The resources presented on this page were created by OBS to assist our clinics with billing issues, and we are happy to share them with the larger optometric community with our compliments. We have made every effort to ensure these documents are accurate and reflect current billing standards at the time they were created. However, it is always the responsibility of doctors and staff to review any documents they are using to ensure they meet the policies and standards of your office. As such, these materials are offered “as is” with no warranty provided of any kind.
ICD-10 ROUTE SLIP, 2017 revision
For offices that use paper route slips or need a backup for those times when your software is down, OBS has compiled an updated version that reflects the 2017 ICD-10 coding changes. Please note that an underline in the codes indicates that additional digits are required for laterality, stage, encounter, etc. If you are a client of OBS and would like an Excel version which you can modify for your office, please call us and we’d be happy to email one to you.
Download PDF route slip here: ICD-10 Route Slip, rev 2017
Please be aware that this is an abridged document not intended to replace a standardized coding manual with complete references and annotations. Optometric Billing Solutions has made a good faith effort to review the contents for accuracy, but it is up to doctors and office to review all codes for completeness and correctness. However, if you do find an error we missed, please email Mary at mary@optometricbilling.com and she’ll be happy to review and correct the error and get an updated version posted!
Insurance Handout
Sometimes patients have a difficult time understanding why they owe a balance after insurance processed their claim. Deductibles, coinsurance, copays, and noncovered services can be confusing if you don’t work in the field. Unfortunately, there are always a handful of patients who are upset with the doctor’s office if they owe more than they expected, not understanding that their plan’s coverage is outside of our hands. In fact, coverage is based entirely on the decisions they or their employer made when they purchased the plan. Therefore, we’ve compiled a brief handout that goes over terms, hoping that this will help unhappy patients understand why they owe and redirects their questions to their insurance company.
Download PDF here: Patient Insurance Coverage
Predetermination Form for Medically Necessary Contacts through Medical Insurances
The rules for filing medically necessary contact lenses with routine payers like VSP or EyeMed are clearly defined and relatively simple. However, medical insurances don’t always understand the world of optometry, and getting a medically necessary claim to process correctly can be tough. Many medical insurances don’t cover medical contacts at all, or if they do, they pay so poorly that the office can lose money if they don’t handle these claims correctly.
When you file medically necessary contacts with medical payers, you have to be aware that sometimes they incorrectly hit a routine fee schedule that can significantly lower your reimbursements. When this happens, insurance reimbursements are usually not enough to cover the office’s costs, especially on specialty lenses where the newer technology is so expensive. Therefore, it is critical to call the patient’s insurance and verify benefits prior to ordering or dispensing contacts. When checking benefit information, always get a dollar amount, not just coverage as a percentage of their allowance. (For example, 80% can mean 80% of $150 or 80% of $1,200. You have to know!) Ensure the insurance allowance is enough to cover your costs because you cannot charge your patient any overage.
If you anticipate filing an insurance claim to a medical carrier like Blue Cross, Cigna, or UHC, you’ve got to know the patient’s benefit before you start the process. In order to help, we’ve created a predetermination form your practice can use when verifying benefit information with commercial medical carriers. Either send this form in or use it as a guide on what questions to ask when you call for benefit information.
Med Nec CL Predet for Commercial Ins
