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.
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?"
