Opening Lines

FSOA webinars address COVID-19

By Jim Thomas, Editorial Director ​

To address the recent changes in federal regulations and practice challenges posed by the COVID-19 pandemic, the Florida Society of Ophthalmic Administrators (FSOA) recently presented a series of webinars that addressed key issues, including the Payroll Protection Program (PPP) of the CARES Act, CMS rule modifications and accelerated payments, and relaxed telehealth regulations.

James D. Dawes, president of the J. Dawes Group, acted as facilitator for the webinars, which included presentations on:

The Cares Act

The PPP was “the most salient feature of the Act,” says Hugo S. “Brad” deBeaubien, attorney with the law firm Shumaker, Loop & Kendrick, LLP. He noted that although the program’s money is available as a loan, “most, if not all of it will be forgiven for businesses with fewer than 500 employees.”

Mr. deBeaubien explained that the funds must be used for specific basic operational expenses such as payroll, rent or utilities. The loans will cover an 8-week period and are based on 2.5 times the business’ average monthly payroll.

Mr. deBeaubien said practices can also apply for 7(b) Economic Injury Disaster Loans under the CARES Act, but the two loans cannot be used for the same purpose. Shumaker, Loop & Kendrick offers a CARES Act resource page at .

Accelerated and advance CMS payment options

Jessica Smith West, attorney with Shumaker, Loop & Kendrick, LLP, explained that the advance payments will need to be repaid, “and repayment will begin 120 days after the payment has been issued.”

Providers will be able to request up to 100% of the Medicare payment amount for a 3-month period, said Ms. West. Once reviewed by the Medicare Administrative Contractor, the payments should come through within 7 days.

”Understand that you can keep billing as normal through the 120 days and beyond, but then once you hit the 120-day mark after the money goes into your account, it will be offset against future payments received,” Ms. West says.

Under the program, providers are not going to have administrative appeal rights related to the payments, except under certain circumstances. A CMS fact sheet on the program can be found at ).

Telehealth updates

The FSOA series included presentations by John Rumpakis, OD, MBA, and Ranya Habash, MD, medical director of technology innovation at Bascom Palmer Eye Institute. Dr. Habash said that due to strict regulations, telehealth “never had a chance to demonstrate its true value.”

“All of that has changed,” she says. “With the new relaxing of the regulations there are less requirements in general for documentation, location of service, and diagnosis codes used, and payments are now on par with what other insurers would pay.”

One example: Medicare beneficiaries can now receive telemedicine visits from their homes. “One of the things we are doing at Bascom Palmer is going through our schedules and trying to figure out which patients would benefit from telemedicine,” says Dr. Habash.

“We are triaging that way first,” she notes. “We have a lot of patients who are high-risk, and we don’t want to bring them into the facility unless they really need to be there.”

Dr. Habash presents a further discussion of telehealth on YouTube (see ).

Dr. Rumpakis, a coding expert and founder of Practice Resource Management, Inc. ( ), presented a telehealth webinar. Under the new relaxed regulations, Dr. Rumpakis noted that Evaluation and Management (E/M) codes (99201-99215) continue to be appropriate for telemedicine visits for established or new patients, but other changes have occurred, including:

  • Virtual check-ins (code G2012), previously for established patients only, can now be provided to new or established patients and are now covered by Medicare. The G2012 code is the only encounter that can be initiated by the physician. All other encounter types must be initiated by the patient.
  • Both online digital evaluations (99421-99423), and video or image evaluation (G2010), can be provided to new or established patients and are covered. Previously, both services were for established patients only.
  • CMS now allows for telephone services (99441-99443) for physicians, nurse practitioners, and physician assistants for use with established or new patients. Previously, telephone services were not covered.

Also, Dr. Rumpakis noted the change in place of service (POS) designator: POS code 11 should be used in place of POS code 02, and the modifier 95 should be used in place of the modifier GT. Another big change during this PHE is that these synchronous communications can take place using conventional technology such as Skype, and the Office of Inspector General has effectively eliminated the audit risk associated with waiving co-pays and deductibles for these encounters. Because information can change daily, Dr. Rumpakis recommends providers check in regularly with resources such as the AAO and CMS websites, as well as local carriers.

The webinars were developed and organized by three industry professionals active in the FSOA: Mr. Dawes; Jane Shuman, president of Eyetechs and regular contributor to FSOA (and co-editor of OP); and Lauren Levine, regional business manager of ScienceBased Health. (Ms. Levine has been active in sponsoring FSOA meetings and helping with the group’s organization.)

For more information on the FSOA, contact Ms. Levine at or 813-784-2523. OP

In Brief

Icare completed its merger with CenterVue. The merged companies will operate under the name Icare USA. The merger occurred after the acquisition of CenterVue by Icare USA parent company Revenio.

Heidelberg Engineering relaunched its HRT3 Rostock Cornea Module (RCM), which uses confocal scanning laser microscopy to provide images of the cornea, conjunctiva or limbus at the cellular level. The relaunched HRT3 RCM features a new headrest for corneal assessment and integrates the HEYEX 2 image management software environment.

ImprimisRx announced an exclusive agreement with telemedicine service provider to offer all of ImprimisRx’s ophthalmology, optometry, and wellness practices with the “Clinic” level telemedicine solution at no charge.

Reichert Technologies signed an exclusive deal with CATS Tonometer, LLC to distribute the CATS Reusable Tonometer Prism in the United States. The device features a dual-curved surface designed to help nullify IOP measurement errors caused by corneal biomechanics and corneal thickness.

The StimulEYE Breath + Germ Shield can be secured to a slit lamp or laser to protect patients and ophthalmic staff from contact during operation to help stop the spread of COVID-19. Purchase the shield at .

Positivity during the pandemic

By Meghan Kriner, COA

What if I could find the silver lining in all this? I can’t change what’s going on around me, but I can change how I am reacting to it. So, there must be a way to find some positivity and make the most out of this time.

Personally, I have found that I needed to separate my roles as a clinical director with work responsibilities from those as a single mom taking care of and homeschooling a young boy. I started by setting up an office area for myself and a “school zone” for my son.

Here’s what else I’ve found helpful.

  • Create a routine. Waking up with a purpose and getting ready for the day (minus the make-up) makes me feel like I am off to a good start. Scheduling time for home schooling and balancing play time has been important. I think my son could play video games all day!
  • Learn something new. I have always tried to stay up-to-date with coding and documentation standards, but telehealth presented a whole new world for me. Many practices are implementing this approach to keep staff safe while helping patients and tapping into a revenue source. Webinars and articles have gotten me through the learning curve.
  • Pursue certification or continuing education. Certification is an investment in yourself, and it shows dedication to continuing education. I realized it was time for me to re-certify, but with everything upside down, it almost passed me! If certification isn’t your thing, then focus on learning something new. Many practices offer access to programs that offer CE credits. IJCAHPO has study materials available. ATPO just published a COA Review Course, and BSM has created an annual subscription for individuals. Additionally, many of the onsite one-day CE programs are being converted to virtual and on demand format. I had a hard time traveling before this pandemic, so having the opportunity to join one of these meetings virtually is amazing!
  • Take time for bigger projects. As a manager, I have time to invest in big-picture projects that always seem to get put on the back burner. Updating standard operating procedures, polishing our training program and materials, performing audits on documentation and coding, to name a few. We recently switched to a new EHR (which I blame for a few of my gray hairs that are rapidly becoming apparent while my hairdresser is off limits). So, I am planning to fine-tune our templates and content.
  • Find a healthy habit. Try yoga with your partner, or head out for a walk every day. Our favorite is riding bikes around the neighborhood. My son loves putting on his gloves, getting into the dirt, and learning about nature. Thankfully, spring has sprung in Tennessee.

Relish the pause

Having time to focus on family and quality time has had a huge impact on me. I used to get caught up in the Monday through Friday routines—rushing home, rushing dinner, rushing bedtime. I am thankful to have the opportunity to slow down and focus more on the little things. Maybe for you it’s time to focus on faith or investing time in yourself. Finding the things that fulfill us mind, body, and soul will be what keeps us positive during these times. OP