What are Insurance Audits and how important are they? Dr. Bethany and Dr. Viktoria discuss what the factors are for an Insurance Audit and how we can be ready for them.

September 7, 2022

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Dr. Viktoria Davis: If you are billing appropriately and correctly, you don’t have to worry about if you do happen to get audited. The most important thing is that you can substantiate what you’re billing and that your charts can support what you’re billing.

 

Dr.Bethany Fishbein: Hey! Welcome back to the Power Hour Optometry podcast. I am Bethany Fishbein, host of the podcast and CEO of the Power Practice. And we’re continuing my series that we fell into accidentally of things that strike fear in optometrists. We’ve gone from violence in the office up to and including an active shooter situation, jumped over to Medical Malpractice, and we’ll round out and hopefully, finish this series today with the other terrifying item in the Trio which is a potential of an Insurance Audit. Probably after this, people are going to email me and we’ll think of other things and there’ll be more parts. But this is what we’ve got for now. So my guest today is Dr. Viktoria Davis. And Viktoria is a private practice optometrist. She’s one of our consultants at the Power Practice. She’s our Director of Billing and Coding. She’s been a guest on the podcast before. And Viktoria is the one behind our service. It’s called a Power Audit  which we’ll talk about in a moment. But it’s kind of a friendly insurance audit. A way to see how you’re doing without all the fear that goes with her real audit. And we can talk about that. But for now, Viktoria, thank you for coming on again.

 

Dr. Viktoria Davis: Thank you for inviting me. It’s always a pleasure. It’s always fun to chat with you.

 

Dr.Bethany Fishbein: I think when we did this last time, it was one of the first times I had ever recorded and was figuring all this stuff out. So now, hopefully, I got a little experience under my belt and we can get things running smoothly here. 

 

Dr. Viktoria Davis: Hopefully so. You never know. Technology always can have glitches. I was at a doctor’s appointment with my daughter the other day and they were in the middle of doing a procedure and the power went out in the entire building. Which was a little terrifying as well in a different way to strike fear into hearts. But you never can predict everything that’s going to happen and that perhaps is something that dovetails well into the strike fear into hearts because I am, as you well know Bethany, a huge planner. If I had my way there would never be any surprises in life. And you never know what life is gonna throw at you. But there are certainly ways to prepare for some things. And I guess that’s what we want to talk about today. 

 

Dr.Bethany Fishbein: Absolutely and thank you for the segue and I appreciate it. That’s been the message, right? You can’t control these things that are going to happen. But controlling the things that you can, and knowledge, and preparation just helps get you set. So that when something does happen, you are absolutely as prepared as possible. And that’s what we’re trying to do here. We’ll talk about some of the things that you see when you do Power Audits in a practice. And what are some of the common things that could get somebody in trouble in the event of a real audit. That, hopefully, somebody listening hears these and says, “Oh! Maybe I do that.” and takes a look at their own charts and corrects it before an audit ever takes place. So that if it does, they can say, “ Yeah. So what? Yeah, it’s a little bit stressful, but I know I’m doing the right thing.” And that’s really what we want. 

 

Dr. Viktoria Davis: Exactly. 

 

Dr. Bethany Fishbein: Talk about just the idea of an Insurance Audit in general. Like why are they done? What are they looking for? Why does that even exist?

 

Dr. Viktoria Davis: So the biggest reason why audits exist is because the insurance companies want to make sure that their money is going to things that are actually legitimate items and legitimate reasons. It’s kind of like the same way that people may track their own personal expenses or, you know, look at their credit card statement when it comes through rather than just paying it all and never checking anything on it. There certainly are people that do that but it’s not recommended because you want to know where your money’s going. And in case some of it is being misdirected, particularly fraudulently misdirected. You know, like I say it’s like your credit card. If somebody’s using your credit card and you don’t know it,  that’s bad. And the only way to know that is if you watch it and you keep track of it. And that sort of is the same idea behind an Insurance Audit. The insurance company wants to make sure that their money is being used for actual real legitimate medical purposes. The way that they do that, they can’t just, you know, pull up a credit card statement and say, “Oh, yeah, that looks right.” They have to, you know, their way of doing that is to ask. Well, originally, to run kind of a report and see what looks like it’s outside of normal. That’s typically the way that an audit starts. Seeing unusual billing trends from a particular practice or provider or things like that. There are some random audits as well. So it doesn’t necessarily mean that you got “flagged” for lack of a better term. But basically they’re just saying, “Hey, is our money going to legitimate purposes? And are we paying you for things that you actually did? And can you substantiate that?” It’s, again, going back to the analogy of your credit card statement. It’s kind of like looking at the statement and then going and checking the receipt or something like that and saying, “Oh, yeah, that is legitimate.” 

 

Dr.Bethany Fishbein: So there are some that are just random like your number came up and they’re gonna look at you for no apparent reason. And then there’s some, like you said, that can get flagged because of unusual billing practices. Do you know what some of those unusual billing practices in optometry could be?

 

Dr. Viktoria Davis: Well, this is something which I always kind of object to with a lot of my fellow code-heads or things like that. When they’ll say something like, “Oh, you don’t want to bill, for example, a level five office call because that’s a red flag.” And I completely and totally disagree with that. Because like you were saying in the beginning, if you are billing appropriately and correctly, you don’t have to worry about if you do happen to get audited. The most important thing is that you can substantiate what you’re billing and that your charts can support what you’re billing. So you know, although it is not typical for optometrists to bill, you know, a huge number of level five office calls, there may be practices that do. You know?  As you know Bethany, from your low vision practice, some of those low vision patients take a lot of time. Particularly now that office calls can be billed strictly on time. You know, if you spend more than 54 minutes with an existing patient, that’s a level five office call. So like I say, your low vision practices, your rehab practices, things like that. You may be getting a lot of level five office calls. There’s not a reason for you not to bill that even though that may be outside the norm for most optometry practices. I always say it’s kind of like the old phrase, “It’s not rare if it’s sitting in your chair.” You know? It’s as far as disease goes. Your billing as long as you’re billing it accurately and appropriately is unique to your practice. And that may mean that it’s not unique to the practice down the street or others in the state or in the nation, and that’s okay.

 

Dr.Bethany Fishbein: So when you’re selecting codes and you’re doing the billing, really, it shouldn’t be about worrying about whether what you do is going to trigger an audit. It just has to be about making sure that it’s appropriate for what you’re doing.

 

Dr. Viktoria Davis: It is and making sure that your chart supports that. You know? That you are actually billing and coding and developing that code off what your chart says. Not necessarily what you remember from the exam. Not that you know that you did what your chart says that you did.

 

Dr.Bethany Fishbein: So if you get audited, and we’ve gotten those letters in the practice, I mean, they’ve been presumably for random audits. But I guess you don’t really know. If you get that letter that says, “We’re reviewing our charts, can you please send the records for these 10 encounters? That’s an audit. Right? Is that an audit?

 

Dr. Viktoria Davis: That is an audit. Yes, that is absolutely an audit. Yeah. In some cases. I mean, there’s all sorts of different things that there can be audits for as well. There can be audits of certainly for insurance billing, which is kind of what we’re talking about today. There can be audits that insurance companies run to make sure for example, that diabetic patients actually are getting their eye exams. That’s something which has been pretty common in certainly in our state. As there’s been more emphasis on, you know, proper care and coordinated care and things like that. So we will not infrequently get what are called the HEDIS audits. I don’t even know if that’s how you say it. But it’s HEDIS which basically is health, education, and information. I forget what it stands for. But anyway, basically, they aren’t auditing our billing and coding. What they’re auditing is they’re actually making sure that their patients are getting or that they’re insured people are getting appropriate care. And they have on record that this person saw an eye doctor, so they’re making sure that they actually got a Dilated Fundus exam. 

 

Dr. Bethany Fishbein: So that’s actually like a quality control audit? Not a billing audit? 

 

Dr. Viktoria Davis: Exactly. And those, I mean, we get those very commonly in my practice. It’s something that, I don’t know, if it’s just a Minnesota thing or if it’s a nationwide thing. But like I said, certainly in Minnesota. We get those all the time. That just say, “Hey, we want these charts just to make sure that this patient actually had these the services.” which is they’re making sure that they’re doing a good job taking care of their insured clients which I think is a good thing. 

 

Dr.Bethany Fishbein: So usually you get that request for the charts. It’s a little bit stressful just because you have to print everything out and it’s just like a pain to do it. Then you send them in and ideally, nothing really happens after that, right? So if nothing really happens, that means that you probably pass that audit? 

 

Dr. Viktoria Davis: Correct.

 

Dr. Bethany Fishbein: They looked at it. They saw it. They wanted to see everything was fine and then it goes away. But what happens if they look and then they see something that doesn’t make sense to them? What could happen from there? What’s the scary part?

 

Dr. Viktoria Davis: It depends on the insurance company. Each insurance company will handle things a little bit differently. So, you know, the experience that I talk about, you know, there certainly are going to be listeners who say, “Oh, well that’s not right. That’s not what I had.”  And don’t send emails to Bethany because, you know, every insurance company could treat things differently. But certainly, if there is something that they find that they are concerned about then typically they will send a letter that says there were errors that were found, you know, in your coding or your charting or things like that. Frequently that letter will say, at least in general, what the problem was. The big scary part about it is that frequently there is a dollar amount that is attached to this letter that says, “Because of what we found here, you have to pay us back some sum of money.” The thing which is most scary about this for doctors is that usually insurance companies will extrapolate based on their audits. So in other words, if they asked for 10 charts and they found three of them with audit problems, you know, with problems, be it insufficient records to support the code that you selected or whatever, they won’t just ask for the money back on those three charts. They will ask for the money back on 30% of the services that you billed in that category with that insurance company. So if you billed 1000 of those codes, they’re going to ask for money back on 300 of them. And that’s where things get, you know, dollars add up and things get scary.

 

Dr.Bethany Fishbein: Does it happen anymore that they send a person to visit? Or is it all like mail and electronic now? I remember the early days of practice, like an auditor, came to the office unannounced.

 

Dr. Viktoria Davis: I’m sure that there still are some insurance companies that do that. This was another era in which COVID kind of changed things a little bit because insurance companies couldn’t send people out into you know, health care practices, and people couldn’t show up on announced and things like that. And I think they realized that they could get a lot more work done if they didn’t have to travel and if they just stayed home and evaluated their charts at home or in the office. So most of them now are done either by sending the chart somewhere and then with processes done via electronic communication or by mail. Like I say, that’s no guarantee that there isn’t some insurance company that still sends those auditors out in person but it is the exception rather than the rule at this point.

 

Dr.Bethany Fishbein: And I don’t know if you know, I mean, I guess we’re just guessing but are they looking for accidents? Are they really looking for fraud and sometimes finding carelessness? You know, like you see these articles in the newspaper or online or whatever about, you know, somebody’s billing for podiatry services for patients who don’t even have feet. There’s a big fraud. And when an optometrist gets this, there’s some for optometry too. I’ve seen those. But the average optometrists doing a good job when they get this, you know, you saw the patient you know, you took care of the patient, you know, you did stuff. Is there a delineation or both of those just things that audits can catch?

 

Dr. Viktoria Davis: It really is just things that audits can catch. I mean, they’re really looking for the big fraud, they care a whole lot more if somebody you know fraudulently claimed $10 million in claims for people who were all dead on that data service. Then if you billed a level four and only had documentation for a level three, you know? I mean they care more about the big fraud stuff but that doesn’t mean that they aren’t going to catch the little stuff as well.

 

Dr.Bethany Fishbein: So they’re just kind of casting their net or something triggers it and they see what they’re going to see. And if they see something that they don’t like, they can take back money for not only the services that they looked at but for some, whatever they think that represents over the amount of time that you’ve worked with them or that they’ve determined as appropriate. So that’s pretty scary. I get why people worry about that. And so when you do these Power Audits, we call it a friendly audit, which is that you’re really just doing it for the sake of information.

 

Dr. Viktoria Davis: Exactly. Correct. By the time, and one thing that I was going to mention back when you were talking about the process, you know, they asked for these charts and then you have to send them. My personal recommendation is that the doctor not be involved in pulling and copying those charts that the insurance company asks for. Because by the time that they’ve asked for charts, it’s too late to fix anything. One of the worst things that you can do.

 

Dr.Bethany Fishbein: So you don’t advise going back to change them? Is that it?

 

Dr. Viktoria Davis: Correct. At that point, right? And that’s something which is tempting to do, you know? Because you might look over them and be like, “Oh my gosh, I didn’t write this down.” or “I didn’t record this.” or “This isn’t completed or whatever.” Don’t try and change things in your charts after they’ve already requested the chart. That smells bad. So you know? So like I say, I recommend even just having a staff member do it. Because what’s in your chart is in your chart. But the whole point of the friendly audit is to let you know what things are looking like now and how you can do better in the future. It’s kind of like, you know, if you have a heart attack, you want to stop smoking. But it’s not really going to help the heart attack if you stop smoking right now. The train has already left the station there but that doesn’t mean that you can’t improve things for the future.

 

Dr.Bethany Fishbein: Yeah. And I mean, the example that you gave, right? Of if the doctor pulls the charts and looks at them with that critical eye if they get the audit and they pull the charts themselves and they look and they say, “Oh no, I forgot to enter this. I didn’t record this. I didn’t know what this was or whatever.” That’s a sign, right? That they can analyze in that manner. And so it’s just making the time and making it a priority to do that periodically every two years or two to make sure. And then?

 

Dr. Viktoria Davis: Exactly. Yes. Absolutely. If doctors are comfortable with their own billing, and they think that they know what they’re doing, and they think that they’re doing things right, and stuff like that. I very highly recommend that they themselves pull, you know, some handful of random charts, you know, 10-20 charts a year or something like that. Go through them and look at them and be like, “Okay, am I doing this right?” or “Oh, wow, have I forgotten something? Do I need to change something?” Because it just happens that we slip into habits or our staff does or things like that and you don’t know if you don’t know? So it’s always a good idea to do those internal audits or self-audits as well. No, of course, if you don’t know what you’re looking for, and then that maybe isn’t terribly helpful, and that’s when getting a friendly audit done first to teach you what you’re looking for is a very good idea.

 

Dr.Bethany Fishbein: Okay, so let’s kind of get into the substance of that. When you do those, I want to talk about some of the things that you see pretty commonly. Just common errors that could get an office in trouble if they got into one of these. Maybe people can hear this and go back and recognize something they do and correct it. So what are some of the like super common easy-to-fix mistakes that you see when you do this?

 

Dr. Viktoria Davis: Probably the number one thing that I see, well, pretty much all of them have to do with documentation first. So many of the errors that I see in charts are purely due to documentation errors. Whether that be items that are missing from the chart or documentation within the chart which is internally inconsistent. We’ll talk about that in a little bit. Or, you know, reports that are incomplete or charts that are unsigned. Those are all documentation sorts of things. But the one that I really find most commonly that people don’t even think about is that an individual chart needs to stand on its own. Now what I mean by that is that an auditor, were they to come in, you know, or request the chart. They can only request the chart for a given timeframe, a given, you know, range of dates. But I have patients that I’ve been seeing for, you know, all 25 years I’ve been in practice. They are not going to be able to request that chart. They can’t even look at things that are outside the specific timeframe of their audit. And so that means that you can’t just reference, “See previous history.” or something like that. It needs to be stated explicitly in each chart, what they’re there for. And, you know, if they’re somebody with glaucoma or something like that, you know, you can’t just say, “Same as previous.” or something, you know? The chart has to be able to stand on its own. One of the things which I see most consistently as well is that it is very frequently not explicitly recorded whether a patient is a new patient or an established patient. So you’re reading through the chart, you know, as an auditor. You’re reading through the chart and you have no idea if this patient has been seen in this practice before or not, which can dramatically change how you’re looking at the chart. And not only that, it can obviously, will change your billing. The code which is selected. And if it appears that it was an established patient, but they billed a new patient code, that’s going to be a problem. So I always recommend that practices state very, very clearly on the chart, “Existing Patient” or “New Patient” here or “Last exam here” and the date or something like that. So that it is extraordinarily clear, right off the bat, whether it’s a new patient or an established patient.

 

Dr.Bethany Fishbein: That’s like true, right? That’s if you’re writing a chief complaint, blurry vision, right? Or chief complaint, eye pain, and the patient report it’s resolving. And you saw that they can’t tell from that if you’ve been seeing that patient for three weeks in a row following a corneal ulcer or are seeing them for the first time that day. Right?

 

Dr. Viktoria Davis: Correct.

 

Dr. Bethany Fishbein: So like every time, you have to have the meds and the Family History. You can’t write, “Unchanged from the previous.”? So if your EHRs make it pretty easy, right, you can copy that from last time. But in a paper chart,  if doctors are still using that, meds, etc, it should be recorded every single time,

 

Dr. Viktoria Davis: Correct. Yep. 

 

Dr. Bethany Fishbein: Wow. Okay. 

 

Dr. Viktoria Davis: Yep. And you bring up an interesting point. As far as EHRs make things easy what you can bring forward, that leads to the next most common thing that I see, which is improper use of pull forward in EHRs. Because it is so easy in those EHRs to pull forward findings. And this is particularly done and this is kind of another instance of something that I see commonly, is your chief complaint has to drive your exam. So if your chief complaint which is listed is that the patient feels like they got something in their eye. They were out grinding yesterday afternoon without eye protection or you know. You can tell I’m in a rural area. This is your chief complaint and this will make sense. And then you go through the chart, and there’s a recording of a Fundus examination. That chief complaint does not, you know, like you may have that you removed, you know, piece of metal from the eye or whatever. But there’s no medical reason to have a Fundus exam there. And maybe you just accidentally hit the pull forward button and put that in there. If there’s a reason why you have it if you’re like concerned about a penetrating foreign body or you know, something like that, then I mean. I’m trying to figure out a reason why you might medically need to do a Fundus exam in this example. But, you know, I always try to give people the benefit of the doubt. But most of the time, it’s not recorded why they needed to do those kinds of things and it is just a case of an inadvertent pull forward.

 

Dr.Bethany Fishbein: Before you go on to the next. That one is super easy to do, like, especially I mean, I’ve seen it in practices. A patient has a red eye or something and all of a sudden they’ve had that red eye for years in the chart. And they probably one year stopped having it very shortly after the first time they did have it. But yes, okay. So it makes it easier because you’re not writing out a whole list of meds. But it also opens you up to be lazy and just copy forward without looking which is a problem.

 

Dr. Viktoria Davis: Yes, some EHRs give different categories of pull forward. So you may be able to pull forward an entire exam so that, you know, and that sounds awesome. You’re like, “Oh, I can pre-populate this whole exam as normal or something,” Because, “Oh, it’s probably going to be, you know.” or pre-populated from what they had before. Or you can pull forward sometimes like one page on the screen, or you can pull forward an individual test like a slit lamp exam and pull forward that section. I personally recommend that you pull forward as small a section as possible, because otherwise, it’s way too easy to miss that you didn’t do something on this exam, you know. That, “Oh yeah. On this exam, I didn’t. I don’t know. Do Gonioscopy or something.“ But, “Oh, look, my chart says that I did.” You know? Because I just use the pull forward entire exam, but I mean, I don’t know. I’m just kind of pulling things out. But it is so easy to inadvertently record the same data using pull forward.

 

Dr.Bethany Fishbein: I’m thinking about Eisah in our practice. We were recording height and weight, you know, when you had to do that for the reporting or whatever. We started doing that and that got pulled forward along with medical history. So you would have this patient in the chair right before they’re leaving for college, you know. Six foot two to go play soccer or whatever at university and you look and it says their height is four three and they weigh 61 pounds. I’m like, “Yeah, okay, probably guilty of doing that.” And really, the thing is, once you sign and close your chart for the day, whatever’s in there, you’re saying, “This is what I did.”, Right? Like that’s what kind of signing the chart is about. It is you’re putting your stamp of approval on whatever is in there. And so, if it’s not accurate, it doesn’t matter because you put your name or your initials or whatever you said it was.

 

Dr. Viktoria Davis: Yeah, technically when you sign a chart, you are certifying you as the doctor. You are certifying and attesting that all of the information contained in the chart is complete and correct to the best of your knowledge. 

 

Dr.Bethany Fishbein: Okay. So look at the chart, and make sure that that’s actually true. It is a big thing to do to just protect yourself. So that if you are audited, you have a better likelihood of passing.

 

Dr. Viktoria Davis: Correct Yep. 

 

Dr. Bethany Fishbein: Talk about signing the charts because I remember that came up in a Power Audit that was done with one of our clients. And it honestly was something that I didn’t even know. That even if it’s a solo doctor in practice and one doctor is seeing every single one of the patients, they still have to sign their chart.

 

Dr. Viktoria Davis: Absolutely. Yep. And this, again, goes back to the you as the doctor are certifying that all the information in the chart is complete and correct to the best of your knowledge. Is that if you don’t sign your chart, then nothing in there. Basically, if you don’t sign the chart, nothing was done as far as any insurance company or legal entity would accept. Because it is not like I say, “You have not attested to that. You have not certified that the chart is correct.” And so even in a solo practice, and most of the reason for that is because in most like EHRs and things like that, you know, staff may be able to go in and change things. Until the chart is signed. Typically once the chart is signed in any EHR, it’s much more difficult to go in and change things. There’s a reason for that. Back when we use paper charts, I remember when I was even like in school and stuff, it was always recommended that you used black ink for like for all your findings on that day once you sign the chart. But if you had to change something, for whatever reason, make a correction or whatever, then you use blue ink to do that. I have no idea if that was just something that I heard or put. I mean it makes sense. Because again, then you’re showing what was done when and once that chart is signed, that chart is complete. But until it’s signed, it’s not. You also shouldn’t bill anything until it is signed.

 

Dr.Bethany Fishbein: That’s kind of a mindset shift because I think most I don’t know a lot of doctors see the signing of the chart as indicating, “I saw the patient.”  Right? Especially in a multidoctor practice. When I signed a chart, it means I saw them instead of my husband or somebody else. And always that’s it. So I think shifting that to the blurb that you said you know, “I attest that everything in here is correct, etc.” is a good mindset. What’s another common thing?

 

Dr. Viktoria Davis: Probably another common thing I see is for like documentation on special testing. Things like photography, OCTs, visual fields, and things like that. That documentation doesn’t have to be incredibly elaborate. But it does need to include more than just, “Testing was normal.” or “Testing was unchanged.” or things like that, you know? And that’s something that I see a lot, is that that documentation on that special testing is very limited at best. For any special testing that’s done, you need to have clearly in the chart the reason why it was done and why that specific special testing was done so far. In other words, if you have a patient with, you know, glaucoma. “Okay, you want to do an OCT, you know optic nerve head, or CT. Then your reason for testing would be primary open angle glaucoma, monitor progression, and guide treatment. That’s the reason why you’re doing that. It’s not just because they have glaucoma. It’s because you are monitoring the progression of their glaucoma and guiding their treatment. And then you also need to state the results of it. So what things look like. Most of our testing that we do has some numerical values that are associated with it. It’s always an easy thing to put those numerical values in. Some EHRs will let, you know, and automatically import those numerical values from your instruments and things like that. And that’s totally fine. Otherwise, even just a brief analysis of what it is, you know, what the results of it were? And then any comparison to previous. Insurance companies love to see, you know. That again, that monitor progression and guide treatment. They want to know if things have changed. And that’s what we’re looking for. So basically it is just documenting what your brain is thinking. You know what you’re looking for when you do this. And then in that case saying, “No change from previous as your comparison is probably sufficient if you’ve stated what your results are also. And then also your recommendations. So what are you going to do about it? What happened? What are your results from this? And that could be continued Latanoprost, one drop of qHS, return three months or whatever. But why do you want this test? What is it going to do to help you? What the results of it were? What changes you saw? and what you’re going to do from it. And that’s really what needs to be documented. Like I say, this does not have to be a huge multi-page thing. This doesn’t even have to be really a multi-sentence kind of thing. One thing which I think can help all of us as optometrists now is the fact that almost every general practice healthcare these days have patient portals. And anybody who’s ever had any imaging or scans done whether that be you know, an x-ray on a broken bone or whether that be, you know? A routine mammogram or things like that. You can look on your patient portal and see what that radiologists report looks like. That’s very similar to what our special testing reports need to look like. It’s the same guidelines there’s nothing which is different for optometry as opposed to anything else. And they’re going to do the same things there. You know, as far as what they’re saying, Why did you have to have this done? What did you find? If there was a comparison to the previous, what any changes were and what they’re going to do about it? And that’s like I say exactly the same things that they’re presenting in their reports or things that we’re presenting in our reports as well. And that lack of documentation on those special testing is fairly rampant in optometry.

 

Dr.Bethany Fishbein: Yeah, I imagined that to be so. Before we close here, give an example of some of the crazy ones. Of things that you don’t see too often but you’ve seen once or twice that really could have gotten this doctor in trouble.

 

Dr. Viktoria Davis: So one of them and this kind of again, goes back to EHR documentation. And this is kind of talking about what I mentioned earlier, internal inconsistency in charts. I have no idea how this doctor’s EHR was set up. But somehow, the same test was recorded multiple times in an encounter once as normal and once as a problem. So basically, the doctor would go through and push the normal button and normalize the chart. And then if there were wrong things, then he’d go back and change those. So the same test was in the charts that I was auditing multiple times with different results.

 

Dr.Bethany Fishbein: I mean, that can’t be right, no matter which way it goes. Because it can’t be both?

 

Dr. Viktoria Davis: Exactly . It can’t be both right. It can’t be both. I mean, even down to things like CD ratios being recorded differently in two different spots in the chart. And I had a really, really hard time doing this audit because I couldn’t figure out why it was done. And like I say, when I’m doing a friendly audit, in particular, I’m always trying to give the doctor the benefit of the doubt and say, “Okay, it looks like this and you know, kind of trying to get inside their brain a little bit and I literally could not tell what was done. And most auditors at that point would have just thrown in the towel and said, “I can’t figure this out and so they don’t deserve any money.” 

 

Dr.Bethany Fishbein: Yeah, so there’s an advantage of having a friendly auditor.

 

Dr. Viktoria Davis: Definitely. So and then the other. This is one that I heard of. I did not personally see this, so I can’t actually vouch for it, but I heard it from the doctor who was doing it and I mentioned this actually on the other podcast that I did with you. With a doctor who was really trying to work the system for insurance. And so for special testing codes, which are either unilateral or bilateral, some macular or binocular, or things like OCTs and visual fields and stuff like that. He would have the patient in one day to do one eye. And then like a few weeks later to do the other eye. And bill for both of those. And there’s a lot of reasons why.

 

Dr. Bethany Fishbein:  He billed twice? 

 

Dr. Viktoria Davis: Yes.

 

Dr. Bethany Fishbein: And an office visit for each? 

 

Dr. Viktoria Davis: I don’t know for sure whether they billed an office visit for each if you’re doing just a standalone visit. Like all you’re doing is a field then, you know if you’re not spending any time with the doctor and it’s just with the technician then typically there’s not an office call that’s billed along with that. But yeah, he’d be like, “Oh yeah, they came in to get their glasses adjusted and so we just stuck them in for an OCT on one eye and then billed for it.

 

Dr.Bethany Fishbein: That crosses the line from, “Oopsie. I hit the copy Forward button.” to “I figured out a loophole and want to get paid for two fields every time I do one instead of one.”

 

Dr. Viktoria Davis: Exactly.

 

Dr. Bethany Fishbein: But I mean that exists out there. Somebody’s looking for the loopholes is probably not going to be the conscientious one saying, “I’d like a friendly audit.” They know, right? That they probably wouldn’t pass and are just taking their chances.

 

Dr. Viktoria Davis: Right? Correct. 

 

Dr. Bethany Fishbein: Okay.

 

Dr. Viktoria Davis: The much more common thing that I see and this isn’t necessarily something that’ll, you know, get you in trouble. But it’s just something which is not the smartest thing to do from a billing standpoint or bottom line standpoint, is the doctor who is so afraid of an audit that they just downcode everything, you know? For example, they’ll say, “Oh, well, optometrists. I’ve heard that they never should bill a level five. So just to be safe. I’m gonna bill level three on everything. And, you know, insurance companies don’t like that either. They really want you to bill properly, you know, and appropriately. So even though you know, they aren’t just out to get you. And I don’t think insurance companies for the most part are out to get you. Some of them may want to bleed you dry but that gets into a whole different issue. But, you know, they want you to bill properly and appropriately and bill based on what you actually did and what’s in your chart. 

 

Dr.Bethany Fishbein: Yeah. I know that. That certainly comes up I remember you did a webinar for our Power Practice clients on “Don’t Fear the Four” and it was all about level four offices and codes. And that was really the feedback that we got afterward. It was a lot of people saying, “Wait, I’m doing this and I’m coding. I’m coding for level three because I was afraid.” And that fear can be depending on the company, a $30, $40,or $50 encounter. So learning that and getting over that fear is important. Okay.

 

Dr. Viktoria Davis: Yes. And one other thing I wanted to mention here. Also when we’re talking about the process of an audit and what happens if you do get audited and when you do get that letter. There frequently, almost always, there is an opportunity for you to appeal the audit or to explain your charts in your auditing. You know, explain your side of the story. And that is always something that I encourage doctors to do. Again, if they believe in their coding and if they believe their charts are correct, then, by all means, explain it. There’s no reason just to take what they say just because they’re a big company or something like that.

 

Dr.Bethany Fishbein: That explanation, does that go with, “Okay, we’re just requesting 10 charts.” They might have just been your random turn or do you appeal when they say, “Three of these charts you didn’t have appropriate documentation for the code and we want $14,000.” Like when do you appeal? Or is it if they request those charts and then you look and you realize you didn’t sign them? And you copied forward and you have inconsistent findings, etcetera, etcetera, etcetera? And you think, “Okay, I’m gonna fail this.”

 

Dr. Viktoria Davis: Don’t give them more information than they asked for. That’s another kind of big thing is that you know, give them exactly what they asked for and only what they asked for. So don’t volunteer information, you know. Even if you looked at the charts and you’re like, “Oh my gosh! I totally messed this up should I say something?” No. Let them look at it first. And if they say that something’s wrong, you know, then follow up with that. 

 

Dr.Bethany Fishbein: Gotcha. All right, Viktoria. Thank you. You have the unique ability to make insurance interesting and give good advice and solid things that people should know and really feel doable if you just pay attention to them. If somebody wants to find out more, or is interested in getting a Power Audit, where do they go for information?

 

Dr. Viktoria Davis: They really can go to the Power Practice website, which is www.powerpractice.com. And there is a tab there that talks about the Power Audit and that’s really where more information is. There are also email addresses on there as well and we’ll come to shoot off an email and somebody will get back to you.

 

Dr.Bethany Fishbein: Awesome. Thank you so much for taking the time once again and sharing all of this useful information. To take something that sounds really scary and makes you realize it doesn’t have to be as long as you’re doing what you’re supposed to. So thank you so much. Thank you for listening. 

 

Dr. Viktoria Davis: Thank you. I enjoyed it.

 

Read the Transcription

Dr. Viktoria Davis: If you are billing appropriately and correctly, you don’t have to worry about if you do happen to get audited. The most important thing is that you can substantiate what you’re billing and that your charts can support what you’re billing.

 

Dr.Bethany Fishbein: Hey! Welcome back to the Power Hour Optometry podcast. I am Bethany Fishbein, host of the podcast and CEO of the Power Practice. And we’re continuing my series that we fell into accidentally of things that strike fear in optometrists. We’ve gone from violence in the office up to and including an active shooter situation, jumped over to Medical Malpractice, and we’ll round out and hopefully, finish this series today with the other terrifying item in the Trio which is a potential of an Insurance Audit. Probably after this, people are going to email me and we’ll think of other things and there’ll be more parts. But this is what we’ve got for now. So my guest today is Dr. Viktoria Davis. And Viktoria is a private practice optometrist. She’s one of our consultants at the Power Practice. She’s our Director of Billing and Coding. She’s been a guest on the podcast before. And Viktoria is the one behind our service. It’s called a Power Audit  which we’ll talk about in a moment. But it’s kind of a friendly insurance audit. A way to see how you’re doing without all the fear that goes with her real audit. And we can talk about that. But for now, Viktoria, thank you for coming on again.

 

Dr. Viktoria Davis: Thank you for inviting me. It’s always a pleasure. It’s always fun to chat with you.

 

Dr.Bethany Fishbein: I think when we did this last time, it was one of the first times I had ever recorded and was figuring all this stuff out. So now, hopefully, I got a little experience under my belt and we can get things running smoothly here. 

 

Dr. Viktoria Davis: Hopefully so. You never know. Technology always can have glitches. I was at a doctor’s appointment with my daughter the other day and they were in the middle of doing a procedure and the power went out in the entire building. Which was a little terrifying as well in a different way to strike fear into hearts. But you never can predict everything that’s going to happen and that perhaps is something that dovetails well into the strike fear into hearts because I am, as you well know Bethany, a huge planner. If I had my way there would never be any surprises in life. And you never know what life is gonna throw at you. But there are certainly ways to prepare for some things. And I guess that’s what we want to talk about today. 

 

Dr.Bethany Fishbein: Absolutely and thank you for the segue and I appreciate it. That’s been the message, right? You can’t control these things that are going to happen. But controlling the things that you can, and knowledge, and preparation just helps get you set. So that when something does happen, you are absolutely as prepared as possible. And that’s what we’re trying to do here. We’ll talk about some of the things that you see when you do Power Audits in a practice. And what are some of the common things that could get somebody in trouble in the event of a real audit. That, hopefully, somebody listening hears these and says, “Oh! Maybe I do that.” and takes a look at their own charts and corrects it before an audit ever takes place. So that if it does, they can say, “ Yeah. So what? Yeah, it’s a little bit stressful, but I know I’m doing the right thing.” And that’s really what we want. 

 

Dr. Viktoria Davis: Exactly. 

 

Dr. Bethany Fishbein: Talk about just the idea of an Insurance Audit in general. Like why are they done? What are they looking for? Why does that even exist?

 

Dr. Viktoria Davis: So the biggest reason why audits exist is because the insurance companies want to make sure that their money is going to things that are actually legitimate items and legitimate reasons. It’s kind of like the same way that people may track their own personal expenses or, you know, look at their credit card statement when it comes through rather than just paying it all and never checking anything on it. There certainly are people that do that but it’s not recommended because you want to know where your money’s going. And in case some of it is being misdirected, particularly fraudulently misdirected. You know, like I say it’s like your credit card. If somebody’s using your credit card and you don’t know it,  that’s bad. And the only way to know that is if you watch it and you keep track of it. And that sort of is the same idea behind an Insurance Audit. The insurance company wants to make sure that their money is being used for actual real legitimate medical purposes. The way that they do that, they can’t just, you know, pull up a credit card statement and say, “Oh, yeah, that looks right.” They have to, you know, their way of doing that is to ask. Well, originally, to run kind of a report and see what looks like it’s outside of normal. That’s typically the way that an audit starts. Seeing unusual billing trends from a particular practice or provider or things like that. There are some random audits as well. So it doesn’t necessarily mean that you got “flagged” for lack of a better term. But basically they’re just saying, “Hey, is our money going to legitimate purposes? And are we paying you for things that you actually did? And can you substantiate that?” It’s, again, going back to the analogy of your credit card statement. It’s kind of like looking at the statement and then going and checking the receipt or something like that and saying, “Oh, yeah, that is legitimate.” 

 

Dr.Bethany Fishbein: So there are some that are just random like your number came up and they’re gonna look at you for no apparent reason. And then there’s some, like you said, that can get flagged because of unusual billing practices. Do you know what some of those unusual billing practices in optometry could be?

 

Dr. Viktoria Davis: Well, this is something which I always kind of object to with a lot of my fellow code-heads or things like that. When they’ll say something like, “Oh, you don’t want to bill, for example, a level five office call because that’s a red flag.” And I completely and totally disagree with that. Because like you were saying in the beginning, if you are billing appropriately and correctly, you don’t have to worry about if you do happen to get audited. The most important thing is that you can substantiate what you’re billing and that your charts can support what you’re billing. So you know, although it is not typical for optometrists to bill, you know, a huge number of level five office calls, there may be practices that do. You know?  As you know Bethany, from your low vision practice, some of those low vision patients take a lot of time. Particularly now that office calls can be billed strictly on time. You know, if you spend more than 54 minutes with an existing patient, that’s a level five office call. So like I say, your low vision practices, your rehab practices, things like that. You may be getting a lot of level five office calls. There’s not a reason for you not to bill that even though that may be outside the norm for most optometry practices. I always say it’s kind of like the old phrase, “It’s not rare if it’s sitting in your chair.” You know? It’s as far as disease goes. Your billing as long as you’re billing it accurately and appropriately is unique to your practice. And that may mean that it’s not unique to the practice down the street or others in the state or in the nation, and that’s okay.

 

Dr.Bethany Fishbein: So when you’re selecting codes and you’re doing the billing, really, it shouldn’t be about worrying about whether what you do is going to trigger an audit. It just has to be about making sure that it’s appropriate for what you’re doing.

 

Dr. Viktoria Davis: It is and making sure that your chart supports that. You know? That you are actually billing and coding and developing that code off what your chart says. Not necessarily what you remember from the exam. Not that you know that you did what your chart says that you did.

 

Dr.Bethany Fishbein: So if you get audited, and we’ve gotten those letters in the practice, I mean, they’ve been presumably for random audits. But I guess you don’t really know. If you get that letter that says, “We’re reviewing our charts, can you please send the records for these 10 encounters? That’s an audit. Right? Is that an audit?

 

Dr. Viktoria Davis: That is an audit. Yes, that is absolutely an audit. Yeah. In some cases. I mean, there’s all sorts of different things that there can be audits for as well. There can be audits of certainly for insurance billing, which is kind of what we’re talking about today. There can be audits that insurance companies run to make sure for example, that diabetic patients actually are getting their eye exams. That’s something which has been pretty common in certainly in our state. As there’s been more emphasis on, you know, proper care and coordinated care and things like that. So we will not infrequently get what are called the HEDIS audits. I don’t even know if that’s how you say it. But it’s HEDIS which basically is health, education, and information. I forget what it stands for. But anyway, basically, they aren’t auditing our billing and coding. What they’re auditing is they’re actually making sure that their patients are getting or that they’re insured people are getting appropriate care. And they have on record that this person saw an eye doctor, so they’re making sure that they actually got a Dilated Fundus exam. 

 

Dr. Bethany Fishbein: So that’s actually like a quality control audit? Not a billing audit? 

 

Dr. Viktoria Davis: Exactly. And those, I mean, we get those very commonly in my practice. It’s something that, I don’t know, if it’s just a Minnesota thing or if it’s a nationwide thing. But like I said, certainly in Minnesota. We get those all the time. That just say, “Hey, we want these charts just to make sure that this patient actually had these the services.” which is they’re making sure that they’re doing a good job taking care of their insured clients which I think is a good thing. 

 

Dr.Bethany Fishbein: So usually you get that request for the charts. It’s a little bit stressful just because you have to print everything out and it’s just like a pain to do it. Then you send them in and ideally, nothing really happens after that, right? So if nothing really happens, that means that you probably pass that audit? 

 

Dr. Viktoria Davis: Correct.

 

Dr. Bethany Fishbein: They looked at it. They saw it. They wanted to see everything was fine and then it goes away. But what happens if they look and then they see something that doesn’t make sense to them? What could happen from there? What’s the scary part?

 

Dr. Viktoria Davis: It depends on the insurance company. Each insurance company will handle things a little bit differently. So, you know, the experience that I talk about, you know, there certainly are going to be listeners who say, “Oh, well that’s not right. That’s not what I had.”  And don’t send emails to Bethany because, you know, every insurance company could treat things differently. But certainly, if there is something that they find that they are concerned about then typically they will send a letter that says there were errors that were found, you know, in your coding or your charting or things like that. Frequently that letter will say, at least in general, what the problem was. The big scary part about it is that frequently there is a dollar amount that is attached to this letter that says, “Because of what we found here, you have to pay us back some sum of money.” The thing which is most scary about this for doctors is that usually insurance companies will extrapolate based on their audits. So in other words, if they asked for 10 charts and they found three of them with audit problems, you know, with problems, be it insufficient records to support the code that you selected or whatever, they won’t just ask for the money back on those three charts. They will ask for the money back on 30% of the services that you billed in that category with that insurance company. So if you billed 1000 of those codes, they’re going to ask for money back on 300 of them. And that’s where things get, you know, dollars add up and things get scary.

 

Dr.Bethany Fishbein: Does it happen anymore that they send a person to visit? Or is it all like mail and electronic now? I remember the early days of practice, like an auditor, came to the office unannounced.

 

Dr. Viktoria Davis: I’m sure that there still are some insurance companies that do that. This was another era in which COVID kind of changed things a little bit because insurance companies couldn’t send people out into you know, health care practices, and people couldn’t show up on announced and things like that. And I think they realized that they could get a lot more work done if they didn’t have to travel and if they just stayed home and evaluated their charts at home or in the office. So most of them now are done either by sending the chart somewhere and then with processes done via electronic communication or by mail. Like I say, that’s no guarantee that there isn’t some insurance company that still sends those auditors out in person but it is the exception rather than the rule at this point.

 

Dr.Bethany Fishbein: And I don’t know if you know, I mean, I guess we’re just guessing but are they looking for accidents? Are they really looking for fraud and sometimes finding carelessness? You know, like you see these articles in the newspaper or online or whatever about, you know, somebody’s billing for podiatry services for patients who don’t even have feet. There’s a big fraud. And when an optometrist gets this, there’s some for optometry too. I’ve seen those. But the average optometrists doing a good job when they get this, you know, you saw the patient you know, you took care of the patient, you know, you did stuff. Is there a delineation or both of those just things that audits can catch?

 

Dr. Viktoria Davis: It really is just things that audits can catch. I mean, they’re really looking for the big fraud, they care a whole lot more if somebody you know fraudulently claimed $10 million in claims for people who were all dead on that data service. Then if you billed a level four and only had documentation for a level three, you know? I mean they care more about the big fraud stuff but that doesn’t mean that they aren’t going to catch the little stuff as well.

 

Dr.Bethany Fishbein: So they’re just kind of casting their net or something triggers it and they see what they’re going to see. And if they see something that they don’t like, they can take back money for not only the services that they looked at but for some, whatever they think that represents over the amount of time that you’ve worked with them or that they’ve determined as appropriate. So that’s pretty scary. I get why people worry about that. And so when you do these Power Audits, we call it a friendly audit, which is that you’re really just doing it for the sake of information.

 

Dr. Viktoria Davis: Exactly. Correct. By the time, and one thing that I was going to mention back when you were talking about the process, you know, they asked for these charts and then you have to send them. My personal recommendation is that the doctor not be involved in pulling and copying those charts that the insurance company asks for. Because by the time that they’ve asked for charts, it’s too late to fix anything. One of the worst things that you can do.

 

Dr.Bethany Fishbein: So you don’t advise going back to change them? Is that it?

 

Dr. Viktoria Davis: Correct. At that point, right? And that’s something which is tempting to do, you know? Because you might look over them and be like, “Oh my gosh, I didn’t write this down.” or “I didn’t record this.” or “This isn’t completed or whatever.” Don’t try and change things in your charts after they’ve already requested the chart. That smells bad. So you know? So like I say, I recommend even just having a staff member do it. Because what’s in your chart is in your chart. But the whole point of the friendly audit is to let you know what things are looking like now and how you can do better in the future. It’s kind of like, you know, if you have a heart attack, you want to stop smoking. But it’s not really going to help the heart attack if you stop smoking right now. The train has already left the station there but that doesn’t mean that you can’t improve things for the future.

 

Dr.Bethany Fishbein: Yeah. And I mean, the example that you gave, right? Of if the doctor pulls the charts and looks at them with that critical eye if they get the audit and they pull the charts themselves and they look and they say, “Oh no, I forgot to enter this. I didn’t record this. I didn’t know what this was or whatever.” That’s a sign, right? That they can analyze in that manner. And so it’s just making the time and making it a priority to do that periodically every two years or two to make sure. And then?

 

Dr. Viktoria Davis: Exactly. Yes. Absolutely. If doctors are comfortable with their own billing, and they think that they know what they’re doing, and they think that they’re doing things right, and stuff like that. I very highly recommend that they themselves pull, you know, some handful of random charts, you know, 10-20 charts a year or something like that. Go through them and look at them and be like, “Okay, am I doing this right?” or “Oh, wow, have I forgotten something? Do I need to change something?” Because it just happens that we slip into habits or our staff does or things like that and you don’t know if you don’t know? So it’s always a good idea to do those internal audits or self-audits as well. No, of course, if you don’t know what you’re looking for, and then that maybe isn’t terribly helpful, and that’s when getting a friendly audit done first to teach you what you’re looking for is a very good idea.

 

Dr.Bethany Fishbein: Okay, so let’s kind of get into the substance of that. When you do those, I want to talk about some of the things that you see pretty commonly. Just common errors that could get an office in trouble if they got into one of these. Maybe people can hear this and go back and recognize something they do and correct it. So what are some of the like super common easy-to-fix mistakes that you see when you do this?

 

Dr. Viktoria Davis: Probably the number one thing that I see, well, pretty much all of them have to do with documentation first. So many of the errors that I see in charts are purely due to documentation errors. Whether that be items that are missing from the chart or documentation within the chart which is internally inconsistent. We’ll talk about that in a little bit. Or, you know, reports that are incomplete or charts that are unsigned. Those are all documentation sorts of things. But the one that I really find most commonly that people don’t even think about is that an individual chart needs to stand on its own. Now what I mean by that is that an auditor, were they to come in, you know, or request the chart. They can only request the chart for a given timeframe, a given, you know, range of dates. But I have patients that I’ve been seeing for, you know, all 25 years I’ve been in practice. They are not going to be able to request that chart. They can’t even look at things that are outside the specific timeframe of their audit. And so that means that you can’t just reference, “See previous history.” or something like that. It needs to be stated explicitly in each chart, what they’re there for. And, you know, if they’re somebody with glaucoma or something like that, you know, you can’t just say, “Same as previous.” or something, you know? The chart has to be able to stand on its own. One of the things which I see most consistently as well is that it is very frequently not explicitly recorded whether a patient is a new patient or an established patient. So you’re reading through the chart, you know, as an auditor. You’re reading through the chart and you have no idea if this patient has been seen in this practice before or not, which can dramatically change how you’re looking at the chart. And not only that, it can obviously, will change your billing. The code which is selected. And if it appears that it was an established patient, but they billed a new patient code, that’s going to be a problem. So I always recommend that practices state very, very clearly on the chart, “Existing Patient” or “New Patient” here or “Last exam here” and the date or something like that. So that it is extraordinarily clear, right off the bat, whether it’s a new patient or an established patient.

 

Dr.Bethany Fishbein: That’s like true, right? That’s if you’re writing a chief complaint, blurry vision, right? Or chief complaint, eye pain, and the patient report it’s resolving. And you saw that they can’t tell from that if you’ve been seeing that patient for three weeks in a row following a corneal ulcer or are seeing them for the first time that day. Right?

 

Dr. Viktoria Davis: Correct.

 

Dr. Bethany Fishbein: So like every time, you have to have the meds and the Family History. You can’t write, “Unchanged from the previous.”? So if your EHRs make it pretty easy, right, you can copy that from last time. But in a paper chart,  if doctors are still using that, meds, etc, it should be recorded every single time,

 

Dr. Viktoria Davis: Correct. Yep. 

 

Dr. Bethany Fishbein: Wow. Okay. 

 

Dr. Viktoria Davis: Yep. And you bring up an interesting point. As far as EHRs make things easy what you can bring forward, that leads to the next most common thing that I see, which is improper use of pull forward in EHRs. Because it is so easy in those EHRs to pull forward findings. And this is particularly done and this is kind of another instance of something that I see commonly, is your chief complaint has to drive your exam. So if your chief complaint which is listed is that the patient feels like they got something in their eye. They were out grinding yesterday afternoon without eye protection or you know. You can tell I’m in a rural area. This is your chief complaint and this will make sense. And then you go through the chart, and there’s a recording of a Fundus examination. That chief complaint does not, you know, like you may have that you removed, you know, piece of metal from the eye or whatever. But there’s no medical reason to have a Fundus exam there. And maybe you just accidentally hit the pull forward button and put that in there. If there’s a reason why you have it if you’re like concerned about a penetrating foreign body or you know, something like that, then I mean. I’m trying to figure out a reason why you might medically need to do a Fundus exam in this example. But, you know, I always try to give people the benefit of the doubt. But most of the time, it’s not recorded why they needed to do those kinds of things and it is just a case of an inadvertent pull forward.

 

Dr.Bethany Fishbein: Before you go on to the next. That one is super easy to do, like, especially I mean, I’ve seen it in practices. A patient has a red eye or something and all of a sudden they’ve had that red eye for years in the chart. And they probably one year stopped having it very shortly after the first time they did have it. But yes, okay. So it makes it easier because you’re not writing out a whole list of meds. But it also opens you up to be lazy and just copy forward without looking which is a problem.

 

Dr. Viktoria Davis: Yes, some EHRs give different categories of pull forward. So you may be able to pull forward an entire exam so that, you know, and that sounds awesome. You’re like, “Oh, I can pre-populate this whole exam as normal or something,” Because, “Oh, it’s probably going to be, you know.” or pre-populated from what they had before. Or you can pull forward sometimes like one page on the screen, or you can pull forward an individual test like a slit lamp exam and pull forward that section. I personally recommend that you pull forward as small a section as possible, because otherwise, it’s way too easy to miss that you didn’t do something on this exam, you know. That, “Oh yeah. On this exam, I didn’t. I don’t know. Do Gonioscopy or something.“ But, “Oh, look, my chart says that I did.” You know? Because I just use the pull forward entire exam, but I mean, I don’t know. I’m just kind of pulling things out. But it is so easy to inadvertently record the same data using pull forward.

 

Dr.Bethany Fishbein: I’m thinking about Eisah in our practice. We were recording height and weight, you know, when you had to do that for the reporting or whatever. We started doing that and that got pulled forward along with medical history. So you would have this patient in the chair right before they’re leaving for college, you know. Six foot two to go play soccer or whatever at university and you look and it says their height is four three and they weigh 61 pounds. I’m like, “Yeah, okay, probably guilty of doing that.” And really, the thing is, once you sign and close your chart for the day, whatever’s in there, you’re saying, “This is what I did.”, Right? Like that’s what kind of signing the chart is about. It is you’re putting your stamp of approval on whatever is in there. And so, if it’s not accurate, it doesn’t matter because you put your name or your initials or whatever you said it was.

 

Dr. Viktoria Davis: Yeah, technically when you sign a chart, you are certifying you as the doctor. You are certifying and attesting that all of the information contained in the chart is complete and correct to the best of your knowledge. 

 

Dr.Bethany Fishbein: Okay. So look at the chart, and make sure that that’s actually true. It is a big thing to do to just protect yourself. So that if you are audited, you have a better likelihood of passing.

 

Dr. Viktoria Davis: Correct Yep. 

 

Dr. Bethany Fishbein: Talk about signing the charts because I remember that came up in a Power Audit that was done with one of our clients. And it honestly was something that I didn’t even know. That even if it’s a solo doctor in practice and one doctor is seeing every single one of the patients, they still have to sign their chart.

 

Dr. Viktoria Davis: Absolutely. Yep. And this, again, goes back to the you as the doctor are certifying that all the information in the chart is complete and correct to the best of your knowledge. Is that if you don’t sign your chart, then nothing in there. Basically, if you don’t sign the chart, nothing was done as far as any insurance company or legal entity would accept. Because it is not like I say, “You have not attested to that. You have not certified that the chart is correct.” And so even in a solo practice, and most of the reason for that is because in most like EHRs and things like that, you know, staff may be able to go in and change things. Until the chart is signed. Typically once the chart is signed in any EHR, it’s much more difficult to go in and change things. There’s a reason for that. Back when we use paper charts, I remember when I was even like in school and stuff, it was always recommended that you used black ink for like for all your findings on that day once you sign the chart. But if you had to change something, for whatever reason, make a correction or whatever, then you use blue ink to do that. I have no idea if that was just something that I heard or put. I mean it makes sense. Because again, then you’re showing what was done when and once that chart is signed, that chart is complete. But until it’s signed, it’s not. You also shouldn’t bill anything until it is signed.

 

Dr.Bethany Fishbein: That’s kind of a mindset shift because I think most I don’t know a lot of doctors see the signing of the chart as indicating, “I saw the patient.”  Right? Especially in a multidoctor practice. When I signed a chart, it means I saw them instead of my husband or somebody else. And always that’s it. So I think shifting that to the blurb that you said you know, “I attest that everything in here is correct, etc.” is a good mindset. What’s another common thing?

 

Dr. Viktoria Davis: Probably another common thing I see is for like documentation on special testing. Things like photography, OCTs, visual fields, and things like that. That documentation doesn’t have to be incredibly elaborate. But it does need to include more than just, “Testing was normal.” or “Testing was unchanged.” or things like that, you know? And that’s something that I see a lot, is that that documentation on that special testing is very limited at best. For any special testing that’s done, you need to have clearly in the chart the reason why it was done and why that specific special testing was done so far. In other words, if you have a patient with, you know, glaucoma. “Okay, you want to do an OCT, you know optic nerve head, or CT. Then your reason for testing would be primary open angle glaucoma, monitor progression, and guide treatment. That’s the reason why you’re doing that. It’s not just because they have glaucoma. It’s because you are monitoring the progression of their glaucoma and guiding their treatment. And then you also need to state the results of it. So what things look like. Most of our testing that we do has some numerical values that are associated with it. It’s always an easy thing to put those numerical values in. Some EHRs will let, you know, and automatically import those numerical values from your instruments and things like that. And that’s totally fine. Otherwise, even just a brief analysis of what it is, you know, what the results of it were? And then any comparison to previous. Insurance companies love to see, you know. That again, that monitor progression and guide treatment. They want to know if things have changed. And that’s what we’re looking for. So basically it is just documenting what your brain is thinking. You know what you’re looking for when you do this. And then in that case saying, “No change from previous as your comparison is probably sufficient if you’ve stated what your results are also. And then also your recommendations. So what are you going to do about it? What happened? What are your results from this? And that could be continued Latanoprost, one drop of qHS, return three months or whatever. But why do you want this test? What is it going to do to help you? What the results of it were? What changes you saw? and what you’re going to do from it. And that’s really what needs to be documented. Like I say, this does not have to be a huge multi-page thing. This doesn’t even have to be really a multi-sentence kind of thing. One thing which I think can help all of us as optometrists now is the fact that almost every general practice healthcare these days have patient portals. And anybody who’s ever had any imaging or scans done whether that be you know, an x-ray on a broken bone or whether that be, you know? A routine mammogram or things like that. You can look on your patient portal and see what that radiologists report looks like. That’s very similar to what our special testing reports need to look like. It’s the same guidelines there’s nothing which is different for optometry as opposed to anything else. And they’re going to do the same things there. You know, as far as what they’re saying, Why did you have to have this done? What did you find? If there was a comparison to the previous, what any changes were and what they’re going to do about it? And that’s like I say exactly the same things that they’re presenting in their reports or things that we’re presenting in our reports as well. And that lack of documentation on those special testing is fairly rampant in optometry.

 

Dr.Bethany Fishbein: Yeah, I imagined that to be so. Before we close here, give an example of some of the crazy ones. Of things that you don’t see too often but you’ve seen once or twice that really could have gotten this doctor in trouble.

 

Dr. Viktoria Davis: So one of them and this kind of again, goes back to EHR documentation. And this is kind of talking about what I mentioned earlier, internal inconsistency in charts. I have no idea how this doctor’s EHR was set up. But somehow, the same test was recorded multiple times in an encounter once as normal and once as a problem. So basically, the doctor would go through and push the normal button and normalize the chart. And then if there were wrong things, then he’d go back and change those. So the same test was in the charts that I was auditing multiple times with different results.

 

Dr.Bethany Fishbein: I mean, that can’t be right, no matter which way it goes. Because it can’t be both?

 

Dr. Viktoria Davis: Exactly . It can’t be both right. It can’t be both. I mean, even down to things like CD ratios being recorded differently in two different spots in the chart. And I had a really, really hard time doing this audit because I couldn’t figure out why it was done. And like I say, when I’m doing a friendly audit, in particular, I’m always trying to give the doctor the benefit of the doubt and say, “Okay, it looks like this and you know, kind of trying to get inside their brain a little bit and I literally could not tell what was done. And most auditors at that point would have just thrown in the towel and said, “I can’t figure this out and so they don’t deserve any money.” 

 

Dr.Bethany Fishbein: Yeah, so there’s an advantage of having a friendly auditor.

 

Dr. Viktoria Davis: Definitely. So and then the other. This is one that I heard of. I did not personally see this, so I can’t actually vouch for it, but I heard it from the doctor who was doing it and I mentioned this actually on the other podcast that I did with you. With a doctor who was really trying to work the system for insurance. And so for special testing codes, which are either unilateral or bilateral, some macular or binocular, or things like OCTs and visual fields and stuff like that. He would have the patient in one day to do one eye. And then like a few weeks later to do the other eye. And bill for both of those. And there’s a lot of reasons why.

 

Dr. Bethany Fishbein:  He billed twice? 

 

Dr. Viktoria Davis: Yes.

 

Dr. Bethany Fishbein: And an office visit for each? 

 

Dr. Viktoria Davis: I don’t know for sure whether they billed an office visit for each if you’re doing just a standalone visit. Like all you’re doing is a field then, you know if you’re not spending any time with the doctor and it’s just with the technician then typically there’s not an office call that’s billed along with that. But yeah, he’d be like, “Oh yeah, they came in to get their glasses adjusted and so we just stuck them in for an OCT on one eye and then billed for it.

 

Dr.Bethany Fishbein: That crosses the line from, “Oopsie. I hit the copy Forward button.” to “I figured out a loophole and want to get paid for two fields every time I do one instead of one.”

 

Dr. Viktoria Davis: Exactly.

 

Dr. Bethany Fishbein: But I mean that exists out there. Somebody’s looking for the loopholes is probably not going to be the conscientious one saying, “I’d like a friendly audit.” They know, right? That they probably wouldn’t pass and are just taking their chances.

 

Dr. Viktoria Davis: Right? Correct. 

 

Dr. Bethany Fishbein: Okay.

 

Dr. Viktoria Davis: The much more common thing that I see and this isn’t necessarily something that’ll, you know, get you in trouble. But it’s just something which is not the smartest thing to do from a billing standpoint or bottom line standpoint, is the doctor who is so afraid of an audit that they just downcode everything, you know? For example, they’ll say, “Oh, well, optometrists. I’ve heard that they never should bill a level five. So just to be safe. I’m gonna bill level three on everything. And, you know, insurance companies don’t like that either. They really want you to bill properly, you know, and appropriately. So even though you know, they aren’t just out to get you. And I don’t think insurance companies for the most part are out to get you. Some of them may want to bleed you dry but that gets into a whole different issue. But, you know, they want you to bill properly and appropriately and bill based on what you actually did and what’s in your chart. 

 

Dr.Bethany Fishbein: Yeah. I know that. That certainly comes up I remember you did a webinar for our Power Practice clients on “Don’t Fear the Four” and it was all about level four offices and codes. And that was really the feedback that we got afterward. It was a lot of people saying, “Wait, I’m doing this and I’m coding. I’m coding for level three because I was afraid.” And that fear can be depending on the company, a $30, $40,or $50 encounter. So learning that and getting over that fear is important. Okay.

 

Dr. Viktoria Davis: Yes. And one other thing I wanted to mention here. Also when we’re talking about the process of an audit and what happens if you do get audited and when you do get that letter. There frequently, almost always, there is an opportunity for you to appeal the audit or to explain your charts in your auditing. You know, explain your side of the story. And that is always something that I encourage doctors to do. Again, if they believe in their coding and if they believe their charts are correct, then, by all means, explain it. There’s no reason just to take what they say just because they’re a big company or something like that.

 

Dr.Bethany Fishbein: That explanation, does that go with, “Okay, we’re just requesting 10 charts.” They might have just been your random turn or do you appeal when they say, “Three of these charts you didn’t have appropriate documentation for the code and we want $14,000.” Like when do you appeal? Or is it if they request those charts and then you look and you realize you didn’t sign them? And you copied forward and you have inconsistent findings, etcetera, etcetera, etcetera? And you think, “Okay, I’m gonna fail this.”

 

Dr. Viktoria Davis: Don’t give them more information than they asked for. That’s another kind of big thing is that you know, give them exactly what they asked for and only what they asked for. So don’t volunteer information, you know. Even if you looked at the charts and you’re like, “Oh my gosh! I totally messed this up should I say something?” No. Let them look at it first. And if they say that something’s wrong, you know, then follow up with that. 

 

Dr.Bethany Fishbein: Gotcha. All right, Viktoria. Thank you. You have the unique ability to make insurance interesting and give good advice and solid things that people should know and really feel doable if you just pay attention to them. If somebody wants to find out more, or is interested in getting a Power Audit, where do they go for information?

 

Dr. Viktoria Davis: They really can go to the Power Practice website, which is www.powerpractice.com. And there is a tab there that talks about the Power Audit and that’s really where more information is. There are also email addresses on there as well and we’ll come to shoot off an email and somebody will get back to you.

 

Dr.Bethany Fishbein: Awesome. Thank you so much for taking the time once again and sharing all of this useful information. To take something that sounds really scary and makes you realize it doesn’t have to be as long as you’re doing what you’re supposed to. So thank you so much. Thank you for listening. 

 

Dr. Viktoria Davis: Thank you. I enjoyed it.

 

Read the Transcription

 

Jennifer Herring: Because I had the visual impairment nobody ever set real expectations so I’ve always had my own.

Dr.Bethany Fishbein: Hi! I am Bethany Fishbein – The CEO of The Power Practice and Host of the Power Hour Optometry Podcast. And this conversation today is really one that is extraordinarily special and personal for me. I am interviewing Jennifer Herring who is a visually impaired marathoner and all around is an amazing person we’ll get to her for a second, but the reason that it’s so special for me is that when I was growing up when I was in college, I randomly got a summer job working at a camp for blind and visually impaired children. It’s called Camp Marcella and Rockaway, New Jersey. And it’s my experience at that camp that made me realize that I wanted to go into the eye care field and really change the direction of my personal and professional life forever. And Jennifer, or as she was known then by her camp nickname, Pickles, was one of the campers at Camp Marcella. So she and I have known each other for what is it, Jen? Probably 35 years. 

 

Jennifer Herring: Yes. 

 

Dr.Bethany Fishbein: And so when I saw you online, posting about your latest running accomplishments, fundraising accomplishments, I knew I wanted to talk and thank you so so so so so much for doing this with me. It’s bringing me all kinds of warm fuzzies already, we haven’t even started yet. 

 

Jennifer Herring: Thank you for having me on this wonderful podcast!

 

Dr.Bethany Fishbein: My pleasure, last night, I was like going through the camp pictures to try and find a picture of the two of us. Did you actually end up working at the camp for a year or two? 

 

Jennifer Herring: Yes, the first time I was asked to work in the kitchen and then for a couple of weeks when one of the other workers was unable to finish up the year, and then I worked a whole summer in the kitchen and then I worked as a counselor for a full summer. 

 

Dr.Bethany Fishbein: That’s the pictures that I found were from staff training, and it was the two of us out on the blacktop where the basketball nets were and we were learning how to use fire extinguishers. So it might have been the year that you were in the kitchen.  But that was the picture I found that had the two of us in it. I’ll email it to you.

 

Jennifer Herring: Oh, that’s great. 

 

Dr.Bethany Fishbein: Anyway, most of the listeners for my podcast are either optometrist eye doctors, optometry students, and people in the eye care industry. So if you don’t mind, would you share a little bit about your eyes, about your diagnosis, and what your vision is like?

 

Jennifer Herring: Yes, sure. I was born in the mid-70s. So technology has come a long way since then, so early on the eye doctor would do some even right-ups so what they saw on your eyes. I went to an eye and ear in Massachusetts, for them to help diagnose what was going on in my eyes because there is a family history of eye issues, and my family so they knew that there was something wrong. I’d look close, and I also been like near the television and things like that. So I went there. And early on they said I had a form of juvenile macular degeneration so that went on for years I struggled in school and they did give me glasses, but the glasses kind of made everything to focus but I still couldn’t see the blackboard or had issues with seeing far and also I looked very close and so many years went on and then eventually they went to the eye doctor and they looked in and said your macular eyes are fine. It’s your optic nerve. So then it’s white. So they finally diagnosed it as optic nerve atrophy and cone dystrophy and also nearsightedness. So currently that’s what I go by. It’s also been an issue because my eyes outside look very normal. There isn’t really an indication that I do have an eye problem. So going through school that was kind of hard for me because teachers would put your glasses on and they didn’t understand, even though I was a member of the New Jersey Commission for the Blind and Visually Impaired and they tried to help explain to teachers what was going on, but they really weren’t aware of having these issues. There weren’t many children also who had these kinds of issues in their classes. That was also Camp Marcella came in because when I was eight years old, I went there so I would see other children who had eye issues that we helped each other by can see better than you know, it’s there was a totally blind child then we would leave them around and so it was like a beautiful thing to be part of. We did lots of activities. No one ever set limits for us. We did all the activities and you know I met Bethany and all the wonderful people up there. It was happening every summer because she would just be with other kids and wonderful, caring people who wanted to help and so.

 

Dr.Bethany Fishbein: it’s funny when you said that it makes me realize we work with a lot of visually impaired people in the practice. And sometimes we’re talking to parents of kids with low vision or people with low vision and one of the things that I’ve always talked about, is that a vision problem is not like a mobility issue where somebody has a limp or uses a wheelchair or has always an outward sign of having a disability. And so we talk a lot about people, especially kids, but older people too. Who are losing vision later in life that they’re struggling and there’s no way for people around them in the grocery store or server at a restaurant or anything to know that they’re having trouble which makes vision difficulties a little bit more complex? Nobody’s offering to help because they don’t know that there’s a problem. And I’m realizing as you’re saying it that that’s probably a lesson that I learned from you and your friends talking about it because as you describe it, I’m aware now that that’s almost always how I say it. So that’s something I picked up from you. 

 

Jennifer Herring: Yeah, it’s a hidden handicap. It’s like I’ve gone through kind of life, You have this burden but I also don’t see it as something positive because I met so many people with compassion other amazing people who are just keep going you know, a lot of my friends I met at Camp Marcella everyone’s still going and so you can still lead a good life. Even if you have a hidden handicap like this.

 

Dr.Bethany Fishbein: For sure. So tell me we kind of lost touch for a while because I knew when you were a kid at camp and then like most of us at camp we lost touch and it was really when Facebook started to gain popularity that we got back in touch. So talk about what you did after you finished high school. Did you go on in your education? I know you’re working now. What do you do? 

 

Jennifer Herring: Yes. Well, I’m currently a software engineer. I’ve been working in the computer field now for over 20-25 years. Now. And way back in high school to like told me there wasn’t as much technology and so they were kind of leery about me going to college. I only had a monocular some of the early things. I also had glasses that had a monocular on them, but they didn’t work as well. Like I said they would make it clear but I still couldn’t see everything far away. They weren’t really pushing going to college, but I thought I could I did well through school. So I went to the University of Delaware and I majored in computer science. I got a BS in computer science and I was on the Dean’s List and I did well I think I did better than in high school even because I don’t know if that’s also a part of our skillset. But I’ve always been very structured. I felt like it was always my job in school even though I had to concentrate I had to work harder because I couldn’t see so I always had to ask for extra help a little bit. So I’ve always been pretty structured. So I went to college and so I did well doing that, and I also ran intramural track and five K’s. So I did that. And then I got my first job. I got some help with the New Jersey Commissioner for the Blind and Visually Impaired, offered assistance to help find my first job, and then from there I did well and never had a bad review at any of my jobs but I moved back closer to home a couple of times just to be with my family. And so I’ve been doing that now I worked at Lockheed Martin for a little while, which was very interesting. And now I work for a company that handles the Medicare Medicaid claims for New Jersey. So I do a lot of programming for those systems.

 

Dr.Bethany Fishbein: And are using any technology or talk about what you’re using to make the computer and stuff like that accessible for you. 

 

Jennifer Herring: I do the looking close into the screen. I’ve tried some of the other technology they have with the closed-circuit TV and things like that. But now then I’m working at home so when I worked in the office, I would have a lot of people wondering, Why is my face and my screen? and I mean, I’ve been doing it for 25 years. I’m just used to that. It’s just my personal preference, but I know others use the talking technology that you can use in me I have my iPhone and I can look close, and I made the font bigger. So yeah, a lot of the bigger font. I do that on a lot of the applications, it’s on my home laptop. So, fortunately, I looked low so you know they always told you not to do I mean I’ve been doing it for 25-30 years almost. But that’s just my personal preference. 

 

Dr.Bethany Fishbein: And that’s another piece of education that we’re giving to parents, especially of kids with low vision telling the parents telling the teachers that they were raised saying don’t put your head up in your phone. Don’t get that close to the TV. Don’t get that close to the book. And for somebody who needs that working distance to be able to see it. It is absolutely appropriate and healthy and necessary for them to do that. So we provide that as well. 

 

Dr.Bethany Fishbein: So you mentioned that you ran in college and really I want to talk about your running but I remember when you were younger, there was awards that we used to give out at the campfire, right so they ended the session we always had a closing campfire and then there were different awards for the kids and you were always kind of almost guaranteed recipients of the Super Girl award for your extraordinary athleticism.

 

Jennifer Herring: Yeah

 

Dr.Bethany Fishbein: I don’t think any other girls at Camp stood a chance to win that when you were there in that session. So when did you figure out that you had some ability in specifically running?

 

Jennifer Herring: Yeah, it’s an innate thing. I think nobody introduced it to me from a young age even like in gym class since you didn’t really have to see well for the gym teacher would say okay, we have to run around the field or inside the gym. I did the Presidential physical fitness test. I love to do all that jumping and running. And so it started just innately, I am blessed that was born with a passion that I love to be active, you know, and I tried to let other people know how to just whatever you can do just walk whatever. Find yourself something that can help you be a good even new track and cross country in high school and the coach helped me because one of the teachers wasn’t nice to me one time with the understanding that I couldn’t see the board. So my coach talked to him because he didn’t want to have his runners upset. So he talked to one of the teachers to explain. I just always loved running and luckily too I wasn’t a superstar. I got my varsity letters all four years and I was captain senior year for track and cross country but luckily I was good enough but not superstar so I didn’t burn out I didn’t get injured. I took care of my body properly. So I mean, what do you got to keep going now? 20-30 years later, 35 years later, so I started to helping people.

 

Dr.Bethany Fishbein:  Right? Yes, you’ve been running ever since. And not only are you a runner, but you’re also a marathon runner, and not only are you a marathon runner you’re really fast. how many marathons have you done at this point?

 

Jennifer Herring: 39 marathons 

 

Dr.Bethany Fishbein: 39 And what spurred this podcast am I reached out to you is you just posted on Facebook that you got back from your 19th Boston Marathon?

 

Jennifer Herring: Yes. 

 

Dr.Bethany Fishbein: Amazing. I did one once. And afterward, I said one and done. And I realized about maybe 20 minutes into the first one that this is something that I was never going to experience again. So 39 is extraordinary. How old were you when you did your first one? Do you remember?

 

Jennifer Herring: Yeah, I was 28 and I did New York. That’s one of the most special ones to do. It’s like you’re a rock star the whole time. There are just people cheering and that’s why to people come from all over the world and get along and just people are cheering there is music and you can’t get lost in your strong woman pretty buddy and I always make friends you know you talk to people and everyone has different reasons that they’re doing the run. So that’s always special and charities if there are people raising money, it’s a really special thing, I always said I do marathons and then I started in that first marathon I qualified for Boston and so that’s how I got involved with starting to run the Boston Marathon.

 

Dr.Bethany Fishbein: My first and only marathon I finished in six hours and 10 minutes. How did you do in yours?

 

Jennifer Herring: Ah, that one I was, I did 3:35 for the first year, And I know of course over the years now I’m slowed down but it depends on your training and everything. so sometimes you need to get some more training in but my best was 3:22 there so I run then in New York and then 3:26 in Boston, it’s my elder best one.

 

Dr.Bethany Fishbein: Do you run them to be fast? Like, are you going for time or you’re going for the experience?

 

Jennifer Herring: Yeah, it’s always been an experience for me because I was aware of the Boston Marathon and then the qualifying standard and I need to know that I would get that the first time I really wanted to I had read books about it. All the legends and running and eventually, I met Kathrine Switzer, you know, reading all the history of the Boston Marathon and everything. I really wanted to run it, but I didn’t know so yeah, I guess it’s the joy of running. They all talked about the joy of running and I think I have that. Moreover, then even in high school, too, I guess for life because I had a visual impairment nobody ever set real expectations. So I’ve always had my own, at least gone on my own pace through life now, and I hope everyone can do that because that way people set too high expectations or something. And so you should just go along and do it. You can do your six hours. I mean, that’s wonderful to some people never do it. Yeah, those three can be happy with that. It’s just the satisfaction of completing it. And the experience you have.

 

Dr.Bethany Fishbein: And you mentioned that people out there fundraising and over your running career, you’ve done fundraising or done marathons for I think, some different causes, right?

 

Jennifer Herring: I’ve done well, one part there’s a lot of unfortunately cancer in my family and then other loved ones and friends that have been touched by cancer. So I’ve done a story with my father in 2007. He was diagnosed with a brain tumor in November of 2007. And so I told them that I was going to run the Boston Marathon for him in 2008. So they tried to do things for him, but it wasn’t working. But he held on till the day I came home and I handed him the Boston Marathon medal that you get when you finish the marathon. And that evening, he passed away. It was just a wonderful thing he did for me because he hung on because I had told him I did that marathon for him. So I do a lot of charities that are related to brain tumor research. I’ve done several in New York, and run a lot of races in Central Park. And then there’s a American Cancer Research. I’m doing a race in Philly. So I’ve done some fundraising for them in Philly, and then there’s Fred’s team. I’ve done the New York Marathon and then of course for the visual impairment I’ve done the Boston Marathon pretty much I guess, I think about 10 to 15 of the Boston Marathon races I’ve raised money for Team with a Vision which raises money for the Massachusetts Association for the Blind and Visually impaired and they support and rehabilitation services for people in society that have visual impairments there. So that’s how I feel it’s the overall good thing for me and for everyone, you know, for helping people.

 

Dr.Bethany Fishbein: Absolutely! So when you race with Team with a Vision, what’s involved with that? Do you fundraise? Are you running with other visually impaired people? What does that mean, to be part of that?

 

Jennifer Herring: Yes, it’s a group of blind and visually impaired runners and guides and they start fundraising about six months out they have you set up a web page where you can go to fundraise, which says the Boston Marathon was twice in six months. Now, I did it back in October. So that’s the last one I set up. And then for this one, that was just in April, I donate it and then I informed other people to just go to the main web page that GivenGain, they set up many fundraisers. So Team with Ovation was one of those on there and told them when race week comes along about the Friday before the Monday Boston Marathon, you go up there, they have different activities to get together. So you can meet other people that are blind or visually impaired and then the guide under are solely charity runners to that raise money also, and then they have dinner then you get your bed that you wear for the race. And that’s a wonderful thing too. So when I run in the marathon, people are saying “Go Team with a Vision!” so it’s publicized more. So people wonder what is that now look it up and hopefully they can either join the team to run and raise money or just donate or cheer even is wonderful too. That helps that helped me a lot too. 

 

Dr.Bethany Fishbein: Just hearing people cheering for you on the course.

 

Jennifer Herring: Yes

 

Dr.Bethany Fishbein: Yes, that’s awesome! And you mentioned people go up with their guides, but you don’t usually run with the guide, do you?

 

Jennifer Herring:  I have a couple of years? You know, Unfortunately, Tom was a racist. There have been some things that have been so you know, in some cases I always go back and forth, whether it’s better if something goes wrong, it’s better to have someone with me because you know like when I’m on the course I feel kind of sheltered because I know where I’m going. There are people all along, you can get help but if there’s something where they say the race is over or something and you’re still out there or something, I would need help to get back or just to make sure nothing goes wrong, but I run with guides and they help because I do have to slow down go into like the water stops and things and they do help to say okay, you’re making a left turn coming up. So instead I go along on my own and just kind of rely on the other runners. Sometimes, it’s better and I’ll always welcome someone to run with me. I’ve always been Ms.Independence. It’s hard for me to always have somebody helping, but they’re wonderful too.

 

Dr.Bethany Fishbein: And they have to find one who’s fast enough for you like I would offer but.

 

Jennifer Herring: Yeah, well some friends

 

Dr.Bethany Fishbein: or you could stroll along with me.

 

Jennifer Herring: Well, sometimes they have to lie so you can only go up to 11 miles with the person they have this switch off for races and there are all levels to of ability. So there are faster runners, and there’s a guy who runs like 235 marathons and blind, and then there are slower runners that it seems like there’s a whole gamut. So if someone does want to help a guy and there are other associations that they set up, there’s United in Stride, it’s called in America. It’s spread out in different states where you can sign up on the website United in Stride and find if you want to assist a visually impaired runner, and then now I see there’s a team tethered together. And that’s another one that I see is set up. So if there are runners that want to assist, and they have that just even to take a vision curbar out for a run race, which is you know.

 

Dr.Bethany Fishbein: Cool! I will put those websites in the notes when we put the podcast out. So if somebody’s interested in doing that, maybe they can get matched up with somebody in their area. Were you in Boston at the marathon, the year of the bombing? Was it twenty 2013 Oh my god. 

 

Jennifer Herring: Yes. Well, I have the associated story with being going to visually impaired because I finished about 15 minutes before the bombs went off. And I was around the corner about 600 feet around the corner. I guess from there, we had a family meeting area where the team was the Vision Group would meet after the race, and there happened to be a seeing-eye dog there waiting for his person to come. And so of course, since he wasn’t working, I wasn’t petting, but I just kind of kneeled down, Just this was my 10th Boston Marathon. So, of course, I love dogs and I was talking to the dog and I felt, I finished my 10th Boston Marathon and it was a beautiful day, that day too and finally because usually, it’s very cold and windy in that area. So yeah, I just usually want to get going and then all of a sudden I heard a noise and an echo sound like a backfire and I was like, okay? and the dogs heard it too. And then it was a little bit of time and then it happened again. And the dog started shaking. So we’re only what is that noise and Josh Warren who had introduced me to Team with a Vision. He had asked me to join the team couple of years back, He said, I don’t know that doesn’t sound good. So my mom was in the hotel in the Prudential Center there I always told her to stay put because I didn’t want her ever wandering around. She called and she said there was a bomb something was going on at the finish line and to get back to the room. So I got up from there and you know me while the dog was shaking, and so he knew the dog knew something was bad. And I had to get back to the hotel. And luckily, I got back then before they started shutting the doors you couldn’t go in, it’s just horrible there. And then actually, a beautiful thing that just happened is that this was a second Boston Marathon they had the Power Elite Athletes Division and one of the women participating in it. Adrianne Haslet – She was affected by the Boston Marathon bombing. She was a ballroom dancer, she lost her leg and she decided she wanted to run the Boston Marathon again after she had done it in 678 hours I think a couple of years ago. So she participated in this past last week, the Boston Marathon and she was just ready. I mean, it was beautiful to see she was so happy because she trained with Shalane Flanagan. She had won the New York Marathon. She’s a professional runner, and she had her as her support. I saw her at the starting area. I could feel the smile, I couldn’t see but I thought we were on the running scene and what was going on and just to know how happy she was and she finished in I think a little over five hours. So it was like a three-hour improvement. And she posted and has been so happy since joy. Yeah, I was even though you’re part of a horrible thing, but she’s turned it into something beautiful in her life. So that was very nice to see firsthand. I always miss out on things. So it was kind of like right there. I was fortunate to just be in the presence of that.

 

Dr.Bethany Fishbein: I really I think that message or theme has come through and a bunch of different stories that you’ve shared today about your experience of taking something that maybe people would consider a negative and finding the positive side or finding the beautiful things in a situation. So that’s a very positive message for today. You know, I think for anybody who’s listening if they are inspired to do something positive, I will share the links to Tethered Together to United in Stride for somebody who’s looking to give us their time for somebody who may be looking for a wonderful place to give their money. I’ll share links for the Team with a Vision and also for Camp Marcella, which although it’s a little bit different now is still helping blind and visually impaired kids in New Jersey and is still a special place to me, and Jen I know for you too. And I’m really grateful that your running career and my vision career have put us back in touch and given us the opportunity to reconnect all these years later. Thank you so so so so so so much for talking. It was great to have this conversation with you.

 

Jennifer Herring: Thank you Bethany and you are wonderful too, I’m honored to talk with you.

 

Dr.Bethany Fishbein: I am the one who is honored here and for everybody out there, Thank you so much for listening.

 

 

Read the Transcription

 

Jennifer Herring: Because I had the visual impairment nobody ever set real expectations so I’ve always had my own.

Dr.Bethany Fishbein: Hi! I am Bethany Fishbein – The CEO of The Power Practice and Host of the Power Hour Optometry Podcast. And this conversation today is really one that is extraordinarily special and personal for me. I am interviewing Jennifer Herring who is a visually impaired marathoner and all around is an amazing person we’ll get to her for a second, but the reason that it’s so special for me is that when I was growing up when I was in college, I randomly got a summer job working at a camp for blind and visually impaired children. It’s called Camp Marcella and Rockaway, New Jersey. And it’s my experience at that camp that made me realize that I wanted to go into the eye care field and really change the direction of my personal and professional life forever. And Jennifer, or as she was known then by her camp nickname, Pickles, was one of the campers at Camp Marcella. So she and I have known each other for what is it, Jen? Probably 35 years. 

 

Jennifer Herring: Yes. 

 

Dr.Bethany Fishbein: And so when I saw you online, posting about your latest running accomplishments, fundraising accomplishments, I knew I wanted to talk and thank you so so so so so much for doing this with me. It’s bringing me all kinds of warm fuzzies already, we haven’t even started yet. 

 

Jennifer Herring: Thank you for having me on this wonderful podcast!

 

Dr.Bethany Fishbein: My pleasure, last night, I was like going through the camp pictures to try and find a picture of the two of us. Did you actually end up working at the camp for a year or two? 

 

Jennifer Herring: Yes, the first time I was asked to work in the kitchen and then for a couple of weeks when one of the other workers was unable to finish up the year, and then I worked a whole summer in the kitchen and then I worked as a counselor for a full summer. 

 

Dr.Bethany Fishbein: That’s the pictures that I found were from staff training, and it was the two of us out on the blacktop where the basketball nets were and we were learning how to use fire extinguishers. So it might have been the year that you were in the kitchen.  But that was the picture I found that had the two of us in it. I’ll email it to you.

 

Jennifer Herring: Oh, that’s great. 

 

Dr.Bethany Fishbein: Anyway, most of the listeners for my podcast are either optometrist eye doctors, optometry students, and people in the eye care industry. So if you don’t mind, would you share a little bit about your eyes, about your diagnosis, and what your vision is like?

 

Jennifer Herring: Yes, sure. I was born in the mid-70s. So technology has come a long way since then, so early on the eye doctor would do some even right-ups so what they saw on your eyes. I went to an eye and ear in Massachusetts, for them to help diagnose what was going on in my eyes because there is a family history of eye issues, and my family so they knew that there was something wrong. I’d look close, and I also been like near the television and things like that. So I went there. And early on they said I had a form of juvenile macular degeneration so that went on for years I struggled in school and they did give me glasses, but the glasses kind of made everything to focus but I still couldn’t see the blackboard or had issues with seeing far and also I looked very close and so many years went on and then eventually they went to the eye doctor and they looked in and said your macular eyes are fine. It’s your optic nerve. So then it’s white. So they finally diagnosed it as optic nerve atrophy and cone dystrophy and also nearsightedness. So currently that’s what I go by. It’s also been an issue because my eyes outside look very normal. There isn’t really an indication that I do have an eye problem. So going through school that was kind of hard for me because teachers would put your glasses on and they didn’t understand, even though I was a member of the New Jersey Commission for the Blind and Visually Impaired and they tried to help explain to teachers what was going on, but they really weren’t aware of having these issues. There weren’t many children also who had these kinds of issues in their classes. That was also Camp Marcella came in because when I was eight years old, I went there so I would see other children who had eye issues that we helped each other by can see better than you know, it’s there was a totally blind child then we would leave them around and so it was like a beautiful thing to be part of. We did lots of activities. No one ever set limits for us. We did all the activities and you know I met Bethany and all the wonderful people up there. It was happening every summer because she would just be with other kids and wonderful, caring people who wanted to help and so.

 

Dr.Bethany Fishbein: it’s funny when you said that it makes me realize we work with a lot of visually impaired people in the practice. And sometimes we’re talking to parents of kids with low vision or people with low vision and one of the things that I’ve always talked about, is that a vision problem is not like a mobility issue where somebody has a limp or uses a wheelchair or has always an outward sign of having a disability. And so we talk a lot about people, especially kids, but older people too. Who are losing vision later in life that they’re struggling and there’s no way for people around them in the grocery store or server at a restaurant or anything to know that they’re having trouble which makes vision difficulties a little bit more complex? Nobody’s offering to help because they don’t know that there’s a problem. And I’m realizing as you’re saying it that that’s probably a lesson that I learned from you and your friends talking about it because as you describe it, I’m aware now that that’s almost always how I say it. So that’s something I picked up from you. 

 

Jennifer Herring: Yeah, it’s a hidden handicap. It’s like I’ve gone through kind of life, You have this burden but I also don’t see it as something positive because I met so many people with compassion other amazing people who are just keep going you know, a lot of my friends I met at Camp Marcella everyone’s still going and so you can still lead a good life. Even if you have a hidden handicap like this.

 

Dr.Bethany Fishbein: For sure. So tell me we kind of lost touch for a while because I knew when you were a kid at camp and then like most of us at camp we lost touch and it was really when Facebook started to gain popularity that we got back in touch. So talk about what you did after you finished high school. Did you go on in your education? I know you’re working now. What do you do? 

 

Jennifer Herring: Yes. Well, I’m currently a software engineer. I’ve been working in the computer field now for over 20-25 years. Now. And way back in high school to like told me there wasn’t as much technology and so they were kind of leery about me going to college. I only had a monocular some of the early things. I also had glasses that had a monocular on them, but they didn’t work as well. Like I said they would make it clear but I still couldn’t see everything far away. They weren’t really pushing going to college, but I thought I could I did well through school. So I went to the University of Delaware and I majored in computer science. I got a BS in computer science and I was on the Dean’s List and I did well I think I did better than in high school even because I don’t know if that’s also a part of our skillset. But I’ve always been very structured. I felt like it was always my job in school even though I had to concentrate I had to work harder because I couldn’t see so I always had to ask for extra help a little bit. So I’ve always been pretty structured. So I went to college and so I did well doing that, and I also ran intramural track and five K’s. So I did that. And then I got my first job. I got some help with the New Jersey Commissioner for the Blind and Visually Impaired, offered assistance to help find my first job, and then from there I did well and never had a bad review at any of my jobs but I moved back closer to home a couple of times just to be with my family. And so I’ve been doing that now I worked at Lockheed Martin for a little while, which was very interesting. And now I work for a company that handles the Medicare Medicaid claims for New Jersey. So I do a lot of programming for those systems.

 

Dr.Bethany Fishbein: And are using any technology or talk about what you’re using to make the computer and stuff like that accessible for you. 

 

Jennifer Herring: I do the looking close into the screen. I’ve tried some of the other technology they have with the closed-circuit TV and things like that. But now then I’m working at home so when I worked in the office, I would have a lot of people wondering, Why is my face and my screen? and I mean, I’ve been doing it for 25 years. I’m just used to that. It’s just my personal preference, but I know others use the talking technology that you can use in me I have my iPhone and I can look close, and I made the font bigger. So yeah, a lot of the bigger font. I do that on a lot of the applications, it’s on my home laptop. So, fortunately, I looked low so you know they always told you not to do I mean I’ve been doing it for 25-30 years almost. But that’s just my personal preference. 

 

Dr.Bethany Fishbein: And that’s another piece of education that we’re giving to parents, especially of kids with low vision telling the parents telling the teachers that they were raised saying don’t put your head up in your phone. Don’t get that close to the TV. Don’t get that close to the book. And for somebody who needs that working distance to be able to see it. It is absolutely appropriate and healthy and necessary for them to do that. So we provide that as well. 

 

Dr.Bethany Fishbein: So you mentioned that you ran in college and really I want to talk about your running but I remember when you were younger, there was awards that we used to give out at the campfire, right so they ended the session we always had a closing campfire and then there were different awards for the kids and you were always kind of almost guaranteed recipients of the Super Girl award for your extraordinary athleticism.

 

Jennifer Herring: Yeah

 

Dr.Bethany Fishbein: I don’t think any other girls at Camp stood a chance to win that when you were there in that session. So when did you figure out that you had some ability in specifically running?

 

Jennifer Herring: Yeah, it’s an innate thing. I think nobody introduced it to me from a young age even like in gym class since you didn’t really have to see well for the gym teacher would say okay, we have to run around the field or inside the gym. I did the Presidential physical fitness test. I love to do all that jumping and running. And so it started just innately, I am blessed that was born with a passion that I love to be active, you know, and I tried to let other people know how to just whatever you can do just walk whatever. Find yourself something that can help you be a good even new track and cross country in high school and the coach helped me because one of the teachers wasn’t nice to me one time with the understanding that I couldn’t see the board. So my coach talked to him because he didn’t want to have his runners upset. So he talked to one of the teachers to explain. I just always loved running and luckily too I wasn’t a superstar. I got my varsity letters all four years and I was captain senior year for track and cross country but luckily I was good enough but not superstar so I didn’t burn out I didn’t get injured. I took care of my body properly. So I mean, what do you got to keep going now? 20-30 years later, 35 years later, so I started to helping people.

 

Dr.Bethany Fishbein:  Right? Yes, you’ve been running ever since. And not only are you a runner, but you’re also a marathon runner, and not only are you a marathon runner you’re really fast. how many marathons have you done at this point?

 

Jennifer Herring: 39 marathons 

 

Dr.Bethany Fishbein: 39 And what spurred this podcast am I reached out to you is you just posted on Facebook that you got back from your 19th Boston Marathon?

 

Jennifer Herring: Yes. 

 

Dr.Bethany Fishbein: Amazing. I did one once. And afterward, I said one and done. And I realized about maybe 20 minutes into the first one that this is something that I was never going to experience again. So 39 is extraordinary. How old were you when you did your first one? Do you remember?

 

Jennifer Herring: Yeah, I was 28 and I did New York. That’s one of the most special ones to do. It’s like you’re a rock star the whole time. There are just people cheering and that’s why to people come from all over the world and get along and just people are cheering there is music and you can’t get lost in your strong woman pretty buddy and I always make friends you know you talk to people and everyone has different reasons that they’re doing the run. So that’s always special and charities if there are people raising money, it’s a really special thing, I always said I do marathons and then I started in that first marathon I qualified for Boston and so that’s how I got involved with starting to run the Boston Marathon.

 

Dr.Bethany Fishbein: My first and only marathon I finished in six hours and 10 minutes. How did you do in yours?

 

Jennifer Herring: Ah, that one I was, I did 3:35 for the first year, And I know of course over the years now I’m slowed down but it depends on your training and everything. so sometimes you need to get some more training in but my best was 3:22 there so I run then in New York and then 3:26 in Boston, it’s my elder best one.

 

Dr.Bethany Fishbein: Do you run them to be fast? Like, are you going for time or you’re going for the experience?

 

Jennifer Herring: Yeah, it’s always been an experience for me because I was aware of the Boston Marathon and then the qualifying standard and I need to know that I would get that the first time I really wanted to I had read books about it. All the legends and running and eventually, I met Kathrine Switzer, you know, reading all the history of the Boston Marathon and everything. I really wanted to run it, but I didn’t know so yeah, I guess it’s the joy of running. They all talked about the joy of running and I think I have that. Moreover, then even in high school, too, I guess for life because I had a visual impairment nobody ever set real expectations. So I’ve always had my own, at least gone on my own pace through life now, and I hope everyone can do that because that way people set too high expectations or something. And so you should just go along and do it. You can do your six hours. I mean, that’s wonderful to some people never do it. Yeah, those three can be happy with that. It’s just the satisfaction of completing it. And the experience you have.

 

Dr.Bethany Fishbein: And you mentioned that people out there fundraising and over your running career, you’ve done fundraising or done marathons for I think, some different causes, right?

 

Jennifer Herring: I’ve done well, one part there’s a lot of unfortunately cancer in my family and then other loved ones and friends that have been touched by cancer. So I’ve done a story with my father in 2007. He was diagnosed with a brain tumor in November of 2007. And so I told them that I was going to run the Boston Marathon for him in 2008. So they tried to do things for him, but it wasn’t working. But he held on till the day I came home and I handed him the Boston Marathon medal that you get when you finish the marathon. And that evening, he passed away. It was just a wonderful thing he did for me because he hung on because I had told him I did that marathon for him. So I do a lot of charities that are related to brain tumor research. I’ve done several in New York, and run a lot of races in Central Park. And then there’s a American Cancer Research. I’m doing a race in Philly. So I’ve done some fundraising for them in Philly, and then there’s Fred’s team. I’ve done the New York Marathon and then of course for the visual impairment I’ve done the Boston Marathon pretty much I guess, I think about 10 to 15 of the Boston Marathon races I’ve raised money for Team with a Vision which raises money for the Massachusetts Association for the Blind and Visually impaired and they support and rehabilitation services for people in society that have visual impairments there. So that’s how I feel it’s the overall good thing for me and for everyone, you know, for helping people.

 

Dr.Bethany Fishbein: Absolutely! So when you race with Team with a Vision, what’s involved with that? Do you fundraise? Are you running with other visually impaired people? What does that mean, to be part of that?

 

Jennifer Herring: Yes, it’s a group of blind and visually impaired runners and guides and they start fundraising about six months out they have you set up a web page where you can go to fundraise, which says the Boston Marathon was twice in six months. Now, I did it back in October. So that’s the last one I set up. And then for this one, that was just in April, I donate it and then I informed other people to just go to the main web page that GivenGain, they set up many fundraisers. So Team with Ovation was one of those on there and told them when race week comes along about the Friday before the Monday Boston Marathon, you go up there, they have different activities to get together. So you can meet other people that are blind or visually impaired and then the guide under are solely charity runners to that raise money also, and then they have dinner then you get your bed that you wear for the race. And that’s a wonderful thing too. So when I run in the marathon, people are saying “Go Team with a Vision!” so it’s publicized more. So people wonder what is that now look it up and hopefully they can either join the team to run and raise money or just donate or cheer even is wonderful too. That helps that helped me a lot too. 

 

Dr.Bethany Fishbein: Just hearing people cheering for you on the course.

 

Jennifer Herring: Yes

 

Dr.Bethany Fishbein: Yes, that’s awesome! And you mentioned people go up with their guides, but you don’t usually run with the guide, do you?

 

Jennifer Herring:  I have a couple of years? You know, Unfortunately, Tom was a racist. There have been some things that have been so you know, in some cases I always go back and forth, whether it’s better if something goes wrong, it’s better to have someone with me because you know like when I’m on the course I feel kind of sheltered because I know where I’m going. There are people all along, you can get help but if there’s something where they say the race is over or something and you’re still out there or something, I would need help to get back or just to make sure nothing goes wrong, but I run with guides and they help because I do have to slow down go into like the water stops and things and they do help to say okay, you’re making a left turn coming up. So instead I go along on my own and just kind of rely on the other runners. Sometimes, it’s better and I’ll always welcome someone to run with me. I’ve always been Ms.Independence. It’s hard for me to always have somebody helping, but they’re wonderful too.

 

Dr.Bethany Fishbein: And they have to find one who’s fast enough for you like I would offer but.

 

Jennifer Herring: Yeah, well some friends

 

Dr.Bethany Fishbein: or you could stroll along with me.

 

Jennifer Herring: Well, sometimes they have to lie so you can only go up to 11 miles with the person they have this switch off for races and there are all levels to of ability. So there are faster runners, and there’s a guy who runs like 235 marathons and blind, and then there are slower runners that it seems like there’s a whole gamut. So if someone does want to help a guy and there are other associations that they set up, there’s United in Stride, it’s called in America. It’s spread out in different states where you can sign up on the website United in Stride and find if you want to assist a visually impaired runner, and then now I see there’s a team tethered together. And that’s another one that I see is set up. So if there are runners that want to assist, and they have that just even to take a vision curbar out for a run race, which is you know.

 

Dr.Bethany Fishbein: Cool! I will put those websites in the notes when we put the podcast out. So if somebody’s interested in doing that, maybe they can get matched up with somebody in their area. Were you in Boston at the marathon, the year of the bombing? Was it twenty 2013 Oh my god. 

 

Jennifer Herring: Yes. Well, I have the associated story with being going to visually impaired because I finished about 15 minutes before the bombs went off. And I was around the corner about 600 feet around the corner. I guess from there, we had a family meeting area where the team was the Vision Group would meet after the race, and there happened to be a seeing-eye dog there waiting for his person to come. And so of course, since he wasn’t working, I wasn’t petting, but I just kind of kneeled down, Just this was my 10th Boston Marathon. So, of course, I love dogs and I was talking to the dog and I felt, I finished my 10th Boston Marathon and it was a beautiful day, that day too and finally because usually, it’s very cold and windy in that area. So yeah, I just usually want to get going and then all of a sudden I heard a noise and an echo sound like a backfire and I was like, okay? and the dogs heard it too. And then it was a little bit of time and then it happened again. And the dog started shaking. So we’re only what is that noise and Josh Warren who had introduced me to Team with a Vision. He had asked me to join the team couple of years back, He said, I don’t know that doesn’t sound good. So my mom was in the hotel in the Prudential Center there I always told her to stay put because I didn’t want her ever wandering around. She called and she said there was a bomb something was going on at the finish line and to get back to the room. So I got up from there and you know me while the dog was shaking, and so he knew the dog knew something was bad. And I had to get back to the hotel. And luckily, I got back then before they started shutting the doors you couldn’t go in, it’s just horrible there. And then actually, a beautiful thing that just happened is that this was a second Boston Marathon they had the Power Elite Athletes Division and one of the women participating in it. Adrianne Haslet – She was affected by the Boston Marathon bombing. She was a ballroom dancer, she lost her leg and she decided she wanted to run the Boston Marathon again after she had done it in 678 hours I think a couple of years ago. So she participated in this past last week, the Boston Marathon and she was just ready. I mean, it was beautiful to see she was so happy because she trained with Shalane Flanagan. She had won the New York Marathon. She’s a professional runner, and she had her as her support. I saw her at the starting area. I could feel the smile, I couldn’t see but I thought we were on the running scene and what was going on and just to know how happy she was and she finished in I think a little over five hours. So it was like a three-hour improvement. And she posted and has been so happy since joy. Yeah, I was even though you’re part of a horrible thing, but she’s turned it into something beautiful in her life. So that was very nice to see firsthand. I always miss out on things. So it was kind of like right there. I was fortunate to just be in the presence of that.

 

Dr.Bethany Fishbein: I really I think that message or theme has come through and a bunch of different stories that you’ve shared today about your experience of taking something that maybe people would consider a negative and finding the positive side or finding the beautiful things in a situation. So that’s a very positive message for today. You know, I think for anybody who’s listening if they are inspired to do something positive, I will share the links to Tethered Together to United in Stride for somebody who’s looking to give us their time for somebody who may be looking for a wonderful place to give their money. I’ll share links for the Team with a Vision and also for Camp Marcella, which although it’s a little bit different now is still helping blind and visually impaired kids in New Jersey and is still a special place to me, and Jen I know for you too. And I’m really grateful that your running career and my vision career have put us back in touch and given us the opportunity to reconnect all these years later. Thank you so so so so so so much for talking. It was great to have this conversation with you.

 

Jennifer Herring: Thank you Bethany and you are wonderful too, I’m honored to talk with you.

 

Dr.Bethany Fishbein: I am the one who is honored here and for everybody out there, Thank you so much for listening.