Published in Non-Clinical

Practicing Remote Optometry: Opportunities for Telemedicine in Your Practice

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9 min read

Keeping your practice open during the coronavirus pandemic could mean changing the way you practice optometry—if only for the time being. Here's how to add telemedicine to your practice, plus extra tips on what to do when you're not keeping routine appointments!

Practicing Remote Optometry: Opportunities for Telemedicine in Your Practice
During this unprecedented time of the COVID-19 pandemic, socially distancing ourselves can help prevent the spread of disease. As optometrists, we should be encouraging our patients to stay home; however, we want them to receive eye care when they truly have an eye problem. And who better to answer their questions than you, their eye doctor? The AOA, Centers for Disease Control (CDC), Department of Health and Human Services (DHHS) and Medicare have made several changes recently that allow you as an optometrist to use telemedicine to examine and treat your patients, thus limiting face to face contact and the spread of germs.
Given that conjunctivitis can be one of the presenting symptoms in some cases of this novel coronavirus, we need to be uniquely situated to care for our patients with red eyes and the potential for contagious disease. As optometrists, we should be taking the CDC and AOA’s recommendations to limit care to urgent and emergent visits only. This means that staff should be calling all patients to ask the nature of their visit. You should also confirm by phone that anyone coming into your office has not recently been sick, had a fever, been diagnosed with COVID-19 or had contact with anyone who exhibits the above. All non-urgent/emergent visits should be rescheduled for a later time. If the visit is urgent/emergent, to limit the spread of germs in your office, please ask patients to limit those who enter the office to caregivers only. Additionally, patients may be asked to wait in their car if they may be contagious and only brought into the office when the office is available to examine the patient. The patient should call or text the office when they arrive and notify them when they can enter.
Some patients may even be able to be examined using a telemedicine format, meaning using video software to speak with and examine the patient in real time. View telemedicine as adjunct to your in-office practice, a way to grow your services and reach people in a different way, especially during this challenging time. Telemedicine should ideally be used for established patients; however, a new patient with conjunctivitis for example may be best served with telemedicine—at least initially.
Helping with this venture, the Department of Health and Human Services recently made changes to the Medicare requirements for telehealth services beginning March 6, 2020 that will remain in effect until the state of emergency from the coronavirus has passed. That being said, who knows how this can change the way health care and telehealth services are delivered in the future? For more information on how this impacts optometrists, check out the AOA’s Position Statement on Telehealth.
The effective implementation of telehealth carries numerous benefits for eye care practitioners. Optometry and ophthalmology offices are able to now provide care for their patients without potentially risking the spread of infection to staff or other patients they may come in contact with. The recent changes with telehealth expansion may permanently alter the way eye care practitioners triage and manage certain eye problems such as walk-in red eyes.

Check with private insurance plans regarding coverage for current telehealth billable services in eye care.

What COVID-19 means for optometry and telehealth billing

  1. AOA has ensured optometrists are fully recognized as “qualified physicians”
  2. HIPAA compliant software is currently NOT required, meaning telemedicine visits can presently take place using “everyday communications technologies” such as Skype or FaceTime
  3. Reimbursement is the same as if the visit took place face to face
    1. Use modifier “02” prior to your exam code to indicate telehealth
    2. Must code for level of exam you provided, with sufficient exam and case history elements addressed
  4. Telehealth services can now be provided outside of previously designated locations, meaning that the patient’s home is now an acceptable site
  5. Can only bill 99XXX medical office visit codes, not 92XXX “eye” codes
  6. If patients are paying out of pocket, charge your usual and customary fee for the code you are billing. HHS is providing flexibility to providers to waive or reduce cost sharing for telehealth visits paid for by federal healthcare programs (eg. Medicare deductibles)
Many optometrists might think “online refractions” when they hear tele-optometry, but this is not what we’re talking about. Telemedicine for optometry can be a long-term adjunct to your in-office clinical care. Think of a dry eye patient you start on treatment with whom you may want to follow up within a few weeks. You can see them virtually for this check-in, to free up in-office time for other patients. This is even more beneficial if you live in a rural area where patients often travel quite far for a visit. You may have better success with follow-ups if you are more regularly checking in with patients. They’ll also feel their drive to your office is worthwhile for testing they know you cannot do remotely.
For these reasons, more optometry practices are expanding their telehealth offerings in response to the coronavirus pandemic.

New options for optometrists in telemedicine

It may be most convenient in the short term to use communication services you and your patients are already connected with (eg. FaceTime, Skype or Zoom). However, there are a few tele-optometry platforms available that are HIPAA compliant and offers more eye care specific capabilities.

Popular telemedicine platforms for eyecare:

Eyecarelive is a tele-optometry cloud-based portal that can be used on computers and phones alike, where patients can be examined over video call, can send and receive HIPAA compliant messages with their provider, and can conduct certain tests such as visual acuity. (Remember, you still need to satisfy your regular exam elements when providing a telemedicine exam.) Patients can send you a message with a picture of their eye if they are unsure what might be going on. After viewing the image, you can message the patient back if you would like to videochat with them to learn more about their complaint.
GetSetCare from EyeCarePro just launched on April 6, but is free to use during the COVID-19 pandemic for all eyecare practitioners. The program is HIPAA compliant, and enables video appointments with patients. It's also compatible with iOS, Android, and desktop computers.

Advertise to your patients that you are offering these services by sending an email to your existing patients. Additionally, if you are out of the office, have a voice message set that lets patients know they can connect with you in this new way and the best way for them to schedule in this format.

What optometry offices can do remotely

While we’re trying to keep patients safe and healthy, we are also trying to do the same for our staff. We also want to keep our staff employed as much as possible during this uncertain time. The AOA has been working to have small businesses be reimbursed for employee sick time as well as take out loans for payroll. Here are a few key ways to keep your staff productive without seeing patients.
  1. Call all scheduled patients to triage the reason for visit, if urgent/emergent keep appointment, otherwise reschedule.
  2. Call all patients who purchased contact lenses from you last year between January and May. Offer to renew their Rx for 3 months and purchase 6 months of contacts in the meantime. Ship contacts to patients directly.
  3. Call all patients with glasses or contacts waiting to be picked up from your office. Offer patients to pay a balance over the phone and ship products to the patients. If you live in a small community, offer a staff member to deliver glasses to patients’ mailboxes.
  4. Call local primary care, urgent care, and emergency departments to let them know your office is available for urgent eye care.
  5. Work on 2020 social media and marketing plans.
  6. Follow up on patient accounts receivable and as well as unpaid insurance claims, resubmit claims if necessary.
If none of these options are possible for your practice, you might consider initiating a temporary lay-off of your team to allow them to apply for unemployment compensation.
While we all work through these uncertain times, we are a patient-centered profession. Even when we cannot be face to face with our patients, we can find ways to serve their eye and vision care needs. This pandemic may change the way we view red eyes in the future and may even change aspects of how we practice optometry. Now may be the time to take the step into telemedicine for adjunct optometric services that can benefit your patients in the long term.

Do you use a telemedicine platform in your office? Give us your recommendations in the comments!

CovalentCareers is committed to supporting optometrists and optometry students during the Coronavirus pandemic. For more optometry-specific resources and information, visit our Optometry COVID-19 Resource Center.

Kevin Cornwell, OD
About Kevin Cornwell, OD

Dr. Kevin Cornwell graduated from The New England College of Optometry in 2015. He went on to complete a residency in ocular and systemic disease with Indian Health Services in Zuni, New Mexico. He now works with MACT Health Board, Inc in Northern California, a nonprofit organization that provides healthcare for Native Americans. He is enthusiastic about bringing eye care to populations in need, both domestically and abroad. He has been involved with several humanitarian outreach projects, in various parts of California, New Mexico, Nicaragua and Mexico. He is passionate about managing the ocular manifestations of systemic disease, and monitoring ocular pathology through retinal imaging with spectral domain optical coherence tomography. He’s also an avid health crusader and enjoys educating and encouraging patients to better manage metabolic disease. Dr. Cornwell enjoys hiking in the Sierras and recording music as a guitarist for Cornwell Studios' youtube channel.

Kevin Cornwell, OD
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