On-Site Eye Care for Nursing Facilities

Of all the senses, sight is the most precious.

Program Overview

Mission Statement

Good vision is integral to the highest possible quality of life; it is our mission to provide primary eye care to those residents of nursing facilities for whom transportation needs and physical limitations make traditional doctors visits difficult or impossible.

Visitation

We visit most of our facilities on a monthly basis, depending on patient demand.  On the average, most facilities have about 70% resident participation.  The incidence of ocular disease is extremely high, with well over 90% of residents exhibiting some form of disease.  Most of the diseases are chronic in nature; cataracts, glaucoma and macular degeneration, for example.  The treatment of choice for these diseases depends upon medical judgment of the severity of the condition, the resident's mental capability, and the desires of the resident or responsible party.  Each case is individual, but there are general patterns followed.  Cases with minimal disease and low risk of progression will usually be seen on an annual basis.  Those with significant disease and moderate to high potential for progression will be seen every six months.  Cases actively progressing will be seen monthly, when indicated, or referred off-site for acute management or surgery when indicated.

Anticipated Caseload

Assuming adequate participation, a 120 bed facility yields an expected caseload of about  8-12 patients per month.  This would require a one half day visitation, about three hours     of care time. 

Smaller facilities, 60 beds or less, may require only ½ day every other month to meet the expected 8-12 cases. 

Very large facilities, 300 beds or more, may require multiple days per month.

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Billing Procedures

We are participating providers for both Medicare Part B and Medicaid.  We also accept assignment on secondary insurance providers.  This means that for patients with Medicare and Medicaid coverage, our service is entirely covered.  For patients with Medicare and Secondary Medigap insurance, our services are also likely to be entirely covered.  For patients with Medicaid only, we will bill only what Medicaid allows, and again, our service is entirely covered.  For those patients with Medicare only, a 20% co-payment is required.  We are required by Medicare to bill for it, and we will bill the resident’s financial guardian. 

In summary, most of the time the fees are entirely covered.  We will not ask for a balance due unless all known insurers have been exhausted.  If there is a case of financial hardship, or a billing error, please bring it to our attention, and it will be remedied.

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Documentation Requirements

Medicare guidelines require certain forms of documentation to establish:

    1) The medical necessity for eye care services.

    2) The authorization by responsible parties for Medicare to be billed.

The medical necessity requirement is generally met by a specific order from the patient's primary care physician for the services.  Residents who fail the nursing visual screening have proven the medical need to be examined. 

Long term care residents have filed documents upon admission that authorize the nursing facility to direct their medical care from any provider and for that provider to bill to their insurance.  Florida Eye Center also recommends that a resident's responsible party be contacted for direct authorization for eye care services.  We will generally request that either the facility Social Services department or Nursing contact the resident's responsible party for verbal or written authorization prior to initiating eye care services.  This will prevent misunderstandings.  Please contact our office for a copy of our authorization form.

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How it all Works

We will fax you a list of patients, comprised of those established cases under management and their primary diagnosis, 1-2 weeks ahead of our next visitation. We will request screening/order forms and authorization forms for those residents who have failed the screening and need to be added to the list.  We may also request a copy of the resident face sheet to verify insurance. 

We will require a setup area that is at least ten feet in length, reasonably private, and with the ability to dim the light to near dark conditions.  We do not require water access.  We will set up our equipment, and perform our service in this room.  Your CNA staff will help us to locate the residents to be seen, and bring a few (2-3) at a time.  All those who are not strictly bed-bound should be awakened dressed and readied for examination.  Individual room visitation is cumbersome and inefficient with all our equipment, but can be done in rare special cases.

We will chart all our records and orders.  We ask that you keep all eye records in the chart for at least one calendar year.  We will provide you with a sheet summarizing each patient’s primary findings and recommendations and the end of our visitation.

You will usually receive notice of our next visitation date by fax about 1-2 weeks in advance.  We try to stay with the same day of the week:  if it is Tuesdays, then it will stay on Tuesdays unless we mutually decide otherwise.

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We can order eyeglasses up to two pairs per year for Medicaid recipients under 21 years of age.  There presently is no eyeglass benefit for those over 21.   We will deliver the glasses on the next visitation, (4 weeks). They are required to be dispensed by licensed personnel.  If any are sent by mail, they will need to be adapted to fit the patient's face at our next visiting rounds. 

Private pay glasses candidates will have an cost estimate mailed to their responsible party.  All private pay orders must be paid in advance.  Delivery depends on how much delay there is in payment.  Those who forward payment as soon as possible have the best chance of completing the order it time for delivery at the next visitation.

Repairs:  We can usually make minor repairs to broken frames.  Please place all parts in a bag labeled with the resident’s name.  Some private pay repairs may have a charge usually $10 to $20, depending on the difficulty.  We will bill the patient’s financial guardian for most repairs..

Facility orders:  If the facility has agreed to pay for replacement eyeglasses for a resident, these will need to be paid in advance. The facility will be billed for any repairs it specially requests and authorizes.

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Referrals

For cases needing referral to a specialist for surgery or other treatment we will recommend the procedure by letter to the resident's legal guardian, and will send you a copy of the letter.  If you have not heard from the resident’s responsible party in two weeks, we ask that you contact them to see if they intend to move forward with the recommendation.  We respect the right to refuse treatment, but have the responsibility to inform patients and guardians of their treatment options.

If a case is extremely urgent, we will write an order requesting immediate referral.

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Staff Examinations

We generally discourage nursing facility staff needing eye care services seeking our care.  We are here for the residents, and would be happy to see any of your staff at one of our four local offices.  We are happy to answer minor staff questions, or advise treatment for mild conditions, but must decline staff involvement where it interferes with care of residents.