Frequently Asked Questions

CE Credits

Q. Does MOA track my CE credits?

A. No – Please keep your own personal record of your credits. You may also visit: www.ARBO.org to review your CE credits.

Q. Does MOA provide a Certificate of completion?

A. No - go to www.ARBO.org to print your certificate

Q.Are we limited in how many online CE credits we can do?

A. A maximum of 20 hours relating to self evaluation journal tests and multimedia education, including online continuing education.

Q.What are the COPE course category definitions?

CLINICAL OPTOMETRY
- Contact Lenses (CL) All aspects of contact lens therapy inclusive of keratoconus and postsurgical treatments.
- Functional Vision/Pediatrics (FV) Those portions of optometric practice that deal with visual processing and neuro-optometric rehabilitation, including sports vision; binocular vision; and visual training or vision development courses.
- General Optometry (GO) Any study in the area of the eye and vision care, which constitutes eye and vision research, or examination, diagnosis and treatment of anomalies of the human eye and visual system. For the purposes of these categories .General Optometry. excludes any other category enumerated here.
- Low Vision (LV) All aspects of low vision devices, care and therapy.
OCULAR DISEASE
- Glaucoma (GL) The study of the etiology, clinical pathophysiology, diagnosis, treatment, management, and the outcomes of therapeutic regimens for the ocular condition involving the relationship of intraocular pressure and abnormal optic nerve function. Examples: Any course with major emphasis on diagnosis, treatment, and/or surgical and medical management, of glaucoma (i.e., trabeculectomy, laser surgery for glaucoma).
- Peri-Operative Management of Ophthalmic Surgery (PO) The study and clinical training of any ophthalmic surgical procedure of the eye and adnexa (not to include any other procedures covered in other categories). Examples: Includes all aspects of pre- and post-operative management of ocular surgery care (excluding Refractive Surgery), i.e., cataract, lid surgery/procedures, strabismus surgery, keratoplasty, etc.
- Refractive Surgery Management (RS) Instruction and/or clinical training in refractive or photorefractive technologies, which may include Peri-operative Patient Management: Counseling and evaluation for indications or contraindications in patient selection, including recognition of associated complications and course of action in analysis and treatment. Examples: Courses related specifically to management of PRK, RK and LASIK patients; corneal refractive surgery, etc.
- Treatment & Management of Ocular Disease: Anterior Segment (AS) The study of the etiology, clinical pathophysiology, diagnosis, treatment, management, and outcomes of therapeutic regimens for anomalies of the anterior segment of the human eye. Examples: Keratitis, anterior uveitis, conjunctivitis, blepharitis, lid anomalies, foreign body removal, etc.
- Treatment & Management of Ocular Disease: Posterior Segment (PS) The study of the etiology, clinical pathophysiology, diagnosis, treatment, management, and outcomes of therapeutic regimens for anomalies of the posterior segment of the human eye. Examples: Degenerative, infective, and vascular diseases of the retina/choroid/sclera and optic nerve, inclusive of all aspects of surgical care involving the posterior segment of the eye, i.e., retinopathies, neuropathies, retinal laser surgery, retinal detachment surgery, etc
RELATED SYSTEMIC DISEASE
- Neuro-Optometry (NO) The study of the etiology, clinical evaluation, diagnosis, treatment and management of disease and disorders of the nervous system, both systemically, and as it relates directly to the eye and visual system. Examples: Includes all aspects of nervous system conditions involving the brain, cranial nerves, spinal cord, peripheral nerves, and corresponding muscles, i.e., multiple sclerosis, pituitary tumor, brain trauma, Myasthenia Gravis, papilledema, Horner.s Syndrome, etc.
- Pharmacology (PH) The study of the interaction of chemical agents with biological systems. Examples: Toxicology; adverse effects of systemic drugs; adverse effects of ocular drugs; control of ocular pain. Any courses related to medications and how they affect the various tissues or their mechanism of actions.
- Principles of Diagnosis (PD) The study of the art and science of the process of determining the nature and circumstances of a diseased condition with emphasis on the biological and clinical procedures utilized in medical examination and disease differentiation, and underlying clinical pathophysiology, e.g., corneal topography, visual fields (unless specific to glaucoma); laboratory testing and imaging; fluorescein angiography; gonioscopy.
- Systemic/Ocular Disease (SD) The study of the relationship of any anomaly of normal function of the human body and the possible manifestation of such as signs and/or symptoms in the eye or visual system. Examples: General study of diabetes,HIV/AIDS, thyroid disease, etc., along with their ocular manifestations. Vascular diseases both systemic and ocular.
(OPTOMETRIC) BUSINESS MANAGEMENT
- Ethics/Jurisprudence (EJ) The study of body of law and ethics in the practice of optometry and its relationship to the medicolegal system. Example: Any courses related to rules and practice acts for optometry or addressing medicolegal issues related to patient treatment, judicious prescribing, medical errors and other liability concerns and issues.
- Practice Management (PM) The study of management of the affairs of optometric practice. This does not include courses that are intended strictly for personal enhancement, business development, or investment prowess. Examples: Concepts in managed care and operations management; courses designed to help market practices; educate and/or manage office staff; improve fiscal efficiency; billing and coding, clinical record keeping, etc

Practice Questions

Q. Are optometrists subject to the surety bond requirement?

A. No

The surety bond requirement for DME suppliers traces back to a 1997 federal law that CMS has finally implemented. The AOA and others successfully explained to CMS that the surety bond requirement was not intended to apply to physicians (including ODs). In January 2009, CMS published the final regulations and agreed with us that physicians who supply DME do not need to obtain a surety bond. There are two exceptions. First, CMS does not want DME supply companies to elude the rule by naming a physician as a figurehead, so CMS cautions that the exemption applies only to physicians who supply DME to their patients. When a patient comes into an optometrist’s practice for care, a doctor-patient relationship is probably established. Second, since opticians are not physicians, opticians still need a surety bond. If an optometrist employs an optician and the optician has a DME supplier number, then the entire practice might need to obtain a surety bond. We think these two carve outs will not subject many ODs to the surety bond requirement.

The bottom line is that all or nearly all ODs who supply post-cataract eyeglasses to their Medicare patients do not need to obtain a surety bond. A new DME supplier enrollment form has a section on surety bonds and includes an option for the OD to check a box that they are exempt from this requirement. If CMS, the National Supplier Clearinghouse (Palmetto) or your DME contractor insists that an OD must obtain a surety bond, then please let us know about that situation.

AOA Secures OD Exemption from CMS Surety Bond Requirement (.pdf)

Board Certification: Changes include ‘board eligible’ status, governance (.pdf)

Q. Is an optometrist authorized to prescribe medical marijuana to patients?

A. No

The medical marijuana law, as passed by the voters, does not allow ODs to sign certifications for patients to register as medical marijuana users. Only a "physician" can sign the certification, and "physician" is defined to include only MDs and DOs (MCL 333.26423)

Medical professionals aren't going to dispense the marijuana, so it won't be placed in the controlled substance schedule.

Medical professionals will simply issue "written certifications" stating what the patient's debilitating medical condition is and offering a professional opinion that the patient will likely receive therapeutic or palliative benefit from medical use of marijuana. The patient then uses the "written certification" to register with the Department of Community Health and obtain a registry ID card. Persons who register in this way are protected from arrest, prosecution and penalty for having or using medical marijuana in accordance with the act.

The issue for optometrists is the new law's definition of "physician," which includes only MDs and DOs:

"(f) "Physician" means an individual licensed as a physician under Part 170 of the public health code, 1978 PA 368, MCL 333.17001 to 333.17084, or an osteopathic physician under Part 175 of the public health code, 1978 PA 368, MCL 333.17501 to 333.17556."

A patient is not a "qualifying patient" unless s/he has been "diagnosed by a physician ...." This means that a person diagnosed with glaucoma by an optometrist cannot be a "qualifying patient." Similarly, a "written certification" must be "signed by a physician...." The bottom line is that a patient who sees an optometrist cannot qualify for registration and, consequently, cannot qualify for these protections.

Glaucoma is included in the definition of "debilitating medical condition" in the new law. So, the scenario that Dr. Swan feared -- i.e., having a new glaucoma treatment approved that ODs can't offer their patients -- appears to already be reality.

Q. Where can I find information about licensing?

A. Visit http://www.michigan.gov/mdch/0,1607,7-132-27417_27529_27546---,00.html

Q. Where can I find information regarding DEA registration, renewal and number?

A. http://www.deadiversion.usdoj.gov/

Q. What does Michigan impose a state sales tax on?

Professional Services, such as eye exams: No
Glasses: No
Contacts: No – Medical, Yes – Cosmetic
Solutions: Yes
Cases, Sunglasses, etc: Yes
Provider Tax, Other than regular Income tax: No

Q. Can I withhold a patient’s records?

A. No, you are allowed to charge a “reasonable” fee to release charts (i.e. fees to make copies, etc).

Q. Do I have a legal obligation to see patients that do not have insurance or income to pay for services?

A. If you have an existing relationship with the patient, you cannot abandon him or her in an emergency, or in some situations where treatment is not urgent but is it necessary and there has not been reasonable advance notice that the relationship is being terminated. Abandonment is a form of malpractice in Michigan.

There is no duty to treat when a patient cannot pay, when there is no existing relationship and there is NO emergency. Rather, the patient-physician relationship is created by contract, albeit with the patient having more flexibility to withdraw from the relationship on short or with no notice. The notable exceptions relate to facilities subject to the Emergency Medical Treatment and Advanced Labor Act that requires ERs to treat people who walk in off the street when there is an emergency, though EMTALA may require federal funding for the facility in some for to apply in the first place.

Q. Am I required to release a contact lens prescription to a patient?

A. Yes. You must give the patient a copy of the patient contact lens prescription upon the completion of the fitting of the contact lens. You must do so automatically. No request from the patient is necessary and you may not require the patient make such a request.

Q. What must be included on a contact lens prescription under the Contact Lens Rule?

A. The contact lens prescription must include all the required information under both your State law and Federal law, including, but not limited to, the following:
1) the name of the patient
2) The date of the examination
3) The issue date and expiration date of the prescription
4) The name, postal address, telephone number, and fax number of the prescriber
5) The power, material or manufacturer or both of the prescribed contact lens
6) The base curve or appropriate designation of the prescribed contact lens
7) The diameter, when appropriate, of the prescribed contact lens
8) In case of a private label contact lens, the name of the manufacturer, trade name of the private label brand, and, if applicable, trade name of equivalent brand name.

Q. Does Priority Health require prior authorization for optometrist to prescribe Restasis?

A. No. Their system does, however, require DEA numbers. Include your DEA number on the Rx for those patients

Q. How can obtain my NPI?

Going to the web at https://nppes.cms.hhs.gov and fill out their online application.
Obtaining a paper application form, filling it out, and mailing it to the NPI Enumerator. They can obtain the paper application form (CMS 10114) by downloading it from www.cms.hss.gov/forms or by calling the NPI Enumerator at 1-800-465-3203 and requesting a copy.
Submitting an application through Electronic File Interchange (EFI). EFI allows an approved organization, after obtaining the permission of a provider, to send the provider’s NPI application date to us in an electronic file.

Q. What do I do and how do I accommodate a hearing-impaired patient?

A. An optometric office is considered a public accommodation under the ADA. As such, it must provide access to people with disabilities, including those who are hearing-impaired. This requires that reasonable accommodations be made to allow the disabled individual to access the services in the optometric office. Reasonable accommodations include providing auxiliary aids or services for disabled patients. One possible auxiliary aid or service for a hearing-impaired person is sign language interpreter. Other reasonable aids include writing notes, computer, or computer screen.

MOA Membership Questions

Q. Do I qualify for a Loyalty Membership?

A. Loyalty membership may be conferred by the board of directors upon any optometrist who has been an active, federal services, special class or optometric educator member who retires from practice, federal service or employment or who works twenty four (24) or few hours per week in compensated optometrically related activities.

Q. Where do I report illegal sales of cosmetic, non-corrective lenses sold by beauty salons?

A.

Michigan Department of Community Health
Bureau of Health Profession
Health Regulatory Division,
Allegation Section
P O Box 30670, Lansing MI 48909
(517)373 - 9196

Michigan Department of Labor & Economic Growth
Bureau of Commercial Services, Enforcement Division
P O Box 30018, Lansing MI 48909
(517) 373 – 9196

Food and Drug Administration
5600 Fishers Lane
Rockville, Maryland 20857
1-888-463-6332

Q. How frequently are commercial bus drivers required to have a physical exam and a vision exam?

A. A Department of Transportation (DOT) physical exam is valid for up to 24 months. The medical examiner may also issue a medical examiner's certificate for less than 24 months when it is desirable to monitor a condition, such as high blood pressure.

A DOT physical examination is conducted by a licensed "medical examiner." The term includes, but is not limited to, doctors of medicine (MD), doctors of osteopathy (DO), physician assistants (PA), advanced practice nurses (APN), and doctors of chiropractic (DC).

To find a medical examiner to conduct the DOT physical exam you may contact your primary care provider to inquire if they will conduct a "DOT physical exam." You may also find a medical examiner in the yellow pages of your telephone book, or on the Internet by using an Internet directory or search engine. If your medical examiner does not have a Medical Examination Report, one may be downloaded.

Vision Requirements:

A medical examination for a person operating or wanting to operate a commercial motor vehicle should include a driver being able to meet vision requirements as regulated in 49 CFR 391.41:

(b) A person is physically qualified to drive a commercial motor vehicle if that person-
(b)(10) Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70° in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber.