Applies to: Surgical Counselors, Front Office Leads, Clinic Leads, Jason K. Darlington, M.D.; Eric Straut, O.D.

There are a significant number of one week PO cataract surgery exams on his schedule that should be scheduled with Dr. Straut. 
 
Dr. Straut can see all patients for their one week PO cataract surgery appointment, except: 

• Those patients that Dr. Darlington specifically requests to examine personally;
• Patients referred by outside Optometrists;
• Patients referred by Dr. Michael Mandese – they should see Dr. Mandese for their one week PO visit, unless he is out of the office for the week;
• Patients who have had a multifocal or accommodate lens implant (ReStor, Tecnis Multifocal, Crystalens, or Trulign).

 
Patients who have had toric IOLs can be placed on Dr. Straut’s schedule, unless they were Optometric referrals.
 
(One week exams on patients referred by outside Doctors’ of Optometry typically see that doctor, but this refers to cases in which Dr. Darlington wants the patient seen here one additional time prior to the return to their family eye doctor).
 
If a patient refuses to see Dr. Straut for their one week PO appointment for any reason, email the particulars to the CEO, cc’ing Dr. Darlington, Scheduling Supervisor, Clinic Leads.
 
For clarification:
Cat, Cat/istent, YLC can be seen postop by our OD or referring OD.
Glaucoma, Cornea, Lid will need to see Dr. Darlington postop.

Applies to: Surgical Counselors, Front Office Lead, Clinic Leads, Billing Lead
 
On all elective cases, we need to get payment up front.  There are simply too many scenarios in which, when this does not happen, one of two things result:
 

1. We spend an inordinate amount of time pursuing the payment;
2. We do not get paid.

 
Therefore  do not make payment plans on the day of surgery because monies may not collected. It is a key responsibility of the each of the Counselors to explain that their (estimated) copayments, co-insurance, deductibles, and other amounts due for surgery (FEC and ASC) must be paid in advance of surgery.  The Counselors also need to explain that if the payments due in advance of surgery are not made, unfortunately, their procedure will be cancelled. This is especially important with regard to patients having DSEK and Transplants (PKs).
 
We should not be ordering corneal tissue – which costs ~ $4600 – until the Counselor confirms that any copayments, co-insurance, deductibles, and other amounts due for surgery (FEC and ASC) have been paid in advance of surgery.
 
All such scenarios – concerns/issues related to payment must be brought to the attention of the CEO, Billing Supervisor, ASC DON and Scheduling Supervisor.
 
Patients are not to pay for premium IOLs, LRIs, copayments, deductible, co-insurance and other patient financial responsibilities on the day of surgery,  these monies are to be collected in advance of the day of surgery.  Some people may not be prepared to make payment at the time of pretesting/Counseling, but they could do so at any time in advance of surgery.
 
Some patients who may not feel comfortable providing you with credit card information over the phone.  They can drop a check off in advance of surgery or pay by credit or debit card in person if this makes them more comfortable.  They can also pay via our patient portal.  (If you have questions regarding this, ask the Billing Supervisor).
 
This should be explained to patients at the time of pretesting to ensure that the payments we need to receive are, in fact received prior to surgery.

Applies to: Surgical Counselors, Front Office Leads, Billing Lead, Clinical Lead, HR, ASC Director of Nursing
 
The Surgical Counseling Checklist form is for use with all cataract and related procedures and eyelid surgeries.
 
Consider it an essential tool to minimize the possibility of errors and to enhance efficiency throughout the surgical process, prior to surgery. This will be used across the board on related cases. 

Applies to: Jason K. Darlington, M.D.; Anterior Segment Assistants; Billing, Marketing, Front Office Leads; Clinical Leads

In order that billing be correct, and in order for us to be in compliance, the following steps must be taken in all cases and without exception.
 
In order that YAG Cap procedures that are to be co-managed get filed appropriately from the start, three items need to be addressed:
 

1. The record needs to be appropriately documented under PLAN that the patient is to be co-managed.  Be specific in your note.  Example:   “Patient to see Dr. Lawrence Thomas for PO care and be co-managed at Optique Unique.”
2. The Superbill needs to be noted – “COMANAGED – 54 – Dr. L. Thomas.”
3. The usual co-management paperwork should be signed – both by the surgeon and the co-managing doctor, as well as the patient.   If the patient does not arrive with co-management paperwork from the referring/co-managing doctor,  this paperwork should be available in the exam rooms and signed by the surgeon and patient.  This should be placed in the outguide.  When it gets to billing, it should get to Louise to ensure that the document is countersigned by the co-managing doctor.  This paperwork must be kept on file.
4. If at checkout, the Superbill is noted that the patient is to be co-managed but there is no paperwork in the outguide, this must be brought back to the surgeon to be addressed by check out or the front desk supervisor.  (Front desk supervisors – review this carefully with all checkout staff.).
5. Clinical Supervisors – be certain that all assistants are fully clear as to their role and responsibilities relating to this matter.

Applies to: Clinic Leads, Front Office Leads, Dr. McManus Assistants, Surgical Counselors;
Whenever Dr. McManus has a patient that he determines requires YAG PI laser surgery prior to cataract surgery make certain that the following protocol is followed:
 
1.  All patients having laser PIs are to be returned to see Dr. McManus personally in two weeks.

2.  Patients should be scheduled for pre-op before seeing clinic tech so pre-op/cataract evaluation is pre-oped.

3.  On the day of the two week follow-up, the patient is to have keratometry, IOL Master, then topography (in this order).

4.  Next, the patient is to be worked up to see Dr. McManus.  This is a follow up evaluation prior to cataract surgery.  As such, the cc/hpi cannot be something like "Patient here for PRE-OP Testing" or "Pt here for PO YAG PI."  The post-op period for YAG PIs is ten days.  The cc/hpi should be something to the effect of "Patient here for follow up DFE due to blurred, decreased vision at distance (and/or near) in his (left, right or both) eyes x ____  months.  Pt states (how is the patient's quality of life being affected) i.e. glare at night in the presence of oncoming headlights, difficulty reading, difficulty driving, difficulty using computer or watching television, etc."   Also include any comments on dryness, itching, burning, tearing, pain, etc.
 
The cc/hpi information should always include how the patient's decreased vision is affecting his or her lifestyle.  The cc/hpi example noted above is for example only, and is not intended to be used as is except when these are the specific complaints that a patient may have.
 
When writing a cc/hpi, remember to always include at least four elements, including comments on the vision of both eyes and how quality of life is being affected.  Problems should have location, severity, timing, onset, duration, pain, progression, relief and frequency of each concern noted.
 
5.  During the work up and after you have measured checked EOMs, Pupils, CFs and measured IOP, check for patency of the PI.  If the PI is open, proceed with dilation.  If you are unsure if the pupil is patient, feel free to ask Clinic Supervisors or Dr. McManus to assist with evaluating the patency of the PI.