Eyeworld

July 2016 • Ophthalmology Business 9 Remember that checking the list is the responsibility of the practice, not the employee. "Don't think that you're OK if you ask every employee to certify that they are not on the list," Ms. Shuren said. Documentation errors Documentation errors can raise some interesting compliance and liabili- ty issues, according to Ms. Shuren. Looking at a recent survey of paid claims, the Ophthalmic Mutual Insurance Company (OMIC) found in many cases that documentation could have made the difference be- tween something considered to be a maloccurrence versus malpractice, for which a physician has liability and can be found negligent, she said. Failure to document elements of an exam and telephone care are 2 classic examples where physicians can make documentation errors. Ms. Shuren described 1 case where a physician received an after-hours call from a patient post-LASIK who complained of red, irritated eyes, and was told to use drops for dryness. The patient called again, several days lat- er, complaining of worsening symp- toms, and was given the same advice, but it was reported that the medical record did not contain any mention of the calls. The patient ultimately developed an infection and a corneal ulcer and sued the physician for neg- ligence. Without documentation, it is very difficult to defend against such claims. Complicated or uncompli- cated, there has to be a record in the chart, Ms. Shuren said, to protect you from liability and any other issues. "Telephone care is an extend- ed part of your care," she said. "If you are taking calls and speaking to patients and providing advice, there should be documentation in the chart that the interaction happened with the patient and what the pa- tient was advised." OB Contact information Reider: alan.reider@aporter.com Shuren: allison.shuren@aporter.com an opportunity to invest after a cer- tain period of time, he said. Dealing with the OIG exclusion list Ophthalmology practices must be vigilant about ensuring their employ- ees are not on the OIG exclusion list for health care workers, according to Ms. Shuren. Every time a practice has a new hire, a new contractor, or a new vendor, checking the list should be first thing you do, she said. In addition, continue to check the list at least once a year; this includes checking everyone in your practice or ASC and all major vendors. "Checking the list is not a 1-time obligation," Ms. Shuren said. Some states even require practices to check the list monthly. In these cases, it is easiest and fastest to have the same person check each time, but there are also automated programs that can do it for you, she said. If you do find an employee is on the list, ignoring it is not an option, Ms. Shuren said. Voluntarily report- ing it should be the first thing you do. "The penalties are far greater if the OIG finds out from someone else," she said. If an employee does show up on the exclusion list, voluntarily report it and immediately prohibit that per- son from providing care to federally insured patients while you work with the OIG to sort out the problem and determine a settlement. Reider said. "Make it clear that the purpose is the provision of educa- tion." In addition, never accept any sponsorship from industry for these events; there's no way to justify it, Mr. Reider said. He suggests reaching out to local OD societies and hav- ing the society do the sponsoring to avoid any potential problems. Other OD relationship issues When leasing space, equipment, or staff from an OD, make sure you have a written lease describing all you are leasing, and make it for at least a period of a year, Mr. Reider said. Also make sure you pay a fixed amount that is fair market value. Despite concerns over compli- ance, some ASCs have ODs as equity partners. To reduce compliance risk, the key is to follow as many of the requirements for ASC safe harbor as possible, according to Mr. Reider. You can further reduce the risk of noncompliance by showing that the OD and ASC physicians have a long-standing referral relationship prior to any investment in the ASC, he said. Physicians will almost certainly increase their risk of noncompliance by offering ODs an opportunity to invest in an ASC in order to change their referral patters, Mr. Reider con- tinued. The risk will be even greater if ODs are told to change their referral patterns and that they will be offered " Make it clear that the purpose of this is not to provide a nice dinner in a nice place for your ODs. Make it clear that the purpose is the provision of education. " Alan Reider, JD, MPH

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