AE March/April 2018 Vol 27 No 2 - 43

As more attention has focused on this
disease, the diagnostic options available to
physicians have expanded significantly.
blood. Autologous means the
donor and the recipient are the
same person. Blood is drawn from
the patient; red blood cells and
clotting factors are removed using
a centrifuge, leaving behind blood
serum. The serum is diluted with
sterile, preservative-free, artificial
tears to produce a tear substitute
that is unique to the patient.
Doctors commonly prescribe a
20-25% concentration of serum
to tears, but sometimes use higher
concentrations. SEDs contain
growth factors and nutrients
normally found in healthy tears.
A typical blood draw will yield
enough SEDs to last 3 months;
however, they must be kept frozen
until used. The patient defrosts
one bottle at a time. Once all
the SEDs are used, the physician
repeats the blood draw to make a
new batch. Some plans, like Aetna,
have positive coverage of SEDs.
Other options include thermal
expression of meibomian glands
(LipiFlow) and scleral shells. In
most cases, 0207T (Evacuation of
Meibomian glands, automated, using
heat and intermittent pressure) does
not have coverage. In severe cases,
scleral shells may be used, and
Medicare has a national coverage
determination for scleral shells
(§80.5) that states
Scleral shells are occasionally used in combination
with artificial tears in
the treatment of 'dry eye'
of diverse etiology....the

half-life of artificial tears
may be greatly prolonged
by the use of the scleral
contact lens as a protective
barrier against the drying
action of the atmosphere.
Thus, the difficult and
sometimes hazardous
process of frequent installation of artificial tears
may be avoided. The lens
acts in this instance to
substitute, in part, for the
functioning of the diseased
lacrimal gland and would
be covered as a prosthetic
device in the rare case
when it is used in the
treatment of 'dry eye.' 2
TrueTear™, by Allergan, is a new
treatment that employs neurostimulation to improve tear production.
It is available by prescription only
and is currently not covered by
insurance.
Moisture chamber glasses are
used for these more severe patients
although there is generally no
insurance coverage.
With many of the above treatments, if coverage is vague and
uncertain, a financial waiver is
advisable. These can include an
Advanced Beneficiary Notice
(ABN) for a Medicare patient or a
Notice of Exclusion from Health
Benefits (NEHB) for a patient with
commercial insurance, to ensure
that you can be paid by the patient
if their insurance plan does not
reimburse you. AE

NOTES
1
Wolffsohn, James S. et al. (N.D.).
TFOS DEWS II Diagnostic Methodology report. The Ocular Surface
15(3) Pp. 539-74.
2
CGS. (2015, September 3).
PROSE® Device - Correct Coding. Joint DME MAC and PDAC
article retrieved from https://
www.cgsmedicare.com/jc/pubs/
news/2015/0915/cope30252.html
Kevin J. Corcoran, COE,
CPC, CPMA, FNAO
(800-399-6565;
kcorcoran@corcoranccg.
com), is president of
Corcoran Consulting
Group, San Bernardino,
Calif.
Sara B. Rapuano, MBA,
OCS, COE (srapuano@
gmail.com), is a practice
management consultant,
Philadelphia, Pa.

IN A BLINK
What should you keep in
mind about dry eye?
* It's common and growing
more so as the population
ages; a large number of
patients are affected.
* It's readily diagnosed but
cannot be cured.
* The severity of dry eye
varies a great deal.
* There are many treatment
options.
* Some, but not all, diagnostic and treatment
options are covered
by insurance.

www.asoa.org // AE

43


https://www.cgsmedicare.com/jc/pubs/news/2015/0915/cope30252.html https://www.cgsmedicare.com/jc/pubs/news/2015/0915/cope30252.html https://www.cgsmedicare.com/jc/pubs/news/2015/0915/cope30252.html http://www.asoa.org

Table of Contents for the Digital Edition of AE March/April 2018 Vol 27 No 2

How We Can Successfully Lead
Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
Business Operations: Some Things to Know About Professional Liability Insurance
Customer Care: Making a Diffi cult Journey A Little Easier
Fast Practice: Breaking Down Practice Cliques
Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
InfoTech: Cloud Computing— Storms or Blue Skies?
Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
Technicians: Creating a “Feeder Program” to Staff Your Clinic
Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
Taking Your Practice to the Top
Use Podcasts to Increase Practice Visibility—and Thrive
Trailblazing— How to Implement Career Pathing in Your Practice
Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
Asked and Answered
ASOA News
Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
Advertisers’ Index
Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover1
AE March/April 2018 Vol 27 No 2 - Cover2
AE March/April 2018 Vol 27 No 2 - 1
AE March/April 2018 Vol 27 No 2 - 2
AE March/April 2018 Vol 27 No 2 - 3
AE March/April 2018 Vol 27 No 2 - 4
AE March/April 2018 Vol 27 No 2 - How We Can Successfully Lead
AE March/April 2018 Vol 27 No 2 - Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
AE March/April 2018 Vol 27 No 2 - 7
AE March/April 2018 Vol 27 No 2 - Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
AE March/April 2018 Vol 27 No 2 - 9
AE March/April 2018 Vol 27 No 2 - Business Operations: Some Things to Know About Professional Liability Insurance
AE March/April 2018 Vol 27 No 2 - 11
AE March/April 2018 Vol 27 No 2 - Customer Care: Making a Diffi cult Journey A Little Easier
AE March/April 2018 Vol 27 No 2 - 13
AE March/April 2018 Vol 27 No 2 - Fast Practice: Breaking Down Practice Cliques
AE March/April 2018 Vol 27 No 2 - 15
AE March/April 2018 Vol 27 No 2 - Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
AE March/April 2018 Vol 27 No 2 - 17
AE March/April 2018 Vol 27 No 2 - InfoTech: Cloud Computing— Storms or Blue Skies?
AE March/April 2018 Vol 27 No 2 - 19
AE March/April 2018 Vol 27 No 2 - Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
AE March/April 2018 Vol 27 No 2 - 21
AE March/April 2018 Vol 27 No 2 - Technicians: Creating a “Feeder Program” to Staff Your Clinic
AE March/April 2018 Vol 27 No 2 - 23
AE March/April 2018 Vol 27 No 2 - Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
AE March/April 2018 Vol 27 No 2 - 25
AE March/April 2018 Vol 27 No 2 - Taking Your Practice to the Top
AE March/April 2018 Vol 27 No 2 - 27
AE March/April 2018 Vol 27 No 2 - 28
AE March/April 2018 Vol 27 No 2 - 29
AE March/April 2018 Vol 27 No 2 - 30
AE March/April 2018 Vol 27 No 2 - 31
AE March/April 2018 Vol 27 No 2 - 32
AE March/April 2018 Vol 27 No 2 - 33
AE March/April 2018 Vol 27 No 2 - Use Podcasts to Increase Practice Visibility—and Thrive
AE March/April 2018 Vol 27 No 2 - 35
AE March/April 2018 Vol 27 No 2 - 36
AE March/April 2018 Vol 27 No 2 - 37
AE March/April 2018 Vol 27 No 2 - Trailblazing— How to Implement Career Pathing in Your Practice
AE March/April 2018 Vol 27 No 2 - 39
AE March/April 2018 Vol 27 No 2 - 40
AE March/April 2018 Vol 27 No 2 - 41
AE March/April 2018 Vol 27 No 2 - Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
AE March/April 2018 Vol 27 No 2 - 43
AE March/April 2018 Vol 27 No 2 - Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
AE March/April 2018 Vol 27 No 2 - 45
AE March/April 2018 Vol 27 No 2 - Asked and Answered
AE March/April 2018 Vol 27 No 2 - 47
AE March/April 2018 Vol 27 No 2 - ASOA News
AE March/April 2018 Vol 27 No 2 - 49
AE March/April 2018 Vol 27 No 2 - Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
AE March/April 2018 Vol 27 No 2 - 51
AE March/April 2018 Vol 27 No 2 - COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
AE March/April 2018 Vol 27 No 2 - 53
AE March/April 2018 Vol 27 No 2 - Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
AE March/April 2018 Vol 27 No 2 - 55
AE March/April 2018 Vol 27 No 2 - Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
AE March/April 2018 Vol 27 No 2 - 57
AE March/April 2018 Vol 27 No 2 - Advertisers’ Index
AE March/April 2018 Vol 27 No 2 - 59
AE March/April 2018 Vol 27 No 2 - Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover3
AE March/April 2018 Vol 27 No 2 - Cover4
http://www.nxtbook.com/ygsreprints/ASOA/g107843_ae_julyaug19
http://www.nxtbook.com/ygsreprints/ASOA/g105962_ae_mayjun19
http://www.nxtbook.com/ygsreprints/ASOA/g104576_ae_marapr19
http://www.nxtbook.com/ygsreprints/ASOA/g103212_ae_janfeb19
http://www.nxtbook.com/ygsreprints/ASOA/g99529_ae_novdec18
http://www.nxtbook.com/ygsreprints/ASOA/g97160_ae_septoct18
http://www.nxtbook.com/ygsreprints/ASOA/g96528_ae_julyaugust18
http://www.nxtbook.com/ygsreprints/ASOA/g93925_ae_mayjune18
http://www.nxtbook.com/ygsreprints/ASOA/g92298_ae_marapr18
http://www.nxtbook.com/ygsreprints/ASOA/g89361_ae_janfeb18
http://www.nxtbook.com/ygsreprints/ASOA/g86698_ae_novdec17
http://www.nxtbook.com/ygsreprints/ASOA/g81746_ae_septoct17
http://www.nxtbook.com/ygsreprints/ASOA/g80299_ae_julaug17
http://www.nxtbook.com/ygsreprints/ASOA/g77256_ae_mayjun17
http://www.nxtbook.com/ygsreprints/ASOA/g74401_ae_marapr17
http://www.nxtbook.com/ygsreprints/ASOA/g72340_ae_janfeb17
http://www.nxtbook.com/ygsreprints/ASOA/ae_novdec16
http://www.nxtbook.com/ygsreprints/ASOA/ae_septoct16
http://www.nxtbook.com/ygsreprints/ASOA/ae_julaug16
http://www.nxtbook.com/ygsreprints/ASOA/asoa_mayjune2016
http://www.nxtbook.com/ygsreprints/ASOA/asoa_marapr2016
http://www.nxtbook.com/ygsreprints/ASOA/asoa_janfeb16
http://www.nxtbook.com/ygsreprints/ASOA/ae_novdec15
http://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct15
http://www.nxtbook.com/ygsreprints/APTA/g52750_apta_25ada
http://www.nxtbook.com/ygsreprints/ASOA/asoa_julyaug2015
http://www.nxtbook.com/ygsreprints/ASOA/asoa_mayjune2015
http://www.nxtbook.com/ygsreprints/ASOA/asoa_marapr2015
http://www.nxtbook.com/ygsreprints/ASOA/asoa_janfeb15
http://www.nxtbook.com/ygsreprints/ASOA/asoa_novdec14
http://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct14_AE
http://www.nxtbook.com/ygsreprints/ASOA/asoa_julaug14
http://www.nxtbook.com/ygsreprints/ASOA/ASOA_MayJunAE
http://www.nxtbook.com/ygsreprints/ASOA/ASOA_MarAprAE
http://www.nxtbook.com/ygsreprints/ASOA/ASOA_JanFebAE
http://www.nxtbook.com/ygsreprints/ASOA/ASOA_no4eZine
http://www.nxtbook.com/ygsreprints/ASOA/asoa_fall_2013
http://www.nxtbook.com/ygsreprints/ASOA/asoa_no3_ezine
http://www.nxtbook.com/ygsreprints/ASOA/asoa/asoa_summer_2013
http://www.nxtbook.com/ygsreprints/ASOA/ehr_cust_survey_Apr2013
http://www.nxtbook.com/ygsreprints/ASOA/asoa_no2_2013_ezine
http://www.nxtbookMEDIA.com