AE May/June 2021 Vol 30 No 3 - 46

ASOA PROFESSIONAL // ASKED & ANSWERED

QUESTIONS
FROM ASOA EYEMAIL

Consider joining ASOA EyeMail. It's
free as part of your ASOA membership. Where else can you have access
to almost instantaneous answers to
your ophthalmic practice management questions?

Q:

Staff have
been logging
in under the
physician to do
e-prescribing,
opening/
adding to clinic notes or
interpreting tests, then
signing the note under that
login. I explained to the
physician and staff that this
is not acceptable. Does
anyone have information
from either HIPAA or OIG or
CMS that I can email to the
doctor? I need to make it
clear that this is not appropriate and is a huge
security violation.
ANSWERS FROM YOUR PEERS
* In our state techs fall under
" Medical Assistants " and must
follow our state's definition of
MA Scope of Practice. Start with
looking up your state's definition

46

AE // May/June 21

*

of scope of practice. The code of
ethics and scope of practice are
also on the JCAHPO site.
This problem has been
around since the beginning
of EHR. Doctors should not
give passwords or permission to anyone else, but they
do. The message to stop must
come from them. They may
support your view but behind
the scenes it is just too much
to do for them and too easy
to delegate.

Q:

If a patient has
an insurance
provider that
does not have
us in their
network, but
the insurance plan has
out-of-network benefits, may
we bill the patient for the
difference between the
charged amount and the
reimbursement amount? Are
we required to have patients
sign a form to inform them of
the responsibility?
We would like to continue
accepting patients with the
insurance as long as they
have out-of-network benefits.

What is the proper billing for
this scenario?
ANSWER FROM THE EXPERT,
LAURIE K. BROWN, MBA, COMT,
COE, CPC, CPMA, OSC
Most commercial insurance plans
do have out-of-network as well as
in-network benefits. For the patient
choosing to go out-of-network,
in most cases you may accept the
reimbursement amount from the
carrier and follow your state laws
regarding any balance billing.
There may also be the option for
accepting out-of-network assignment, which would limit balance
billing. Some states have strict laws
for " inadvertent " and " emergent "
out-of-network billing with requirements for patient pre-notification,
etc. Nuances may be insurance
plan- and situation-dependent.
I suggest researching each payer
you encounter for their associated plans (rules may vary for
HMOs, PPOs, etc.). Most require
advance patient notification, such
as an estimate of the cost of the
services, any payment terms that
apply, and whether your doctor
will charge you interest on any
unpaid balance and the amount
of the interest, if any. AE



AE May/June 2021 Vol 30 No 3

Table of Contents for the Digital Edition of AE May/June 2021 Vol 30 No 3

AE May/June 2021 Vol 30 No 3 - Cover1
AE May/June 2021 Vol 30 No 3 - Cover2
AE May/June 2021 Vol 30 No 3 - 1
AE May/June 2021 Vol 30 No 3 - 2
AE May/June 2021 Vol 30 No 3 - 3
AE May/June 2021 Vol 30 No 3 - 4
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AE May/June 2021 Vol 30 No 3 - 46
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AE May/June 2021 Vol 30 No 3 - 59
AE May/June 2021 Vol 30 No 3 - 60
AE May/June 2021 Vol 30 No 3 - Cover3
AE May/June 2021 Vol 30 No 3 - Cover4
https://www.nxtbook.com/ygsreprints/ASOA/ae-may-june-2021-vol-30-no-3
https://www.nxtbook.com/ygsreprints/ASOA/ae-march-april-2021-vol-30-no-2
https://www.nxtbook.com/ygsreprints/ASOA/ae-january-february-2021-vol-30-no-1
https://www.nxtbook.com/ygsreprints/ASOA/ae_nov_dec_20
https://www.nxtbook.com/ygsreprints/ASOA/ae_sept_aug_20
https://www.nxtbook.com/ygsreprints/ASOA/ae_july_aug_20
https://www.nxtbook.com/ygsreprints/ASOA/ae_may_jun_20
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https://www.nxtbook.com/ygsreprints/ASOA/ae_jan_feb_20
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https://www.nxtbook.com/ygsreprints/ASOA/g107843_ae_julyaug19
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https://www.nxtbook.com/ygsreprints/ASOA/ae_septoct16
https://www.nxtbook.com/ygsreprints/ASOA/ae_julaug16
https://www.nxtbook.com/ygsreprints/ASOA/asoa_mayjune2016
https://www.nxtbook.com/ygsreprints/ASOA/asoa_marapr2016
https://www.nxtbook.com/ygsreprints/ASOA/asoa_janfeb16
https://www.nxtbook.com/ygsreprints/ASOA/ae_novdec15
https://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct15
https://www.nxtbook.com/ygsreprints/APTA/g52750_apta_25ada
https://www.nxtbook.com/ygsreprints/ASOA/asoa_julyaug2015
https://www.nxtbook.com/ygsreprints/ASOA/asoa_mayjune2015
https://www.nxtbook.com/ygsreprints/ASOA/asoa_marapr2015
https://www.nxtbook.com/ygsreprints/ASOA/asoa_janfeb15
https://www.nxtbook.com/ygsreprints/ASOA/asoa_novdec14
https://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct14_AE
https://www.nxtbook.com/ygsreprints/ASOA/asoa_julaug14
https://www.nxtbook.com/ygsreprints/ASOA/ASOA_MayJunAE
https://www.nxtbook.com/ygsreprints/ASOA/ASOA_MarAprAE
https://www.nxtbook.com/ygsreprints/ASOA/ASOA_JanFebAE
https://www.nxtbook.com/ygsreprints/ASOA/ASOA_no4eZine
https://www.nxtbook.com/ygsreprints/ASOA/asoa_fall_2013
https://www.nxtbook.com/ygsreprints/ASOA/asoa_no3_ezine
https://www.nxtbook.com/ygsreprints/ASOA/asoa/asoa_summer_2013
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