Over the past few months I have noticed that when we publish a piece relating the billing of insurance companies for cataract post-operative procedures our hits go way up! This, among various Google and Bing searches, leads me to believe that this is a hot button issue for optometrists. In fact, I know it is a hot button issue because we get calls at opticXpress concerning this issue all the time.
What I don't understand is why? Why is it that it is so hard for optometrists to bill for this procedure and get paid for it?
There are just a few steps needed to properly bill and get paid for the procedure.
- Establish a set price for cataract post-operative care. Why? Because Medicare and the likes of other insurance companies consider post-op work to be a maximum of 90 days and pay a certain amount for this procedure intended to cover you for ALL visits with this patient in the 90 days following the actual surgery. So then, it stands to reason that you need to bill for a reasonable amount of money that will cover you for EVERY planned visit of the patient within that 90 day period. Billing your usual and customary fee for a standard eye examination is not a good idea cause most likely that is all you will be paid!
- Coordinate with the physician that provides the surgery- In other words, require that a patient bring a referral sheet from the surgeon's office. Most opthamological centers have a standard one. This sheet will list the procedure code used to bill medicare by that office for the original surgery as well as an modifiers that may have been used and the ORIGINAL surgery date. IF THE PATIENT DOESN'T HAVE THIS SHEET AND YOU CAN'T GET IT FROM THE SURGEON'S OFFICE, DON'T PERFORM THE EXAM UNTIL YOU DO.
- Coordinate with the surgeon's billing staff-make sure that you verify what was billed to Medicare when they originally billed for the surgery. IF THEY HAVEN'T BILLED THE SURGERY YET THEN DON'T BILL FOR THE POST-OP WORK, YOU WILL NOT GET PAID!
- Make sure that you are using billing software that allows you to manipulate lines on the 1500 form!-Believe it or not most of the major pieces of software like officemate and maxim eyes either don't support this feature in earlier versions or make it very difficult to do. Sometimes, it is best to just leave off information from the procedure in order to generate a CLEARINGHOUSE denial so that you can manipulate the claim through their web portal. If you are using opticXpress to bill for cataract post-op work then you don't have to worry about this because the software does it for you.
- You will need to write in the dates that you saw patient-This means that when you manipulate the claim lines you will have to write a) the date you saw the patient and b) the date, 90 days from the start date, the post-op care will terminate. Also, you need to write 90 days after the dates. This information must be listed in box 19 on the 1500 form and should look like this: assume care date-care end date-90 days (02022012-05022012-90days). IF THIS IS NOT ON THE CLAIM YOU WILL NOT GET PAID!
- The date of service IS NOT THE DATE YOU SEE THE PATIENT, IT IS THE SURGERY DATE!
- Use proper modifiers
- List the surgical provider as your "referring physician".
After looking back at all those steps and how wordy it is I can see why so many doctors don't get paid for these services! It's too bad, it can be very lucrative for your office. However, unless you are handwriting these claim forms, it's most likely not your fault that your getting nothing for these services. The bottom line is that you just spent way too much money on office management software without taking into account the fact that it needs to be able to help you provide these services to your clients! If you had known about or chosen opticXpress software, the 8 steps listed above....GONE! You could have stopped at number 3!
Billing for Cataract Post-Operative care should not be hard. It should be as easy for billing for an eye exam. With opticXpress at your side, billing for these services IS EASY! Watch this 59 second video to see just how easy it can be. Then...
Is this something that you have experienced in your office? Do you have stories about billing for cataract post-op care? Use the comment section below to let us know.