Northern Sights NewsletterA3AD1AE4-B4C6... · Fargo, ND 58103 701-280-3000 [email protected] Dr....
Transcript of Northern Sights NewsletterA3AD1AE4-B4C6... · Fargo, ND 58103 701-280-3000 [email protected] Dr....
Northern Sights May/June 1
Vol. 29 Issue 3 May / June 2017
As I sit in my
den watching it
snow on April
26th...I recall the
beautiful weather
I experienced less
than a month ago
in Bismarck. It
was while
attending the NDOA Meeting on
March 30-31, 2017.
It featured 10 hours of
excellent CE that covered topics from
MIPS to OCT, both very important
acronyms in our practices.
Attendance was fairly meek at
this most recent convention. The
NDOA Board and myself hope to see
all of you at our Annual Convention
this fall in Fargo. If you have any
suggestions regarding CE topics you
would like to attend at the fall
convention, please do not hesitate to
contact myself or my fellow board
members.
We discussed at our most
recent Board Meeting the idea of
developing a New Member Task
Force, in hopes of getting the younger/
newer members involved in the
planning of activities and/or CE topics
during our conventions. It was also
suggested to have this task force
contribute to the NDOA
Newsletter. If you would like to be
involved in organizing such a Task
Force and/or planning of the Fall
Convention, please contact myself or
Nancy Kopp.
We hope to continue to have 2
meetings per year that offer at least 10
hours of CE per meeting, but with the
rising costs of speakers and rental of
meeting space, we need increased
attendance from our membership, to
continue to provide these conferences.
I ask that you continue to
support your association by not only
paying your membership dues, but
also by attending the association
meetings and welcoming new
optometrists to become involved in
the NDOA. Strength in numbers is
always a good thing...let's keep our
NDOA strong and growing.
Thank you for your time,
Amy DuBois
Inside This Issue
Nevada Lawmaker Drops
Support of Proposed Legislation
Restricting Online Eye Exams
Medical Billing Policy Waivers
and Discounts
BCBSND Vision Advisory
Committee Meeting
Vision Vs. Medical Insurance:
When to Bill Each
Growing Ransomware Threat:
What If Your Data is Held
Hostage?
www.ndeyecare.com
President’s Message ~ Dr. Amy Mitzel-DuBois
Northern Sights Newsletter
North Dakota
Optometric Association 921 South 9th Street, Ste. 120
Bismarck, ND 58504
Phone: 701-258-6766
Fax: 701-258-9005
E-mail: [email protected]
Website: www.ndeyecare.com
2017 NDOA OFFICERS
Dr. Amy Mitzel DuBois President
3232 13th Ave. South Fargo, ND 58103
701-280-3000 [email protected]
Dr. Darin Johnson President Elect
1525 31st Ave. SW, Ste. E Minot, ND 58701
701-857-6050 [email protected]
Dr. Nate Shilman Vice President
2273 3rd Ave West Dickinson, ND 58601
701-225-7886 [email protected]
Dr. Krista Heil
Secretary/Treasurer 111 E Century Ave
Bismarck, ND 58503 701-222-1420
Dr. Blaine Burdick Past President
PO Box 888 Devils Lake, ND 58301
701-662-2817 [email protected]
Nancy Kopp Executive Director
Northern Sights May/June 2
Nevada Lawmaker Drops
Support of
Proposed Legislation
Restricting Online Eye Exams
Legislation proposed in Nevada that would
have restricted the use of “certain automated testing de-
vices” in eye exams – including online exams – was ex-
pected to die in committee Friday (April 14) after the
sponsor of the legislation withdrew her support.
The proposed legislation, Assembly Bill 129,
would have required a complete eye exam performed by
an optometrist or ophthalmologist to be part of a patient
visit that resulted in a prescription for an ophthalmic
lens. The proposed legislation stated: “Before issuing a
prescription for an ophthalmic lens, an ophthalmologist
[or optometrist] in this state must make an assessment of
the ocular health and visual status of the patient that
does not solely consist of the use of an automated testing
device to generate the refractive error of the eyes of the
patient.”
The Nevada Optometric Association (NOA) was
among the bill’s supporters, however Assemblywoman
Jill Tolles, who introduced the proposal in February, had
decided to back away from the proposal.
“We decided to drop the bill after all. I am proud
of the work everyone did on the issue, but we couldn’t
find the right amendment language to meet everyone’s
goals.”
After its introduction, the bill was referred to the
Assembly’s Commerce and Labor Committee, which
had a deadline of Friday, April 14, to take action on the
proposal, or otherwise it would lapse in committee for
the remainder of this session of the legislature.
NOA supported the proposed legislation “100
percent.” The association would take time to consider its
options for moving a new version of the legislation for-
ward. The Nevada legislature holds sessions every other
year. The next time a proposal covering online eye ex-
ams is likely to arise in the state would be 2019.
Unlock your Staff’s Potential! Build Staff Skills & Confidence Enroll Your Staff Today!
How To Enroll Staff: Log-in to www.aoa.org
1. Under the Optometrist tab, click on My Profile/ My AOA. Click on the “Manage Staff” Tab
2. Enter information for each staff person (non-OD)
You will need:
- Legal name of staff ( as appears on Driver’s license)
- Date of Birth
- Unique email address for each staff person
Have Questions? Need Help? Contact: [email protected] 800-365-2219, ext. 4108
Medical Billing Policy:
Waivers and Discounts
Blue Cross Blue Shield of North Dakota
(BCBSND) has received numerous inquiries regarding
its policy on a participating provider's ability to waive
member cost-sharing amounts or to offer discounts. The
following is BCBSND's policy regarding these issues.
Waiver of cost-sharing amounts: Per the Provid-
er Group Participation Agreement, a provider must not
waive or reduce any member's cost-sharing amounts,
including coinsurance, co-payment and deductible
amounts. The provider is expected to bill the member
for cost-sharing amounts and non-covered services iden-
tified as billable by BCBSND. This policy shall not pro-
hibit the provider from accepting a lesser amount per
their hardship and/or collection policies.
Member discounts: BCBSND defines a member
discount, for the purpose of this policy, as any promo-
tion or special consideration that reduces the provider's
customary charge for covered services. Participating
providers offering member discounts must adhere to the
following guidelines:
The discount must be available to all patients,
regardless of whether insurance coverage is involved.
The provider's customary charge submitted to
BCBSND must reflect the discounted amount as demon-
strated below:
Provider's customary charge - $100
Less: Member's discount - $30
Charge billed to BCBSND - $70
BCBSND allowance - $85
Member co-payment - $20
BCBSND payment to provider - $50
Amount to be collected from member - $20
Northern Sights May/June 3
FROM THE DESK OF YOUR DIRECTOR
~ Nancy Kopp ~
“Spring Has Sprung…I think!”
This time of the year usually brings a breath of
fresh air to my mind. Subtle changes within our personal
and professional lives, such as new growth, blossoms,
rejuvenation and cleanup! Cleanup is first on my list of
TO DO!
The 65th Session of the North Dakota Legislative
Session adjourned Thursday, April 27th. The 77th Day of
80 allowable days per the constitution. This leaves only
3 days for the Legislature to re-convene, if necessary to
address issues, such as Health Care Reform, that may or
may not surface in the next few months, under the
Trump Administration.
This whole Legislative session, for some reason,
was very “frustrating” for me. I can’t pinpoint a particu-
lar reason, other than not being fully prepared, due to
staff transition and/or the atmosphere of the makeup of
the Legislature, with a very super majority and differ-
ence of personalities between the two chambers.
The key to Legislative efforts and success in the
process that dictates your profession, are GRASS-
ROOTS EFFORTS; COMMUNICATION, RELATION-
SHIPS, and the inevitable PAC/FINANCIAL SUP-
PORT. Much like optometric commercial support, we
support those that support us…
During the 2017 Legislative session, I tried my
best to keep you updated on the issues optometry was
involved with on a weekly basis. I’m not going to go into
great detail as to the results of optometry’s exposure in
this newsletter article, but will follow-up in an e-mail
survey, especially with the impact on the on-line driver’s
license renewal bill, that did pass with amendments. This
leads me to conversation on a report of conversation with
the North Dakota State Board of Optometry, at their
most recent meeting on April 29th.
Unofficially, the State Board has indicated that
they are planning to introduce the following Administra-
tive Rule changes in 2017/2018:
- Prescription Drug Monitoring Program
- Telemedicine
- Minimum Eye Examination Requirements
- Background Checks
- Education Requirements (Increase to 60 Hours with 24
Online)
Notes From BCBSND Vision Advisory Committee
Meeting March 8th, 2017
NDOA Attendees: Dr. Dori Carlson, Dr. Barbara
Brookshire, Laura Palmer (Para) and Nancy Kopp.
BCBS Vision has set a 2017 goal for new vi-
sion contracts and thus far has reached 42% of their
goal. The fourth quarter of each year is the time for the
greatest opportunity for new contract sales, simply due
to the number of employers who have anniversary re-
newal dates.
BCBS Vision is seeing more activity in north-
west North Dakota as a result of oil prices rebounding
somewhat, however they do not anticipate nearing the
contract levels they were in 2014 and 2015. Some of
those employers are choosing to add benefits to attract
and retain good employees.
Competition in the vision plan market is grow-
ing. Many carriers have entered the market in North
Dakota in the past few years. As a result, this makes it
more difficult to gain new business and retain existing
contracts. New competition are pricing their products
and benefits, as good or perhaps better than existing
product offerings.
Despite the provider network advantage of
BCBS over the competition, decision makers tend to
sacrifice employee disruption, in order to be able to
offer a product at a lower cost or voluntary products,
at no cost to the employer. Self funded groups also, are
looking towards decreased cost and hesitate to include
vision reimbursement and polycarbonate lenses for
children were both discussed, but no solution was pre-
sented. BCBS will continue to administer vision bene-
fits for the Healthy Steps Program.
I as your fiscal agent, as well as the NDOA
Board, have been discussing strategies to address
changes in membership dues collections, membership
benefits and external influences, on how we function in
the future. We need to be the “voice” of optometry
within our small state “together”!
Thanks to all who have participated in the re-
cent past with your contributions and I sincerely hope
that we can keep the momentum going!
Have a great summer. Enjoy the fruits of your
profession and some family/personal rejuvenation!!
Northern Sights May/June 4
Vision Vs. Medical Insurance:
When to Bill Each
By Mark Wright, OD, FCOVD
and Carole Burns, FCOVD
The patient presents in your office with a red
eye. The patient has both medical insurance and
vision insurance coverage. The medical insurance has a
$500 deductible, which has not yet been met. The vision
insurance has a $20 co-pay. The patient wants to use the
vision insurance for today’s examination because there is
only a $20 co-pay. What do you do?
The key to helping the patient navigate the
insurance minefield is to understand how a refraction fits
into this situation. The CPT medical examination codes
(92000 and 99000 codes) do not include a refraction in
their definitions. That means if a refraction is done, the
medical examination code is billed and the refraction
code (92015) is also billed. On the other hand, vision
insurance codes for a comprehensive or intermediate
code include a refraction, therefore, only the examina-
tion code is billed even when both an examination and a
refraction are done.
Vision insurance is for “routine” eye examina-
tions. Medical insurance is for situations where there is a
medical sign, medical symptom, or ongoing care for a
medical condition. Medical insurance does not cover
cases where the reason for the examination, or primary
diagnosis, is myopia, hyperopia, astigmatism or presbyo-
pia.
Another important difference between medical
insurance and vision insurance is how many times each
year the coverage can be used. Most vision insurance
plans only permit the vision insurance to be used one
time per calendar year. It’s also important to note that
vision insurance cannot be separated into examination
and refraction. The examination and
refraction are tied together and can only be used on the
same day, once a year. Medical insurance can be used
multiple times over the course of the year. The only lim-
iting parameter for medical insurance is
medical necessity. Medical necessity opens the gate for
medical insurance reimbursement.
In the case above, the patient presents with a red
eye. The red eye is a medical sign of an
underlying medical condition. This is covered by medi-
cal insurance, not vision insurance.
The conversation to have with the patient is to
explain that if you use the vision insurance today, it uses
the refraction coverage today, then, in one week, when
the patient returns to the office, they would have to pay
for the examination and for the refraction. This means
that they will end up paying more for the two exams.
The best way to approach this case is to do it the
way the two insurances have been set up to be used. Use
the medical insurance for the first visit
because there is a medical reason for the examination,
then, when the patient is healed, you can use the
vision insurance with its covered refraction. Doing it this
way coordinates the patient’s insurance coverage. You
are following the insurance rules, and at the same time,
minimizing the patient’s total out-of-pocket
expenses.
Special Olympics: Opening Eyes
Saturday, June 10th, 2017
8 AM to 1 PM at
Fargo South High School.
(clinic starting at 9 AM)
Open to all staff & family that would like to help.
Lunch and t-shirt provided
For more information contact
Jed Hillmer at [email protected]
Mark Your Calendar!
NDOA 114th Annual Congress
October 19-20, 2017
Fargo Holiday Inn
-Schedule of Events-
Thursday, October 19th 12pm (noon) - 5pm—Continuing Education
5pm - 9pm—Exhibit Hall/Fun Night
Friday, October 20th: 8am - 9am—Breakfast
9am - 12pm (noon)—Continuing Education
12pm (noon) - 2pm—NDOA Awards Lunch and
Membership Meeting
2pm - 5pm—Continuing Education
5pm—Adjournment
Your Support of NDOA Events is
Vital and Appreciated!
Northern Sights May/June 5
The Growing Ransomware
Threat: What If Your Data is
Held Hostage? It’s True! Ted McElroy, OD, was shocked to
find his practice cyber-attacked by ransomware
that encrypted all of his business files and patient data,
essentially freezing his practice. After exploring his op-
tions, he paid a $3,000 ransom to the hijackers to get
back in business. On investigation, he corrected weak-
nesses in his backup system, and he devised a defensive
plan should an attack happen again. Data hijacking is
part of a growing trend, as cyber criminals target medical
practices and health care systems as easy prey and will-
ing payers. How prepared are you to defend against
cyber criminals?
DEFENSIVE PLAN:
Continually monitor your backup to be sure it’s
working and archived offline. If attacked, be prepared to
wipe clean your entire computer system and re-install it.
Negotiate with hijackers to send you the key to open
your data, not for their price, but for what it costs you for
your IT personnel to re-install. Estimate: three hours or
$300.
DON’T LOAD NEW SOFTWARE FROM E-MAIL.
When loading a new piece of software onto your
server, first load it onto a zip drive. Then, do a virus scan
to make sure no viruses are present, and only then load
onto your server.
HIPAA CONCERN:
Are you sure your patient data has not been
breached? You may be required to inform all patients of
a potential breach of their patient data and payment
method.
BACK UP FILES.
Back up your files both on external hard drives
(around $100 a piece at an office supply store) and also
back it up in the cloud using a service like Carbonite, or
one its competitors. The cost of backing up your data
online depends on the amount of data you have to back
up. In the case of Dr. McElroy’s practice, it costs just
$89 a month to back up online, “in the cloud.”
GET WHOLLY IN-THE-CLOUD.
Choose an electronic health records and practice
management system that resides wholly in the cloud.
EHR/practice management systems that reside entirely
online, in the cloud, guarantee the security of your data
as part of your contract with them, and if the information
is encrypted by a hacker, they are the ones who are re-
sponsible for paying the fee to unlock it, and if the infor-
mation is breached and exposed, they are responsible for
paying damages to your practice to cover related expens-
es and the potential loss of patients.
Remember To Thank Those
Who Support the NDOA!
2017 Legislative/CE Conference:
- Walman Instruments - Provided OCT Vision
Screenings at the Capitol (Jason Thornton)
- Practice Compliance Solutions (Honorarium
Waiver)
- Essilor Laboratories - Speaker/Event Sponsorship
- Dakota Eye Institute - Social Sponsorship
Clinicians: MIPS
Participation Status Letter
CMS is reviewing claims and letting practic-
es know which clinicians need to take part in the Merit
-based Incentive Payment System (MIPS), an im-
portant part of the new Quality Payment Program
(QPP). In late April through May, you will get a letter
from your Medicare Administrative Contractor that
processes Medicare Part B claims, providing the par-
ticipation status of each MIPS clinician associated
with your Taxpayer Identification Number (TIN). Cli-
nicians should participate in MIPS in the 2017 transi-
tion year if they:
- Bill more than $30,000 in Medicare Part B allowed
charges a year and
- Provide care for more than 100 Part B-enrolled Med-
icare beneficiaries a year.
QPP intends to shift reimbursement from the
volume of services provided toward a payment system
that rewards clinicians for their overall work in deliv-
ering the best care for patients. It replaces the Sustain-
able Growth Rate formula and streamlines the
“Legacy Programs” - Physician Quality Reporting
System, the Value-based Payment Modifier, and the
Medicare Electronic Health Records Incentive Pro-
gram. During this first year of the program, CMS is
committed to working with you to streamline the pro-
cess as much as possible. Our goal is to further reduce
burdensome requirements so that you can deliver the
best possible care to patients. Learn more about
the Quality Payment Program.
Visit www.cms.gov to learn more.
Northern Sights May/June 6
IN SEARCH OF PER DIEM OPTOMETRIST
1 day/ week, occasional Saturday morning post ops.
Competitive pay and a great staff!
No refractive surgery experience required - will train.
TLC Laser Eye Centers - Fargo.
Call 701-293-7945 or email
PART-TIME TO FULL-TIME
POSITION AVAILABLE
Focus Family Eyecare—Fargo
Contact Dr. Stacey Archibald at
FULL TIME ASSOCIATE OD
POSITION AVAILABLE
This practice has an excellent reputation for patient care,
newest equipment, and state-of-the-art finishing lab. We
are 30 years old and going strong with a brand new
facility in 2011. The position includes benefits and a
retirement plan.
Send cover letter and curriculum vitae to
Eyewear Concepts
PO Box 149
Dickinson, ND, 58601
PURCHASE OPPORTUNITY
Private Practice offering a job opportunity for an
optometrist or two person team to practice full scope
Optometry. This is a newly constructed office with
state of the art equipment in an ideal location. Current
owner wishes to practice part-time or retire as desired.
New doctors will be able to set their own hours with
excellent benefits. Purchase opportunity is negotiable.
For more information about this profitable practice,
please send inquiries to:
Dr. Robert Nyre - Vision Source - Minot
701-852-2020 or email: [email protected]
PRACTICE FOR SALE
Well established 38-year practice for sale in Bozeman,
Montana. Touted as one of the best places to live by
Sunset Magazine and the New York Post, the U.S.
Census estimates show that Bozeman's population is
growing faster than other Montana cities, which will
your further enhance practice growth. Located across
from Montana State University, the largest university in
Montana. Same optometrist has been serving families
and community members. Full inventory and equipment
will enable you to move right in and practice. Owner
wishes to retire, will help with transition.
For details and more information, contact
[email protected] ASSOCIATE OD NEEDED
Looking for one or two associate ODs to join large
independent optometry practice in Jamestown.
Opportunity for partnership also.
Please contact Larry Motacek, O.D at 701-252-2020
or email: [email protected]
Classifieds & Employment Opportunities
FULL OR PART TIME
ASSOCIATE OD POSITION
We are a busy one-doctor owned practice in our 10th
year of ownership seeking an Associate OD to join our
practice in Minot, ND. We have a fully trained staff and
updated equipment. This salaried position, with future
partnership potential, is open as either Full or Part time,
2-5 days/week. No evenings, weekends or holidays. Full
benefit package available.
Please contact Dr. Darin Johnson at (701) 240-0812 or
[email protected] for more details.
You may also mail your CV to
1525 31st Ave SW, Ste E Minot, ND 58701
http://www.johnsoneyecarepc.com/
HELP WANTED ASSOCIATE OPTOMETRIST IN
WESTERN NORTH DAKOTA
Looking for caring and personable optometrist to join
our eye care team, the position is full time and flexible.
Base salary $117,000/year with production incentives
based on gross production.
Interested optometrists please call:
Vincent Biesiot at 701-483-1466 or
email me: [email protected]
Northern Sights May/June 7
NEW OR RECENT GRAD WANTED
Busy private practice seeking new or recent grad: Havasu Eye Center was founded 25 years ago and continues to
be the community's premiere choice in vision care. We are a 3 doctor, private practice with 3 locations. We are a
busy practice focusing on high quality, comprehensive eye care. Havasu Eye Center was selected as one of the Top
10 Eye Care Practices in the nation by the Best Practices Initiative. Types of exams seen at our practice include:
comprehensive eye exams for all ages, soft contact lenses, specialty contact lenses (gas permeable and scleral
lenses), ocular disease management (glaucoma, macular degeneration, dry eye), co-management of common eye
surgeries, ocular emergencies, and more! We pride our practice with delivering the best possible eye care in a
friendly environment. We are open M-F from 8-5. We have 26 fantastic staff members for your support. Our main
office is located in beautiful Lake Havasu, AZ. Salary or per diem rate are both options, and we can discuss bonus
incentives as well! Competitive salary of $120,000! IRA matching benefits as well. License fees, continuing
education, and vacation benefits are always open to discussion.
Please email [email protected] for more information!
EQUIPMENT FOR SALE—USED, GOOD CONDITION
Chair/Stand: one a Marco, the other handicap accessible Reliance. Slit lamps: SL-7D Topcon, Zeiss,
portable SL 14Kowa. Two Marco keratometers. Reichert/ Leica phoropters: projectors, BIO's, a wireless Keeler,
wall mounted Proppers. A variety of Volk BIO and SL lenses. Retinomax. Humphrey 745i fields analyzer, GDX
Miscellaneous instrumentation
Joe Thorman, OD (retired), Rolla Eye Clinic [email protected] 701-212-6328
Classifieds & Employment Opportunities Continued
Northern Sights May/June 8