Compliance Plan for Ophthalmology / Optometry

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This Coding Compliance plan written specifically for eyecare is the result of well over forty hours of consulting time. Click here to review a DRAFT copy of the plan.

The Key to a Coding Compliance Plan is consistency. This Coding Compliance Plan for Ophthalmology/Optometry establishes standards for formats and auditing tools. 

It is recommended the practice performs between 3 to 30 audits per provider. Determine if audits are quarterly, bi-annual or annual. Be sure to document benchmarks, clearly define how to fix any problems and provide and document training for the Providers.

The final and most important component is a follow-up audit in 3, 6 or 12 months and compare and evaluate progress. Sometimes it is best to get an outside or third-party to conduct the coding audit.

It includes the seven (7) elements of an OIG compliance Plan:

  1. Conducting compliance & practice standards. 
  2. Implementing compliance and practice standards.
  3. Designating a compliance officer or contact.
  4. Conducting appropriate training and education
  5. Responding appropriately to detected offenses and developing corrective action.
  6. Developing open lines of communication.
  7. Enforcing disciplinary standards through well-publicized guidelines.

The Coding Compliance Plan for Ophthalmology/Optometry includes:

  1. Lists of ICD-9 codes that can cause problems (fifth digit accuracy and required second codes.
  2. Lists of specific CPT codes to audit.
  3. An Evaluation and Management Audit Form
  4. An Eye Exam (920xx) Audit Form.
  5. Specific eyecare audit elements