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Cover Focus | Jul/Aug '16

Staying Compliant While Comanaging Care

When it comes to sharing care with another provider, navigating the rules of being successful and staying compliant can be challenging. Before embarking on this wonderful—yet sometimes overwhelming—aspect of ophthalmic practice, you must first do your due diligence. This involves ensuring that you fully understand the responsibilities not only of the surgeon but also of the comanaging optometrist. More importantly, you must know what insurance companies recognize as comanagement and how to get paid.

Medicare is the primary insurance for recognizing comanagement, with major surgery performed by the ophthalmologist and postoperative care performed by the optometrist, with few commercial insurance carriers; however, the commercial carriers do differ depending on the region in which you practice. Medicare has published regulations that both parties must follow and requires a transfer agreement between the two doctors and specific billing codes for each specialty.

At times, it is daunting to think of all that is related to ensuring that you stay compliant when sharing care. The following five pearls will help you not to reinvent the wheel but rather to get jumpstarted with tools for a successful program.

1. Get Acquainted

Know your potential comanaging partners. Investigate the region within a 5-mile radius of your practice, and then eventually expand to a 10-mile radius and beyond, by going out to the optometric community during your lunch hour. Take the time to introduce yourself and explain your specialty and how you can work together to give the patients the best in surgical care and postoperative care. Promote a win-win situation.


Take the time to bring the optometrist into the OR with you to see not only standard cataract surgery but also premium lens implantations. Make sure to have the optometrist join you in your clinic on postoperative day 1 so that he or she understands what is expected for the patient’s postoperative care.


Share with the optometrist the paperwork that is required for proper billing. A transfer of care document is required for all patients.1 This form outlines the patient demographics and information on the surgical procedure and lists the dates when the patient will be transferred from the ophthalmologist to the optometrist. It would be ideal for you to have a sample form that the optometrist can use, with all of the details outlined.


Billing is one of the most important aspects of shared care. Outlining the codes that the optometrist will use and showing examples of how to bill sets the stage for guaranteed success. Too many times, this becomes a hindrance or the reason why you might not get continued referrals if the optometrist cannot get paid. Providing a sample billing form with the appropriate modifiers for the optometrist to use and reviewing the timeframes for which both parties are responsible for the patient care shows your commitment to the relationship.


Follow up and maintain your relationship with the comanaging provider. Set a quarterly meeting on the calendar when you or a representative from your office will go out and meet with the optometrist. Make it so that you are at the top of his or her mind when it comes to surgical intervention.

Having a packet of information to bring with you to meet potential referring optometrists will only solidify your stance as being on top of your game. The less they have to do figure this out, the more likely they will be to refer a new patient before you even get back to the clinic from your lunch meeting. Foster your partnership and create a referral relationship, where you are promoting the optometrist for glasses and even contact lenses. As you expand your surgical repertoire, keep your optometric collaborators in the loop, invite them back into the OR, and even expand into your LASIK practice. You will be amazed what happens to your bottom line.

Tracy J. Kenniff, MBA, OCS
Tracy J. Kenniff, MBA, OCS