Optometry Coding & Billing Alert

Published on Mon Feb 13, 2006 PDF

Question: What evidence or documentation do we need to prove the supervising physician was in the office when we reported incident-to services?


Arizona Subscriber


Answer: When you report technicians- services -incident-to- the optometrists- work, have the optometrists save all personal calendars to prevent frantic scrambling in the event of an audit. If no other records are available, auditors may ask to see the physician's personal planner and calendar to verify he was in the office suite when he claimed to be.

You should also make it a point to keep old appointment schedules and calendars when you close out billing at the end of the year--these documents can provide valuable proof that you met the supervision requirements. If your software erases scheduling information at the end of the year, ask your vendor to create a backup.

Bright idea: One way to preserve scheduling information and prove that the optometrist supervised a tech on a particular date is to have the billing department batch all information together each day. If you staple a copy of the day's schedule onto each batch of superbills, you can easily retrieve that information when the need arises. Also save sign-in sheets that prove a physician saw patients on a particular day.

Reason: You must have solid proof the optometrist was on the premises supervising the tech to protect your incident-to claims in the event of an audit. For example, if auditors find records showing that your physician was actually at a nursing home during the time you reported incident-to services, you could have to refund the entire day's worth of incident-to claims.

Each carrier has its own guidelines on how to demonstrate that the physician was in the office suite during an incident-to service. Trailblazer, for instance, requires the physician to sign off personally on all incident-to services. CIGNA, on the other hand, doesn't require a signature. And many carriers don't require any positive proof that the doctor was on-site.

Advice for Reader Questions and You Be the Expert contributed by David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas; and Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va.