Medical Model

Getting on Track with the Medical Model: Patient Intake Process

By Jerry Godwin, MBA, CEO, Optometric Medical Solutions

January 14, 2015

Front office staff members are key players in the patient interaction cycle. They are the point of entry for the patient, and they collect key patient demographics. They set the tone for the patient’s perception of the practice.

Educate While Scheduling

In building a medical model practice, it is critical for staff to let patients know that the doctor can see them for medical eye conditions. Educating patients and gathering complete information during the scheduling call creates the foundation for proper reimbursement and collections. Also, the more information obtained during the call will result in efficiency and professionalism at the front desk check-in and check-out processes.

Verification is Essential

Verifying the patient’s medical benefits is key for proper reimbursement. It also is a matter of compliance in participating in accepting medical insurance. Practice revenue will increase and staff will have more time to devote to their tasks (e.g., patient care, selling products, and accounting functions) instead of working denied claims.

Communicate Fully

Communicate benefits information to the patient prior to their appointment, at confirmation of appointment, and reiterate it when the patient comes in for appointment. This educates the patient and is necessary for the doctor to understand the financial responsibilities of the patient.

Checklist of Duties: Intake

• Collect, document and verify patient demographics.

• Collect vision plan and medical insurance information.

• Validate the patient’s identity at the time of the visit to avoid fraud possibilities (driver’s license or other form of ID).

• Paperwork requiring patient signature (acknowledgment)

• HIPAA Notice of Privacy Practices Acknowledgement (required only once, unless policy is updated, then all patients must sign again)

• Advanced Beneficiary Notice (ABN) where required

• Consent to Treat

• Financial Assignment of Benefits

• Release of Information

• Insurance eligibility and verification is key prior to patient being seen. Understanding the difference between medical insurance and vision plans.
o Coverage
o Co-pay
o Deductible
o Co-insurance benefits
o Out of Pocket
o Specific Procedure (CPT) codes verified

Jerry Godwin, MBA, is CEO of Optometric Medical Solutions, based in San Antonio, Texas. OMS is a leader in providing comprehensive management services and systems to optometric practices and a “change agent” in helping practices to embracethe medical model.To reach him: jgodwin@optmedsol.com

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