How ordering the right diagnostic at the right time can benefit your practice

In the ophthalmic practice, diagnostic testing plays a critical role in patient care, clinic flow, efficiency and compliance. Because it takes the whole practice team — and not just clinic staff — to facilitate testing, there is usually ample opportunity for improvement. This rings especially true for practices that take a “shotgun” approach to screening/testing, as this approach tends to foster greater staff confusion, inefficiencies and compliance risks — which may lead to billing errors and eventual reimbursement denials.

How can you be sure your practice is facilitating the right test at the right time?

WHAT NOT TO DO

It can be quite inefficient for practices to try to remember what insurance carriers cover which tests for which diagnoses.

Since some practices regularly see the same types of patients, screen testing can seem like a valid way to circumvent that issue and ensure the right people receive a diagnostic test. However, running every patient through screening tests creates surplus testing, an unnecessarily large staff workload and machine wear and tear — ultimately swinging the inefficiency pendulum further than testing on a case-by-case basis.

Additionally, Medicare only pays for services and visits based on their medical necessity. To be eligible for reimbursement, the medical necessity of diagnostic tests must be documented by the physician (as a physician’s order) before being performed. “Standing orders” or screening tests, however, usually don’t involve the patient being seen in advance, the physician ordering the test for the individual patient or the reason for performing the test documented in advance.

For these reasons, along with the testing not specifically addressing each patient’s unique condition, the testing is not considered compliant.

WHAT TO DO

While taking a “one-size-fits-most” method to diagnostic testing is clearly not the best approach, having an inconsistent testing culture creates confusion for staff, who may begin doubting whether practice systems are compliant or based on doing the right thing. To avoid this, practices should make it a goal to facilitate the right test at the right time for each patient.

I encourage your practice to adopt a philosophy of completing appropriate testing, billing for that work and getting reimbursed accordingly.

Below are some efficient and practical ways to keep your practice compliant with diagnostic testing.

1. Ensure the test has a physician’s order. As previously mentioned, each diagnostic test must have a physician’s order before being performed. When charting for established patients, physicians should try to anticipate and “order” testing to be performed at the patient’s next visit. Be sure to include testing details, such as the diagnosis, retina or macula for OCT, 30-2 threshold pattern or similar for visual fields and which eye(s) are to be tested. Most EHRs have a designated treatment plan area for each diagnosis where you can input this information.

2. Know what is required. To ensure compliant charting, most diagnostic tests require an interpretation and report. This should include items such as the date the test was performed, indication for the test, who performed the test, reliability, findings, resulting diagnosis, impact on the patient’s care, resulting next steps and the physician’s signature. EHR interpretation and report templates can be customized to make data entry efficient and complete. Practices are paid separately for testing, so it makes sense that the interpretation and report is completed on its own.

3. Have the right number of equipment. In a busy practice, two OCTs may be better than one. The practice could run a schedule of appointments for one OCT when testing is known to be needed, while reserving the other OCT for add-on testing throughout the day. This not only helps ensure practice efficiency but also reduces machine wear and tear, saving money.

4. Be efficient with new patients. Create a workflow in which the physician can be called in quickly either to examine new patients during their workups or review workups with the patients. For instance, create a flagging system in your clinic to prioritize patients with this need to avoid lengthy waits. This will also enable the ordering of diagnostic testing mid visit based on preliminary findings.

5. Create a surgery order set in your EHR. Include the necessary testing associated with each procedure, so it can be placed efficiently when the surgeon orders the surgery to be scheduled. For example, a cataract surgery order may have associated biometry, lens choice and anesthesia type as automatic cues to customize the testing orders when inputting the surgery order.

6. Ensure appropriate staff access. Staff responsible for checking insurance eligibility and doing preauthorizations should also have access to the testing orders for the visit. This allows them to ensure they obtain any preauthorizations needed for what will be performed during the patient’s next visit, helping to improve clinic flow and practice efficiency.

7. Delegate tasks to ensure efficiency. Keep your clinic half-day sessions flowing smoothly and decrease wait times by designating who on your team will perform testing, who will do preliminary workups, who will scribe, etc. To facilitate this, rotate technician assignments by the half day to ensure clinic flow positions are covered and skill maintenance remains an ongoing activity.

8. Cross-train staff. Cross-training ensures the practice is never at a loss for a trained staff member to perform diagnostic testing. Whether a staff member calls out sick, is on vacation or has recently departed from the practice and no replacement has yet been hired, crossing-training your clinical staff to perform tests and related work will help keep the practice operating smoothly.

COMPLIANCE IS KEY

Performing the right test at the right time not only ensures your practice is compliant, it simultaneously reduces wasted steps for the practice. The result is maximized patient care and clinic efficiency. Involve your team in brainstorming solutions for your practice (like those listed above) to ensure the processes in place are functional. By becoming more efficient, your practice should realize decreased patient wait times and more performed tests being reimbursed. Your patient and staff satisfaction scores will show you if your efforts are working. OM

Laurie K. Brown MBA, COMT, COE, CPC, CPMA, is a senior consultant for BSM Consulting, based in Tucson, Ariz. She is certified as a professional coder and auditor, and brings more than 30 years of health-care experience to BSM.