The quick synopsis of PIMO
I am sitting in a up-to-date SCCO lecture hall, comfortable seating 120 ODs and staff as John Rumpakis O.D. and Scot Morris O.D. take the stage for the Pathways in Medical Optometry Bootcamp (PIMO).
By a show of hands, there is about 80% doctors here and 20% staff, a truly wonderful mix considering how important staffing is to an optometric practice.
Dr. Morris immediately strikes a cord, bringing up a specific point, that the average O.D. competes with not only other eye care professionals, but with local businesses and markets who are enticing our patients to open up their wallets. Immediately, I start thinking about the local businesses that surround my practice! Starbucks, the haircut salon, the supermarket and more.
The lecture is incredibly professional. In the murky waters of medical optometry, with myths swirling around, and people cutting corners on just about every HIPAA and medical billing rule imaginable, my 98.8 mile drive up from San Diego to Orange County begins to feel worth it. I can't stress how important it is to get the right information. John and Scot gave me some new-found confidence that I didn't know I had.
My Review of PIMO
One thing that was extremely helpful, was when the seminar explained how audits from medical and vision care plans work. It was the clearest distinction I have seen on how and why we must correctly bill. Imagine seeing a medical insurance audit asking for $102,000 and documenting exactly what you did wrong. Bone chilling but extremely educational.
One enlightening tidbit from Scot was that the average workflow, to get a patient into the doctor's exam chair is 16 steps, each with an opportunity to educate, promote or sell. He drilled down exactly what his office does, and what he trains other offices to do. It made me realize some pretty important changes to make at my office, particularly ensuring the doctor and patients are well aware of medical insurance co-pays, deductibles and more. He provided some real gems that I was able to take back and implement.
Something I can completely attest to, and something Scot brought up, is that workflow within a practice can be out-of-wack.
One can crack this nut by doing a work-flow-analysis, something that the PIMO bootcamp delves into quite well. The workflow-analysis was probably my favorite part because I am a huge "workflow nerd." Seriously, I do everything I can to maximize my personal workflow throughout the day and I try to use every piece of technology available.
I have practiced optometry for two years now, and have been involved with private practices for nearly four years, and have heard countless stories from my colleagues about their workflow. Hearing the right way to do things was reassuring.
Scot made me realize that I have many redundancies during my exam and I was keeping my patients in the chair for way to long. From the moment the patient walked into the practice until when he/she walked out of my exam room way excessive and therefore I was pushing patients to "come back" to pick out their glasses. I was literally spending too much face time with them, and it was killing my productivity.
This meant that the entire world would compete with me from the moment they walked out the door of my practice till the moment they came back to get glasses (if they ever did).
Here are some PIMO Pearls of Wisdom for you
- Most offices send patients to the waiting room with forms. Instead, begin using a formless process.
- Most offices explain diagnoses in a long, drawn out way. Instead, use faster scripts and explanation tactics (Scot / John give lots of scripts which is nice).
- Many offices pick a random code, bill it and hope for the best. Instead, use a set formula to bill and code correctly.
- Many offices let the front desk staff say whatever they want when patients come in. Instead, provide scripts for efficiency.
- You can charge for photos as a screening, but be sure to document using S9986 code.
- Most offices bill for surgical procedures and office visits at the same time. Instead, bill just the surgical procedure and obey the global period.
- Most offices take bandage lenses from your trial set to treat corneal problems. Instead, you must purchase a specific set for this purpose because it is against the rules to just use a "free trial lens."
- Most offices do not use ABNs with (GA, GX, GY, GZ) modifiers. Try using them!
- Most offices do not know how to bill glaucoma screenings. Learn the basic billing with G0117 with v80.1.
Curious what a HCPCS code is?
Well, I had no idea whatsoever, but for the first time in my life, this seminar explained it. Here is the overview!
- Level 1 HCPCS - CPT code
- Level 2 HCPCS - Non-CPT code for materials, services, and the PQRS
- Level 3 HCPCS - Emerging technology and temporary use codes
Here are two quotes that really stood out to me:
Quit trying to fix problems that you have nothing to do with. - John Rumpakis O.D.
All the planning in the world means nothing if you don't do something about it - Scot Morris O.D.
One clear message that was uncovered by John, was that many practices completely fall short when it comes to setting patient expectations.
This is particularly prevalent when it comes to letting patients know that we treat medical conditions. Yet, with the race-to-zero on managed vision care plans, it has never been more important to adopt the medical model.
Key messages I took home
- Focus on what you can control, don't waste energy on what you can't.
- The CPT book and ICD-9 book are the "rule books," just purchase them to solve your problems with medical billing.
- Optometrists have an over reliance on managed vision care plans.
- $5.1 billion dollars will be recovered from doctors in medicare in the coming years from improper payments, billing, and unnecessary costs to the medical system - this can result in criminal and civil penalties.
- ICD-10 is an entirely different way of coding in your medical records, and it should make things easier than ICD-9.
- ICD-10 will likely come on October 1st 2015.
Key lessons I took home and ones that you will learn too
- What to do when coding and billing for a systemic disease and ocular disease that are related
- The basic translation of ICD-9 to ICD-10
- What each digit of an ICD-10 code represents
- How to do an audit on your own records
- How to have the confidence to stand behind your fees
- How to manage your accounts receivable list and create efficiencies
- When dilation is required and when it is not
- The differences between a comprehensive and intermediate exam
- How to schedule a frequency of return for patients with medical diagnoses
- Role playing for front desk interactions
- How to use 3 CPT codes to manage 95% of your visits instead of 12
- How to eliminate your lowest paying managed care plan and do private pay instead
- How to batch your exams into medical exams at one part of the day, and vision exams the other in order to improve efficiency.
Should you take the Pathways in Medical Optometry Bootcamp?
The short answer is absolutely, yes.
First off, no one creates content like Dr. Rumpakis and Dr. Morris. Secondly, the content is delivered through a "true" experience that both of these ODs have lived and experimented with. Thirdly, being present and making the small investment in this course is what will drive you to actually make change. This just can't be done with an article in a practice management magazine.
Also, they give you a ton of great stuff in a binder to take home. This binder is priceless, and has lots of information you can review later on and share with your staff.
My vote is go for it, but bring your staff. You will be happy you did.
Want to sign up for the program?
- Just visit the AllerganODPathways website.
Here's a short interview with Dr. Rumpakis and Dr. Morris about Pathways in Medical Optometry