Optometric Billing-Increase Reimbursement From Vision Insurances (VSP, DAVIS, EYEMED, SUPERIOR, ETC)

Yes. It's true. You can increase your reimbursement from vision plans that you participate with. There is no special trick to doing this. No special coding that you are required to learn. It's such a big secret, the vision company execs would probably kill me if I let this get out...but I'm gonna take the risk.

It's not hard to make this happen, in fact, it's actually quite simple. All you need is an individual working for you that is talented on the phone and the "cohones" to say "Cancel my contract"!!! Don't believe me?

Here at our clinic, we have successfully negotiated will ALL BUT ONE of our vision plans for an across the board increase of base pay for exams. Where we were receiving $38-$45 before for eye exams, we are now receiving $75 per exam FROM EACH COMPANY and many of the vision insurance companies have been gracious enough to raise our materials reimbursements as well, in most cases without us asking! The only company that didn't want to "play ball" was N.V.A and guess what? I just faxed them our notice of termination.

The bottom line is this: you don't have to continue to accept these low-ball reimbursements from vision plans! You can do something about it...especially if you are in a market where allot of employees utilize a particular plan or if it is a "high rent district". 

Not sure you are ready to try this on your own? Want some help from an optometric billing specialist ? Call us today and we can help you get paid what you deserve from vision insurance companies!

Call Toll Free: (866)688-3335 x1, ASK FOR ANDREW!

Optometric Billing-All About Vision Plans

I stumbled across this blog post by Al Clenimann. This is a wonderful write up on the evils of Vision Plans. I sincerely do not advocate an optometrist's use of vision plans. I believe that optometrists are legitimate doctors that need to provide legitimate medical care to their patients and vision plans are not the way to go about it.

Read Al Clenimann's article,The Dealer and the Junkie. I guarantee you will agree with every word he says.

Optometric Billing-Insurance Fraud

One of our biggest request from potential clients is for us to do things that we believe might be construed as "inusrance fraud". It is our goal as optometric medical billers to provide the best possible service and help optometrists recoup money from insurance as best as possible, but not un-ethically. Take a look at what happened to this Caldwell, ID optometrist:

"A federal grand jury has charged a Caldwell optometrist with swindling more than $1 million from health care benefit programs.

Christopher Card, 59, of Caldwell, allegedly lied and submitted false material to several programs, especially to Medicaid and Medicare. He dishonestly billed the programs, the indictment says, for false diagnoses, including glaucoma, color blindness, tension headaches and treatment of eye injuries.

This went on from as early as Sept. 1993 to Aug. 2010, the indictment claims.

The indictment further alleges that — although Card treated only 3.9 percent of Idaho’s Medicaid clients from Jan. 1, 2004 to May 8, 2009 — he reported diagnosing 99 percent of all acquired color deficiency cases among Idaho Medicaid patients. He also diagnosed 92 percent of all glaucomatous atrophy (optic cupping) cases and 86 percent of all chronic angle closure glaucoma cases.

It is also alleged that, in 2008, Card learned about the federal investigation, abruptly stopped submitting claims for glaucoma-related services and began billing for a variety of new diagnoses."

(You can read the article in its entirety by clicking here)


Apparently this Optometrist can see up to 10 years in prision, a fine of $250,000 and an additional 3 years of supervision after his release! It just doesn't pay to bill insurance incorrectly, NO MATTER HOW CROOKED YOU MAY THINK THE INSURANCE PLAN MAY BE!

By hiring a good and knowledgeable optometric billing expert, however, you don't have to worry about finding creative methods to bill insurance. For example, the industry average for collection from insurance is 70% while the average for collection using in-house staff is closer to 60%. opticXpress averages 75% collection rates from insurance. Did you realize that even this doctor and all his fraudulent billing yielded him only about 60-65% collection rates based on those statistics and HE USED FRAUD TO ACCOMPLISH THIS?!

CALL opticXpress TODAY AND SEE YOUR COLLECTION RATES RISE THE LEGITIMATE WAY!

Optometric Billing-When To Bill Medical Vs. Vision Plans

Here at opticXpress we always council our doctors to do their best to bill a patient's medical insurance vs. the patient's vision insurance whenever possible. Recently, Dr Augustin Gonzalez sent me this article he wrote that explains exactly why a doctor should do this.

"To my amazement, there continues to be plenty of confusion between eye care
professionals and patients about the role of vision plans and medical insurance. It is no wonder our patients are still more confused! Hopefully, the following information will help clear some of the confusion.

The proper usage of Vision Plans is indicated for refractive care. In other words Vision Care Plans are a pre-paid rider of your medical insurance that is intended to provide a service and a durable good at a reduced fee. It is limited to a refractive diagnosis with the doctor (optometrist mainly as ophthalmologist rarely take Vision Care Plans) performing a screening evaluation of the health of the eye and a full refractive evaluation of vision. Vision plans such as VSP, EyeMed, or Comp Benefits cover vision care diagnosis only, which is limited to the icd9 367.XX series of codes or what is commonly known as nearsighted, farsighted, and refractive astigmatism.

Many OD’s and in such many patients do not realize that Medical Insurance is the responsible entity to be used when a medical related eye problem is detected. Problems such as cataracts, dry eyes, infections, inflammation (even those cause by medical devices such as contact lenses), macular degeneration and complications from diabetes or high blood pressure are often found during the course of the eye evaluation. The management and medical decision process of these eye related medical conditions is not reimbursed by your vision plan.

Medical care involves those situations where during the course of the evaluation, a medical condition with a management decision is related to your eyes and there is a need for counseling, documentation, follow-up care, regular monitoring, prescription of medications or referral to a surgeon is indicate"

Call opticXpress today for more information on how we can help you properly use a patient's vision and medical benefits!

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