Cover Costs Using an ABN

Collect a fee for the OPD-Scan III test, boost conversion rates, and create positive word-of-mouth referrals

BY CYNTHIA MATOSSIAN, MD, FACS

When I purchased the OPD-Scan III (Marco), I realized from the start that I wanted to use this technology on every patient scheduled for cataract surgery. I knew that without the data it provided, I couldn’t accurately and consistently match the IOL to each patient.

However, Medicare and other insurance carriers don’t cover the OPD III test, so I needed a way to generate compensation from my patients to cover the cost of the equipment and the cost of my technicians performing the test. I worked with the folks at Marco, who suggested charging a fee that was determined by combining cost and patient volume. From day one, I had no problem getting patients to accept this fee, and I’ve always had them sign an Advance Beneficiary Notice of Noncoverage (ABN) form to ensure that I can bill them for payment.

The result: An indispensable clinical device that pays for itself.

Getting the ABN Signed

The key to getting virtually all of my patients to accept my fee for the OPD III, $90.00, is in getting them to understand the importance of the test and how it will benefit them. To do this, I stick to a very simple process with every single candidate for cataract surgery.

At the time of the cataract consult, if there is a visually significant cataract and if the patient and I agree that cataract surgery would be beneficial, I explain that he will need to return for biometry and a variety of additional tests, one of which is the OPD III. These tests are scheduled several weeks later, giving me time to optimize the patient’s ocular surface.

Moreover, I explain to the patient that the OPD III is not covered by insurance; the test has a $90.00 out-of-pocket cost for both eyes. (I emphasize that the cost is not $90.00 per eye). In addition, I hand the patient an information sheet on the OPD III. I review how the data are essential in helping me customize the IOL to each of the patient’s eyes in order to obtain the best possible visual outcome. I also stress that without the data, I can’t select the best IOL.

I explain that patients don’t need to pay this fee until their next appointment. I then ask the patient to sign the ABN. Because the ABN gets signed at the cataract consult visit, my staff and I don’t need to reopen that discussion at the biometry appointment.

This whole interaction takes less than 1 minute. It’s very successful; in a year, about two patients decline the test. Because my patients understand the importance of the OPD III for their visual outcome and they have lead-time to get their payment ready, they don’t object to the $90.00 fee.

Reinforcing the Test’s Value

When I have all the information from the OPD III, I display it on a large-screen monitor in the exam room to show my patients and their families. Not only is there a huge “wow factor,” but the display also allows me to demonstrate to patients the value of their out-of-pocket payment. I always say, “This is the $90 test,” as I point to the information from the OPD III. This reaffirms that although the test costs some money, it’s an integral part of their surgical planning.

Because I give patients this visual explanation, pointing to the various displays that help me choose a toric or multifocal lens, my conversion rate is very high. We’re not talking about abstract concepts; we’re looking at tangible images and reports that prove premium lenses will deliver better outcomes. For example, I can get many more patients to understand astigmatism by showing them the “bowtie” in a graphic display than I ever could by explaining this difficult concept verbally. My patients visualize their astigmatism and agree to a toric lens.

Patients verify for themselves that they’re candidates for premium IOLs such as torics, multifocals or accommodative lenses, or a procedure like a limbal relaxing incision. This makes them more confident in following my recommendation. The higher conversion rate to out-of-pocket procedures is another way that the OPD III creates additional revenue.

Implementing the ABN

Offering advanced technology such as the OPD creates added revenue opportunity. If the test isn’t covered by insurance, the only way to charge is out of pocket. And the only way to charge Medicare patients out of pocket is to have them sign an ABN in advance, accepting responsibility for payment.

I follow my plan religiously with every patient, explaining the importance of the test, the fact that there is a fee and the Medicare requirement that they must sign an ABN form for any out-of-pocket fee. As I’m having the discussion, a technician hands me the form. I initial it, and the patient signs as well. The whole process adds less than a minute to my cataract consultation. When patients return, the form is already in their chart, and we proceed with the test and charge the fee.

Unlike some of my colleagues, I don’t selectively use the OPD-Scan III; I use it for every cataract surgery patient. When I present this model for using an ABN to colleagues, I think that some are hesitant because they aren’t familiar with the form. It’s very simple when you make it a scripted part of your cataract consultation. It’s also an absolute requirement of Medicare. With this model, we have very satisfied patients with outstanding surgical outcomes who become our goodwill ambassadors.

Cynthia Matossian, MD, FACS, is owner of Matossian Eye Associates, an integrated ophthalmology and optometry practice in Doylestown, Penn., Hopewell, N.J., and Hamilton, N.J. Contact her at Cmatossian@matossianeye.com.