opticXpress has updated their webpage. It now includes easier access to information about services, the ability for patients to logon and pay invoices they have revamped it throughout with cleaner, more concise text.
opticXpress is an optometric billing company that provides a clearinghouse, billing service and software strictly for optometrists.
Tuesday, March 18, 2014
Friday, March 7, 2014
Optometric Billing-New 1500 Claim Form
In case you are not aware, though I am sure you are, there is a new 1500 claim format going into effect April 1. After looking over the attached manual there are many changes going into effect that you as a billing person or doctor's office should be aware of. Below you will find a copy of the most recent new 1500 claim form and a link to the intsruction manual for filling this out. It would be in your best interest to print out the form and fill it in with "dummy" information according to the attached instructions as many times as needed in order to familiarize yourself with the information and new form.
As always, opticXpress can handle all your billing needs and help you ease the transition to this new format.
Friday, February 28, 2014
Optometric Billing-Vermont Medicaid Timely Filing Limits
As Per Section 8.1 of the Vermont Medicaid Timely Filing Manual:
1) When Vermont Medicaid is Primary the timely filing limit is 6 months (one of the shortest in the nation):
2) Crossover Claims-you have 2 years (weird but true):
1) When Vermont Medicaid is Primary the timely filing limit is 6 months (one of the shortest in the nation):
When the system indicates that Vermont Medicaid is the primary payer, the timely filing
limit for such claims is six months from
the date of service. In no case will a claim be
considered if the date of service is greater than two years prior to the DVHA’s receipt of
the claim. If a claim has a date or dates of service past the timely filing limit, it may be
submitted for payment directly to HPES if one or more of the following conditions are
met:
•HPES denied the claim within the timely filing limit for a reason other than
exceeding the
time limit. A copy of the remittance advice showing the denial must be
attached to each
claim.
•Abeneficiary’s eligibility was made retroactive and the date of service is within the
retroactive period. The claim must be submitted within the first twelve months of
thedate on the Notice of Decision. Include a note with the claim stating the
retroactivedate
of eligibility.
•Inpatient claim, the timely filing limit is 180 days from the date of
discharge.
2) Crossover Claims-you have 2 years (weird but true):
When a claim is billed to Medicare with Vermont Medicaid noted as the secondary payer
(using the crossover function), the crossover claim will be
considered timely if it is
received within two years of the date of service.
opticXpress specializes in Medicare and Medicaid billing for optometrists. We also handle the billing of ALL other insurance companies as well, espescially our home state of Vermont.
Thursday, February 13, 2014
Optometric Billing-Submitting Refractions to Medicare-92015
For those of you who are not sure, you can not bill Medicare for a refraction...it is considered to be part of an eye exam by default and is therefore "statutorily excluded" from being billed (ref: EyeCor, 2014). However, you do have options.
1) You can bill your patients at the time of service for this service, ALWAYS MAKE SURE TO GIVE YOUR PATIENTS AN ABN (CALL opticXpress at 866-688-3335 x1 if you need a copy of one) informing them in advance of your intention to do this.
2) Don't bill Medicare for the refraction at all
3) Include the refraction on your claim but use a "GY" modifier. This will signify to Medicare that you know this service is not covered and you have informed of this via an "ABN". (Hint; if you chose option 1, you will need to perform option 3 as well).
1) You can bill your patients at the time of service for this service, ALWAYS MAKE SURE TO GIVE YOUR PATIENTS AN ABN (CALL opticXpress at 866-688-3335 x1 if you need a copy of one) informing them in advance of your intention to do this.
2) Don't bill Medicare for the refraction at all
3) Include the refraction on your claim but use a "GY" modifier. This will signify to Medicare that you know this service is not covered and you have informed of this via an "ABN". (Hint; if you chose option 1, you will need to perform option 3 as well).
As always, opticXpress is here to help! Click here to contact us today and let us handle your optometric billing for you!
Wednesday, February 12, 2014
Optometric Billing-VSP to Begin Covering Google Glass
The following text was copied from a January 28 article in "Optometry Times". This will most likely affect optometric billing personnel over the coming months and it would be a good time to start aquainting yourself with these developments. I am sure that many other insurance companies will begin following suit, espescially if it proves to be popular. It will also be a good way for an optometric practice to provide cutting edge technology to its patients and customers and one more reason to get people through your doors.
Begin Article:
San Francisco, CA*VSP and Google have reached a deal to offer subsidized frames anq
prescriptlon lenscs for Google Glass.
"We know our 64 million members are seeing and hearing about Google Glass and how itwill affect
their lives and vision, so we are really focusihg on the eye health management perspective," says
Jim lvlcGrann, president of vsP vision caro, vsp's insurance division, which insures one-fifth of
Americans.
Google plans to sell Glass to the public lator this year, While it did not originally offer traditional
framos or prescription lenses, early Glass owners "hacked" the device to add prescription lenses
an0 sungtasses.
Now, Google has designed 4 styles-curvy, thin, split, and bold, all shown above*made of
lightweight titanium, and plans to offer 2 new styles of sunglasses. The color, frame, and shade
choices will offer 40 style variations for Glass.
Justin lJazan, OD, Optometry flmes Editorial Advisory Board member, speaking exclusively, says
ho hopes VSP's decision to cover Google Glass will bring in new customers looking for prescription
versions of the much-hyped new device.
"Being able to provide €yewear that incorporates revolutjonary technology will make us more
valuable to our patients," says Dr. Bazan.
VSP and Google croated a training program foroptometrists to learn howto mount Glass on frames
and fit thc device on patients. '[he companies have alroady begun training ODs in New york City,
San Francisco, and Los Angeles, although they have not said how many ODs have been tralned.
"VSP providers can prepare online. I got an e-mail directing to me a specifically designed Web site.
I watched a video, took a quiz, signed a non-disclosure document and then was told something like
'Congratulations. Your VSP Glass welcome package will be mailed to you. Expect it in a week or
so,"'says Dr, Bazan.
VSP's lab rn Sacramento, Cn, will cut lenses for Glass frames. Google Glass costs g1,SOO for thosc
invited to buy the current version, but it will retail for several hundred dollars less when it is
introducod to the public later this year. The titanium frames will retail for $225. VSP will reimburse
members based on their plan, with an average reimbursoment of $120, plus the costs of buying
prescription iensos. lt will not subsidize the computer portion of Glass.
"Smart glasses may or may not find their way into our practices. -fhere
are companies out thero that
aro likely to do everything online and skip using an eyecare provider. In fact, I would say it's only a
matter of time before we see smart glasses available direct from the manufacturer
or reseller online," says Dr. Bazan.ODT
Begin Article:
San Francisco, CA*VSP and Google have reached a deal to offer subsidized frames anq
prescriptlon lenscs for Google Glass.
"We know our 64 million members are seeing and hearing about Google Glass and how itwill affect
their lives and vision, so we are really focusihg on the eye health management perspective," says
Jim lvlcGrann, president of vsP vision caro, vsp's insurance division, which insures one-fifth of
Americans.
Google plans to sell Glass to the public lator this year, While it did not originally offer traditional
framos or prescription lenses, early Glass owners "hacked" the device to add prescription lenses
an0 sungtasses.
Now, Google has designed 4 styles-curvy, thin, split, and bold, all shown above*made of
lightweight titanium, and plans to offer 2 new styles of sunglasses. The color, frame, and shade
choices will offer 40 style variations for Glass.
Justin lJazan, OD, Optometry flmes Editorial Advisory Board member, speaking exclusively, says
ho hopes VSP's decision to cover Google Glass will bring in new customers looking for prescription
versions of the much-hyped new device.
"Being able to provide €yewear that incorporates revolutjonary technology will make us more
valuable to our patients," says Dr. Bazan.
VSP and Google croated a training program foroptometrists to learn howto mount Glass on frames
and fit thc device on patients. '[he companies have alroady begun training ODs in New york City,
San Francisco, and Los Angeles, although they have not said how many ODs have been tralned.
"VSP providers can prepare online. I got an e-mail directing to me a specifically designed Web site.
I watched a video, took a quiz, signed a non-disclosure document and then was told something like
'Congratulations. Your VSP Glass welcome package will be mailed to you. Expect it in a week or
so,"'says Dr, Bazan.
VSP's lab rn Sacramento, Cn, will cut lenses for Glass frames. Google Glass costs g1,SOO for thosc
invited to buy the current version, but it will retail for several hundred dollars less when it is
introducod to the public later this year. The titanium frames will retail for $225. VSP will reimburse
members based on their plan, with an average reimbursoment of $120, plus the costs of buying
prescription iensos. lt will not subsidize the computer portion of Glass.
"Smart glasses may or may not find their way into our practices. -fhere
are companies out thero that
aro likely to do everything online and skip using an eyecare provider. In fact, I would say it's only a
matter of time before we see smart glasses available direct from the manufacturer
or reseller online," says Dr. Bazan.ODT
Tuesday, February 11, 2014
Optometric Billing-92225-Ophthalmoscopy Extended w retinal drawing - Initial-Acceptable DX Codes
We have done numerous posts on the 92225 proc code. My main reason for this is because it is highly abused among optometrists and optometric billers and billing staff alike. Therefore, in an effort to continue to provide more clarity on this subject I am publishing a list of acceptable Diagnosis Codes that can be reported to Medicare (and most other insurances) when billing for this procedure. I would like to point out that this list is based on Texas medicare Local Coverage Determinations (LCD's) but it is a good reference point for any state as variations in the rule are minute. If you have any questions about your state, feel free to contact Andrew Roy at 802-253-7201 and we will help you find the EXACT DX codes for your state.
| Allowed Reimbursamble Diagnoses Pertaining to 92225 |
| 115.02 Retinitis - Infection by Histoplasma Capsulatum [American histoplasmosis - Darling`s disease] |
| 130.2 Chorioretinitis Due To Toxoplasmosis |
| 190.5 Malignant Neoplasm - Retina |
| 190.6 Malignant Neoplasm - Choroid |
| 224.5 Benign Neoplasm - Retina [Retinal Nevus] |
| 224.6 Benign Neoplasm - Choroid [Choroidal Nevus] |
| 228.03 Hemangioma of Retina |
| 228.09 Hemangioma - Other Sites |
| 282.60 Sickle-cell Disease, Unspecified |
| 282.64 Sickle-cell/Hb-C Disease With Crisis |
| 282.68 Other Sickle-cell Disease Without Crisis |
| 360.01 Endophthalmitis - Acute |
| 360.21 Progressive High (degenerative) Myopia - Malignant myopia |
| 361.00 Retinal Detachment - Defect - Unspecified |
| 361.01 Retinal Detachment - Recent - Partial - One Defect |
| 361.02 Retinal Detachment - Recent - Partial - Multiple Defect |
| 361.03 Retinal Detachment - Recent - Partial - Giant Tear |
| 361.04 Retinal Detachment - Recent - Partial - Dialysis |
| 361.05 Retinal Detachment - Recent - Total or Sub-total |
| 361.06 Retinal Detachment - Old - Partial |
| 361.07 Retinal Detachment - Old - Total or Sub-total |
| 361.10 Retinoschisis - Unspecified |
| 361.11 Retinoschisis - Flat |
| 361.12 Retinoschisis - Bullous |
| 361.13 Retinal Cysts - Primary |
| 361.14 Retinal Cysts - Secondary |
| 361.19 Other Retinoschisis And Retinal Cysts |
| 361.2 Retinal Detachment Serous - without retinal defect |
| 361.30 Retinal Defect - Unspecified w/o Detachment |
| 361.31 Retinal Hole w/o Detachment |
| 361.32 Retinal Tear w/o Detachment |
| 361.33 Retina - Multiple Defects w/o Detachment |
| 361.81 Retinal Detachment - Tractional |
| 362.01 Background Diabetic Retinopathy |
| 362.02 Proliferative Diabetic Retinopathy |
| 362.03 Nonproliferative Diabetic Retinopathy |
| 362.04 Mild Nonproliferative Diabetic Retinopathy |
| 362.05 Moderate Nonproliferative Diabetic Retinopathy |
| 362.06 Severe Nonproliferative Diabetic Retinopathy |
| 362.07 Diabetic Macular Edema |
| 362.10 Background Retinopathy - Unspecified |
| 362.12 Retinopathy - Exudative - Coats` syndrome |
| 362.13 Changes In Vascular Appearance of Retina - Vascular sheathing of retina |
| 362.14 Retinal Microaneurysms - NOS |
| 362.15 Retinal Telangiectasia |
| 362.16 Retinal Neovascularization - NOS |
| 362.21 Retrolental Fibroplasia [Cicatricial retinopathy of prematurity] |
| 362.31 Central Retinal Artery Occlusion |
| 362.32 Arterial Branch Occlusion |
| 362.35 Central Retinal Vein Occlusion |
| 362.36 Venous Tributary (Branch) Occlusion of Retina - BVRO |
| 362.41 Retinopathy - Central Serous |
| 362.42 Serous Detachment of Retinal Pigment Epithelium [Exudative detachment] |
| 362.43 Hemorrhage Detachment of Retinal Pigment Epithelium |
| 362.52 Macular Degeneration - Exudative Senile (WET) [Kuhnt-Junius degeneration] |
| 362.53 Macular Degeneration - Cystoid |
| 362.54 Macular Cyst or Hole or Pseudo-hole of Retina |
| 362.56 Macular Puckering [Preretinal Fibrosis, Epiretinal membrane] |
| 362.63 Lattice Degeneration of Retina [Palisade degeneration of retina] |
| 362.74 Pigmentary Retinal Dystrophy [Retinitis Pigmentosa, Albipunctate] |
| 362.81 Retinal Hemorrhage |
| 362.83 Retinal Edema [Cotton Wool Spots, Macular, Peripheral, Localized] |
| 362.84 Retinal Ischemia |
| 363.00 Focal Chorioretinitis - Unspecified |
| 363.01 Focal Choroiditis and Chorioretinitis - Juxtapapillary |
| 363.03 Focal Choroiditis and Chorioretinitis of Other Posterior Pole |
| 363.04 Focal Choroiditis and Chorioretinitis - Peripheral |
| 363.05 Focal Retinitis and Retinochoroiditis - Juxtapapillary [Neuroretinitis] |
| 363.06 Focal Retinitis and Retinochoroiditis - Macular or Paramacular |
| 363.07 Focal Retinitis And Retinochoroiditis of other Posterior Pole |
| 363.08 Focal Retinitis And Retinochoroiditis - Peripheral |
| 363.10 Disseminated Chorioretinitis - Posterior |
| 363.11 Disseminated Chorioretinitis - Unspecified |
| 363.12 Disseminated Chorioretinitis - Peripheral |
| 363.13 Disseminated Chorioretinitis - Generalized |
| 363.14 Disseminated Retinitis and Retinochoroiditis - Metastatic |
| 363.15 Disseminated Retinitis and Retinochoroiditis - Pigment Epitheliopathy [Acute posterior multifocal placoid] |
| 363.20 Chorioretinitis - Unspecified [Choroiditis NOS, Retinitis NOS, Uveitis posterior NOS] |
| 363.21 Pars Planitis [Posterior cyclitis] |
| 363.22 Harada`s Disease |
| 363.30 Chorioretinal Scar - Unspecified |
| 363.70 Choroidal Detachment [Commotio Retinae, Choroidal Hemorrhage] |
| 363.71 Choroidal Detachment - Serous [Commotio Retinae, Choroidal Hemorrhage] |
| 363.72 Choroidal Detachment - Hemorrhagic [Commotio Retinae, Choroidal Hemorrhage] |
| 365.10 Open-angle Glaucoma Unspecified [Wide-angle Glaucoma NOS] |
| 365.11 Primary Open Angle Glaucoma [Chronic, Simple, Noncongestive, Nonobstructive] |
| 365.12 Low Tension Open-angle Glaucoma |
| 365.13 Pigmentary Open-angle Glaucoma |
| 365.14 Glaucoma of Childhood [Infantile, Juvenile Glaucoma] |
| 365.20 Primary Angle-closure Glaucoma Unspecified |
| 365.21 Intermittent Angle-closure Glaucoma [Interval, Sub-acute] |
| 365.22 Acute Angle-closure Glaucoma [Attack, Crisis] |
| 365.23 Chronic Angle-closure Glaucoma |
| 365.24 Residual Stage of Angle-closure Glaucoma |
| 365.31 Corticosteroid-induced Glaucoma Glaucomatous Stage |
| 365.32 Corticosteroid-induced Glaucoma Residual Stage |
| 365.42 Glaucoma Associated With Anomalies of Iris [Anomalies NEC, Atrophy, Essential] |
| 365.44 Glaucoma Associated With Systemic Syndromes |
| 365.62 Glaucoma Associated With Ocular Inflammations |
| 365.63 Glaucoma With Vascular Disorders of Eye |
| 365.65 Glaucoma Associated With Ocular Trauma |
| 368.15 Other Visual Distortions and Entoptic Phenomena [Refractive: diplopia; polyopia; Photopsia; Visual halos] |
| 379.21 Vitreous Degeneration [Vitreous cavitation, detachment, liquefaction] |
| 379.23 Vitreous Hemorrhage |
| 379.24 Other Vitreous Opacities [Vitreous Floaters, Vitreous Syneresis] |
| 379.26 Vitreous Prolapse |
| 379.29 Other Disorders of Vitreous |
| 379.34 Dislocation - Posterior Lens |
| 871.5 Penetration of Eyeball with Magnetic Foreign Body |
| 871.6 Penetration of Eyeball with Nonmagnetic Foreign Body |
| 996.53 Mechanical Complication Due To Ocular Lens Prosthesis |
| E931.4 Antimalarials/Drugs Acting On Other Blood Protozoa Causing Adverse Effects In Theraputic Use |
| V58.69 Long-Term (current) Use of
Other Medications
Need Help With other Codes or Just want a full time billing department to handle your optometric billing? Click here to contact opticXpress now!
|
Thursday, February 6, 2014
Optometric Billing-92132-Scanning Computerized Ophthalmic Diagnostic Imaging ANTERIOR Segment
Billing for 92132 is rather straightforward.
1) The procedure is considered Unilateral or Bilateral-This means you can either bill for it once, if it is both eyes or ammend it with an RT or LT modifier
EX: 92132 (for both eyes) 92132-RT( for right eye only) or 92132-LT (for left eye only)
2) The procedure is considered to mutually exclusive of 92285 (External Ocular Photography For Documentation of Medical Progress ) which means you can bill the 92132 with the 92285 but you must have a separate diagnosis code for the 92285 and MAY have to use a 59 modifier.
3)Never bill 92132,92133 or 92134 on the same day, bring your patients back on separate days to do these procedure as they are generally done with the same machine and therefore will be considered to be one procedure. If you were to bill for all of these on the same day, you will find that you will most likely only be paid for the lowest reimbursing procedure.
4) If you do decide to do the patient a favor and perform 92132, 92133 and 92134 all on the same day, bill for the highest reimbursing procedure only.
5) If for some reason you do get paid for any of the above codes bilaterally or more than one of the above codes, this money will be taken back by the insurance company during a coding audit and will likely reduce the payable amount of future checks.
6) The above rules apply to Medicare only. Though other insurance companies generally follow the medicare reimbursement rules, each insurance company may have separate reimbursement policies that do not necessarily follow what is laid out here. It would be a good idea to call Provider Services of the insurance company you plan on billing to find out what their individual reimbursement policies are for the above codes.
1) The procedure is considered Unilateral or Bilateral-This means you can either bill for it once, if it is both eyes or ammend it with an RT or LT modifier
EX: 92132 (for both eyes) 92132-RT( for right eye only) or 92132-LT (for left eye only)
2) The procedure is considered to mutually exclusive of 92285 (External Ocular Photography For Documentation of Medical Progress ) which means you can bill the 92132 with the 92285 but you must have a separate diagnosis code for the 92285 and MAY have to use a 59 modifier.
3)Never bill 92132,92133 or 92134 on the same day, bring your patients back on separate days to do these procedure as they are generally done with the same machine and therefore will be considered to be one procedure. If you were to bill for all of these on the same day, you will find that you will most likely only be paid for the lowest reimbursing procedure.
4) If you do decide to do the patient a favor and perform 92132, 92133 and 92134 all on the same day, bill for the highest reimbursing procedure only.
5) If for some reason you do get paid for any of the above codes bilaterally or more than one of the above codes, this money will be taken back by the insurance company during a coding audit and will likely reduce the payable amount of future checks.
6) The above rules apply to Medicare only. Though other insurance companies generally follow the medicare reimbursement rules, each insurance company may have separate reimbursement policies that do not necessarily follow what is laid out here. It would be a good idea to call Provider Services of the insurance company you plan on billing to find out what their individual reimbursement policies are for the above codes.
If you don't want to worry about coding these yourself, CALL OPTICxPRESS TODAY and we will help you !
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