Thoughts from my first month in ophthalmology solo practice

March 15:

This is awesome.  I’m getting busier fast!  Today, so far, I saw 3 patients and made an additional 4 appointments for the week!  Thank goodness I came prepared with a bigger boat.

Now, I have an interview with the local Korean television station in 30 minutes.  I have no white coat to wear because the ink from my pen bled through my pocket this morning.  I should’ve ordered more white coats.

March 17:

I received my first insurance check today.  It was from a large corporation’s employer group health plan through Blue Cross for $116.  Hence, I only received 80% of the Medicare fee schedule for a 92004 new patient comprehensive visit.  (Copay was $15).  Based on what my front desk person told me, it sounds like payment came directly from the employer’s health insurance fund using Blue Cross as an intermediary payer.  That’s probably why I got paid so fast.  I’ll take it.

On the other hand, I also got my first claim denial from Medicare today.  I submitted the claim on March 4, and got a response within 2 weeks.  Turns out that I made the mistake of putting down my organizational NPI in the individual NPI column in my practice management software.  It was my fault.  I probably will have another 6 claim denials coming my way within the next week or so. Technically, it’s an incomplete submission, so I didn’t have to go through the resubmission process.    Instead, I had to submit the same claim again electronically as a new claim.  If they process my correct claim just as fast as my denial, I will be happy.  That’s probably not going to be the case though.

March 18:

Obviously with a niche population, comes niche pathology.  Out of the 27 patients I’ve seen so far, 3 will need an LPI (laser peripheral iridotomy).  Another patient was borderline, but I decided to hold off.  I’ve always been one to undercall narrow angles, but all these people really do have it.  Of course we’ve all read in books that Asians tend to be at risk for normal tension glaucoma and angle closure glaucoma.  I guess it really is indeed true.  Now, I’m actually pretty glad I got a YAG for my office.  I bet I’ll be doing 10 to 20 LPI’s a month when I reach a steady state in patient volume.  I bet I’ll get a decent number of acute angle closures as well. 

Now, I’m also not looking forward to doing surgery on these patients in the future as well.  I can tell that I’m going to be the short eye king.  My shortest eye so far was 19.95 mm.  I wonder if I’ll break that mark.   

March 24:

Just signed up a focal laser today.  Gonna bring him back for a fluorescein angiogram first.  I have 2 fluorescein angiograms scheduled in 2 weeks.  I didn’t think I’d be doing this many this fast.  The other patient has diabetic retinopathy as well, and not sure if she has CSME or an ERM in one eye.  She had poorly dilating pupils and a 3-4+ NS.  Not the best view, but I did see what looked like a bit thickened sheen with speckles of lipid in a non-circinate pattern.  OCT did show some thickening, a shoddy ERM, diminished foveal depression, but no fluid.  I did see the lipid on OCT also, but once again, no cystic changes around it. My guess is that this is an ERM and not CSME.  Hopefully, the FA will give me a little more information.  If everything’s ok, I’ll have another cataract surgery on the schedule!

I’ll be injecting the fluorescein and taking the pictures myself.  Hopefully it won’t be that bad.  I’m going to contact the photographers in my residency and my equipment vendor for some advice before hand.  I’m going to use an FA kit that I bought for $5 or $10, which includes fluorescein, syringe, butterfly needle, bandaid, etc.

March 23:

I’m going to see zero patients today for the first time since March 4.  So far, I’m on pace to meet my pro forma volume projections.  As of today, I’ve had exactly 30 visits, and have an additional 4 scheduled before March ends.  I have one cataract surgery, with another in the pipeline, and 4 LPI’s (2 per person) scheduled.  I’m billing more than I had expected because of my my ancillary testing.  Also, the insurance payments are coming in faster than I had imagined.  I might actually be able to pay for my rent this month!  That’s way better than the $1,000 I had thought I would collect.

As optimistic as I have become, I can tell that the long run will indeed be long.  I need to believe that business will eventually ramp up, which isn’t easy to do on all days.  Still, I’m content with my performance so far, and have confidence.

I sent out my first patient statements today.  It was super easy to generate with my practice management software.  Also, posting electronic insurance payments was easy and automatic as well.  Some of the EOB’s (Explanation of Benefits) I received showed that a few patients had additional financial responsibility because they haven’t met their annual deductibles yet.  I’m not sure how these figures get calculated, but the bill goes to them now.  Hopefully, they will mail their payments promptly.  None of them have any follow up appointments, so I won’t have the opportunity to collect on the come back.  We’ll see how my accounts receivables ages.

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