Patient Education Check-Up Project

The Academy and OMIC are jointly sponsoring the fourth annual Patient Education Check-Up Project. This campaign encourages MDs and office administrators to audit all of their Academy patient education materials and informed consent documents to ensure they are current. While the connection between patient education and patient compliance is widely known, the connection between accurate, timely patient education and informed consent materials in reducing malpractice risk may not be. The primary message of this campaign is risk mitigation through up-to-date patient education materials and informed consent documents.

Download the checklist to help you review your existing patient education materials.

Visit OMIC’s library of informed consent forms to make sure you have the most current version.

For more information on the Academy’s patient education products e-mail patientinfo@aao.org.

For information on OMIC’s informed consent documents, contact the OMIC Risk Management Hotline at 800.562-6642, extension 641.

Want to have the most up-to-date patient education at a click of a button?
Subscribe to the Academy’s Downloadable Patient Education Handouts
Have peace of mind that you are reducing your malpractice risk by giving your patients the most up-to-date information about their eye condition and treatment options. The Downloadable Patient Education Handout Subscription – gives you unlimited, print on demand, access to a comprehensive collection of nearly 100 titles in downloadable PDF format. The handouts are updated regularly, eliminating the time-consuming task of having to audit your own materials.

Appeal Letter to MCO When Treatment is Denied (Not Covered Service)

APPEAL LETTER TO MCO WHEN TREATMENT HAS BEEN DENIED ON GROUNDS THAT IT IS NOT A “COVERED MEDICAL SERVICE”

Chairperson

Utilization Review Committee

RE:     (Patient Name)

Patient ID Number

Dear:

On (Date), I prescribed (Test/Procedure) for (Patient’s Name). On (Date), you denied authorization of payment for that (Test/Procedure) on the grounds that it was not a covered medical service. I request that you reconsider your determination for the following reasons:

(List Reasons That Demonstrate Why the Test/Procedure is a Covered Service)

In my medical judgment, a (Test/Procedure) is a very important part of my overall care of (Patient’s Name). (Patient’s Name) suffers from (Describe Condition). In addition to being a covered benefit, the (Test/ Procedure) is necessary to (Describe Why Necessary). Failure to perform the (Test Procedure) could result in the following problems:

(Describe Problem)

For these reasons, I urge you to reconsider your denial of payment authorization for the procedure I have prescribed. Enclosed are pertinent medical records supporting my recommendation.

By copy of this letter to (Patient’s Name), in my best medical judgment, I suggest that he/she obtain the (Test/Procedure), despite your denying payment authorization.

Yours truly,

(Your Name)

cc: (Patient’s Name)

Appeal Letter to MCO When Treatment is Denied (Not Medically Necessary)

APPEAL LETTER TO MCO WHEN TREATMENT HAS BEEN DENIED ON GROUNDS THAT IT IS NOT “MEDICALLY NECESSARY”

Chairperson

Utilization Review Committee

RE:     (Patient Name)

Patient ID Number

Dear:

On (Date), I prescribed (Test/Procedure) for (Patient’s Name). On (Date), you denied authorization of payment for that (Test/Procedure) on the grounds that it was not medically necessary. I request that you reconsider your determination for the following reasons:

(List reasons that demonstrate why the test is medically necessary)

In my medical judgment, a (Test/Procedure) is a very important part of my overall care of   (Patient’s Name). (Patient’s Name) suffers from (Describe Condition). The (Test/Procedure) is necessary to (Describe Why Necessary). Failure to perform the (Test/Procedure) could result in the following problems:

(Describe problem)

For these reasons, I urge you to reconsider your denial of payment authorization for the procedure I have prescribed. Enclosed are pertinent medical records supporting my recommendation.

By copy of this letter to (Patient’s Name), in my best medical judgment I suggest that he/she obtain the (Test/Procedure), despite your denying payment authorization.

Yours truly,

(Your Name)

cc: (Patient’s Name)

Referral Form for Managed Care Patients

REFERRAL FORM FOR MANAGED CARE PATIENTS

Date:                                                  

Dr.                                                        has referred you to Dr.                                              

Phone:                                                

This referral is:

                                          Emergency

                                           Urgent (24-48 hours)

                                           Timely (1-2 weeks)

                                           When convenient

This appointment will have to be made for you by your primary care physician,

Dr.                                                       , who has been notified.  If there are any problems scheduling this appointment, please contact this office.

For office use only:

Outcome:                                                                                                                                           

(Original to patient. Copy to chart.)

Noncompliant Patient Missed or Cancelled Appointment (Sample Letter)

NOTE:  This sample letter is provided as a guideline only and should be modified according to the situation. Be sure to place a copy of the letter in the patient’s chart.  If the patient’s condition warrants a receipt, ask for delivery verification (DV).  DV is cheaper than certified, and does not require the patient’s signature.  Instead, the mail carrier verifies that the letter was delivered.   If DV is not available, send the letter certified and through the regular mail.  Place the letter and the verification or signed return receipt in the patient’s chart.

[SENT WITH DELIVERY VERIFICATION OR CERTIFIED MAIL-RETURN RECEIPT REQUESTED (send also through regular mail)

only if patient risks serious vision loss, otherwise use regular mail]

(Date)

Dear (Patient):

You have canceled your follow-up appointment on (date) without rescheduling. We were unable to reach you by telephone.

Continued care is essential to the health of your eyes. You have an eye condition which will worsen without proper care (If the patient has a condition that requires specific care, state the care AND the consequences of  no care in clear, patient-friendly language.  If the patient has a condition that needs regular follow-up, state the frequency and urgency of the follow-up, AND state the consequences of not getting the follow-up at the recommended time in clear, patient-friendly language.)  Permanent damage may occur, resulting in visual loss or blindness. Kindly realize this letter is not meant to alarm you. We only wish to inform you of the seriousness of your condition, as it was also explained during office visits, and encourage you to seek proper care.

Please contact our office as soon as possible to reschedule.

With best regards,

(Physician’s Signature & Name)