Frequently Asked Questions (FAQs)
Unpack answers to the most common questions when considering implementing a diabetic retinopathy screening program at point-of-care.
Getting Started
The goal of diabetic retinopathy screening is to detect eye disease before the disease progresses. This is especially important because many patients who develop diabetic retinopathy have no symptoms until macular edema and/or proliferative diabetic retinopathy are already present. Our experience shows that there are patients who will be diagnosed with an active vision problem that require referral to a specialist. Although a dilated eye exam is still recommended for patients with diabetes, an estimated 60% of diabetic patients do not receive annual dilated eye exams, resulting in a significant care gap¹. Diabetic retinopathy screening in primary care is intended to help close this gap by identifying eye disease early and ensuring that those patients with diabetic retinopathy are referred for specialist care.
No. An annual dilated eye exam is still recommended at the time of diagnosis for patients with Type 2 diabetes. A patient with Type 1 diabetes should have an eye exam within 5 years after the onset of diabetes.²
Primary care providers may be able to access this information in their EMR by viewing a “problem list,” “medication list,” or patients with an ICD 10 for diabetes.
Health plans will typically provide care gap reports detailing this measure. This data may be accessed in your EMR.
Many patients confuse routine eye exams with medical eye exams. During a routine eye exam, a doctor performs a refraction test for purposes of determining whether a patient needs corrective lenses. A medical eye exam like screening for diabetic retinopathy uses different techniques to examine overall eye health. It is important to ask your patients what types of eye exams they’ve had in the past and when. In order to meet HEDIS³ and Star requirements, you will also need to document a patient’s eye exam history prior to screening for diabetic retinopathy
Endocrinologists should contact their patients’ primary care practices to see if these practices are offering point-of-care testing for diabetic retinopathy. For those patients who do not have access to this service, the endocrinology practice can bill for this service. It will also close any quality measures.
The Topcon Screen Process
Topcon Screen is a leader in eye care diagnostics. We provide point-of-care testing for diabetic retinopathy, so you can reach more patients and improve care coordination for your diabetic population diagnosed with a vision pathology. Topcon Screen provides the complete infrastructure, including reading services and retinal camera.
Topcon Screen offers complete flexibility regarding retinal camera solutions. Whether it is a fully automated desktop camera or a handheld camera, we have options that work for your practice. Implementing our solution is pain-free: no purchase of capital equipment or long-term software contracts are required and you have the full support of Topcon’s reimbursement resources to ensure a successful implementation.
Depending on the patient’s insurance policy, the patient may be responsible for paying a copay or deductible as with other services. Patients with a high deductible plan should contact a local eye care specialist to determine the cost of an eye exam that will include imaging of the eye. With this information, the patient can decide where they would like to have the screening done.
Topcon will provide installation and training for the office staff. Topcon Technical Support is available from 8am-8pm EST Monday through Friday. Support can be reached at 866-922-6278 option 2.
Interpretation reports are returned to the practice within 24 hours.
No, the provider can refer the patient to any eye care specialist.
Reimbursement
During the onboarding process, Topcon will connect with your billing and coding team to provide guidance around reimbursement. Most private insurance plans, Medicare Advantage, and Managed Medicaid plans will provide reimbursement. Medicare reimbursements may vary depending on the region. Various federal and state incentives, quality assurance programs, and legislation may affect the coverage and reimbursement rates of both private insurance and Medicare and Medicaid plans. We recommend that you check with your patient’s insurance provider to verify reimbursement eligibility before the screening. Topcon Screen also includes the support of an experienced reimbursement team. We will work with you to answer any billing and coding questions along the way.
Coverage of diabetic retinopathy screening varies by payer. We recommend that you check with your patient’s insurance provider to verify reimbursement eligibility prior to screening. Coverage may also vary depending on what type of eye exam a patient has had in the past. If a patient with diabetes has only had a dilated eye exam, then payers may be more likely to cover screening for diabetic retinopathy. Even in cases where a patient has had a prior screening exam, payers may still cover an additional screening exam provided the appropriate criteria are met. Again, we recommend that you verify coverage with each payer.
No, the reading physician does not need to be credentialed, as they are not billing for the professional component of this service. As a Topcon screen customer, the practice bills the global fee for fundus photography with interpretation and then pays Topcon an interpretation fee. Topcon then remits this fee to the reading physician as payment for their services.