Growing Your Eyecare Practice with Co-Management Agreements

Are you looking to expand your practice? Looking to obtain new patients or maybe to increase your presence in surgeries? Co-Management is a fantastic way for Ophthalmologists to do this. The concept of co-management is where an Ophthalmologist and Optometrist partner up to create a full-circle care plan for a patient. 

Optometrists cannot address medical diagnoses like Cataracts; they need to refer the patient to another specialist. When optometrists partner with an Ophthalmologist they trust, they participate in co-management. A co-management agreement can be established between the two practitioners or offices outlining the expectation of referrals and post-operative care instructions. 

Whether you are new in the area or a highly recognized doctor, the key to a good co-management relationship is following the guidelines outlined in the agreement. There are many advantages to co-management relationships, but there are common pitfalls to avoid and allow these relationships to prosper. 

First, Optometrists may not receive their patients back for the outline aftercare. This is critical and ensures that they are receiving payment and retaining their patient going forward. 

Being proactive in communication with optometrists is very important. An area of struggle is when you have a non-compliant patient that does not return according to the plan. The best way to combat this is as follows: 

1. Keep a detailed record of the optometrist that referred the patient. 

2. Provide a list of key dates to the patient and where/when to follow up. 

3. Keep a record of telephone calls made to the patient and detailed instructions provided.

4. Send a monthly list to the optometrist so they can verify and confirm they have seen the patient. 

Open communication between practices to reduce the negative implications that can come with "sharing" a patient. Setting up this plan when you sign the agreement will avoid any pitfalls that could arise during care. 

As an ophthalmologist, it is not just your responsibility to maintain the relationship. Make sure the referring optometry practice understands the information you require when a patient is sent over. Set realistic expectations on scheduling, timing, and overall process within your practice. 

The best way to assure your co-management provider is happy—under-promise and over-deliver! Promising patients that they will be seen the same day in each instance is not realistic. Set more realistic expectations. How about promising patients will be seen within 2 weeks, setting aside specific time slots for these patients so that you and your team can prioritize and monitor the fluctuation?

Second, Ophthalmologists are responsible to ensure payment for after-care makes its way to the co-managing provider. The insurance company pays you according to the procedure and modifier applied to indicate your office is not providing all of the care. 

Because you receive the payment, maintaining workflows that ensure there is no delay in providing payment to the Optometrist is important. This starts from day one. When sending the claim to the payer, it must be documented on whom the co-managing provider is; when sending out the claim ensure that the correct modifier is present and that the adjustment is applied to create the credit to send the funds to the co-managing provider. 

To ensure you understand the laws and regulations around co-managing with another provider, always check the Medicare LCD's for your state. This will provide a clear outline of what is needed to maintain a high quality of care. When signing your agreement, make sure both teams are on the same page. Being Medicare compliant is extremely important and should not be overlooked by either provider. 

Before sending payment, you will want to confirm the patient has the following information provided: 

1. All aftercare appointments scheduled

2. Notes from the post-op visits were sent to you and in the chart

3. Final clear from the optometrists that the patient followed aftercare instructions for a successful outcome 

Payment should not be sent to the provider if these are not met. Send out notices monthly of what you need and keep the communication lines open. Always keep your co-management provider in the loop with their payment status. 

Once the postoperative period is over, neither office is required to maintain the relationship for that particular patient and they are free to see whichever provider they would like. 

Overall, a co-management relationship can be a benefit to your eyecare practice. Keeping the communication lines open, setting realistic expectations, and managing the payments quickly and appropriately will lead to a successful relationship. Always stay updated on Medicare rules and regulations around co-managing relationships.