Regulatory Issues
Senior Eye Associates is committed to delivering the highest quality eye care with efficiency and appropriate utilization within the regulatory framework. I recently attended a seminar given by our local Medicare Intermediary, WPS that reiterated important issues for eye care professionals.
Referrals and Surgery
Senior Eye Associates is concerned at the overuse of referrals and unnecessary surgery performed on residents of long term care facilities. Our primary care Optometrists are highly trained and qualified in ocular diagnosis and treatment. Routine cataract, glaucoma, and diabetic patients do not require further referral. Our Ophthalmologists examine patients referred by Optometrists for those conditions outside their scope of practice. Medicare regulations concerning such consultations are;
To support the need for a consultation:
- The Requesting Provider must document the request in the medical record.
- The Consultant must indicate the visit is for a consultation and,
- The Consultant provides a written response to the Requesting Provider as to his findings and recommendations in the medical record.
Senior Eye Associates has a long standing protocol regarding potential surgical candidates. Not only must the resident desire the surgery, but their Power-of-Attorney for Healthcare, or closest family member, and Attending Physician agree to the procedure. After these steps have been taken and documented, arrangements are made for surgery. One must remember that cataract surgery is an elective procedure to improve a patient's quality of life. Only when there is a potential benefit to the patient should surgery be undertaken. It is the patient, his family and physician who make the ultimate decision for or against surgery, and not the Ophthalmologist.
Authorizations for Examination
Beginning in 1997, all Medicare recipients residing in nursing homes require authorization for examination as indicated in the following Medicare regulation.
To authorize an eye examination in a Nursing Facility there must be:
- An order by the Attending Physician or
- A request by the patient, or their representative.
Medicare does not allow a "PRN" or standing order.
Senior Eye Associates strictly adheres to this Medicare regulation prior to examining any resident for the first time. NOTE: This does not apply to established patients of the practice.
For further information go to www.wpsmedicare.com/provider/pdfs/eyecare_notes.pdf.
