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Streamlining Scheduling and Billing
Busy practices offer practical solutions.

By Sean McKinney

As retina practices increase office volume by up to 40%, many are working to improve how they schedule and bill for visits. They're finding that the key is to improve patient flow and expedite paperwork while eliminating mistakes that can result in rejected claims. Here are solutions that two practices are using to address these issues.

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Snowball effect
David Baczewski, MBA, practice administrator at Illinois Retina Associates, says the use of anti-VEGF agents for neovascular AMD and retinal vein occlusion, plus the emerging unlabeled use of anti-VEGF therapy for diabetic macular edema, have created unprecedented burdens on practices.

The drug aflibercept (Eylea), also known as VEGF Trap-Eye, is expected to receive FDA approval for the treatment of neovascular AMD in November. This injectable drug should decrease the frequency of injections for AMD, potentially decreasing patient volume to some extent. However, Mr. Baczewski doesn't see the appointment books and billing logs clearing anytime soon.

"We need to rethink how patients are scheduled," says Mr. Baczewski, whose practice includes 12 retina specialists in and around Chicago and Indiana. "The retina community is considering the possibility of developing injection days or block times for injections — or even injection-only areas of the office. You can't have patients waiting two hours or longer for an injection. One or two of our physicians have moved forward with these ideas and are trying to schedule injection days and/or block times for injections."

Despite best efforts
There's no perfect system. A physician dedicating an afternoon to injections still has to move acute cases to the front of the line. "The clock is ticking on a retinal tear when the patient is in danger of losing his vision," he says. "You have to do the best you can."

Angelo Retina Associates, a solo practice in San Angelo, Texas, has increased data collection in advance of patient visits to better manage 40 to 50 injections a week performed by Bryan N. Angle, MD. Practice manager Bobbie Jo Smith says her nine-member staff establishes eligibility for reimbursement, updates charts, prepares operative reports and collects signatures on consent forms so that no tasks will slow the visit when Dr. Angle decides whether to treat.

"Unnecessary tests are excluded from our screening," she adds. "We look for every possible way to become more efficient — even closing the eye to speed up dilation."

To increase overall efficiency, Mr. Baczewski also recommends eliminating non-essential steps. "We're considering a more streamlined work-up," he says. "With the physician's guidance, staff can evaluate charts to focus only on what is necessary, so they can move the patient through the practice faster."

Illinois Retina Associates has separated the fluorescein angiography and OCT stations and trained more staff members to perform OCT. "This encourages increased efficiency and flexibility," notes Mr. Baczewski. "The physician can see the OCT before or after the visit."

"Better scheduling and billing are achieved through better communication," says Ms. Smith. "The front office and technicians need to communicate about which patients should be signed up for support programs such as the Genentech Access to Care Foundation."

When a new treatment is approved, Illinois Retina Associates uses a checklist. "We need to make sure we use the correct diagnostic codes and, just as important, the correct diagnostic code sequence," says Mr. Baczewski.

An efficient benefits investigation, usually conducted by computer or telephone, is also critical. "Making claims as clean as possible avoids the extra work associated with appealing rejected claims," he says. "Rejected claims slow practice administration and revenue streams. It may take as long as 60 days before you learn that you're not being paid, which might be too late to appeal. Monitor each claims submission carefully to make sure you're getting paid."

Consider implementing these tips so your patients won't spend hours in your waiting rooms — they will increase your practice's efficiency and improve your patients' experience.


Retinal Physician | 323 Norristown Road, Suite 200, Ambler, PA 19002 | 215-646-8700
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