tremendous—and across the board. First of all, there’s the professional

satisfaction of being able to provide

A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

ALLDocsALLDocsThe

NewsletterRx Therapeutics for Practice Growth

First Quarter 2006

glaucoma. When you do that, you canalmost develop a resentment for pa-

tients with eye disease becausethe exam and explanationstake so long, and the compen-sation is comparatively low.”

But having determined tofollow the principles of med-ical billing, “I’m getting paidalmost twice as much for thepatient who has ocular dis-ease now than I was just fivemonths ago,” he says. About

one-third of his patients in Novemberand December fell into this medicalbilling category. The results have been

Bob Mulgrew, O.D., Tucson, AZ,has experienced what every con-tact lens wearer who lives near

this desert town does: dry eye symp-toms. Recently, he tried OPTI-FREE®

RepleniSH™ Multi-Purpose DisinfectingSolution (MPDS) and says that within aweek, his lenses started to feel morecomfortable. “I’m originally a NewYorker, so I’m a born skeptic. But myeyes feel less dry now.”

He has since heard similar com-ments from his patients to whom heis recommending the new solution.

“Numerous patientshave told us it isbetter. They saythat they couldn’twear their lensescomfortably for aday and now theyhave all-day com-fort. I’m impressedso far,” he says.

Dr. Mulgrew says that while con-tact lens solution chemistry is not anissue most patients think about, hedoes explain that there is new science

behind this product. He tellsthem, “There are always new prod-ucts coming out, but I’ve tried thisfor myself and it is specifically de-signed for the silicone hydrogellenses that you have. Previous so-lutions may have been created be-fore silicone hydrogel lenses wereavailable.”

Recommending the right care

“This is the most excited I’vebeen about optometry sinceI started the prac-

tice from scratch 10 years ago,”says Robert Duvall, O.D.,Bowling Green, KY. Dr. Duvallattended the medical billingand coding seminar at theALLDocs annual meeting inMiami in October, and it haschanged the way he practices.

“For too long, I had beencharging everyone about thesame fees—whether it was the 12-year-old myope or the older patient withcataracts, macular degeneration and

ANNUALMEETINGNovember 5-9 inMexico

Medical Billing Makes Practice Exciting AgainAnnual meeting session encourages O.D. to revisit medical billing

Contact Lens Comfort in the Desert?

Dr. Duvall

Dr. Mulgrew

First Stepsto Success

Dr. Robert Duvall recom-mends these steps for

starting with medical billing.Because he was already onthe panels for medicalproviders in the area, he hadthe first step under his belt.

◆ Join every medical insur-ance plan in your area.

◆Get a copy of every patient’smedical insurance card, even ifyou’re not a provider. Keeptrack of what plans patientsare on as it will help you deter-mine which plans to join first.

◆ Create an easy superbillfor circling CPT codes and ICD-9 codes. “Using this takessome practice, but it’s wellworth it,” he says, explainingthat his superbill has under-gone some revisions.

◆ Use the “S” codes for rou-tine well patient exams and use“92000” codes for patients pre-senting with medical complaintsor history of eye disease.

◆ Have a summary sheetfor all glaucoma patients, withwhich you can easily assesswhich tests you’ve performedand how long it’s been sincethe last visual field, opticnerve photos or gonioscopy. ■

Continued on page 3

Continued on page 2

ALLDocsALLDocsThe

Newsletter

If you thought last October’s ALLDocsannual meeting was exciting, wait

until you hear about the one comingup. The feedback on the medicalbilling and coding seminars was verystrong, so we’ll be providing even more of those.

At this year’s meeting, right on the beautifulbeach of Playa del Carmen, Mexico, practitionerscan attend a medical billing seminar, focusing on thespecifics of procedures, diagnoses and codes. It will

be a true how-to session, including not only when to do it, but how todo it and how to make it flow within the office.

ALLDocs is emphasizing medical billing and coding because we be-lieve that is where a big opportunity lies for optometry. The financialopportunity is attractive, but even more importantly, our role as pri-mary eye care providers depends on our being able and willing to di-agnose and treat eye conditions to the full extent of our certifications.

In this issue, Dr. Robert Duvall explains how he came awayfrom the October meeting convinced that he needed to take the nextstep in medical billing. His results have been tremendous—but notatypical. Success is within our reach.

I encourage leaseholding LensCrafters O.D.s to initiate appropri-ate medical billing if they’re not already doing so. It will buoy ourcollective professional reputation, build goodwill to LensCrafters be-cause its customers are receiving one-stop full-service, quality care,and help our bottom line. ■

Kerry Gelb, O.D.drkmg@comcast.net

Dr. Gelb

2

Alcon’s new drug NEVANAC™

(nepafenac 0.1% ophthalmicsuspension) has been ap-

proved for the treatment ofpain and inflammation associ-ated with cataract surgery.1

Two recent studies demon-strated that NEVANAC™ sus-pension dosed three times perday, in the absence of steroidtherapy, was effective in controllingpain and post-operative inflammationassociated with cataract surgery.2,3 Morethan 80 percent of patients treated with

NEVANAC™ suspension were pain-free onday one, compared to only 40 to50 percent in the placebo group.3

By day 14, approximately 95 per-cent of patients were pain-freewhen treated with the drug,compared to 45 to 60 percent ofpatients in the placebo group.3

Results for inflammationcontrol were similarly positive,

as greater than 85 percent of patientstreated with NEVANAC™ suspensionhad no clinically significant inflamma-tion at day 14, compared to approxi-

mately 49 percent of patients in theplacebo group.3 ■

1. NEVANAC™ Suspension package insert.2. Data on file, Alcon Laboratories, Inc. 2005.3. Lane SS, Modi SS, Holland EJ, et al.

Nepafenac ophthalmic suspension 0.1% beforeand after surgery for postoperative anterior seg-ment inflammation. Paper presented at: AmericanSociety of Cataract and Refractive Surgery, April 19,2005; Washington, D.C.

FROM THE PRESIDENT’S DESK

Alcon Introduces New Drug for Post-Surgical Pain and Inflammation

Clinical studies demonstrate effectiveness of NEVANAC™ suspension

Building on Our Strength A L LD O C S

ASSOCIATION OFLEASEHOLDINGLENSCRAFTERSDOCTORS

solution is essential for practice success.“We’re fitting the best products, but ifpatients are not comfortable or their eyesfeel dry, the rest is for naught. I believeO.D.s should take control of the entirecontact lens experience: what lensespatients wear,how long theyshould wearthem and whattheir care solu-tions shouldbe,” Dr. Mul-grew says.

Jeff Lewis,O.D., anotherleaseholder inTucson, says he’s enthusiastic about thenew solution. “At a recent conference Iattended, I heard about how the care so-lution reconditions the lens surface so itstill remains wettable at 14 hours. Com-pared to other solutions that keep lenseswettable for six or eight hours, that’s verybeneficial,” he says. ■

*trademarks are properties of their respective owners

Comfort in DesertContinued from page 1

3ALLDocsALLDocsThe

Newsletter

unhurried care to these patients. Med-ical patients require more time, andnow his scheduling allows for that. In-terestingly, this coding method has notreduced the number of patients in Dr.Duvall’s office. His office actually per-formed 90 more comprehensive eye ex-aminations during this two-month pe-riod than it did the previous year.

The new attitude has also resulted ina boost to the bottom line. “I had a totalincrease in exam revenues of 41 percentover November and December of 2004,”

and a 31 percent increase in total netfees during that time frame, he says.

The ALLDocs meeting couldn’t havecome at a better time, says Dr. Duvall. “Iwent into that meeting last October alittle depressed. For the first time in 10years, my practice was trending towarda net decrease for the year.” The meet-ing showed him that he was leaving asubstantial amount of money on thetable with every medical patient.

To help get the staff fully onboard, Dr. Duvall developed a specialincentive for staff. The goal: surpass2004 revenue. He explained how bigthe gap was between 2005 revenue-to-

date and 2004 revenue. Then he toldthe staff that if they exceeded 2004revenue, they could split 10 percent ofthat gap. “I didn’t care if we went overby $1; I didn’t want to have a yearwhere we fell behind,” he says. As itturns out, the practice met that goal at2 p.m. on December 31. Consideringthat he went to the ALLDocs meetingsix percent down, that was quite a gapto make up. “The bonus added up tomore than $2,000, and it was wellworth it. The staff was energized andenthusiastic, which is very importantwhen you’re introducing a new idea,”he says. ■

By John Rumpakis, O.D., M.B.A.

Contact lenses are a big part of a practice, yet it is of-ten one of the areas where practitioners tend to give

away their services. Contact lens technology has under-gone significant advances with the advent of the siliconehydrogel materials. For all the good they do, however,these lenses also tend to be more finicky to carefor because of their unique chemistry and design.

Let’s focus on this interaction between lenstechnology and care systems. Some multipurposesolutions cause an interaction, through biocide re-lease, with ocular tissue, making the balance be-tween anti-microbial efficacy and clinical safetydifficult to achieve. Clinical concerns such ascorneal staining, tarsal plate hypertrophy andedema, limbal hyperemia and discomfort can attimes be related to the adverse effects some chemicalsexert on these tissues. Clinical literature cites numerousreferences to the effects of some biguanide solutions oncorneal staining. If you are not staining your soft lenspatients on a regular basis, however, you might be al-lowing solution-induced corneal staining to go bylargely unnoticed. Nevertheless, solution-related stain-ing can damage the ocular surface, which may triggerinflammation even though you and the patient fre-quently remain unaware. Resolving these issues maybe as simple as examining your patient more closelyand prescribing the right contact lens solution.

That brings us back to the point about giving awayservices for free. Today’s new technology lenses requirepractitioners to prescribe a system of lenses and solutions

IMPLEMENTING THE MEDICAL MODEL

Are You Giving Away Some of Your Contact Lens Services? together for optimal performance, comfort and health.With the interaction and potential reactivity of specificsolution and lens combinations, corneal staining and lidreactions can be common. When presented with the in-creasingly common interaction and potential reactivityof specific lens and solution combinations, you must re-alize that these are medical eye conditions that must be

addressed, treated and resolved. It is not part of the “contact lens follow-

up” visit category, where you provide themedical eye care in a predetermined “pack-age” price. Instead, it would be billable to themedical carrier with the appropriate medicaldiagnosis. The CPT codes most likely to be in-volved here would be the 992XX codes, de-pending on whether or not the patient is newto the practice or established, and the particu-

lar level of care. The new patient billing code wouldmost likely be a 99202, and for an established patient,the code 99213 most likely would be used.

Remember to make sure that your medicalrecord is thorough and establishes medical necessity,and that you are following the guidelines of the levelof case history, examination performed and medicaldecision-making performed. When you approach themedical management of each patient appropriately,by recognizing the medical nature of the solution/sili-cone hydrogel reactivity, then you and the patient canhave a positive outcome. Prescribe an appropriatecombination system of solution and lenses, and billthe medical carrier for the resolution of the presentingcorneal and lid reactions. ■

Dr. Rumpakis

Medical BillingContinued from page 1

Supported by an unrestricted educational grant from Alcon Laboratories

4 ALLDocsALLDocsThe

Newsletter

By Bob Scott, Senior Director of National Accounts

What patients want most of all out of their contactlenses is comfort. Recent CooperVision eye care

practitioner research confirmed that comfort ranked as themost important criteria for successful daily wear. Perhaps itis this reason that an estimated 90percent of silicone hydrogel lenswearers are removing their lenses on a nightly basis.

This is a key reason why CooperVision has beenexpanding its PC Hydrogel™ family of lenses. That nowincludes Versaflex® XC, available now from yourCooperVision sales representative. Versaflex XC deliv-ers extended comfort by utilizing CooperVision patent-

ed PC Technology tocreate a unique, bio-compatible lens materi-al that attracts waterand remains hydratedlonger, keeping the

lenses moist and comfortable throughout the day. Be-cause the Versaflex XC material is compatible with hu-man cell membranes, the body does not attempt to re-ject the lens and coat it with lipids and proteins. PCbinds water molecules, creating a shield of water,which allows the lens to stay clean and moist all day.

The PC Hydrogel omafilcon A material is the onlylens material with an FDA-cleared labeling indication,“may provide improved comfort for contact lens wearerswho experience mild discomfort or symptoms relating to

dryness during lens wear.” VersaflexXC also delivers on comfort and fitwith a lower modulus versus existingsilicone hydrogel lenses.

Survey respondents agreed thatthe technology behind PC Hydrogel

lenses oftenprovides bet-

ter comfort than today’s silicone hydrogel lenses. Re-sults also indicated that the patient satisfaction ratewith PC Hydrogel sphere lenses is higher than with ex-isting silicone hydrogel lenses, indicating that VersaflexXC lenses can offer better comfort and fit than the two-week silicone hydrogel lenses that are currently avail-able for daily wear.

“Sixty percent of patients have to remove their cur-rent lenses before the end of the day because of dis-comfort,” says CooperVision Single Vision MarketingManager Howard Higgins. “CooperVision is committedto Versaflex XC and the PC Hydrogel family of productsbecause we believe that eye care practitioners should beable to offer their two-week replacement/daily wearpatients a more comfortable contact lens-wearing experi-ence. Versaflex XC lenses feature proven biocompatibletechnology in a lens material shown to be preferredby practitioners over leading silicone hydrogels.”

Contact your CooperVision sales rep at1.800.538.7850 for complete information on howthis new lens will improve your profitability, patientsatisfaction and patient retention. ■

Breakthrough Comfort in a Contact Lens Is Here

GUEST COLUMN FROM COOPERVISION

Bob Scott

Make Plans for Mexico

The ALLDocs annual meetingwill be held Sunday, Novem-ber 5, to Thursday, Novem-

ber 9, in Playa del Carmen, Mexi-co. The ALLDocs board has madearrangements at the fabulous Roy-al Porto Real,an all-inclu-sive luxury re-sort easily ac-cessible fromthe Cancunairport.

Markyour calen-dars now. ■