coding strategies

Begin With the End — Getting Paid — in Mind

BY CLARKE D. NEWMAN, OD, FAAO

The great physician Joseph Lister was once called urgently to the home of a Lord who had a chicken bone stuck in his throat. After deftly removing the bone, the grateful Lord asked Lister what he thought would be a reasonable fee for his services. Lister responded, "I would think that my fee should be half of what you would be willing to pay if that bone were still in your throat."

Stephen Covey, in his landmark book The Seven Habits of Highly Effective People, describes a habit that applies directly to getting paid for insurance claims: "Begin with the end in mind." So, let's begin with this — in the end, we have to get paid.

Understand Your Goal

When we bill for eyecare services, our goal is to get paid for competently rendering the care that cures the eyecare-related suffering of humankind. There's nothing wrong with that. However, sometimes the altruistic ethos hammered into us in school precludes us from properly valuing what we do.

Look, I would love to do what I do for free, but at this stage of my life I can't afford to, and most of you can't either. So, my goal when I go to the office each morning is to earn as much money as I can. Notice I said "earn." At no time will I ever advocate doing anything that is unethical, reprehensible, illegal or shameful.

Quite the contrary, when I walk into my office each day, I walk past the Code of Ethics of our profession. It's the first thing you see hanging on the wall of my office. When we start there, we can charge properly for what we do and still sleep at night.

Recognize Your Value

The cool part about what we do is that we offer something of tremendous benefit to humankind — we correct the vision of people who otherwise can't see clearly. Everything we do, from diagnosing and treating eye disease to carefully refracting, is aimed at providing clear vision to our patients. There's great value in providing that service, and it earns us the right to get paid.

If you can't get past believing that what you do is worth getting paid for, then you won't succeed in the modern healthcare environment. It's a sin to be really good at what you do and then not charge enough — and so not get paid enough — to keep doing it.

Our patients, especially our medically necessary lens patients, value what we do for them more than we seem to. Remember, your patients are the ones with the bone in their throat.

So, let's get our heads in the right place, and next month we'll begin the process by defining medical necessity. CLS

Author's Note: For those of you who don't know me, which is most of you, I'm a solo practitioner in the trenches of specialty contact lens prescribing. Every day I prescribe medically necessary contact lenses to patients who need them and cosmetic contact lenses to patients who want them. I feed a staff and a family with the fruits of that endeavor. I think that many of you do so as well.

My goal for this series of columns is to deconstruct the process of billing so that, at the end of the year, each of you will be able to get paid properly, fully and ethically for the services that you render.

Dr. Newman has been in private practice in Dallas, Texas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine and refractive surgery.