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!