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GP Lens Institute Newsletter | May 27, 2022 | |
This newsletter is kindly sponsored by: | |
Building Your Specialty Contact Lens Practice through Proper Coding and Billing | |
This month we will feature how to appropriately code and bill to optimize revenue and minimize negative audits. Fortunately, we have one of the foremost experts in the United States to address this important area, Dr. Clarke Newman. Dr. Newman founded Plaza Vision Center in Dallas, TX and is the past Chair of the American Academy of Optometry’s Cornea, Contact Lenses & Refractive Technologies Section, and past Chair of the American Optometric Association’s Federal Relations Committee. His numerous honors include recipient of the “Optometrist of the Year” award from the Texas Optometric Association and “GP Practitioner of the Year” from the GP Lens Institute. He also developed – and serves as Coordinator – of the GPLI Coding and Billing Module which is highlighted later in this issue. This module is a must view for anyone desiring to ensure they are properly coding and billing for specialty lenses including those used for myopia management. Also, highlighted in this issue is the passing of a CLMA icon, Quido Cappelli, whose influence in the contact lens industry has been nothing short of remarkable. | |
SPOTLIGHT ON EDUCATION:
Billing, Coding, and ICD-10 for Medically Necessary Contact Lenses
Clarke Newman, OD, FAAO, FBCLA, FSLS, FNAP
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Key Initial Thoughts:
- Most doctors fail in medically necessary prescribing not because they lack the skill, but because they lose interest and motivation when they start to lose money. When you charge enough so that you don’t lose money, then you stay motivated enough to solve these complicated cases.
- There is no escaping the fact that YOU have to do your homework to be successful at billing for medical services. There are enough contractual differences between carriers and between regions, that you have to determine what the payment policies and fees are for each type of service and for each carrier.
Other Topics Discussed Included the Following:
- Covered vs. Non-Covered Services
- Establishing Medical Necessity for A Covered Service
- Reference books and websites: importance of the material being current (i.e., 2022)
- Understanding CPT Codes: defining the relevant and when you should apply them including important CPT Code Modifiers
- Contact Lens Services (Notably Keratoconus): Important Concepts
- Patient Management Issues
- Letters of Medical Necessity
- Importance of Proper Documentation
- Clinical Cases: Keratoconus Patient
- Vision Care Plans:
- Vision Service Plan (VSP)
- Eyemed (EM)
- Superior Vision
- Vision Benefits of America (VBA)
- Spectera
Final Thought:
The gross per patient visit for prescribing specialty contact lenses, especially medically necessary lenses, is nearly twice the national average for all other types of eye care. These patients need glasses also and they may have other medical conditions such as glaucoma, dry eye disease, and macular degeneration.
Conclusions:
- Know what the contracts say for each code that you use on your office
- Use the correct codes and modifiers to maximize the reimbursement for the services rendered
- Bill appropriately for all of your services . . . forget about “fitting fees”
- Make sure that your fees are in line with the contracts that you have signed, but high enough to be commensurate with the complexity, time, and liability involved
- Learn to consult with your colleagues
- Learn to promote this aspect of your practice
A highlight of the program was the question and answer session following the presentation which is also available on the archived webinar. This topic always generates enormous interest from our attending eye care professionals and a number of excellent questions were answered by Dr. Newman.
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June 14th at 8PM Central
Spherical and Toric GP Lens Design, Fitting, and Problem-Solving by Edward S. Bennett, OD, MSEd, FAAO, FSLS
This course is COPE Qualified for 1 hour of live continuing education.
COPE Course ID: 78584-CL
The GP Lens Institute has gratefully received commercial support from ABB Optical Group, Acuity Polymers, Contamac, Menicon, and TruForm Optics for this activity in the form of unrestricted educational grants.
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SPOTLIGHT ON RESOURCES:
Coding and Billing: All Your Questions Answered
| Orders shipped to the US only - 200 of each complimentary including shipping | |
We have almost 3000 GP specialists with their area(s) of specialty listed to assist you when you need to refer a patient or for patients looking for a GP specialist as this resource is also available on our consumer site: contactlenses.org. If you are interested in signing up to be a referral GP lens practitioner, you can do so here.
Specialties Include:
General GP Contact Lenses
Bifocal/Multifocal Contact Lenses
Contact Lenses for Irregular Corneas
Corneal Reshaping / Orthokeratology
Scleral Lens Designs
| Do you have an inspiring or success story to share? Email it to [email protected] to have it featured in a future newsletter or social media post! | | |
Spotlight on a CLMA Icon: Quido Cappelli | |
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By: Dr. Ed Bennett
On May 6th the contact lens industry lost one its most remarkable leaders and pioneers with the passing of Quido Cappelli at the age of 91. Quido was, quite simply, larger than life. The only two-time President of the CLMA, he was the second President in the 60-year history of this important organization, serving from 1967-1971 and returned at a time when his leadership was greatly needed and served from 1994-1996. No one has been honored more by the CLMA and four awards he has received include the two highest: The CLMA Medal of Honor and the Dr. Josef Dallos Award.
After studying Civil Engineering at Georgia Tech University, he enlisted in the Navy and was a communications officer aboard the USS Rushmore. He then worked with a contact lens manufacturing firm, Danker & Wohlk, and served as President during his tenure and later founded his own firms, Conar Optics and Cappelli Ophthalmics. In addition, he worked closely with his friend and renown cornea and contact lens researcher, Dr. William “Joe” Benjamin – who preceded Quido by six weeks as he passed away on March 24th – on advancements in contact lens standards via a working group for the International Organization for Standardization (ISO).
The last time I saw Quido was when he came to a National Keratoconus Foundation event highlighting major league baseball player Tommy Pham held three years ago inside the Tampa Bay Rays stadium. As the Master of Ceremonies of the event I made sure that Quido was introduced and properly recognized for his achievements and the official video resulting from this event has a great shot of Tommy and Quido talking after the conclusion of the event. Another great CLMA leader and icon in the profession, Carl Moore, summarized his legacy best: “Quido was one of the early founders of the CLMA and an enthusiastic supporter and twice President of the organization. He was always focused on the big picture for the industry. His contribution is unparalleled.”
Quido is survived by his wife of 64 years, Katherine “Kitty” Cappelli and three daughters. In lieu of flowers, friends and family who are inclined, are invited to donate to Gulfside Hospice in memory of Quido A. Cappelli.
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Virtual GSLS
June 9-11, 2022
| An extension of the in-person Global Specialty Lens Symposium, Contact Lens Spectrum brings you GSLS: Virtual. This digital event, focused on the successful management of ocular conditions using today's specialty contact lenses, offers the opportunity to stay up-to-date on best practices & new techniques through interactive, educational sessions streamed conveniently from home. This free program acts as a complement to the live, winter meeting and features many of the same faculty with a new & different agenda. | |
Drs. Ed Bennett and Joe Barr to be inducted into the National Optometry Hall of Fame | |
By: Beth Anderzhon
I'd like to congratulate Drs. Ed Bennett, Joe Barr, Charles Brownlow, and Don Williamson on their induction to the National Optometry Hall of Fame. Dr. Barr was the long-time Editor of Contact Lens Spectrum as well as an Advisory Board member of the GPLI. The induction ceremony will occur Thursday evening, June 16th, from 8:00 - 10PM in Chicago at Optometry's Meeting. Congratulations to all
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Edward S. Bennett, OD, MSEd, FAAO, FSLS
Professor Emeritus, University of Missouri St Louis College of Optometry
President and Executive Director, GP Lens Institute (GPLI)
The Gas Permeable Lens Institute is dedicated to providing eyecare professionals with unbiased educational and practice-building resources highlighting GP and custom manufactured soft contact lenses.
Please support the educational opportunities provided by the GP Lens Institute. We will continue to support all ECPs, staff and your patients. Be kind, respectful and find happiness within yourself!!
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Thank you again to our newsletter sponsors | |
GP Lens Institute | www.GPLI.info | (402) 465-4122 | (800) 344-9060 (US & Canada) | | | | |
