Diagnostic testing is immensely important in ophthalmology for patient care and clinic operations — and it fills a large part of any clinic day. As technicians, understanding the critical role of diagnostic testing and how it impacts patient care, workflow, and compliance is essential for providing high-quality support to physicians and ensuring smooth clinic operations.

One common challenge in ophthalmic practice is the use of a one-size-fits-all approach to screening and testing. While seemingly comprehensive, this approach can cause inefficiencies in clinic flow from over-testing and increase the risk of compliance issues and billing errors, which can have negative financial implications for the practice.

To address these challenges, it is important to prioritize precision and efficacy in diagnostic testing. This means moving away from indiscriminate screening measures and toward a targeted approach that considers each patient’s unique needs.

By following these key aspects of diagnostic testing, we can optimize patient outcomes, streamline clinic operations, and increase practice regulatory compliance.

Appropriate ordering of tests

Effective diagnostic testing starts with the physician ordering each test appropriately. This establishes medical necessity and ensures testing activities are supported by documented clinical rationale.

It is important to understand that Medicare does not reimburse for screening or protocol orders for testing, even if pathology is found. Medicare bases coverage on the medical necessity documented before a test is performed, similar to visits and surgeries. As technicians, we play a crucial role in facilitating a compliant and efficient process by ensuring all necessary documentation is in place and tests are performed according to the physician's orders.

Physicians often place diagnostic test orders for established patients during the patient’s current visit, with the tests planned for the patient's next visit. For same-day or new-patient testing, the requirement is that the individual patient order is placed after the physician has examined the patient. Rarely, a complicated new patient’s past medical records and test results may be reviewed in advance of the first visit, and the physician may document their review and place orders for testing for their first visit. The order must reflect the medical necessity for the test that exists before the test is performed. For example, an order for a surgery-related test should not be made until the decision for surgery has been made.

Knowing the requirements for tests

It is also important for technicians to familiarize themselves with the specific requirements associated with different diagnostic tests. This includes understanding the documentation standards and reporting obligations for each test.

Most of our diagnostic test billing CPT codes in eye care include the requirement of interpretation and report. Additionally, payor guidance is found in various payer coverage manuals and articles, such as the Medicare Benefit Policy Manual and Medicare Local Coverage Articles and Determinations (LCAs and LCDs). By adhering to these standards, we can ensure compliance and facilitate effective communication among the care team (see Table for example).

Table. Examples of non-compliant versus compliant orders and interpretations.

Continuous improvement efforts

Technicians can contribute to optimized diagnostic testing processes by providing feedback on workflows and necessary equipment and technologies. This may involve providing input on test scheduling and equipment needs, performing equipment maintenance and calibration, or advising on servicing needs.

Technicians should become familiar with their practice’s EHR system’s built-in capabilities for test ordering and interpretation documentation. The goal should be to capture appropriate and patient-specific information for each order and interpretation. An example recommendation may include adding an EHR template field to ensure the medical reason for each test order is apparent in the final visit document.

These efforts to streamline the entire testing process will ultimately minimize related clinical and administrative burdens.

Staff training

Finally, scheduling periodic training with diagnostic testing manufacturer representatives ensures the practice is educated on any new features available through software updates. Many technicians learn by watching others, but periodic training refreshers can ensure the testing is performed to a uniform standard. By investing in professional development, we can continue to provide high-quality support to physicians and contribute to the practice’s overall success.

Conclusion

Diagnostic testing plays a critical role in ophthalmic practice, and as technicians, we play a vital role in ensuring its success. By prioritizing precision, efficiency, and compliance in our approach to diagnostic testing, we can help to optimize patient care and clinic operations. OP

Laurie K. Brown, MBA, COMT, COE, CPC, CPMA, CPSS, LSSYB, is a senior consultant with BSM Consulting in Tucson, AZ. She has experience in the ophthalmic industry holding managerial, clinical, and surgical roles for more than 35 years.