Ophthalmology and Optometry Coding Alert

Steven M. Verno, CMBSI

Thank you very much.  I would like to welcome everybody to the conference and I am sure we will have a good time over the next hour.  I want to start out with the disclaimer.  I am not an attorney.  I just sound like one and the information I am presenting is strictly for training purposes only. 

I am going to start off this seminar with a little scenario here.  We are going to have a patient named Mary Jones.  She has a medical complaint and she goes to one of the local emergency rooms for medical care, and in her possession she has an expired driver's license and an old insurance card that she obtained from her previous employer.  I am sure some of you have met Mary Jones at some time in the past.  She signs the emergency room log, she is seen by the Triage nurse, and then she is called by the hospital registrar, who takes her information and enters it into the hospital computer system.  So we already know at this time that Mary Jones is giving you bad information in order to be seen.  While in the emergency room, she is sent to the laboratory for tests and she is sent to the x-ray department for a series of x-rays.  She has an EKG performed and is later discharged with instructions to see her primary care provider.  Now, the claims for the hospital, the emergency room physician, the cardiologist that performed an interpretation of her EKG, all lab tests, and the radiologist--they are all denied because Mary Jones did not have coverage at the time of service.  The bills that are sent to Mary by all of these people--the hospital, the radiologist, the laboratory, emergency room physician, and cardiologist have all been returned as a mail return, and it says moved, no forwarding order by the post office.

This scenario, I know, takes place on a daily basis.  It happens in hospitals, health clinics, urgent care centers, and it happens with the ancillary providers simply because the registrar took the information that was given to them at face value without verifying it and the billing companies allowed the claim to be sent without verifying the information that they received.  I know this happens on a daily basis and we will explain why later on, and how you can find how out how this is happening.

Now it has been my personal experience that many hospital registrars do not verify the information they receive and they do not understand the impact that the information that they receive and [...]