Turning Problems into Profits

Practice Pointers: Helpful hints for successful billing

Practice Pointers: Helpful hints for successful billing

Practice Pointers is a series we recently published with great billing tips for busy practices. We’ve included some of the most popular posts here.

 

 

 

 

PATIENT STATEMENTS: Is your practice good about sending out patient statements on a regular basis? Do you have a process in place that ensures your patient accounts receivable is under control? If patient statements are a struggle for your practice, you might consider using an outside service. For example, if your clearinghouse is TriZetto, they can do your patient statements cheaper than you can usually do it in-house! You still have to review patient balances and upload a file, but then TriZetto takes over from there, saving you tons of time from mundane tasks like stuffing envelopes and running postage. Whatever your routine, having a good process in place for patient statements ensures you won’t miss out on money owed your practice!

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CO-MANAGES FOR SURGICAL POST-OPS. Co-manage post-ops have a 90-day global period, and you’re paid one time for all care related to the surgery in the ensuing 90 days, regardless if you see the patient two or ten times. So how do you bill out multiple post-op visits if you’re only paid once? We suggest that you create a fee slip with charges to be filed to the patient’s insurance on the first post-op visit. Then on all subsequent visits, create a fee slip with the description “Continued Care” with a zero charge. How much should you charge for a post-op? Medicare generally attributes 20% of their surgical reimbursement to follow-up care. Therefore, a good rule of thumb is to look at Medicare’s fee schedule and set your post-op charge above that 20% mark since commercial insurances usually have higher allowables.

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MEDICALLY NECESSARY CONTACTS.  When you see patients with high prescriptions (10 dioptors or greater) or anisometropia (a difference of 3 dioptors or greater), don’t miss the opportunity to file medically necessary contacts to their routine vision insurance. Most doctors know routine payers like VSP and EyeMed will cover med nec lenses for medical conditions like keratoconus or corneal dystrophy, but not everyone is aware that high scripts will also qualify their patients. Medical contacts reimburse practices well and patients appreciate that you’ve significantly increased their benefit to cover a year’s supply of contacts. It’s a win-win!

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THINGS TO CONSIDER BEFORE CHANGING PRACTICE MANAGEMENT SOFTWARES. Branda is always getting calls from doctors or office managers who are considering switching their practice software, hoping to eliminate the annoying quirks and irritations in their current system. OBS works with six of the largest practice management softwares in the industry as well as several others in the past, so we have a lot of experience. Here’s the first thing you need to know: there are no perfect softwares! They all have their own unique foibles and frustrations, so you may be just trading one set of problems for another. Also, changing softwares is a huge investment, not just in money but also in time. A new software creates a large learning curve for your staff, causing additional errors, considerable downtime, and lost production as everyone gets up to speed. So if you’re an OBS client considering a software change, please get on Branda’s calendar before you make your final decision. She can give you the pros and cons of each and help you make a good decision about that’s right for your practice!

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BILLING RELATIONSHIP FOR CHILDREN ON MEDICAID.  When entering children on Medicaid into your software, please remember to mark the “relationship to insured” box as SELF! We often see these children marked as “child” because it just seems to make sense. However, a child Medicaid patient is technically his/her own insured, and almost all state Medicaids will deny claims if this relationship is not marked correctly.

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HIRING THE RIGHT PEOPLE is critically important to any company, but too often it seems things can go wrong. However, there are some steps you can do to increase your chances of getting the right people hired for the right positions.  Some of our best new hires come to us as referrals from current employees. We find that good people usually refer other good people. There is truth to that old saying “birds of a feather”– bright, reliable people tend to associate with other bright, reliable people and can be a great resource for your practice. So if you’re getting ready to hire, put the word out among your current staff and ask them to recommend any one they think would be a good fit for your opening. You may very well find your best recruiters are already on your payroll! 

GROUP INTERVIEWS AND ASSESSMENT TESTING are two great ways of getting good information about a lot of different people in the shortest amount of time. Based on their resumes, we invite the best potential candidates to an evening group applicants’ meeting. We also ensure we have 4 or 5 OBS managers attending because the more input we have afterwards on the job candidates, the more reliable our mutual consensus. The group interview consists of three parts. First, we talk about our company and answer common questions about the position, saving us time by doing this once rather than repeat the same process over multiple individual interviews. Second, we have the applicants complete two short assessments related to skills important to a billing position: simple math and basic reasoning. These assessment tools help us identify who will likely be the most successful in the position, especially the reasoning test that pinpoints people with good critical thinking skills. In a practice, your needs may be a little different, but try to assess whatever skills are necessary for the position. For example, a brief personality survey could help identify self-confident, task-oriented individuals who won’t be afraid to ask for money at the checkout position. And finally, we give the applicants a short tour of our facility, allowing us time to visit with each individually in small groups of 2-4 people. We don’t ask interview questions at group meetings or put the applicants on the spot in front of other people. The whole purpose of the group interview is just to gather information. Within a space of two hours we are able to assess 15-20 people simultaneously and reduce the field to the best 4 or 5 candidates whom we want to bring back for working interviews. 

ONE-ON-ONE WORKING INTERVIEWS are the best way we’ve found to see how a person will actually perform in the position. The group interview allowed us to compile a short list of best candidates; the working interview allows us to narrow the field to the final one or two. We strive to make the working interview as real-world as possible. At OBS, we show the applicant around the billing software, talk them through the claim auditing process, and then ask the candidate to file actual claims. At an optometric practice, however, you might have the job applicant answer phones, enter patient data in the computer, and schedule appointments. The point is to allow the applicant to hop in and interact with patients, watching how well they retain information and how well they handle themselves. At the end of the day, you will be able to identify which candidate performed better than the others, and by now you’ve also spent enough time with each one to evaluate other employment considerations such character and personality. Now you are ready to offer the position to your top choice with the confidence of knowing you have done everything possible to ensure you’ve hired the right person for your position!

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FEES CAN’T VARY BASED ON INSURANCE. One important rule of insurance billing is that you have to charge all patients the same way regardless of their insurance coverage. We’ve seen offices who have decided not to charge their Medicare patients for the refraction because they know Medicare doesn’t cover this service. While wanting to help out their older patients is admirable, practices could be in serious trouble when they go through an insurance audit. You cannot write off a service for Medicare patients unless you’re writing off the service for all patients. You cannot treat a refraction as content of service to the exam for Medicare and not treat it as content for all other insurance carriers. If you have any questions about this or other billing considerations, do not hesitate to call your coordinator! We’re here to help!

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EVERY DAY SHOULD BE A STAFF APPRECIATION DAY! Successful practices know how important enthusiastic staff members are to their overall success. Employees who are excited to come to work each day make an invaluable contribution to your patients’ positive experience in your office. And it is a wise doctor and office manager who understand that what keeps many of their best employees motivated and enthusiastic is a feeling of appreciation. Frequent words of praise and genuine expressions of gratitude for work well done lets employees know you recognize their contributions and consider them a critical part of your healthcare team!

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ONLY DOCTORS CAN CODE THEIR EXAMS! Sometimes when we audit claims prior to submission, we come across obvious coding errors that need to be sent back to the doctor to review. Generally it should always be the doctor who reviews and updates the chart record. We’ve seen instances in which staff members have taken it upon themselves to correct the coding, always with the best intention to save the doctor time. However, only the doctor has the authority to authorize changes in the official record. Even in those cases where the practice has hired a certified coder, it is still the doctor who is legally and financially responsible.

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GLASSES AFTER CATARACT SURGERY. We see a lot of confusion about where to file glasses after cataract surgery. If your patient is insured by traditional Medicare, then the glasses are filed to DMERC, not Medicare, but you have to be credentialed with DMERC, a separate credentialing altogether. However, if your patient has a Medicare Advantage plan, then the glasses are filed to the replacement plan, not DMERC.

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MEDICAL TESTING DURING A ROUTINE EXAM.  We recently had a good question from one of our offices. A patient came in for a routine eye exam without any medical symptoms or complaints. However, during the exam, the doctor identified a potential medical issue and ran some additional medical testing. The office wanted to know if they could bill the exam to the patient’s routine vision plan based on the patient’s chief complaint but still bill the testing to his medical carrier. The answer is yes! Depending on your software, you may want to enter the testing on a separate fee slip for ease of billing,

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CODING YOUR PRIMARY DIAGNOSIS:  It’s important for doctors to order their diagnosis codes so that their claims will process correctly. The first diagnosis should always be the main reason for performing the exam based on the patient’s chief complaint or symptoms, and the exam should always be pointed to the first diagnosis in position A. We see some docs who point the exam to a diagnosis in a secondary position, but these claims can deny since some insurance companies just look at diagnosis position and not pointers.  So if doctors please remember to list the primary diagnosis in the first position and point the exam to A, you’ll avoid a lot of unnecessary denials!

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NEW INSURANCES:  Always ask for patients’ insurance cards at each annual visit. Patients don’t always remember they’ve switched insurances or understand that a Medicare Advantage plan is not the same as Medicare. If you do find a patient’s insurance has changed, please scan a copy of the new card, enter the new insurance in your software, and deactivate or delete the old. However, you cannot deactivate the old insurance if there are still outstanding balances attached to it, so move it to the bottom of the list. The new insurance should always be in the first position under the insurance tab so that it is clear it is now primary. This will allow OBS to file the claim to the correct payer and avoid unnecessary delays in claims processing!

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LOCAL COVERAGE DETERMINATIONS, OR LCDS. Medicare, Aetna, and some Blue Crosses will not pay for medical testing unless it’s pointed to an approved diagnosis that they consider establishes medical necessity. Medicare calls their approved diagnosis lists LCDs, or Local Coverage Determinations. Please ensure when you do medical testing for these payers that you have an approved diagnosis in the record to avoid unnecessary denials. If you do not have a current list of LCDs for your area, please ask you coordinator to email these to you!

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MEDICARE SUPPLEMENTALS. It’s hard for checkout staff to know what to collect from Medicare patients if they don’t understand coverage for Medigap, or supplemental plans. So we put together the chart below to help! Medigap C and F plans (refer to patients’ cards) are the only supplemental plans which will pick up the Medicare deducible, but all of them pay patients’ coinsurance, with these exceptions: Plans K and L only pay a percentage until a max limit is satisfied,and N plans have a deducible that has to be met first. Of course, routine services like refractions are not covered on either Medicare or Medigap plans. Hope this chart helps you know what to collect the next time you have a Medicare patient in your office!

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TRADITIONAL MEDICARE VS ADVANTAGE PLANS:  A reminder for front desk personnel: Patients cannot have both traditional Medicare and a Medicare Advantage plan. Over 25% of seniors have opted for a replacement Medicare policy managed by a private insurance company, but they often don’t understand this distinction. If the new card says “Medicare” or “Advantage,” then it’s probably a replacement plan, not a new supplemental. Deactivate Medicare and enter the new insurance. Advantage plans eliminate the need for a supplemental insurance so you can deactivate their former secondary insurance as well. Not sure? Most Medicare websites or IVRs can tell you if the patient has opted for a Medicare replacement plan. One last thing to keep in mind: some Advantage plans are HMOs so you may need a referral.

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SCANNING INSURANCE CARDS: If your practice doesn’t currently scan patients’ insurance cards, please make this a priority in 2018! Offices frequently have to refer back to insurance cards to correct ID numbers, verify name spelling, locate claims address, find EDI payer IDs, or determine if the policy is an HMO.  A scanned card always ensures your staff has this information at their finger tips and don’t have to waste time trying to contact patients to confirm information.

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MEDICARE REMINDERS:  When you see Medicare patients at the beginning of the year, you can check how much of their deductible has been met on most Medicare websites or IVR. Clearinghouses like Trizetto also offer this service, and you can often sign up to get this information on Availity. Secondary Medigap B, C, and F policies usually pick up the Medicare’s deductible, but collect the noncovered refraction!  Also, remember to always check seniors’ insurance cards at the beginning of the year since they may have changed to a Medicare Advantage plan.

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OFFICE VISIT AFTER CATARACT SURGERY: Here’s a question we recently got from one of our offices: Their patient had cataract surgery with a surgeon who doesn’t co-manage, but the patient wasn’t happy with his vision and came in for a second option. Since the patient was still within the global period of the of the first surgery, our office wanted to know if they could still bill for an office visit? The answer is yes! Since the office isn’t co-managing and billing under a separate tax ID, they can bill a normal office visit and get paid!   (OBS also had a question:  Why are you referring to a surgeon who doesn’t co-manager?)

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NEW PATIENTS VS ESTABLISHED PATIENTS: We got a call today from one of our offices asking about new patients vs established patients, so we thought a reminder for everyone would be a great idea! You can bill a new patient exam if the patient has not been seen by the doctor or any doctor in your group within the last 3 years. The group is identified by tax ID, so for practices with multiple locations, if a patient sees a doctor at a different location within a 3 years time period, the patient would still be considered an established patient.

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EDUCATE YOUR STAFF!  Knowledge is power. Doctors who take the time to educate their staff reap the benefits in customer service for their patients. Everyone in the office should be able to explain the main elements of an eye exam and why each diagnostic test is performed. Staff members should be able to explain what a refraction is, why diabetic patients are at risk, or why the dreaded puff test is so important. Knowledgeable staff members are better able to answer patients questions and feel more a part of the important work provided by your healthcare team!

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INSURANCE WRITE OFFS ARE A GOOD THING! It means that your fees are above insurance allowables, so you’re not leaving money on the table. Every practice should evaluate their fee schedule periodically, but this is especially true if your EOBs are not requiring you to take a write off. Need help deciding where to set your fees? Since all Medicare jurisdictions publish their fee schedules, this is a good place to start, and the information is easy to find with a simple internet search. Commercial medical payers usually won’t give you a copy of their fee schedules, but their allowables are generally higher than Medicare’s. Many practices set their fees 25-30% above Medicare allowables. If you’re an OBS client, don’t hesitate to ask us to review your fee schedule with you! With clinics in 40 states, we are very knowledgeable about what insurances allowables are for your area.

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DO NOT IGNORE YOUR MEDICARE REVALIDATION LETTER! We’ve seen it time and time again: the office gets a letter and somehow it doesn’t get anyone’s attention as critically important. When the doctor doesn’t respond by deadline, Medicare payments stop. If 60 days go by, the doctor is officially deactivated as a Medicare provider and has to go through the entire credentialing process all over again to get back on panel. The process can take a minimum of six months, and the doctor won’t get paid for any Medicare services while he/she is deactivated.  Alert your staff that you need to see all communications from Medicare. Doctors have to revalidate every five years. Not sure when you’re due for revalidation? Check on PECOS or look on CMS website: https://data.cms.gov/revalidation. Also, if you’re an OBS clinic, call Branda when you get your revalidation notice. She’s a good resource since these forms can be confusing!

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DATA ENTRY ERRORS MEAN CLAIMS DENY. In a busy office, it’s inevitable that data entry mistakes are going to happen. Typos are going to happen. But every time a patient’s information gets entered incorrectly, it means the claim will reject or deny, and someone is going to have to do additional work to find the mistake. How do you keep this from happening? A few simple processes can help eliminate the majority of these errors!

First, at check-in always double check basic demographic information: Is the name spelled correctly? Is the address right? Do you have the correct date of birth? Next, ask for a copy of patients’ insurance cards, even if they say their insurance hasn’t changed, and always check that policy ID numbers are entered correctly into your system with alpha characters included but no spaces or dashes. Does the name match the card; is the spelling right? Is the relationship between the subscriber and patient correct? Always get both the patient’s medical and routine vision insurance information since you don’t know where the claim will be filed. Finally, scan the card into your system for future reference should the need arise.

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REMEMBER TO COLLECT THE REFRACTION FROM YOUR MEDICARE PATIENTS AT CHECKOUT! Because of the medical issues that come with age, most annual exams for our older patients are medical in nature, but the refraction is always considered routine. Medicare won’t cover routine services, and most supplemental plans follow Medicare’s lead and won’t cover the refraction either. Therefore, it’s a safe bet that the patient is going to owe for the refraction. However, even through you collect the refraction, still file it to Medicare just to give the patient’s secondary a chance to consider payment on the crossover.

A couple of instances in which you don’t have to collect the refraction is when the patient has Medicaid as secondary or a routine insurance like VSP or EyeMed to which you can coordinate benefits and get the refraction paid. So if you’re planning to coordinate, you don’t have to charge the patient for the refraction on date of service. You do, however, have to make sure it’s filed to Medicare for the denial so it can be coordinated. (Important Note: You do have to know the routine payers rules about coordination. There are only a few routine plans that don’t coordinate, but some of them like EyeMed have special rules on how you have to file to get your COB to pay.

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EXCLUSIONARY CODES. According to the National Correct Coding Initiative, doctors cannot bill OCTs and fundus photography on the same date of service. (You can’t bill two OCTs either.) Most insurances will pay the OCTs and deny the photos. However, in those circumstances where doctors feel they need both tests, we can append a modifier to see if both tests will pay. Your chart records have to clearly document the medical necessity for performing both, and OBS will request your consent before filing them together. Be prepared to submit your documentation for an insurance review. Because the overuse of this modifier has been known to trigger an insurance audit, some doctors find it easier just to perform these tests on two different dates of service.

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DOES YOUR OFFICE VERIFY BENEFITS? It’s always a good idea to know patients’ insurance coverage and what they will owe prior to seeing them. This is the only way you can collect correctly at checkout. We know this takes time, but offices who don’t verify benefits usually end up spending just as much time and even more resources on the back end trying to collect from patients whose testing applied towards their deductible or exams denied as not covered. In some cases, billing the patient after insurance processes may mean you won’t collect at all. We all know it’s easier to get payment at time of service rather than weeks later.

If your office is struggling to find the time to verify benefits, here are some suggestions that may help: Pretesters often have downtime late in the morning after the doctor sees his/her last patient before lunch. This is a great time to start calling on benefits. Utilize web sites. Most insurance companies allow you to look up plan benefits, deductibles, and copays online. Most clearinghouses like Trizetto provide this service.  When you do have to call insurance companies for benefits, inquire about several people at once to save time. And finally, if your staff is too busy throughout the day, have you considered hiring a part-time person, like a reliable college student, to work a couple of hours every day.

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ALWAYS CHECK THE INSURANCE CARD TO SEE IF IT’S AN HMO!    We all know that HMO plans won’t pay without a referral, but you’d be surprised how often we get denials from insurance companies because the office saw the patient for medical care and no one got a referral. How can you avoid this? Always check the patient’s card! If it says “HMO” or has a primary care physician (PCP) listed, then the plan requires a referral for medical eye care.  Many of your insurance contracts put the burden for obtaining a referral on the provider, and the EOB shows the denial as a contractual write off. Even if your contract doesn’t stipulate and it’s your office’s policy that patients are responsible for getting all referrals, a courtesy reminder to patients can go a long way in gaining goodwill and saving the patient from a large bill he/she didn’t expect.

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MEDICALLY NECESSARY CONTACTS ARE A WIN FOR PATIENTS AND PRACTICE ALIKE!   If your clinic doesn’t do medically necessary contacts, you really should take a look at your processes. These can be a huge benefit for both you and your patients. Also, did you know that med nec lenses are not just for keratoconus or corneal dystrophy/transplant patients? Most routine payers like VSP and EyeMed extend medical contact benefits to patients with high prescriptions (>10 dioptors) or anisometropia (>3 dioptors). The process for filing with VSP and EyeMed is pretty straightforward and simple. (Not so with medical payers, however!) For patients who qualify, you’ve not only maximized your patients’ benefits and gained their gratitude, but you’ve also opened an important new revenue source for the practice since these lenses reimburse well.

If you’re an OBS clinic, we have a training video on our website that covers medically necessary contacts with VSP that you and your staff may find helpful. Also, don’t hesitate to call your coordinator for more information!

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NEW AOA GUIDELINES RECOMMEND ANNUAL EYE EXAMS FOR ALL CHILDREN. Based on new research, the American Optometric Association now recommends school-aged children have an eye exam every year. How frequently are you seeing your youngest patients? Children’s vision can change quickly, and with each progressive year the visual demands in the classroom increase significantly. If you’ve been hesitant to ask children to return to the office each year because of the old guidelines, you can now have the confidence to tell parents that you need to see their children on an annual basis, even if they’re not in a script.

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Glasses After Cataract Surgery

Glasses after cataract surgery can be really confusing for some of our practices, so let’s see if we can help you out! If your patient is insured by traditional Medicare, then the glasses are filed to DMERC, not Medicare, but you have to be credentialed with DMERC. However, if your patient has a Medicare Advantage plan, then the glasses are filed to the replacement plan, not DMERC. If the patient’s primary insurance in a commercial insurance, file there.  Hope that helps!  And please remember, any time you have a billing questions, don’t hesitate to call your coordinator.  We love sharing our expertise.

Time to Update your Fees?

The beginning of the year is a great time for clinics to review their fee schedule to ensure they’re getting reimbursed fairly from insurance payers.  Every practice needs to periodically review their fees to make sure they’re charging enough. One of the best ways you know it’s time to increase fees is if you’re not taking a write-off when we post your insurance payments. If insurance companies are allowing everything you charge, it means they’d actually pay you more if your fees were higher! For practices who need help deciding where to set their fees, Medicare is a good place to start. All Medicare jurisdictions publish their fee schedules, and the information is easy to find with a simple Google search. Commercial medical payers usually won’t give you a copy of their fee schedules, but their allowables are generally higher than Medicare’s. Many practices set their fees 25-30% above Medicare allowables. If you’re an OBS client, don’t hesitate to ask us to review your fee schedule with you! With clinics in 41 states, we are very knowledgeable about what insurances allowables are for your area, and we can do an analysis and let you know where you may be undercharging based on your insurance payments.

Glitch with VSP Dual Coordinations

March 2022.  For several months, VSP has been experiencing a glitch with the way they process dual benefit coordinations for glasses. Even when opticians files the COB correctly, VSP has been processing the coordination wrong. On the VSP remit, the patient will have two back-to-back claim entries, but both process as primary, costing the practice money. As OBS billers come across these errors, we are calling VSP and asking them to correct it.

Medicare Telehealth Options to Address COVID-19 Emergency

As many optometrists are aware, the CDC and AOA have both recommended all routine eye exams be rescheduled because of the coronavirus outbreak.  Medicare has also issued three new coding options to help address the challenges COVID-19 is presenting to optometrists.

First, optometrists are now allowed a VIRTUAL CHECK-IN with patients for follow-up visits.  If the physician has not seen the patient within the last seven days and will not see the patient again for 24 hours, they can use this option.  Virtual check-ins are 5-10 minute visits over the phone or using captured video or images that are billed with G codes.  Physicians can’t bill this option if they decide to have the patient come in within 24 hours.  G2012 is used for telephone follow-up visits and G2010 is for captured video or images. The reimbursements for these G codes are generally low, around $15.

The second option, called ON-LINE DIGITAL EVALUATION, is communication with patients through the physician’s online portal. If the patient initiates the portal contact, the physician can bill for the cumulative time they spend communicating with the patient over a seven day period, provided they don’t see the patient for a medical visit within 24 hours. Previous HIPAA requirements or the capabilities to store these patient communications have been waived during the COVID-19 emergency. The billing codes are based upon total time spent answering the patient through the portal: 99421 is for 5-10 minutes and reimburses around $15.52; 99422 for 11-20 minutes, $31.04; and 99423 for 21 or more minutes, $50.16.

Finally, Medicare’s new COVID-19 guidelines allow for TELEHEALTH SERVICES. These are office visits conducted over video applications such as Facetime or Skype and are billed with the 99-series evaluation and management codes, such as 99212 or 99213.  The 92-series eye exam codes do not apply.  Unlike previous telehealth guidelines, this option is no longer restricted to remote or rural areas, the patient can be at home, and providers do not have to use a HIPAA compliant software, only any real-time audio and video for live, interactive telecommunication between the provider and patient.  Billing for telehealth exams requires some software setup for required modifiers and place of service, so if any of OBS doctors decide to utilize this option, please notify your coordinator or Branda so that we can ensure the claims have the proper coding.

So far these three billing options have only been approved by Medicare, but because Medicare sets the gold standard in billing, other commercial payers often follow. Some commercial carriers may already have other remote billing options in place for telephone evaluations. We can only advise providers to check with their local commercial insurance carriers to see what options they may have to continue to provide medical eye care to patients throughout this emergency.

Here are links to the AOA webinar held on March 17 that covers Medicare’s changes in more detail:   AOA Recorded Webinar     Link to PowerPoint

IMPORTANT INFORMATION FOR SPECTERA PROVIDERS

Spectera is currently issuing new contracts which require all clinics to use an Essilor lab for glasses, including Vision Source providers who have always had the autonomy to choose their own lab. If you are a Spectera provider, this means you will no longer have the option to operate as your own lab UNLESS you live in a state that has passed legislation allowing optometrists and patients the freedom of choice in lab selection. Doctors who practice in a “Lab of Choice” state (such as Alabama, Arkansas, Florida, Georgia, Kansas, Maine, Missouri, New Jersey, Oregon, Texas, Vermont, Virginia, and West Virginia) cannot be forced to use a designated lab IF THEY DO NOT SIGN THE NEW LAB CONTRACT and negotiate a new agreement. So if you live in one of the above states, please do not sign the new Spectera contract until you talk to Branda. If you are a Vision Source provider, you also need to talk to Branda. Even if your practice is in a state without legislative protection and you’re forced to use a designated lab, there are still things that need to change in the way your opticians operate and how we bill for you. And finally, if you are uncertain what the new Spectera contract means for your practice or you just have questions, please feel free to call 877-727-3695. Ask our receptionist Misty to schedule an appointment time so you and Branda can discuss your options.

New Route Slip

We recently updated our ICD-10 route slip to reflect the changes in ophthalmoscopy and cataract surgery codes (see below). The route slip is free for anyone to download who wants a paper backup to use at their office for those times when their software may go down.  If you are an OBS client, and would like a copy of the route slip to customize for your office, call Mary at 877.727.3695 and she can send you an editable version in Excel.

Click here to download:  Revised Route Slip

DISCLAIMER:  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@obsTeam.com and she’ll be happy to review and correct the error and get an updated version posted!

Important Coding Changes for 2020

There have been some important coding changes for 2020.

EXTENDED OPHTHALMOSCOPY

First of all, CPT codes 92225 and 92226 for extended ophthalmoscopy were deleted as of January 1, 2020. We now have two new codes based upon what area of the retina was examined and documented. (Ophthalmoscopy is no longer reported as initial and subsequent testing.) Use 92201 for examination of the retinal periphery or 92202 for the optic nerve and macula. Another important change for extended ophthalmoscopy is billing. These codes are now considered bilateral and are billed on one line with one reimbursement. (The old codes were billed per eye.) This, of course, is going to impact our doctors’ reimbursements.

NEW CATARACT SURGERY CODES

Additionally, starting January 1, 2020, two new codes were added for cataract surgeries: 66987 and 66988. These codes are used when two surgeries are done together to treat both cataracts and glaucoma. The surgeon first performs traditional cataract surgery with IOL insertion and then performs a laser surgery called ECP (Endoscopic Cyclophotocoagulation) for patients with uncontrolled glaucoma to reduce their intraocular pressures. CPT 66987 is for complex cataract surgery with ECP, and CPT 66988 is for basic cataract surgery with ECP. Also, the description for existing cataract surgery codes 66982 and 66984 have now been revised to read “without endoscopic cyclophotocoagulation.” We may start to see some of these new cataract surgery codes as we bill co-manages in the coming months.

Late EyeMed EOBs

6/18/19  EyeMed appears to be dropping remits this week from 6/4/19 that have not previously shown up on their website. Therefore, billers need to check their disbursement history to see if they have EOBs that weren’t there two weeks ago. Also, we’re also finding that some of these back-dated remits have no lab charges listed, so the checks don’t balance. However, if you look up the remit on EyeMed’s website, the claim is listed correctly so you can post and balance. Oh, the joys of billing!

DAVIS IS NOW ENROLLING FOR EFTs!

Davis Vision has teamed up with InstaMed to offer EFT payments to providers. For more information, log in to your Davis provider portal.  There is an easy sign up form for providers to begin to receive direct deposits into their bank accounts along with electronic remittances.

Aspex Eyewear Back in Network with VSP

VSP and Aspex Eyewear announced today that they have settled their legal disputes and that Aspex is rejoining the VSP network as an in-network frame provider.    As part of the agreement, Aspex agreed to pay a financial settlement to VSP and settle prior lawsuits.  The agreement between the two companies means that VSP patients may now purchaes Aspex frames under their VSP vision plans.

VSP Checks Shorted by Altair Glitch

ATTENTION VSP CLINICS WITH ALTAIR TAKE-BACKS: If your VSP check usually has take-backs for Altair frames, then the 2/15 check that dropped today may be significantly short because of an Altair-Eyefinity glitch. Altair take-backs were either doubled or totally zeroed out the checks with an additional chargeback line titled “Eyefinity Services.” We called VSP, Eyefinity, and Altair this morning as soon as we discovered the problem. The Altair official said the error was totally on their end. They discovered it late last night and started going through accounts. They are currently in the process of issuing paper checks that will come through the mail. They are prioritizing by the amount of the take-back error, working on the largest take-backs first for accounts that were shorted over $1,000. OBS did an audit for all our clinics’ checks and has already contacted Eyefinity on behalf of those clinics that the Altair error impacted. A paper check should be mailed to you by next week. If you do not have payment for your Altair frames taken out of your VSP checks, then this glitch did not affected your VSP payment.