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-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.

Optometric Billing-Claims to Be Held by Medicare per Congressional Request

Information Regarding the Holding of April 2014 Claims for Services Paid Under the 2014 Medicare Physician Fee Schedule
The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1, 2014. That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014.

CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (i.e., through April 14, 2014). This hold would only affect MPFS claims with dates of service of April 1, 2014, and later. The hold should have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any Congressional actions.

You can always contact opticXpress for help with your optometric medical billing and avoid having to worry about these things yourself. Please click here for more info.

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).

 As always, opticXpress is here to help! Click here to contact us today and let us handle your optometric billing for you!

Optometric-Billing-NHIC-Transitions-To-National-Government-Services-(NGS)

This is especially important for all Medicare providers located in the states of New York, Vermont, New Hampshire, Maine, Massachusetts, Connecticut and Rhode Island. The Medicare providers in this region, known as Jurisdictions 13 and 14, will begin to see claim payments and remittance advices coming from National Government Services instead of NHIC. This transition is taking place on a schedule and that schedule is not only listed below but we have attached a handy pdf to this post to help you find all the information you need to know should you feel left out or have just missed it.

Implementation Schedule

1. Phase 1-States of Connecticut(except HH&H) and New York-Completed as of 06/01/2013-Parts A and B
2. Phase 2-States of Connecticut (HH&H Only), Maine, Massachusetts, New Hampshire, Rhode Island, Vermont-Completed by 10/18/2013-Part A
3. Phase 3- States of Maine, Massachusetts, New Hampshire, Rhode Island, Vermont-Completed by 10/25/2013-Part B

Click here to read the entire letter sent by NGS to providers in the affected region.

For help with your optometric billing needs, please don't hesitate to CLICK HERE to contact opticXpress. We are here to help!

Optometric Billing-Expanded Job Decription for OD's

According to Holly Lafferty at The William's Way, optometrists may soon be required to diagnose and manage other health issues rather than just issues dealing with vision. Though the practice is starting in California, it could quickly spread to other states if the program is successful. This is because, like in California, "Obamacare" is requiring expanded healthcare services and coverage to millions of Americans nationwide and as a result there is a shortage of qualified doctors in many of these areas to fill what would be an explosive need.

If you think that your medical and vision billing can be a headache now, imagine how much different it will be when you or your staff has to code, not only for vision care services, but for other MEDICAL services as well!

Not to fear...opticXpress is always here to help you with your optometric billing needs, CONTACT US TODAY and never worry about issues like this again!

For more info about the bill, please click the links below and don't forget to add your two cents...Comment and tell us what you think!

Original News Paper Article Published in Med City News

Article Posted by Holly Lafferty at The Williams Way

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-Getting The Most Out of Medicare

I received a letter from one of my doctors today concerning certain types of Medicare Rejections having to do with patients that have Medicare but are actually covered by another insurance company for vision services.  He asked me for some tips as to how to minimize these rejections and get more out of his services to Medicare patients. The following excerpt from my reply letter to him should efficiently help any optometric practice or optometrist who has the same questions regarding the billing of Medicare.

***Please note that you will see references in this excerpt to the opticXpress software system. Though most of you do not use it just know that if you do use it to bill Medicare we can virtually guarantee the payment of your Medicare claims provided you enter the required information into the system correctly.

Call opticXpress today for more information!

TIPS ON GETTING THE MOST OUT OF YOUR MEDICARE BILLING FOR OPTOMETRIC SERVICES

    Here are some things that you should follow when performing an exam on a Medicare patient:
1) Medicare does not cover refractions. Make the patient pay for the refraction after you complete
   the exam.
2) Make sure your staff collects ALL of the patient's insurance information and scans it into
   opticXpress. This includes ID cards, social security cards and driver's liscense. Many times
   a staff member sees one insurance card and then stops instead of proceeding forward with finding
   out whether the patient has other insurance. If the staff member collects all of this and enters it
   into opticXpress then it will be most valuable for us should a claim be denied...it allows us to
   work the rejection ASAP.
3) Every medicare patient is required to pay Co-insurance of 20% of the allowed amount of the service.
   This means that if your examination fee is $100.00 you should collect $20.00 in addition
   to what you are charging for the refraction. If the patient has secondary insurance that will cover
   co-insurances and deductibles then Medicare will usually "cross the claim over" to the patient's
   secondary if the patient has alerted Medicare of this additional coverage. If the patient has not updated this    information with Medicare or they don't have secondary
     coverage, than collecting these fees up-front assures cash flow from Medicare while you are
     awaiting final payment. Additionally, if your staff has entered all of the patient's insurance
     info into the system it allows us to "cross the claim over" to his/her other insurance
     on the patient's behalf. You will then receive this additional payment from the patient's secondary
     insurance company.
4)   Remember that Medicare's deductibles are a yearly payment each patient must pay. That means that
     most Medicare patients you serve during the first 4-6 months of the year will owe this deductible
     and hence, they will have to pay you for the service out of pocket after Medicare denies or
     any secondary (supplemental) coverage will cover it but it will add to the turnaround time on
     that claim. Just remember this when working with your Medicare patients and remind them while
     they are in the exam room with you or at another designated time. Most Medicare patients are
     elderly and it is imperative that you take your time to try and help them understand their
     benefits. In the long run, you will profit more.
5)   Finally, ask your patients the following before you begin the procedure:
     a) "Do you fully understand our policy concerning Medicare patients?"
     b) "Are you comfortable or able to pay for a refraction and/or your co-insurance today?"
     c) "Do you understand that Medicare requires you to pay a deductible out-of-pocket and
         you may owe this if you have not met it for the year and do not have supplemental
         coverage to take care of this for you?"

CMS TO REVIEW PECOS ENROLLMENT PROCESS

This just in, IT WILL AFFECT OPTOMETRISTS AND OPTOMETRIC BILLERS ALIKE!

Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process

The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.

As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems. CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.

CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.

The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.

Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation. These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.

While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.

Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.

CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.