Northern Sights NewsletterA3AD1AE4-B4C6... · Fargo, ND 58103 701-280-3000 [email protected] Dr....

Northern Sights May/June 1

Vol. 29 Issue 3 May / June 2017

As I sit in my

den watching it

snow on April

26th...I recall the

beautiful weather

I experienced less

than a month ago

in Bismarck. It

was while

attending the NDOA Meeting on

March 30-31, 2017.

It featured 10 hours of

excellent CE that covered topics from

MIPS to OCT, both very important

acronyms in our practices.

Attendance was fairly meek at

this most recent convention. The

NDOA Board and myself hope to see

all of you at our Annual Convention

this fall in Fargo. If you have any

suggestions regarding CE topics you

would like to attend at the fall

convention, please do not hesitate to

contact myself or my fellow board

members.

We discussed at our most

recent Board Meeting the idea of

developing a New Member Task

Force, in hopes of getting the younger/

newer members involved in the

planning of activities and/or CE topics

during our conventions. It was also

suggested to have this task force

contribute to the NDOA

Newsletter. If you would like to be

involved in organizing such a Task

Force and/or planning of the Fall

Convention, please contact myself or

Nancy Kopp.

We hope to continue to have 2

meetings per year that offer at least 10

hours of CE per meeting, but with the

rising costs of speakers and rental of

meeting space, we need increased

attendance from our membership, to

continue to provide these conferences.

I ask that you continue to

support your association by not only

paying your membership dues, but

also by attending the association

meetings and welcoming new

optometrists to become involved in

the NDOA. Strength in numbers is

always a good thing...let's keep our

NDOA strong and growing.

Thank you for your time,

Amy DuBois

Inside This Issue

Nevada Lawmaker Drops

Support of Proposed Legislation

Restricting Online Eye Exams

Medical Billing Policy Waivers

and Discounts

BCBSND Vision Advisory

Committee Meeting

Vision Vs. Medical Insurance:

When to Bill Each

Growing Ransomware Threat:

What If Your Data is Held

Hostage?

www.ndeyecare.com

President’s Message ~ Dr. Amy Mitzel-DuBois

Northern Sights Newsletter

North Dakota

Optometric Association 921 South 9th Street, Ste. 120

Bismarck, ND 58504

Phone: 701-258-6766

Fax: 701-258-9005

E-mail: [email protected]

Website: www.ndeyecare.com

2017 NDOA OFFICERS

Dr. Amy Mitzel DuBois President

3232 13th Ave. South Fargo, ND 58103

701-280-3000 [email protected]

Dr. Darin Johnson President Elect

1525 31st Ave. SW, Ste. E Minot, ND 58701


Dr. Nate Shilman Vice President

2273 3rd Ave West Dickinson, ND 58601


Dr. Krista Heil

Secretary/Treasurer 111 E Century Ave

Bismarck, ND 58503 701-222-1420

[email protected]

Dr. Blaine Burdick Past President

PO Box 888 Devils Lake, ND 58301


Nancy Kopp Executive Director


Nevada Lawmaker Drops

Support of

Proposed Legislation

Restricting Online Eye Exams

Legislation proposed in Nevada that would

have restricted the use of “certain automated testing de-

vices” in eye exams – including online exams – was ex-

pected to die in committee Friday (April 14) after the

sponsor of the legislation withdrew her support.

The proposed legislation, Assembly Bill 129,

would have required a complete eye exam performed by

an optometrist or ophthalmologist to be part of a patient

visit that resulted in a prescription for an ophthalmic

lens. The proposed legislation stated: “Before issuing a

prescription for an ophthalmic lens, an ophthalmologist

[or optometrist] in this state must make an assessment of

the ocular health and visual status of the patient that

does not solely consist of the use of an automated testing

device to generate the refractive error of the eyes of the

patient.”

The Nevada Optometric Association (NOA) was

among the bill’s supporters, however Assemblywoman

Jill Tolles, who introduced the proposal in February, had

decided to back away from the proposal.

“We decided to drop the bill after all. I am proud

of the work everyone did on the issue, but we couldn’t

find the right amendment language to meet everyone’s

goals.”

After its introduction, the bill was referred to the

Assembly’s Commerce and Labor Committee, which

had a deadline of Friday, April 14, to take action on the

proposal, or otherwise it would lapse in committee for

the remainder of this session of the legislature.

NOA supported the proposed legislation “100

percent.” The association would take time to consider its

options for moving a new version of the legislation for-

ward. The Nevada legislature holds sessions every other

year. The next time a proposal covering online eye ex-

ams is likely to arise in the state would be 2019.

Unlock your Staff’s Potential! Build Staff Skills & Confidence Enroll Your Staff Today!

How To Enroll Staff: Log-in to www.aoa.org

1. Under the Optometrist tab, click on My Profile/ My AOA. Click on the “Manage Staff” Tab

2. Enter information for each staff person (non-OD)

You will need:

- Legal name of staff ( as appears on Driver’s license)

- Date of Birth

- Unique email address for each staff person

Have Questions? Need Help? Contact: [email protected] 800-365-2219, ext. 4108

Medical Billing Policy:

Waivers and Discounts

Blue Cross Blue Shield of North Dakota

(BCBSND) has received numerous inquiries regarding

its policy on a participating provider's ability to waive

member cost-sharing amounts or to offer discounts. The

following is BCBSND's policy regarding these issues.

Waiver of cost-sharing amounts: Per the Provid-

er Group Participation Agreement, a provider must not

waive or reduce any member's cost-sharing amounts,

including coinsurance, co-payment and deductible

amounts. The provider is expected to bill the member

for cost-sharing amounts and non-covered services iden-

tified as billable by BCBSND. This policy shall not pro-

hibit the provider from accepting a lesser amount per

their hardship and/or collection policies.

Member discounts: BCBSND defines a member

discount, for the purpose of this policy, as any promo-

tion or special consideration that reduces the provider's

customary charge for covered services. Participating

providers offering member discounts must adhere to the

following guidelines:

The discount must be available to all patients,

regardless of whether insurance coverage is involved.

The provider's customary charge submitted to

BCBSND must reflect the discounted amount as demon-

strated below:

Provider's customary charge - $100

Less: Member's discount - $30

Charge billed to BCBSND - $70

BCBSND allowance - $85

Member co-payment - $20

BCBSND payment to provider - $50

Amount to be collected from member - $20


FROM THE DESK OF YOUR DIRECTOR

~ Nancy Kopp ~

“Spring Has Sprung…I think!”

This time of the year usually brings a breath of

fresh air to my mind. Subtle changes within our personal

and professional lives, such as new growth, blossoms,

rejuvenation and cleanup! Cleanup is first on my list of

TO DO!

The 65th Session of the North Dakota Legislative

Session adjourned Thursday, April 27th. The 77th Day of

80 allowable days per the constitution. This leaves only

3 days for the Legislature to re-convene, if necessary to

address issues, such as Health Care Reform, that may or

may not surface in the next few months, under the

Trump Administration.

This whole Legislative session, for some reason,

was very “frustrating” for me. I can’t pinpoint a particu-

lar reason, other than not being fully prepared, due to

staff transition and/or the atmosphere of the makeup of

the Legislature, with a very super majority and differ-

ence of personalities between the two chambers.

The key to Legislative efforts and success in the

process that dictates your profession, are GRASS-

ROOTS EFFORTS; COMMUNICATION, RELATION-

SHIPS, and the inevitable PAC/FINANCIAL SUP-

PORT. Much like optometric commercial support, we

support those that support us…

During the 2017 Legislative session, I tried my

best to keep you updated on the issues optometry was

involved with on a weekly basis. I’m not going to go into

great detail as to the results of optometry’s exposure in

this newsletter article, but will follow-up in an e-mail

survey, especially with the impact on the on-line driver’s

license renewal bill, that did pass with amendments. This

leads me to conversation on a report of conversation with

the North Dakota State Board of Optometry, at their

most recent meeting on April 29th.

Unofficially, the State Board has indicated that

they are planning to introduce the following Administra-

tive Rule changes in 2017/2018:

- Prescription Drug Monitoring Program

- Telemedicine

- Minimum Eye Examination Requirements

- Background Checks

- Education Requirements (Increase to 60 Hours with 24

Online)

Notes From BCBSND Vision Advisory Committee

Meeting March 8th, 2017

NDOA Attendees: Dr. Dori Carlson, Dr. Barbara

Brookshire, Laura Palmer (Para) and Nancy Kopp.

BCBS Vision has set a 2017 goal for new vi-

sion contracts and thus far has reached 42% of their

goal. The fourth quarter of each year is the time for the

greatest opportunity for new contract sales, simply due

to the number of employers who have anniversary re-

newal dates.

BCBS Vision is seeing more activity in north-

west North Dakota as a result of oil prices rebounding

somewhat, however they do not anticipate nearing the

contract levels they were in 2014 and 2015. Some of

those employers are choosing to add benefits to attract

and retain good employees.

Competition in the vision plan market is grow-

ing. Many carriers have entered the market in North

Dakota in the past few years. As a result, this makes it

more difficult to gain new business and retain existing

contracts. New competition are pricing their products

and benefits, as good or perhaps better than existing

product offerings.

Despite the provider network advantage of

BCBS over the competition, decision makers tend to

sacrifice employee disruption, in order to be able to

offer a product at a lower cost or voluntary products,

at no cost to the employer. Self funded groups also, are

looking towards decreased cost and hesitate to include

vision reimbursement and polycarbonate lenses for

children were both discussed, but no solution was pre-

sented. BCBS will continue to administer vision bene-

fits for the Healthy Steps Program.

I as your fiscal agent, as well as the NDOA

Board, have been discussing strategies to address

changes in membership dues collections, membership

benefits and external influences, on how we function in

the future. We need to be the “voice” of optometry

within our small state “together”!

Thanks to all who have participated in the re-

cent past with your contributions and I sincerely hope

that we can keep the momentum going!

Have a great summer. Enjoy the fruits of your

profession and some family/personal rejuvenation!!


Vision Vs. Medical Insurance:

When to Bill Each

By Mark Wright, OD, FCOVD

and Carole Burns, FCOVD

The patient presents in your office with a red

eye. The patient has both medical insurance and

vision insurance coverage. The medical insurance has a

$500 deductible, which has not yet been met. The vision

insurance has a $20 co-pay. The patient wants to use the

vision insurance for today’s examination because there is

only a $20 co-pay. What do you do?

The key to helping the patient navigate the

insurance minefield is to understand how a refraction fits

into this situation. The CPT medical examination codes

(92000 and 99000 codes) do not include a refraction in

their definitions. That means if a refraction is done, the

medical examination code is billed and the refraction

code (92015) is also billed. On the other hand, vision

insurance codes for a comprehensive or intermediate

code include a refraction, therefore, only the examina-

tion code is billed even when both an examination and a

refraction are done.

Vision insurance is for “routine” eye examina-

tions. Medical insurance is for situations where there is a

medical sign, medical symptom, or ongoing care for a

medical condition. Medical insurance does not cover

cases where the reason for the examination, or primary

diagnosis, is myopia, hyperopia, astigmatism or presbyo-

pia.

Another important difference between medical

insurance and vision insurance is how many times each

year the coverage can be used. Most vision insurance

plans only permit the vision insurance to be used one

time per calendar year. It’s also important to note that

vision insurance cannot be separated into examination

and refraction. The examination and

refraction are tied together and can only be used on the

same day, once a year. Medical insurance can be used

multiple times over the course of the year. The only lim-

iting parameter for medical insurance is

medical necessity. Medical necessity opens the gate for

medical insurance reimbursement.

In the case above, the patient presents with a red

eye. The red eye is a medical sign of an

underlying medical condition. This is covered by medi-

cal insurance, not vision insurance.

The conversation to have with the patient is to

explain that if you use the vision insurance today, it uses

the refraction coverage today, then, in one week, when

the patient returns to the office, they would have to pay

for the examination and for the refraction. This means

that they will end up paying more for the two exams.

The best way to approach this case is to do it the

way the two insurances have been set up to be used. Use

the medical insurance for the first visit

because there is a medical reason for the examination,

then, when the patient is healed, you can use the

vision insurance with its covered refraction. Doing it this

way coordinates the patient’s insurance coverage. You

are following the insurance rules, and at the same time,

minimizing the patient’s total out-of-pocket

expenses.

Special Olympics: Opening Eyes

Saturday, June 10th, 2017

8 AM to 1 PM at

Fargo South High School.

(clinic starting at 9 AM)

Open to all staff & family that would like to help.

Lunch and t-shirt provided

For more information contact

Jed Hillmer at [email protected]

Mark Your Calendar!

NDOA 114th Annual Congress

October 19-20, 2017

Fargo Holiday Inn

-Schedule of Events-

Thursday, October 19th 12pm (noon) - 5pm—Continuing Education

5pm - 9pm—Exhibit Hall/Fun Night

Friday, October 20th: 8am - 9am—Breakfast

9am - 12pm (noon)—Continuing Education

12pm (noon) - 2pm—NDOA Awards Lunch and

Membership Meeting

2pm - 5pm—Continuing Education

5pm—Adjournment

Your Support of NDOA Events is

Vital and Appreciated!


The Growing Ransomware

Threat: What If Your Data is

Held Hostage? It’s True! Ted McElroy, OD, was shocked to

find his practice cyber-attacked by ransomware

that encrypted all of his business files and patient data,

essentially freezing his practice. After exploring his op-

tions, he paid a $3,000 ransom to the hijackers to get

back in business. On investigation, he corrected weak-

nesses in his backup system, and he devised a defensive

plan should an attack happen again. Data hijacking is

part of a growing trend, as cyber criminals target medical

practices and health care systems as easy prey and will-

ing payers. How prepared are you to defend against

cyber criminals?

DEFENSIVE PLAN:

Continually monitor your backup to be sure it’s

working and archived offline. If attacked, be prepared to

wipe clean your entire computer system and re-install it.

Negotiate with hijackers to send you the key to open

your data, not for their price, but for what it costs you for

your IT personnel to re-install. Estimate: three hours or

$300.

DON’T LOAD NEW SOFTWARE FROM E-MAIL.

When loading a new piece of software onto your

server, first load it onto a zip drive. Then, do a virus scan

to make sure no viruses are present, and only then load

onto your server.

HIPAA CONCERN:

Are you sure your patient data has not been

breached? You may be required to inform all patients of

a potential breach of their patient data and payment

method.

BACK UP FILES.

Back up your files both on external hard drives

(around $100 a piece at an office supply store) and also

back it up in the cloud using a service like Carbonite, or

one its competitors. The cost of backing up your data

online depends on the amount of data you have to back

up. In the case of Dr. McElroy’s practice, it costs just

$89 a month to back up online, “in the cloud.”

GET WHOLLY IN-THE-CLOUD.

Choose an electronic health records and practice

management system that resides wholly in the cloud.

EHR/practice management systems that reside entirely

online, in the cloud, guarantee the security of your data

as part of your contract with them, and if the information

is encrypted by a hacker, they are the ones who are re-

sponsible for paying the fee to unlock it, and if the infor-

mation is breached and exposed, they are responsible for

paying damages to your practice to cover related expens-

es and the potential loss of patients.

Remember To Thank Those

Who Support the NDOA!

2017 Legislative/CE Conference:

- Walman Instruments - Provided OCT Vision

Screenings at the Capitol (Jason Thornton)

- Practice Compliance Solutions (Honorarium

Waiver)

- Essilor Laboratories - Speaker/Event Sponsorship

- Dakota Eye Institute - Social Sponsorship

Clinicians: MIPS

Participation Status Letter

CMS is reviewing claims and letting practic-

es know which clinicians need to take part in the Merit

-based Incentive Payment System (MIPS), an im-

portant part of the new Quality Payment Program

(QPP). In late April through May, you will get a letter

from your Medicare Administrative Contractor that

processes Medicare Part B claims, providing the par-

ticipation status of each MIPS clinician associated

with your Taxpayer Identification Number (TIN). Cli-

nicians should participate in MIPS in the 2017 transi-

tion year if they:

- Bill more than $30,000 in Medicare Part B allowed

charges a year and

- Provide care for more than 100 Part B-enrolled Med-

icare beneficiaries a year.

QPP intends to shift reimbursement from the

volume of services provided toward a payment system

that rewards clinicians for their overall work in deliv-

ering the best care for patients. It replaces the Sustain-

able Growth Rate formula and streamlines the

“Legacy Programs” - Physician Quality Reporting

System, the Value-based Payment Modifier, and the

Medicare Electronic Health Records Incentive Pro-

gram. During this first year of the program, CMS is

committed to working with you to streamline the pro-

cess as much as possible. Our goal is to further reduce

burdensome requirements so that you can deliver the

best possible care to patients. Learn more about

the Quality Payment Program.

Visit www.cms.gov to learn more.


IN SEARCH OF PER DIEM OPTOMETRIST

1 day/ week, occasional Saturday morning post ops.

Competitive pay and a great staff!

No refractive surgery experience required - will train.

TLC Laser Eye Centers - Fargo.

Call 701-293-7945 or email

[email protected]

PART-TIME TO FULL-TIME

POSITION AVAILABLE

Focus Family Eyecare—Fargo

Contact Dr. Stacey Archibald at

[email protected]

FULL TIME ASSOCIATE OD

POSITION AVAILABLE

This practice has an excellent reputation for patient care,

newest equipment, and state-of-the-art finishing lab. We

are 30 years old and going strong with a brand new

facility in 2011. The position includes benefits and a

retirement plan.

Send cover letter and curriculum vitae to

[email protected] or:

Eyewear Concepts

PO Box 149

Dickinson, ND, 58601

PURCHASE OPPORTUNITY

Private Practice offering a job opportunity for an

optometrist or two person team to practice full scope

Optometry. This is a newly constructed office with

state of the art equipment in an ideal location. Current

owner wishes to practice part-time or retire as desired.

New doctors will be able to set their own hours with

excellent benefits. Purchase opportunity is negotiable.

For more information about this profitable practice,

please send inquiries to:

Dr. Robert Nyre - Vision Source - Minot

701-852-2020 or email: [email protected]

PRACTICE FOR SALE

Well established 38-year practice for sale in Bozeman,

Montana. Touted as one of the best places to live by

Sunset Magazine and the New York Post, the U.S.

Census estimates show that Bozeman's population is

growing faster than other Montana cities, which will

your further enhance practice growth. Located across

from Montana State University, the largest university in

Montana. Same optometrist has been serving families

and community members. Full inventory and equipment

will enable you to move right in and practice. Owner

wishes to retire, will help with transition.

For details and more information, contact

[email protected] ASSOCIATE OD NEEDED

Looking for one or two associate ODs to join large

independent optometry practice in Jamestown.

Opportunity for partnership also.

Please contact Larry Motacek, O.D at 701-252-2020

or email: [email protected]

Classifieds & Employment Opportunities

FULL OR PART TIME

ASSOCIATE OD POSITION

We are a busy one-doctor owned practice in our 10th

year of ownership seeking an Associate OD to join our

practice in Minot, ND. We have a fully trained staff and

updated equipment. This salaried position, with future

partnership potential, is open as either Full or Part time,

2-5 days/week. No evenings, weekends or holidays. Full

benefit package available.

Please contact Dr. Darin Johnson at (701) 240-0812 or

[email protected] for more details.

You may also mail your CV to

1525 31st Ave SW, Ste E Minot, ND 58701

http://www.johnsoneyecarepc.com/

HELP WANTED ASSOCIATE OPTOMETRIST IN

WESTERN NORTH DAKOTA

Looking for caring and personable optometrist to join

our eye care team, the position is full time and flexible.

Base salary $117,000/year with production incentives

based on gross production.

Interested optometrists please call:

Vincent Biesiot at 701-483-1466 or

email me: [email protected]


NEW OR RECENT GRAD WANTED

Busy private practice seeking new or recent grad: Havasu Eye Center was founded 25 years ago and continues to

be the community's premiere choice in vision care. We are a 3 doctor, private practice with 3 locations. We are a

busy practice focusing on high quality, comprehensive eye care. Havasu Eye Center was selected as one of the Top

10 Eye Care Practices in the nation by the Best Practices Initiative. Types of exams seen at our practice include:

comprehensive eye exams for all ages, soft contact lenses, specialty contact lenses (gas permeable and scleral

lenses), ocular disease management (glaucoma, macular degeneration, dry eye), co-management of common eye

surgeries, ocular emergencies, and more! We pride our practice with delivering the best possible eye care in a

friendly environment. We are open M-F from 8-5. We have 26 fantastic staff members for your support. Our main

office is located in beautiful Lake Havasu, AZ. Salary or per diem rate are both options, and we can discuss bonus

incentives as well! Competitive salary of $120,000! IRA matching benefits as well. License fees, continuing

education, and vacation benefits are always open to discussion.

Please email [email protected] for more information!

EQUIPMENT FOR SALE—USED, GOOD CONDITION

Chair/Stand: one a Marco, the other handicap accessible Reliance. Slit lamps: SL-7D Topcon, Zeiss,

portable SL 14Kowa. Two Marco keratometers. Reichert/ Leica phoropters: projectors, BIO's, a wireless Keeler,

wall mounted Proppers. A variety of Volk BIO and SL lenses. Retinomax. Humphrey 745i fields analyzer, GDX

Miscellaneous instrumentation

Joe Thorman, OD (retired), Rolla Eye Clinic [email protected] 701-212-6328

Classifieds & Employment Opportunities Continued

Northern Sights NewsletterA3AD1AE4-B4C6... · Fargo, ND 58103 701-280-3000 [email protected] Dr....

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