Eyeworld

Name of Ad Page number 5 requests. In many cross-link- ing practices, a staff mem- ber also distills key informa- tion (e.g., all prior refractions, with dates) from the col- lected records onto a single form for the cornea special- ist to quickly review. Patients' spectacles can have their pre- scription measured if records can't be obtained, so encour- age patients to bring in their spectacles. ■ #03 BEST PRACTICE USE CLEAR AND CONCISE LANGUAGE Claims proces sing and review staff at an insurance company likely will not have ophthalmic experience and will not be able to interpret records in the same way that a cornea specialist, optom- etrist or even a technician would be able to. It is impor- tant to know what the pro- gression documentation requirements are for each payer; the cornea specialist's notes should state how the case meets those require- ments, detailing specific clin- ical requirements cited in the policy in the documentation submitted to the payer. See sidebar for examples of specific phrases that one practice frequently uses in documenting progression. the importance of treatment, and even consider using a "Refusal to Consent for Treat- ment" or "Missed Medical Appointment" form, available at https://www.drkatiespear. com/forms, for patients who don't schedule treatment, to reinforce the importance of follow-through. ■ #02 BEST PRACTICE OBTAIN PRIOR RECORDS TO DOCUMENT PROGRESSION To secure payer authoriza- tion for cross-linking, pro- viders must document pro- gression from prior records, typically including one of the following: An increase of ≥1.00 D in steepest keratometry Increase of ≥1.00 D of cylin- der in subjective or mani- fest refraction A myopic shift of ≥0.50 D of spherical equivalent refractive error (MRSE) However, these records may not need to come from the same provid- er or be obtained from the same diagnostic equip- ment, so the refer- ring doctor's exam findings, notes on visual complaints, and prescription history can serve as some of the data points in documentation. Providing referral sources with a form that includes a checklist of records and/or space to fill in specific details can facil- itate this process; however, keeping the ask simple is also important, so simply collect- ing all records often works best. Some practices even We usually are able to document progression using old refractions and almost always schedule for cross- linking (if indicated) at the first visit. — Derek DelMonte, MD I've never had a claim denied after a peer-to-peer meeting. —Kevin Tozer, MD Having a staff member gather and consolidate all this information has been a huge improvement. At the first visit, I already know whether progression can be documented—about 80% of the time it can—and consequently, fewer patients fall through the cracks. — Brandon Baartman, MD 5 provide a digital link where refer- ring doctors can upload imaging and notes. While sequen- tial Pentacam exams or topog- raphies may be desirable in the diagnosis and evaluation of KC, they are not necessarily a requirement for the doc- umentation of progression. Cornea specialists can con- sider using refraction his- tory, subjective complaints, autorefractions, spectacle prescriptions, inability to correct to 20/20, and driv- ing history as part of their documentation. An adult with keratoconic findings who has never worn glass- es before and now suddenly can't see 20/20, or who used to drive but just failed their vision test at the DMV, can be considered to have pro- gressed. A mismatch between objec- tive measures (including autorefraction) and subjec- tive measures (the manifest or spectacle refraction) can be considered ev id en ce of progres sion. In many prac- t i c e s , w h i l e tomo graphy confirms the diagnosis, his- torical manifest refractions are heavily relied upon to document progression and speed up time to treatment. It is ideal to obtain records from all known eye care pro- viders prior to the first KC consult. A staff member can be tasked with contacting previous eye care providers and following up on records Scan here for the refusal to consent for treatment form

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