Optometric Billing- Does Medicare Cover Routine Eye Exams?

I get this question all the time, sometimes doctors even demand that I "respect their authoritah" (Eric Cartman pun intended) and trust them when they tell me that Medicare Pays for Routine Eye Exams.

Simply put, MEDICARE DOES NOT PAY FOR ROUTINE EYE EXAMS, EXCEPT FOR PATIENTS WITH DIABETES. 

"Medicare Part B (Medical Insurance) covers a yearly eye exam for diabetic retinopathy by an eye doctor who is legally allowed to do the test in your state." link

That being said, if you try to bill Medicare using a V72.0, 367.21, 367.0, 367.4,367.1 DX Code as your primary DX code, expect not to get paid; and if Medicare doesn't cover it, chances are the patient's secondary may not pick it up either, although this is not a definite rule as it varies by payer and patient plan.

By the way, for those docs and staff out there that think you are being paid for routine work because the EOB says you were paid for a "92004 and 92015"....YOU ARE MISTAKEN AND YOU MUST LEARN TO RESPECT MY "AUTHORITAH" !

OPTOMETRIC BILLING-INCREASE REVENUE, BY 50 PERCENT?!?!

I recently came across a website that specializes in medical billing for opthalmologists. The owners of the site, and likely the business, claim right on the home page that you can  "INCREASE YOUR REVENUE BY 50% WHEN YOU OUTSOURCE YOUR BILLING!" .

I CALL BULLSHIT!

I know, I know. It is unprofessional of me to curse on a professional blog site but can you honestly blame me? If you stop and think about it for one second, doesn't that make you feel a little bit stupid as a doctor to see someone advertise to you that they can increase your business by 50% if you just outsource your billing!?!? Maybe stupid isn't even the right word. Maybe foolish is better. Maybe you can think of a better word to describe the feeling that that statement evokes and post it in the comment section below. The bottom line, however, is that no matter how you slice it that is just false advertisement, PERIOD.

First of all some simple math. If your business bills $50k per year to medical insurance it's absolute fodder to believe that outsourcing that job will all of a sudden bring you $50k more per year in insurance business, how does that add up? Where is the logic there? Also, let's just say that the claim this advertiser is making means that you will simply just collect 50% more by outsourcing your billing and your current collection rate is 50%, you will now add $12.5k more money to your bottom line bringing your overall collection rate to only 75% which is the industry average, you can do better than that, why settle for less?

No matter what angle you look at it from, insurance just doesn't work that way. Quite simply, insurance is nothing more than a corporate lottery. These companies are in the business of making money and will do whatever they can to keep their reimbursement rates as low as possible meaning you, the provider, and the patient loose big time. Do you really think that outsourcing is going to improve your odds of DRASTICALLY improving your revenue?

Don't get me wrong. Outsourcing is a great thing and will DEFINITELY improve your revenue and your cash flow if you choose the right partner to outsource too. However, there is no way that I or anyone else can guarantee you that you will improve revenue by 50% if you just outsource your billing. The answer to improving your revenue begins and ends with you, the practice owner. You want to increase your current revenue? You should  outsource your billing to a company like opticXpress who focuses on increasing your collection percentage AND works with your patients. This frees up your office staff giving them the time and flexibility to focus on what matters most, your patients. Second, you should increase your business which is single handedly the only tried and true method to increase revenue. Last, TRAIN YOUR STAFF! A well trained staff who understands patient satisfaction and insurance eligibility procedure not only keeps your customers (patients) happy but it cuts down on billing errors and keeps you "in the black".

So, the next time someone tells you that you can increase revenue just from outsourcing, pipe up and call bullshit.

CHECK OUT OPTOMETRIC BILLING SERVICES BY opticXpress TODAY!

Optometric Billing-Free Optometric Billing?

That's right! opticXpress is working on a way to provide optometrists with a FREE* method to perform optometric billing that centers around their office management software. More info is coming soon, but check their software page for more info about how the ground breaking opticXpress software might be a fit for your practice.

You can also CLICK HERE for software info.

RELATED:

What is Optometric Billing? 

Optometric Billing-Today Funny Video-Sorry Walmart OD's!

This goes out to all of the Walmart Vision Center O.D's and their staff...Clearly, you have it rough!

Dont forget: opticXpress for all your optometric billing needs!

Optometric Billing-Today's Funny Video-04/04/2012

As usual, we here at opticXpress enjoy a good laugh. Watch the video below and remember to clean the glass at your offices regularly!!!!

Contact opticXpress Today For All of Your Optometric Billing Needs!

Optometric Billing-How To Properly Bill For Visual Fields

Using Medicare's Local Coverage Determinations (LCD's) as a guide to billing ALL  insurance companies is a good strategy to employ. Though it does not guarantee payment across the board, it is, in my opinion, a key way to increase reimbursements. This is because Medicare is, by far, the most stringent payer in terms of rules for coverage.

As an optometrist, one of the most important procedures you give your clients is a Visual Field (92081,92082,92083) but it is also one of the most commonly misbilled procedures in the optometric billing field. The biggest reason for this is that it is commonly not paired with a correct diagnosis code which means you loose money because it is denied as "medically unnecessary". You can avoid this by first determining whether or not it is deemed medically necessary to perform a visual field by check the attached chart to see if the diagnosis you are suspecting qualifies for a visual field. If it does not then you need to explain to the patient that you feel it is necessary to perform the procedure and CHARGE THE PATIENT! You would then bill the insurance company with a "-GY" modifier. MAKE SURE THAT YOU INCLUDE THIS INFORMATION IN THE PATIENT'S ADVANCE BENEFICIARY NOTICE (ABN) !

CONTACT opticXpress TODAY FOR HELP WITH YOUR OPTOMETRIC BILLING 

Optometric Billing: Digitally Active Contact Lenses!

Just makes me wonder how we would start billing for this!!!!


"Digitally Active Contact Lenses – Are We Near It's hard to trace the active contact lens' birth date, but the year might be 1973. , researchers at the National Environmental Research Center created a contact lens with a thermocouple built in. The sensor-cum-contact was arguably the first digitally active design to be realized. As the electronics revolution commenced in the 1970s and 1980s, though, little work was done to expand on this precocious design. Interest revived in the late 1990s, but it was not until 2001 that the device began to step from concept into commercial reality. Researchers used micro-electro-mechanic sensors (MEMS) to create a contact lens that monitored ocular pressure -- an important indicator of Glaucoma. The research was presented at the New Directions in Cellular and Tissue Biomechanics conference in Les Diablerets, Switzerland. In 2009, a company Sensimed AG launched the world's first commercial digitally active contact lens. The design, dubbed "Triggerfish", used an embedded a MEMS strain gauge sensor and microprocessor inside a soft silicone contact lens. The circuit elements were exocentric, out of the line of sight. The device received power from and ferried signals via a circular antenna around the eye socket. In the last decade several devising and even more ambitious designs were introduced in this hot field. Among the most noteworthy is Professor Babak Parviz of Seattle's Washington University, who added pixel displays to the mix. Perhaps inspired by Triggerfish - medical sensors, such as a glucose sensor (monitoring tear glucose, an indicator of blood sugar in diabetics), are also inculcated into the design. But creating a contact lens display has been a major obstacle for focusing the image. In short, we need miniature lenses to focus the image on the eye. Ultimately the digitally active contact lens of the future aims to be a high resolution display, which can assert an augmented reality, including text and images over human vision. Such a design would work for business (work displayed right in your eyes), communications (text messages, emails), and pleasure (imagine watching movies or "tripping" without drugs via in-eye vision). The lens will also likely optionally incorporate glucose, occular pressure, and possibly other sensors to monitor eye health and overall body health. , it may be a few decades before the perfected contact lens product is released commercially, but in just 10 years we may have crude commercial contact lens text displays, if you're willing to wearing a bulky wireless power device around your eye socket." (full article here)


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