CoFi and Expert Co-Management Guidelines

The optics of a surgeon collecting a lens fee and paying the ASC or collecting a co-management fee and paying the OD are less than ideal. While this is a common service that ophthalmologists provide, renewed scrutiny has prompted practices to review their processes for handling co-management fees. Ophthalmology practices are responding by adjusting their co-management policies. These changes may bring them into better compliance but at the cost of compromising the patient’s experience.

In a recent webinar hosted by AECOS, Allison Shuren of Arnold & Porter and Alan Reider of LSR Consulting reviewed the current and ongoing legal cases against ophthalmology practices. We recommend you watch this important video to learn more about these cases and the co-management compliance guidance they provide for ophthalmology and optometry practices.

CoFi addresses all 3 payment-related recommendations

In addition to the webinar, the two legal experts co-authored a follow-up article published in CRST. Ms. Shuren and Mr. Reider listed 13 “key take-home points for ophthalmologists to protect themselves in any co-management relationship.” CoFi provides a means for ophthalmologists to meet the three payment-related guidelines from the list. We will review each one here.

• Ensure that fees received by comanagers for postoperative care related to premium IOLs are for services rendered and reflect fair market value.

Ideally each surgical partner should set their fees at a reasonable rate. The practices must consider several factors when making this determination. The ophthalmology practice would need to know what each optometrist’s fees are to tell the patient the total procedure cost – that quickly can become an administrative nightmare. With CoFi, every practice – ophthalmologist, optometrist, and ASC – can set their fees by service and by procedure, independent of the other providers. CoFi automatically reflects every party’s fee on the patient invoice.

• Be clear that it is the patient, not the practice, who is paying any additional fees for noncovered services

It’s a compliance no-no for the surgical practice to collect the additional costs associated with a premium lens or an elective surgery on behalf of their partners. Doing so could lead to violations of regulations or look like the ophthalmologist is paying for referrals. With CoFi, the patient pays each surgical partner directly for the services each is rendering. 

• Move toward having optometrists set and collect their own fees.

Payment separation is a critical component of payment compliance. With CoFi, each party charges the patient separately. The patient sees these separate charges on their card or bank statement. 

Using CoFi, the ophthalmology practice’s staff creates a multi-party invoice in about 60 seconds. The invoice contains each party’s pre-loaded fees with descriptions of services and the name and address of each provider for the patient to review. In one payment event for the patient, each party charges the patient separately and collects directly from the patient. In this way, CoFi provides a payment solution that is both compliant for each practice and results in a better patient payment experience.