OPTOMETRY BILLING-A VIEW ON VSP

I was talking to one of my clients last night about VSP. He, like EVERY OD I HAVE EVER MET OR WORK WITH, was lamenting about the fees and reimbursement from VSP vs. our local Medicaid. Here is what I said about that:

"As for VSP, I'm staunchly against their hold on the industry. I've personally watched some of the media they propagate into the optometric community, specifically to OD students on college campuses. It's quite brilliant, but it's dangerous. VSP was started by a group of OD's with the goal of creating a guaranteed method for their "brethren" to be paid for their services and to make it easier for patients to afford you [and obtain needed vision services]. Since their merging with Eyefinity, however, they have become just like every other major corporation....more interested in their bottom line than in serving their clientele. I believe that a government payer should NEVER pay more than a private one . This propagates in-equality in the marketplace and it is the exact opposite of the capitalistic society were intended to operate as. 

SIDE NOTE: you can actually make ALOT of money on VSP if you have your own edger as they will pay you as a lab. Suddenly, it is only costing you a few dollars to produce glasses in house rather than pay VSP's exorbitant lab fees. One of my clients makes roughly 800%-1000% on each pair of glasses he produces for a VSP patient and he is usually FASTER than lens crafters and pearl vision when it comes to serving his patients' needs. Something to think about. I hope it begins to catch on among the doctors in AOA, it's the only way to fight VSP in this current climate. "

Just as an example of VT Medicaid vs. VSP: VT medicaid pays about $130 for a comprehensive eye exam and refraction. This is offered YEARLY to Juvenile patients and bi-annually to adults. An OD can perform multiple refraction on a patient after the eye exam and get paid for them. VSP caps its Eye Exam reimbursement at about $75. Not every patient qualifies for a refraction and there is no such thing as going to the doctor between covered exams for a followup refraction. In fact, you have to really fight to even be in the $75 reimbursement teer, something our office negotiated with VSP for 3 years before it finally came to fruition. A covered VSP refraction will usually not net you more than $25 (not including patient-out-of-pocet) and VSP includes out-of-pocket fees in their reimbursement rate, medicaid patients don't pay a dime out of pocket for eye exams. 

This is a huge problem. I believe that VSP is the country's largest private vision insurance in the country. Serving the majority of employer groups nationwide as well as being part of government networks, providing out-sourced vision benefits to medicaid patients in California and other states as well (this was something the VT optometric Assc fought against and won). Yet they are one of the worst reimbursing insurances for vision services; BCBS, by comparison, has an excellent vision reimbursement AND THEY ARE NOT FOR PROFIT, UNLIKE VSP!!!!

CONTACT OPTICXPRESS TODAY FOR HELP WITH YOUR OPTOMETRY BILLING.

CLICK HERE.

OPTOMETRY MEDICAL BILLING-Less than 80 days to ICD-10 - CMS and AMA Announce Efforts to Help Providers

Many offices have contacted us regarding ICD-10 over the last few years. Lately these requests for help have become more ernest. While I have traditionally told people that I didn't believe it was the year for ICD-10 to FINALLY become mandatory, all signs are currently pointing to "yes" for this year. I will still hold out till Oct 1 to be certain BUT it is still good to be prepared.

In July Medicare announced that It will not deny claims coded with ICD-10 that don't use high specificity...at least not at first. That means that if you have the ability to translate an icd-9 code to an icd-10 code directly, not highly specific in terms of ICD-10, you will likely not receive a denial for that. However, this is a temporary solution so you shouldn't rest on your laurels.

Here is an excerpt of the original announcement put out by Office Ally:

"According to the CMS, for one year after Oct. 1, 2015, Medicare will not deny physicians or other practitioners Part B claims based solely on the specificity of the ICD-10 diagnosis code as long as the provider used a valid ICD-10 code from the right family. In addition, quality reporting will also receive a grace period, as long as a valid ICD-10 code from the correct family of codes is used. Moreover, if a Part B MAC is unable to process claims within established time limits because of administrative problems, an advance payment may be available. CMS will also have an ICD-10 Ombudsman to help receive and triage provider issues. "

I still do not believe that it is in our best interest to implement ICD-10 while the rest of the world is already moving to ICD-11 but that is a different argument for a different day.

Click here to learn more about the CMS/AMA announcement.
Click here for the guidance/FAQ from CMS.

Contact opticXpress today for more info about OUR medical billing services!

Optometric Billing-Medicare Id Number Suffixes

Ever Wonder what the letters at the end of a patient's Medicare ID# mean? I always did too at one time so I decided to share it with all of you.

As originally published by the Council of Nephrology Social Workers:

*A = retired worker
  B = wife of retired worker
  B1 = husband of retired worker
  B6 = divorced wife
  B9 = divorced second wife
  C = child of retired or deceased worker; numbers after C denote order of children claiming benefit
  D = widow
  D1 = widower
  D6 = surviving divorced wife
  E = mother of a child of a deceased worker
  E1 = divorced mother of a child of a deceased worker
  F1 = aged dependent father
  F2 = aged dependent mother
*HA = disabled worker HB = wife of disabled worker
  HC = child of disabled worker
*J1 = special “over 72” benefit, has A and B
  K1 = wife of “over 72” benefit, has A and B
*M = has Part B Medicare only, no SSA benefit
 *T = has A and B Medicare, no SSA benefit
  W = disabled widow
  WA = railroad retirement

*denotes the recipient’s own social security number.

If you ever have any questions about Optometric Medical Billing (also known as Optometry Billing), click here to contact us today or call 866-688-3335.

OPTOMETRY BILLING-BCBS OF VT-TIMELY FILING

Just as an FYI to all Vermont BCBS providers:

After a brief phone consultation with Provider Services at BCBS of VT, it is confirmed that ALL CONTRACTED providers with BCBS VT have a timely filing limit of 6 months. There is one known exception: patients who went under VT Healthconnect to purchase insurance that became active Jan 1 of 2014 and DID NOT update their insurance info with their provider could have their claim re-opened in the event of a timely filing incident.

For help with optometric billing contact opticXpress today by CLICKING HERE or calling (866)688-3335.

OPTOMETRY BILLING-SPECTERA ELECTRONIC CLAIMS SUBMISSIONS

opticXpress is pleased to announce that we are now online with Spectera as an approved clearinghouse to submit claims to them electronically. Providers will still have to sign up with optum-payments to receive Electronic Remittance Advices and request EFT however, which is a let down, but this is a step in the right direction for an insurance company that is arguably one of the most archaic and backwards thinking insurance companies in the market (most vision plans are similar, as well all know!).

Contact opticXpress today by CLICKING HERE or calling (866)688-3335 and let us be your go-to optometry billing service!

Optometry Billing-Medicare, VSP and Others Increase Audits

* "Medicare, Blue Cross, VSP and ALL  other payers have increased their audits. They know that most practice's documentation is NOT COMPLIANT! Typical Penalties are between $100,000 and $200,000 ! Most practices fail these audits. "





*This came from our friends at Eyecor. opticXpress is a re-seller of Eyecor coding software you can contact us by clicking here to get more info about this ground breaking software. For help with a pending insurance Audit, a Past Insurance Audit or to protect yourself from a possible future audit please contact Eyecor's Nteon Practice consultants by clicking here. 

Nteon Practice Consultants are experienced in what auditors are looking for. They have conducted many audits throughout the country and these audits include a review of compliant documentation, reports, HIPPA and lost reimbursements just to name a few.

opticXpress Provides 835 ERA File Interpretation and Translation Services

Dear Medical Biller,

    One of the most important aspects of your job, if not THE MOST IMPORTANT, is posting and reconciling payments. However, without expensive software, it is near impossible to do this automatically costing you valuable time, money on salary and worse, CLERICAL ERRORS.

opticXpress has a solution that you may be eager to learn about. WE NOW PROVIDE 835 ERA INTERPRETATION AND TRANSLATION SERVICES! Simply put, you receive an 835 file from your payers or clearinghouse, pass that file along to us in its original format and we translate it and send it back to you in ANY FILE FORMAT you wish! Using our service, the possibilities are endless, your clients will benefit and so will your bottom line.

     To find out more about this invaluable service, give me a call today at (866)688-3335 X1 and ask for more info on our 835 Interpretation and translation service. I guarantee that you will have nothing to lose but the seemingly endless piles of EOB's on your employee's desks!

   Sincerely,

   Andrew W. Roy
   President
   opticXpress

Expanded Optometry Billing Services To Choose From This New Year !

Hi All,

    Andrew Roy here, President of OpticXpress. I just wanted to key you in on some of our core services that we offer . As a busy optometric practice, any or all of these services may fit your needs perfectly and I invite you to give me a call and chat with me about them.

    We offer:

1. Free practice management software
2. Paid practice management software that includes fully accredited EMR allowing your practice to take advantage of meaninful use payments
3. Full medical billing services including clearinghouse, claim submission, claim denial resolutions, payment reconciliation, patient invoicing, patient consultations regarding invoice/balance questions, patient access to quick and easy online invoice payments
4. Patient recall services including low cost post-card mailing
5. Access for your practice to discounted equipment just for being an opticXpress client. This equipment includes retinal cameras and OCT machines as well as all other major equipment.
6. Staff training
7. Full practice management

    You can choose from any or all of the above solutions that best fit your practice. Once you have an idea of where you want to go we will help integrate these services into your office. 

Give me a call about these wonderful services today, I can't wait to hear from you. 866-688-3335

HAPPY NEW YEAR!

Sincerely,

Andrew W. Roy

President

opticXpress