Turning Problems into Profits

Billing for ODs

OBS can help your practice!

Posted by on Jun 4, 2013

–Are you struggling to maintain control over your insurance billing and account receivables? –Trouble finding or keeping trained billers who understand the confusing...

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OBS Advantage

The OBS Advantage

Posted by on Jun 4, 2013

Our services pay for themselves.  We’re professionals who know how to collect every available dollar.  We know your insurance payers, so we know how to maximize reimbursements.  We...

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Learn More About OBS

About Optometric Billing Solutions

Posted by on Jun 4, 2013

. Optometric Billing Solutions currently serves clinics in 39 states and is owned by Brooke Armstrong and Branda Barton, two sisters who have both managed large clinics.  They...

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Outsourcing Your Billing

Outsourcing: What You Need to Know

Posted by on Jul 7, 2013

Do you need help with your billing but have concerns about turning it over to an outside company? You are wise to be cautious! We get frequent calls from optometrists who have had...

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Recent Posts

Tricare’s Changes in Vision Care Signal Dangerous Ground for Optometrists

As of January 1, 2018, Tricare will merge their North and South regions into one new East region.  Humana Military will administer the East region, but they have SUBCONTRACTED ALL VISION SERVICES TO EYEMED FOR BOTH MEDICAL AND ROUTINE.  Therefore, optometrists in the new East region will need to be contracted with EyeMed to continue to see Tricare patients.  Providers should have received an email from EyeMed to update their contracts with the new Tricare amendment.

IMPORTANT TAKEAWAY:

There are larger implications for optometrists, however, than just needing to complete a new EyeMed contract.  The change in how Tricare plans to administer vision care signals dangerous ground for our profession.  In the past, Tricare treated optometrists as any other medical professional and reimbursed providers at 100% of the CHAMPUS maximum allowable charge.  Now, vision care reimbursements will be reduced by 30%.  Not only will optometrists be paid less for their services, but the fact that optometrists have been pushed out of the Tricare system and are now forced to deal with an outside routine vision payer signals an alarming change in the way Tricare views our profession.

We’ve seen outsourcing of vision care to routine commercial payers happen before with many state Medicaids, and the results nearly always mean a significant drop in reimbursements, even for medical services.  There are still a lot of unknowns, but every optometrist and state optometric association should be on high alert: Is this the beginning of a system-wide move that reduces insurance reimbursements to optometrists?  If we are willing to accept less for our medical services now, how long will it take for commercial third-party payers like Blue Cross to notice and follow?  When state Medicaids started subcontracting medical vision services out to routine payers, they found little resistance.  Now Tricare is following suit, expanding to the national level the encroachment on our reimbursements and ultimately demeaning our status as healthcare providers.

Even greater than the issue of money is the move to pigeonhole optometrists into the realm of “routine.”  As a profession we need to recognize the danger of payers outsourcing medical vision care to routine carriers lest we lose the parity we’ve fought so hard to gain.  Optometrists remain the primary eye care providers in this country, daily seeing patients to assess and treat their medical eye problems.  The medical care we provide ensures our patients’ visual heath.  Our early interventions often avert more chronic or long-term issues.  We counsel patients on diseases such as diabetes and hypertension and discuss lifestyle choices such as smoking and nutrition. We analyze patient and family histories, evaluate medications for adverse ocular effects, and can identify systemic diseases through their ocular manifestations.  We prescribe medications to treat eye diseases, and we refer our patients to appropriate specialists when they’re in need of additional care.  In every sense we are primary providers on the front lines of our patients’ healthcare.  We play a critical role in our patients’ lives far beyond our skills in refracting and writing glasses prescriptions.  We must be ready to fight any move by insurance payers to discriminate against our role in healthcare, including attempts to subjugate us to lesser reimbursements or relegate our profession to the jurisdiction of routine vision payers. 

We should all be alarmed at Tricare’s new policy on vision care.

 

 

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