Fulfillment

Billing Compliance

100

When is the signature on file captured and what is told to the patient?

What is anytime we complete an insurance order. It gives Walmart the authority to file a claim on the patient’s behalf and informs the patient of their financial responsibility. The signature on file is stapled to the ECS and retained in the insurance record retention folder. Spot check the insurance retention folders to ensure signatures are being captured for insurance claims. 

200

When is an ABN required for a Medicare patient?

What is 

• The ABN is a standardized CMS-approved form that must be completed by both the Provider (Walmart) and the beneficiary (the patient/customer).
• The ABN is used as a written notice given to beneficiaries when the provider finds that items/services may not be covered by Medicare 
  • Medicare deems some items/services as not reasonable and necessary therefore an ABN would be required in order for the provider to bill and/or collect payment directly from the beneficiary. 
• The ABN allows the beneficiary to make an informed decision regarding the items/services for which they may have to pay out of pocket.
• The ABN must be delivered far enough in advance that the beneficiary/representative has time to make an informed decision if they want the item/service. 
• The ABN must be reviewed with the beneficiary or his/her representative and any questions answered before it is signed. 
• If the beneficiary is not given written notice (the ABN) when it is required, they will not be financially liable when Medicare denies payment. 
  • The provider will be responsible for the denied items/services o This will result in a 100% write off to the Pharmacy.
  • After all the blanks on the ABN are completed and the form is signed, a copy is should be given to the beneficiary. 
• Keep a copy of the ABN in the pharmacy filing cabinet. 
• ABN Tutorial web link: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/ABN-Tutorial/formCMSR131tutorial111915f.html 
  • After link is opened scroll down to section titled ABN Interactive Tutorial, click “Go to the ABN interactive tutorial” 
• ABN Instructions by Section-Examples of completed, auto-populated and patient refused ABNs listed below.
  • English
  • Spanish
• When an ABN is required, this is printed from BOSS/eCW, reviewed with the patient and the patient must make a selection in section G, sign in section I and date in section J before the order is finalized.

300

When should a GFE be provided to a customer and where are the documents retained?

What is A GFE should be provided when a customer ask about pricing for contacts or glasses and when scheduling AOD exams. Review the VCOG1516 for additional information. Review the record retention area for GFE retention folders. 

400

Explain each part of the Medicare packet and when it should be completed?

What is:

Operations

100

If you have an electrical fuse box/panel located in your Vision Center, what is the minimum  clearance in front of the electrical fuse box/panel?

What is there is a minimum of 36 inches of clearance in front of the electrical fuse box/panel. Ensure that there is nothing posted on the electrical fuse box/panel or that it is obstructed by filing cabinets, storage boxes, or merchandise. 

200

Where  are the VC/Optical keys stored and who has access to the keys?

What is Only VC/Optical associates should have access to the VC/Optical keys and lockbox. The VC/Optical keys should include copies to IOD areas to ensure authorized access when directed. 

300

What is a key log? Where should it be retained and for how long?

• The Permanent Key Issue Log should be retained in the Vision Center/Optical document retention file cabinets.
  • The log should be retained for 10 years from the date listed on the log.
  • The log can be accessed/printed by clicking the link above.
• The log should be used any time a permanent key(s) is issued to a VCM, OM, AOD, Temporary Manager in Charge, and/or IOD
• In the event of a rekey:
  • New keys being issued should be listed on the log.
  • If a rekey is needed the service can be requested through Fixit>Maintenance & Repair>Locksmith Services.
• Any rekeying requests should be discussed with and approved by the MHWD/OMM before opening a ticket. The facility manager should be made aware of the request and provide guidance on local codes/ordinances.
• All keying changes must follow federal as well as state/local guidelines regarding compliance and protection of PHI.
• When a rekey takes place it should be documented in REACH using the HIPAA Maintenance Form.

400

Walmart owned what requires tethering?

What is Oculus laptops and Zeiss devices (Zeiss HFA and Zeiss Matrix Visual Field devices) 

dditionally, the Oculus laptop, Zeiss HFA and Zeiss Matrix Visual Field devices must be secured. Please verify that the tether is in good condition and shows no signs of breakage or tampering. Replacements are ordered by submitting a ticket to HWequipment via the BOSS system

500

what optical selling and dispensing activities must not be performed by the associate. (If you are in a state requiring licensure or registration, ask the associate what selling and dispensing activities must not be performed if a licensed optician and/or sponsor is not present).

HIPAA Compliance

100

What steps you should take to validate the identity of a caller before disclosing patient information?

What is Per POM/VCOG 1609 Identification and Authority, when an individual calls Vision Center/Optical or Pharmacy, associates should: 1) Verify the identity of the caller by asking them to provide four (4) patient identifiers and 2) Verify the authority of the caller and obtain any necessary documentation to substantiate the caller's authority to request the information. 

200

What does Minimum Necessary standard mean with regard to a patient's protected health information?  * 

What is Per POM/VCOG 1611 Data Use: Minimum Necessary, Limited Data Sets, and De-Identification, associates must make reasonable efforts to limit the use, disclosure, or requesting of PHI to the minimum necessary required to accomplish the intended purpose. The minimum necessary standard has exceptions listed in POM 1611 under the Section Minimum Necessary Standard. 

Practice Compliance

100

When it is appropriate to dispense a trial/diagnostic contact lens to a patient or customer.

What is Associate must only dispense trial contact lenses for a valid, unexpired prescription. 

200

Describe the procedure if a patient requests a copy of their prescription and the doctor's office is closed.

What is Select N/A if our associates do not provide Support Services or if the location does not currently have an Independent Optometrist. Note: If the Independent Optometrist has completed and signed prescriptions in patients' files and instructs associates to provide a copy to the patient through contracted Support Services, this is permissible. 

300

What do you do when a patient comes into the Vision Center/Optical asking to purchase contact lenses but does not have a prescription in hand and there is not one in BOSS.

What is Refer to VCOG 1509 - Contact Lens Prescription Verification for proper procedures. 

 Associates may contact the patients’ prescribers directly to obtain faxed copies of prescriptions or may use the contact lens prescription verification process outlined in this Procedure.

400

What should you do if the associate is contacted by a regulatory agency at their home regarding the associate's actions or responsibilities at Walmart or Sam's Club. 

What is subject to the regulatory agency communication reporting requirements as outlined in VCOG 1501 

After an Inspection / Visit or When Communication Occurs

• Immediately contact your Market Leader with results of the inspection.
• Log all protected health information (PHI) disclosures, if any, which were made during the inspection, according to the appropriate HIPAA disclosures procedures, as outlined in the applicable policy listed below (see POM/VCOG 1613 under “Logging PHI Disclosures” for list of exceptions):
  • POM/VCOG 1603 – Uses and Disclosures Requiring an Opportunity to Agree or Object
  • POM/VCOG 1604 – Uses and Disclosures Not Requiring an Authorization
  • Other POM/VCOGs in the 1600 series
• Log the inspection, visit, or communication by completing the appropriate form(s) in REACH.
  • To access REACH, click “Report Regulatory Contacts” on the ribbon of the Home Page of OneWalmart, and select “Regulatory Agency Contacts-US” on the left side.
  • Alternatively, you can navigate to here: wmlink/RegContacts

500

What constitutes a regulatory agency and what they should do if they receive a visit or communication from a representative of a regulatory agency.

What is Examples of regulatory agencies include, but are not limited to: Law enforcement, State Board of Opticians or Optometry, Department of Professions and Licensing, State Attorney General’s Office, Better Business Bureau, Medicaid Fraud Control Unit, Office of the Inspector General, Any Federal or State Agency or Contractor 

Records and Information Management

100

Where should IODs store their records?

What is stored separately from the Vision Center/Optical records and entirely within the optometrist’s leased space. 

200

Where should the Vision Center/Optical records be  retained?

What is Records should be stored in a secure location. If records are stored in an area other than a room, a keyed lock must be in place with the key stored securely per VCOG 1622. The Records access log must be completed every time the records are accessed. Verify the lock to the record retention area is functional and is locked when not in use. 

300

What must an associate do each time the retention cage is accessed? 

The Records access log must be completed every time the records are accessed.

400

Who can have access to retention cage?

Only Vision Center associates

CARE

100

What does the acronym CARE stand for?

What is