come. Our Member Rewards program allows you to receive stipends for attendance.

Learn more about the meeting and the programs offered, watch videos from our speakers and find more here. Better yet, take the leap and register here. It might just be the most impactful three days of your year. Trust us; you won’t be sorry.

Meet a Presenter

Game-changing Conversations

Mark Hinton, well-known eye care retail advisor and coach, is presenting two sessions at the SNAPP Las Vegas Meeting: 8 Proven Strategies That Increase Optical Capture and SunSense. Both are designed to help Pearle Licensed Operators see an immediate impact on patient satisfaction and sales.

Mark Hinton

“I’m in the trenches,” says Hinton, noting that his experience in his Asheville, North Carolina, practice where he partners with an OD proves that these strategies work. Among the guidance he will provide at the SNAPP meeting is to focus on consistent communication throughout the office. “If we change the way we communicate to focus on the why instead of the what, patients will take our advice—and capture rates and revenues go up,” he says.

But it’s not always easy to be on the same page. For example, he walks through what a patient might hear about sunwear. Here’s how it might sound if the doctor, scribes and opticians are not on the same page.

Doctor: “I recommend that you have good protection from the sun with quality sunglasses.”

Optical staff: “Were you interested in sunglasses? They’re 50% off.”

“It’s easy to see how this conversation occurs,” Hinton says. “Some doctors are hesitant to make it sound like they’re selling. And optical staff members are focusing on the financial transaction, not the impact of a lifetime of healthy vision.”

Here’s how he advises that the same conversation can have much more impact.

Doctor: “I want to be sure you are reducing the risk of vision loss from sun damage, so I’m prescribing sunwear.”

Optical staff: “I’ll make sure to fill your prescription to reduce your risk of vision loss from sun damage.”

See the difference? “People do buy with emotion, but they justify their purchases with reason and logic. So that has to be sound. When doctors talk about prescribing rather than recommending, and when staff embraces the idea that sun damage is a risk factor in developing vision-threatening diseases, the conversation is very different,” he says.

The lens pharmacy

In fact, Hinton wants to change the way that doctors view the optical. “We talk about the optical as being the retail sales environment. I’d like them to think about it as a ‘lens pharmacy.’ It’s part of the entire patient experience,” he says. By coordinating the language and focusing on the why, eye care practices will experience fewer patients who ask for their prescription so that they can shop around.

He compares it to patients going to the dentist for an exam and cleaning and then saying that they’ll go and get their fillings done in a less expensive place. “When we do it the right way, it’s not about sales or selling eyeglasses. The right process will bring the money,” he says.

Practice staff should be prepared for ways to help patients acquire the eyewear they need—and that’s not discounting their option. Remember the dentistry example; dentists (and many eye care practices) quickly explain financing options such as CareCredit, for example, that can help put the needed services within financial reach.

In addition to talking about how tweaks to the patient journey can improve a practice’s financial and metric gains, he will also provide attendees at the meeting with a timeline and guidance for implementation.

Hinton is in high demand because his presentations are practical and he is accessible to focus with individual office teams. The results for practices that have put these strategies into play add up quickly. In fact, practices typically see an average increase of $100 revenue per exam within two-to-four weeks following implementation.

Case Study

Building on a Successful Dry Eye Practice

Lisa Hamilton, OD, has been offering dry eyes services at her Hamilton Vision Center in Centennial, Colorado, since 2020. It makes sense in Colorado’s extremely dry climate. Patients who suffer from dry eyes may have a lower success rate with contact lenses, and the symptoms of dry eye can range from a nuisance to nearly debilitating.

Dr. Hamilton in a consult

To start, she focused on those patients with meibomian gland dysfunction as a contributing factor to dry eye. “Services like LipiFlow and Tear Care are very effective, as is BlephEx to remove biofilm on lid margins. Additionally, we have been offering Low Level Light Therapy (LLLT)—red for thermal treatment and blue to reduce bacteria count in the glands,” she says.

Dr. Hamilton’s dry eye room

She continues with those services but has also brought in radio frequency (RF) technology, which heats up the meibomian glands—and tightens the skin, minimizing fine lines and wrinkles.

“We are expanding our offerings,” adding RF micro needling and intense pulsed light, which addresses rosacea and bacterial load. We have added a full-time treatment room and hired a wonderful aesthetician and laser technician,” she says. “Because we are branching into full-face aesthetic, we also have hired an MD medical director.” As state laws differ on scope of practice for aesthetic services, she felt that was prudent.

In a Pearle?

Patients initially are surprised to find these services offered in her Pearle Vision location. But then they realize that Dr. Hamilton has long been offering patients products and services that help their vision and ocular health. “It’s not unlike talking about myopia management,” she says. That’s another service provided outside of managed vision benefits. Patients appreciate the investments she has made in the practice to make these services more accessible to them. It has helped her forge stronger relationships with patients, she says.

When Dr. Hamilton’s practice went through a remodel, expanding from two exam lanes to four, she took the opportunity to set aside some space for additional services. Two of her lanes are digital exam lanes, reserved for vision exams. A third is the medical lane for more of the medical procedures. In the fourth, she added her visual field technology to minimize bottlenecks in the pretesting area. It has a more spa-like feel, she says.

Watch Dr. Hamilton explain how radio frequency works here.

Compliance Advice

Top 10 Audit Issues

By Peter J. Cass, OD
VP Development, Practice Compliance Solutions

The majority of improper billing leads back to not following two critical concepts: including the reason for the visit and establishing medical necessity. However, here are 10 other tripwires.

1. Upcoding of evaluation and management (E&M) codes—While recent changes have made proper code selection easier, not fully understanding the details is resulting in optometrists billing too many high-level codes, especially Level 5 E&M codes.

2. Overuse of ophthalmological codes—Many providers bill too many comprehensive examinations that should be intermediate examinations or, in many cases, E&M codes. Be sure to follow medical necessity.

3. Medically unnecessary testing—Just because you have an instrument doesn’t mean you can bill for its use on every patient in every situation. Follow a symptom-based approach and only test when the results will influence making a correct diagnosis or assist in preparing a correct treatment plan.

4. Misuse of the 59 modifier—Using this almost never has an application in primary eye care. The most common example of abuse is using it to bill fundus photos and scanning lasers during the same encounter for glaucoma.

5. Misuse of the 25 modifier—Modifier 25 is defined as a significant, separately identifiable E&M service by the same physician or other qualified health care professional on the same day of the procedure or other service. Remember that the office visit is included in the fee for a surgical procedure. The most common example is billing an examination with a foreign body removal.

6. Blurred vision as a medical reason for a visit—Using blurred vision as a medical reason for a visit requires certain examination and documentation requirements be met to be considered medically necessary. If the patient complains of blurred vision but the vision corrects to normal with a change in their eyeglasses, the examination is vision.

7. Major medical/vision therapy claims—Payors will sometimes pay these claims, but unless you have in writing that every CPT code you want to submit is considered a covered service under the patient’s plan, you could find yourself having to repay large sums.

8. Photography—Photography is heavily abused. You cannot document the absence of disease (except in a few instances), you cannot document absence of change (no exceptions), and photos cannot substitute for ophthalmoscopy.

9. Improper exam documentation for vision plan—Vision plan requirements can be surprisingly extensive. Know the history requirements, examination requirements and dilation rules for each plan you participate in. Read what the agreement says about compliance issues.

10. Improper contact lens exam documentation for a vision plan—These can be surprisingly extensive. They can include the history (lenses worn, how they are worn and solutions used); examination (document fitting characteristics of lenses); findings (include K readings and SOR); assessment (state how the patient is doing with the lenses); and the plan (what you are doing going forward, even if that is no change).

Knowing and following the proper guidelines can prevent undue stress and potentially keep you from having to return large sums of money to a payor.

Learn more at www.practicecompliancesolutions.com.

News of Interest

A Record-breaking Back-to-school Retail Season

Get ready. According to the National Retail Federation, customers are “expected to spend record amounts for both back-to-school and back-to-college shopping… Back-to-school spending is expected to reach an unparalleled $41.5 billion, up from $36.9 billion last year and the previous high of $37.1 billion in 2021.” Read the full story in Vision Monday.

Have You Had COVID-19? Nearly 20% in U.S. Hadn’t by End of 2022

According to findings from the U.S. Centers for Disease Control and Prevention (CDC), nearly one-in-five people in the U.S. had not had COVID-19 by the end of 2022.

The CDC analyzed donor blood for antibodies from more than 140,000 people every three months during 2022. Rates of those with antibodies from prior infection rose steadily.

When the vaccine-induced and infection-induced antibody data were combined, the CDC estimated that 97% of people in the U.S. had antibodies as of the end of 2022. Read more here.

Temporarily Slow Myopia by Combining Atropine and Ortho-K

According to a recent study published by Ophthalmology and Therapy, combining orthokeratology lenses and low-dose atropine may temporarily slow myopia progression. However, the study also found that combining these two treatments may only suppress myopia for a “short period of time.” Young children are also more likely to not experience a slowing of the progression. Read more here.

Getty Images photo credits—audit: Thanakorn_Lappattaranan; back to school: SDI_Productions; build new services: Jinda_Noipho; conversations: opico; and eye: PeopleImages

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