This transcript has been edited for clarity.

Hey, this is Christine Funke, MD, here at the Business of Interventional Glaucoma meeting, or the BIG meeting, which is the second year we’ve done this now. This is a really unique component of ASCRS in that we're actually talking a lot more about the business side of medicine and more specifically about glaucoma and interventional glaucoma, because as we've evolved to be more procedurally oriented with glaucoma, we also have to evolve in how we are dealing with business. Most importantly, I think, for a lot of us, is billing. I got to be lucky enough to speak about that today.

I think there's a couple of key takeaways as an ophthalmologist about billing and how I've tried to smooth the path of reimbursement for the rest of the team around me as they start to look at individual patients to see what kind of care they may be offered and what may not be available.

First, I really like to be very specific in my note. And by that, I mean that when I'm looking at a patient and deciding on what interventional care that may be best to offer to them, I think one of the best things to do is write very specifically your first choice. So, for example, if I'm going in and doing cataract surgery, I want to also do a stenting procedure and I want to use a drug-eluting device. When I'm doing both at the same time, I'm not 100% sure what's going to get reimbursed. So I put that as the first thing on my note: with cataract surgery, I would like this MIGS and this procedural pharmaceutical done together as my first option. I'll then put a second option. And why I like to do that is, because if for any reason one is not covered, then my team already knows what my next best option is. That's going to avoid phone calls or emails and back-and-forth questions. Instead, they can look and say, okay, if option one is not available for this specific patient, then there's option two. And that option two would be just doing a stent with the cataract surgery. And then option three being, if there's no MIGS available—which hopefully that is never the case—then we would be doing just the cataract surgery in and of itself. But I think having something very specific so that we can limit some of the redundant communication is really helpful, because we have limited time, our staff has limited time, and so that will help our reimbursement team know the next steps without having to come and talk to us again as providers.

The other thing that's very nice is making sure that all of the codes are correct. So what we've made is actually a cheat sheet in our office that has all of the most common codes that we use in conjunction with any of these procedures, as well as the ICD-10 codes that they may be using. And those can then get circled by my scribes or myself as that is getting placed to the front staff, and that front desk staff will then get that to the billing team. So then there's a really nice line of communication, so that that doesn't get lost or any incorrect coding does not get done. And that has really helped us avoid any kickback happening especially from authorization, and it has really streamlined and smoothed a lot of the time course between when a patient sees me and when they are available to get surgery done.

Finally, I think just, again, communication generally is going to be key with billing and understanding personally what is available to patients based on what's around you in, say the major payers that you have and payers that you're dealing with. Because for all of us, there's going to be a certain set of payers that you know are going to be often coming up. So kind of getting to know those as a Rolodex in your head. More importantly, I will actually have physical sheets made that are available on my desktop when I am working throughout the day. And they're going to have little green patients, yellow patients, and red patients for each individual MIGS or drug deliverable. And that really helps me very quickly at a glance understand, okay, this is going to be covered because they are under a plan that is in a green category, or this is a patient who's in a red category, so no matter what, there's not going to be any reimbursement available for this procedure. I can't offer that. And then if they're in the yellow category, that's oftentimes somebody who needs to have certain qualifying events with other medications. If they then qualify, I can get them to get that procedure done.

That helps my billing team because I'm only offering to those patients who we already have qualified within that realm of if they can or can't get any of these procedures done, and that's helped streamline the backend process of the billing team, so that they're not doing superfluous prior authorizations that we already know unfortunately are just not going to get paid or reimbursed.

So hopefully some of these things help. I know that that's really helped me in terms of being more efficient, not only for my staff, but also for myself, and then also only offering things that are truly available to the patients that I'm seeing. GP