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Texas Optometric Association
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TOA Update: February 1, 2008



 

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2008 TOA Convention: TIME IS RUNNING OUT

TOA Convention 2008: The Heartbeat of OptometryGo On-Line to Register

"The Heartbeat of Optometry"

The 2008 TOA Convention will be held in Austin February 14-17. "The Heartbeat of Optometry" is scheduled with complete dual-track education, top-name speakers, Behind Closed Doors program with a $200 rebate to participants and special events such as the President's luncheon, awards banquet and the band, featuring optometry's own Roland Montemayor, OD.

The 2008 Convention is being dedicated to the late Robert E. Day, Sr. who passed away last month. Dr. Day was a former president of both TOA and AOA.

For the latest CE schedule and Paraoptometric information, or to register, go to TOA's new website http://texas.aoa.org

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Dave Perrigin, OD, FAAO to Receive Pittman Award at TOA Convention

David Perrigin, O.D., F.A.A.O., recipient of the 2008 William D. Pittman AwardThe prestigious William D. Pittman Award will this year honor an outstanding doctor and educator who has seen the classes of optometry students from the University of Houston College of Optometry go on to bigger and better things, and still keeps tabs on his protégées.

David Perrigin, OD, FAAO, associate professor at UHCO, served two years as a military optometrist after graduating from UHCO in 1969, and obtained the rank of Captian. He returned the UHCO in 1972 and joined the faculty.

One of his avocations is raising money for the college through 'optometry class' competitions. So far, his results have netted the college more than a half a million dollars.

Dr. Perrigin and his wife optometrist Judy Perrigin, a former Educator of the Year recipient, have two children.

The award will be presented at the TOA Awards Banquet, Saturday, February 16th during the TOA Convention in Austin.

The Pittman award was established in 1995 for longtime TOA leader Bill Pittman, OD who passed away in 1992. It is given to a member optometrist who has rendered outstanding service and long term dedication to the citizens of Texas and the profession of optometry.

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TOA Members: IMPORTANT ACTION REQUIRED

First Quarter Dues Requested

TOA's delegate count or voting strenth at AOA's Optometry's Meeting in June, is determined by the number of members who have sent in at least the first quarter of their dues.

Since AOA has gone to a calendar year budget, the deadline for sending dues for the first quarter is April 30. Last year, TOA lost delegates because we didn't have enough of our members send a quarter of their dues before that date.

We are asking our members to please submit at least a quarter of your yearly dues by April 1, so we can meet this year's deadline and increase our delegate count. This is important so we make sure Texas has a voice in matters that effect the profession.

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UPDATE Your "Find An Optometrist" Area of TOA's NEW Website

Make sure patients and other doctors can find you

The Doctor Locator or "Find An Optometrist" feature in the top right hand of the banner on TOA's website, http://texas.aoa.org is an invaluable tool for both patients and doctor referrals.

To access the members-only feature, TOA members will need to use their AOA ID number and birthday. Once inside the site, members can go into the "Find An Optometrist" section and select the "Doctor Locator Member Update" to insure the correct, up-to-date location information.

If you don't know your AOA member ID number, you can contact AOA at 800-365-2219, TOA at 512-707-2020 or email TOAsarah@austin.rr.com.

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Billing, Coding and More

From AOA:

AOA has been getting numerous phone calls about NPI and NPI registration. There have been countless communications from AOA on this subject, yet we OD's are a needy breed. AOA and TOA are happy to help our members, but do not have the manpower or resources to take care of all the providers.

The AOA web site is full of information on this topic to assist the OD member. If an OD has questions on the newly required NPI, go to AOA.org first.

Meanwhile, the following are some suggestions:

You need to make sure your NPI assignments are correct and that yourMedicare legacy identifier is in your NPPES record (you need to look in NPPES, not in the NPI Registry, for this information);

You need to verify that your claims were submitted properly (some providers don't know the difference between the Billing and the Rendering Providers);

You also need to know the reason why your claims are being rejected. You may need to contact the claims processor to discuss why your claims were rejected. AOA needs the name of the contractor and contractor staff person with whom the provider spoke--or at least the name of the department in which that person works.

Providers need to know how they are enrolled in Medicare, and if that enrollment accurately reflects the way they do business (e.g., sole proprietorship vs. corporations).

In sum, no later than May 24, 2008, all covered entities are expected to be using the NPI in a compliant manner, and all contingency plans should be lifted.

NPPES and the NPI Enumerator: Misconceptions & Facts

In conversations and correspondence with health care providers, health plans, and others within the health care industry, it is very clear that there are misconceptions concerning the National Plan and Provider Enumeration System (NPPES) and the NPI Enumerator. Below we have listed some common misconceptions and the facts that correct those misconceptions.

MisconceptionFact
NPPES sends data directly to the Medicare provider enrollment system.NPPES does not send data to the Medicare provider enrollment system or to the provider enrollment system of any health plan. As explained in the NPI Final Rule, applying for enrollment in a health plan is a completely separate process from the process of applying for an NPI.
NPPES sends data directly to the Medicare claims system.NPPES does not send data to the Medicare claims system or to the claims system of any health plan. Medicare extracts certain NPPES data and uses those data in its Medicare NPI Crosswalk. That Crosswalk is used in processing Medicare Part A and Part B claims. Other health plans are also free to use NPPES data to help process their claims.
NPPES is part of the Medicare provider enrollment system.Obtaining an NPI is required in order for a health care provider to enroll in Medicare; however, the NPPES does not function as a part of the Medicare provider enrollment system. Medicare requires a health care provider to have an NPI and to furnish that NPI on the Medicare provider enrollment application form (CMS-855). In addition, once a health care provider submits a CMS-855 to Medicare, Medicare compares the NPI and certain other information on the CMS-855 to certain information in that health care provider's record in NPPES. If the information being compared does not match, the health care provider must correct whichever information (NPPES or CMS-855) is incorrect in order for the enrollment process to continue.
Obtaining an NPI guarantees payment to the health care provider by a health plan. As explained in the NPI Final Rule, obtaining an NPI does not guarantee payment to the health care provider by Medicare or by any other health plan. NPI assignment simply establishes the uniqueness of an enumerated health care provider amongst all other enumerated health care providers. Most health plans will not pay a health care provider that is not enrolled in that health plan.
NPPES verifies licenses and credentials that are reported by health care providers when applying for NPIs.NPPES does not verify licenses or credentials. NPPES verifies only two things: (1) It verifies a health care provider's Social Security Number if the health care provider is an individual who furnished his/her SSN when applying for the NPI; and (2) Using special software, it verifies that the health care provider's business mailing and practice location addresses are legitimate Postal Service addresses, but not that the health care provider is actually associated with or located at either of those addresses. Licensure and credentials must be verified by health plans as part of their enrollment processes. It is possible, under certain circumstances, that the NPI Enumerator may contact health care providers who have submitted applications, updates, or deactivations to verify information that was furnished in order to properly process those actions. Health care providers are reminded that the information they send to NPPES must be true, correct, and complete, in accordance with the Certification Statement of the NPI Application/Update Form (paper form and web-based form).
NPPES is a Medicare system.NPPES is not a Medicare system; it belongs to no health plan. It is maintained by CMS for the health care industry in general, in accordance with the NPI Final Rule and as part of CMS' delegated HIPAA authority. Health care providers who apply for NPIs are not required to furnish any information about their enrollment in any health plan. In an optional field, health care providers may report legacy identifiers that health plans have assigned to them in the past. This field, "Other Provider Identification Numbers," can capture the legacy identifiers and the issuers of those identifiers (i.e., the names of the health plans that assigned them). The information in this field is used by health plans to help them locate their enrolled providers in NPPES in order to know of their NPI assignments. For this reason, Medicare providers are urged to report their Medicare legacy identifiers in this field.
The NPI Enumerator can update the Medicare claims and enrollment systems.The NPI Enumerator cannot view, update, or interact with the Medicare claims or the Medicare enrollment systems, nor can it do so with any health plan's claims or enrollment systems.
The NPI Enumerator can view and update/change the Medicare NPI Crosswalk.The NPI Enumerator cannot view or update/change the Medicare NPI Crosswalk. The NPI Enumerator can assist providers with certain aspects of updating their NPPES records, and some of that information in those NPPES records could be used by Medicare in the Medicare NPI Crosswalk.
The NPI Enumerator serves Medicare providers and supports Medicare operations, not other providers or health plans.The NPI Enumerator operates under contract to CMS in accordance with the NPI Final Rule and as part of CMS' delegated HIPAA authority. The NPI Enumerator serves the entire health care provider community for NPI purposes, not just Medicare providers. The functions of the NPI Enumerator are not specific to any health plan.

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Find Your Legislator:

http://www.fyi.legis.state.tx.us/

If you do not know who your legislators are, here is an easy way to find out by adding your address or county.

Please support your profession by voting in the Texas primary March 4 (early voting begins February 19) and the general election in November.

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Thank you for reading our monthly e- news. Please send us your suggestions and comments or thoughts about stories we might include. We are working hard to insure that your dues dollars bring you the maximum benefits of membership. This is a work in progress. Email Bj Avery at the TOA office at texop@aol.com

Sincerely,

Dr. Wright's Signature
David Wright, O.D., President
The Texas Optometric Association Inc.
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