How to overcome hurdles in the ophthalmic practice

Providing interpreter services can create hurdles for practices with limited resources. To help your practice overcome those hurdles, I answer some common questions about interpreter services for Limited English Proficiency patients.

Are we mandated to provide interpreter services?

Yes, Title III of the Americans with Disabilities Act (ADA)¹ and Title VI of the Civil Rights Act² require that physician practices that receive federal financial assistance, including physicians participating in Medicare, Medicaid, or any other joint federal-state program, must provide reasonable access at their own expense to interpreting services for patients who are not English language proficient.

Who can interpret for patients?

The ADA law¹ defines a qualified interpreter as: “ … an interpreter who, via a video remote interpreting (VRI) service or an on-site appearance, is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary. Qualified interpreters include, for example, sign language interpreters, oral transliterators, and cued-language transliterators.”

In a medical setting, this means the interpreter may need to interpret complex medical terminology. Using family members is not endorsed. Further, the ADA law¹ explains “… a public accommodation shall not require an individual with a disability to bring another individual to interpret for him or her.”

Can we recapture the cost with no-shows and cancellations?

Traditionally, practices are on the hook for interpreter services when patients reschedule, cancel, or are no-shows. Federally funded programs generally do not reimburse for interpretative services as they are required by the ADA and Civil Rights Act. Some Medicaid plans and potentially some commercial insurances will cover the cost. Meanwhile, the Medicare Claims Processing Manual³ is in full agreement with the ADA but allows for charging the patient for missed appointments with this caveat:

“CMS’s policy is to allow physicians and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments. The charge for a missed appointment is not a charge for a service itself (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity. Therefore, if a physician’s or supplier’s missed appointment policy applies equally to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the physician or supplier from charging the Medicare patient directly. … Charges to beneficiaries for missed appointments should not be billed to Medicare.”

How can we provide these services efficiently to our patients?

Do your research and create a language access policy⁴ for your practice. You have options to provide interpreter services in your practice, such as in-person or remote services. Below are some tips to get started on your protocol.

• Research your top payers to see if any provide reimbursement for interpreter services. Some Medicaid plans will reimburse you, provided you use their specific vendor for interpreter services, which may or may not be convenient. Weigh the efficiency against cost when creating your office protocol.
• Research language interpreter vendors, and ask other practices for their vendor recommendations. Also, investigate the method that will be most efficient for your practice: online, dial-up, log onto a site, etc. Remote services can help with avoiding in-person minimum hours, the need to schedule the services, and rescheduling costs. Work to ensure a large selection of languages is available, as well as video options for sign language and lip-reading along with audio capabilities.

Having standard procedures will make the entire process more efficient and enable your staff to better handle requests for and delivery of interpreter services in your practice. OP

REFERENCES:

1. Americans with Disabilities Act Title III Regulations. Department of Justice. https://bit.ly/3LjQOVu . Accessed March 13, 2023.
2. Limited English Proficiency (LEP). U.S. Department of Health & Human Services, Civil Rights. https://bit.ly/2MyIZ03 . Accessed March 13, 2023.
3. Medicare Claims Processing Manual: Chapter 1 – General Billing Requirements. CMS. https://go.cms.gov/3YEO741 . Accessed March 13, 2023.
4. Language Access Assessment and Planning Tool for Federally Conducted and Federally Assisted Programs. Department of Justice. https://bit.ly/3mOli7Y . Accessed March 13, 2023.

Ms. Brown is a senior consultant with BSM Consulting in Tucson, AZ. She has experience in the ophthalmic industry holding managerial, clinical, and surgical roles for more than 30 years.