We visit most of our facilities on a monthly basis, depending on patient demand. On the average, most facilities have about 70% resident participation. The incidence of ocular disease is extremely high, with well over 90% of residents exhibiting some form of disease. Most of the diseases are chronic in nature; cataracts, glaucoma and macular degeneration, for example. The treatment of choice for these diseases depends upon medical judgment of the severity of the condition, the resident’s mental capability, and the desires of the resident or responsible party. Each case is individual, but there are general patterns followed. Cases with minimal disease and low risk of progression will usually be seen on an annual basis. Those with significant disease and moderate to high potential for progression will be seen every six months. Cases actively progressing will be seen monthly, when indicated, or referred off-site for acute management or surgery when indicated.
Assuming adequate participation, a 120 bed facility yields an expected caseload of about 8-12 patients per month. This would require a one half day visitation per month, about three hours of care time.Smaller facilities, 60 beds or less, may require only one day every other month to meet the expected 8-12 cases.Very large facilities, 300 beds or more, may require multiple days per month.
At the initiation of our program, we will assist your nursing staff with our Visual Assessment and Care Planning Method to screen your current residents and subsequently obtain orders for eye consultation. This method combines basic acuity screening with a review of medical records to determine which residents are currently triggering for eye care under the Federal Guideline MDS 2.0. All new residents will be screened as an ongoing process near the time of admission.If the screening is failed, the following protocols are suggested:
- The facility sends a copy of the screening report to the resident’s primary care physician. A consultation order for medically necessary eye care is obtained from resident’s primary care physician.
- The facility notifies patient’s family / guardian / POA of the failed screening. Optionally send a copy of the screening report to responsible party.
- We will intiate medical care once primary care physician orders and family/POA notification are completed.
The original copy of this assessment report to remain on file in resident’s medical chart. Residents who pass the screening will be retested annually.This method will assure that all residents in need will receive medically necessary eye care.
We are participating providers for both Medicare Part B and Medicaid. We also accept assignment on secondary insurance providers. This means that for patients with Medicare and Medicaid coverage, our service is entirely covered. For patients with Medicare and Secondary Medigap insurance, our services are also likely to be entirely covered. For patients with Medicaid only, we will bill only what Medicaid allows, and again, our service is entirely covered. For those patients with Medicare only, a 20% co-payment is required. We are required by Medicare to bill for it, and we will bill the resident’s financial guardian.
In summary, most of the time the fees are entirely covered. We will not ask for a balance due unless all known insurers have been exhausted. If there is a case of financial hardship, or a billing error, please bring it to our attention, and it will be remedied.
Medicare guidelines require certain forms of documentation to establish:
- The medical necessity for eye care services.
- The authorization by responsible parties for Medicare to be billed.
The medical necessity requirement is generally met by a specific order from the patient’s primary care physician for the services. Residents who fail the nursing visual screening have proven the medical need to be examined.
Long term care residents have filed documents upon admission that authorize the nursing facility to direct their medical care from any provider and for that provider to bill to their insurance. Lifetime Vision Care also recommends that a resident’s responsible party be contacted for direct authorization for eye care services. We will generally request that either the facility Social Services department or Nursing contact the resident’s responsible party for verbal or written authorization prior to initiating eye care services. This will prevent misunderstandings. Please contact our office for a copy of our authorization form, or you can download it in PDF format from this link: Authorization Form.
We will fax you a list of patients, comprised of those established cases under management and their primary diagnosis, 1-2 weeks ahead of our next visitation. We will request screening/order forms and authorization forms for those residents who have failed the screening and need to be added to the list.We may also request a copy of the resident face sheet to verify insurance.
We will require a setup area that is at least ten feet in length, reasonably private, and with the ability to dim the light to near dark conditions. We do not require water access. We will set up our equipment, and perform our service in this room. Your CNA staff will help us to locate the residents to be seen, and bring a few (2-3) at a time. All those who are not strictly bed-bound should be awakened dressed and readied for examination. Individual room visitation is cumbersome and inefficient with all our equipment, but can be done in rare special cases.
We will chart all our records and orders. We ask that you keep all eye records in the chart for at least one calendar year. We will provide you with a sheet summarizing each patient’s primary findings and recommendations and the end of our visitation.
You will usually receive notice of our next visitation date by fax about 2 weeks in advance. We try to stay with the same day of the week: if it is Tuesdays, then it will stay on Tuesdays unless we mutually decide otherwise. We will contact you multiple times if needed to work out the details of each visit.
After we have completed our care rounds, we will provide the facility with a tabular summary of our visit, listing who was seen, their overall status and important issues, and when we will need to re-evaluate their case. MDS values are forwarded to you later.
If a case is urgent, and there is a medical need to proceed we will write an order requesting immediate referral to a surgical provider.
For cases with recommended optional referral to a specialist for surgery or other non-critical treatment we will first discuss the option with the patient, and if deemed prudent, recommend the procedure by letter to the resident’s legal guardian.
We may also request that the facility contact the resident’s legal guardian to begin a dialog regarding the recommended procedures.
We respect the patient’s right to refuse treatment, but have a medical responsibility to inform patients and guardians of available treatment options.
We generally discourage nursing facility staff from seeking our care while we are at your facility. We are here for resident medical care, but we would be happy to see any of your staff at our St. Petersburg eye doctor's office. We are available to answer minor staff questions, or advise treatment for mild conditions, but must decline staff involvement where it interferes with care of residents.
Most managed care organizations do not provide for eye care services to be delivered in the facility, and will require that the patient be managed by the primary care physician or sent out to a panel provider.Managed care organizations often do not cover the cost of wheelchair transport, which usually costs about the same as our exam services. So, many times, it is just as sensible for them to utilize our services and pay privately. The cost is about the same.
If a managed care plan does not provide eye care for the resident, or will not aid in arranging eye care for the resident who urgently needs care, we can provide that care and bill the facility, or accept payment from the resident or responsible party directly, or negotiate for other acceptable arrangements.
- We can order one pair of eyeglasses per year for Medicaid recipients. We will deliver the glasses on the next visitation, (4 weeks). Please call us if faster delivery is required. We can usually arrange this for an additional fee. Glasses are required to be dispensed by licensed personnel. If glasses are sent by mail, we will need to adjust them to fit the patient’s face at our next visiting rounds.
- Private pay eyeglasses candidates will have an cost estimate mailed to their responsible party. All private pay orders must be paid in advance. Delivery time often depends on how much delay there is in payment. Those who forward payment as soon as possible have the best chance of completing the order it time for delivery at the next visitation.
- Repairs: We can usually make minor repairs to broken frames. Please place all parts in a bag labeled with the resident’s name. Some private pay repairs may have a charge usually $10 to $20, depending on the difficulty. We will bill the patient’s financial guardian for most repairs.
- Facility orders: If the facility has agreed to pay for replacement eyeglasses for a resident, the cost will need to be paid in advance. The facility can be billed for any repairs it specially requests and authorizes.
- Unless otherwise requested, all eyeglasses will be engraved on the outside margin of the left lens with the resident’s last name. This will help to prevent loss and mixups.
- We suggest that each facility take a digital photograph of each resident upon admission, with eyeglasses on, to aid in future identification of missing eyeglasses.