Turning Problems into Profits

Are you exempt for MIPS?

CMS has a handy tool for doctors to determine if they are exempt from MIPS participation in 2018 because they saw less than 200 Medicare patients or billed less than $90,000 in Medicare fees.  Go to https://qpp.cms.Gov/participation-lookup.

CAUTION: It’s the number zero, not the letter O!

One of our billers was so excited because she filed her first claims with the new 11-character Medicare IDs, but her excitement soon turned to disappointment when 14 of the 16 claims rejected.   It took a little research and a few calls to Medicare to discover the problem:  the office had entered the ID numbers with the letter O instead of the number zero!

In order to avoid confusion over letter and number look-alikes, the new IDs will NOT have the letters O, I, B, L, S, or Z.    So when you see that round character in the ID, type in the number zero and not the letter O! (Or 1, 8, 5, and 2, instead of I, B, S, or Z!)  Being careful to enter the correct ID will save us all of lot of time-consuming rejections!

Please remind your front desk staff to be asking patients if they have received their new Medicare cards yet.  Scan copies of the new cards and update the Medicare numbers in your software.  Medicare will allow us to file under both IDs through next year, but you’ll want to start updating your records now.   Also, when you type in the numbers, please enter the IDs without dashes even though dashes appear on the card.

New Medicare Cards with New Numbers

April 1, 2018–Important Medicare Changes Starting Now!

Beginning today and continuing throughout the next year, Medicare patients will be receiving new cards with new ID numbers.  In an effort to protect beneficiaries from identity theft, CMS is switching from social security numbers to 11-character IDs using both numbers and upper case letters.  Numbers will be generated randomly for each patient, and characters will have no assigned meaning.

Starting today, please make sure your front desk staff asks to see all cards from your senior patients.  If patients have already received their new card, take a copy and enter the new ID into your software, without the dashes.  If patients don’t have a new card yet, tell them that sometime during the next year they will be receiving a new card with a new number and ask them to bring  the new card to all appointments.  All Medicare patients will have new cards and numbers by April 16, 2019.

Railroad Medicare patients will also be receiving new cards. The new Railroad IDs don’t appear to be any different than traditional Medicare numbers, which could create filing issues since Railroad claims have to be sent to a different address.  Therefore, your front desk staff should be especially diligent to look for the Railroad logo on the top of the card or the “Railroad Retirement Board” notice on the bottom banner so they can enter these cards into your system as Railroad Medicare and not under traditional Medicare.

CMS knows that this will be a big change for both beneficiaries and providers alike,  Therefore, they will allow claims to be filed under either the old ID or the new ID until December 31, 2019 to give providers enough time to get their systems updated with the new numbers.  However, after this transition period is over, all claims without the new ID numbers will deny, so it’s important to start updating your software now!  Starting in June, CMS will also be providing a new lookup tool to assist offices in getting the most current numbers for their patients–but the easiest way is to get into the habit of asking patients for their new cards now!

Training Videos are Working

The office training videos are back up! You should be able to log in now; the password is the same,  Thank you for your patience!

For our offices who haven’t looked at these videos, we invite you to check them out!  Click on Office Training on the upper right menu bar. We created the content because we found that staff members at our offices often had the same questions, especially when they hired new staff. So these videos are meant to train your staff about the insurance side of their positions. Each video runs from 5-10 minutes in length. All videos are password protected, so if you don’t have the password, please call your coordinator or Mary at 877-727-3695, ext 210.


EyeMed Issuing Corrected 1099s

3.1.18  EyeMed is currently notifying providers that some of the 1099s they issued had wrong payment amounts, so they are currently in the process of reissuing corrected 1099s.  Per EyeMed, clinics should be getting new 1099s within the next two weeks.   The corrected form will have an X at the top in the CORRECTED box, and this is the one offices must file with their 2017 returns.


1.22.2018  The latest iteration of inaccurate EyeMed disbursements involves remits from the middle of February for which the paid amount is exactly double what the claims on the EOB add up to.  For example, the remit may say the deposit was for $350, but there will only be $175 in payment when we post.  Other clinics are seeing two identical remits for the same amount, same patients but with different check numbers.

EyeMed claim representatives tell us they’re aware of the problem but they have little additional information.  As we encounter these double payments, we’ll be reaching out to our offices on the Team Site to have you confirm how much money was actually deposited into your bank account.  If you were truly paid double, we’ll need to post the additional monies so we’ll have something to offset future chargebacks when EyeMed recoups the overpayment.   But it could be that you were paid correctly and it’s just the remit that’s wrong.  Either way, we have to know for sure in order to reconcile accounts correctly.

Notice to our OfficeMate Clinics

1.30.18  ATTENTION OBS OFFICEMATE CLINICS:  Please do not update to Version 14 in OfficeMate without talking to OBS first! This was a major upgrade that switched the program from a Visual Basic platform to a .NET platform, and there are TONS of ISSUES.  We are seeing lots of problems with our clinics who already upgraded, and you don’t want these headaches!

TRICARE East: No updates yet on how claims are paying.

TRICARE EAST:  We have no updates yet about how TRICARE East claims are paying. You’ll remember we’re looking to see if doctors are paid more if they’re credentialed directly through TRICARE vs doctors credentialed through the EyeMed TRICARE network. Unfortunately, the new East region is getting off to a slow start. They’re quoting a 30-90 day processing time for electronic claims submissions, so it may be a bit before we have our answer. But we will keep you updated just as soon as the first claims come back for doctors in each credentialing group!

EyeMed No Longer Coordinates Medical Exams


EyeMed has changed their medical coordination policy for refractions.  Many medical payers do not cover refractions because they are routine in nature, but EyeMed has always paid for these refractions under the patient’s routine exam benefit when medical claims were coordinated. This changed in November; EyeMed no longer covers refraction-only COBs.  When we questioned EyeMed representatives about this change, we received a variety of answers, from refractions are content of service to an exam (which, of course, is not correct according to the CPT manual) to EyeMed wants to ensure patients get comprehensive examinations (which their medical EOBs clearly show they did).  A few weeks ago we talked to a senior official at EyeMed and were told that, except for a handful of plans, EyeMed contracts do not cover coordinations, and they were just trying to get claims processing back in line with their contracts.

Whatever the reason, this policy change denies many EyeMed patients access to their exam benefit.  For patients with medical conditions or eye diseases, the refraction is the only routine professional service they will receive during the year. EyeMed patients must now pay for the routine portion of their exams even though they have routine coverage.  At the very least, this policy financially penalizes patients and, at the very worst, has the potential of interfering with appropriate patient care if patients elect not to proceed with a medical exam because of the financial barriers EyeMed has imposed.

OBS currently have unpaid refractions sitting on patients’ accounts from COBs which EyeMed denied. We confirmed with EyeMed that these are patient responsibility and not a contractual write off, so we will be transferring these balances to patients with a note that EyeMed denied their claims.  Moving forward, you will need to collect the refraction from your EyeMed patients if their exam is medical. If you encounter unhappy patients, offer to give them EyeMed’s number.  The EyeMed official we spoke with did say that the company may consider revising this policy in the future, and he welcomed calls from offices and patients who had concerns.

This process only affects EyeMed patients, not VSP.  VSP has always placed a high value on customer service, and they automatically allow coordinations except for a few plans which specify otherwise. (If it helps you remember, think of it as an inverse ratio:  EyeMed only has a few plans we can coordinate, but VSP only has a few plans for which we cannot.)  VSP pays up to $66 under coordination, less the patient’s copay.  It is only EyeMed patients for whom you will have to collect the refraction at time of service.

If you have questions or concerns about EyeMed’s no-coordination policy, do not hesitate to call your coordinator–and EyeMed!

Health Net Federal Services is new TRICARE West contractor

1.10.18  With so much confusion centering on Tricare East, it’s worth remembering that Tricare West also had an important change–not a new region, but a new contractor. Their MCS contractor has moved from UHC Military to Health Net Federal Services. West region providers who are not already contracted with Health Net Federal Services (HNFS) may need to fill out a new Tricare West enrollment packet.  However, doctors may still choose to see Tricare patients as a non-network provider, but Prime patients will need a referral or prior auth to go to a non-networking provider for care.  You’ll also want to register for the secure provider portal where you can look up eligibility, submit authorizations, and check claim status.

Below are some helpful links to get you started!

Claims for dates of services on or before December 31, 2017 should still be submitted to UnitedHealthcare Military.  In addition, myTRICARE.com will continue to be available for account information and claims submission through April 30, 2018.  However, all claims for dates of service on or after January 1, 2018 must be filed to Health Net Federal Services, but HNFS will honor all active referrals and authorizations issued by UHC Military prior to January 1.


Tricare West Region:  Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (areas of Western Texas only), Utah, Washington, and Wyoming.

Things to Know in January: Duplicate Superior Payments and Medicare Deductibles

1.8.18  SUPERIOR VISION PAYMENT ISSUES: Some of our clinics recently received duplicate payments from Superior that were previously issued in September. When we called Superior we were told that their new payment system did not successfully issue the original EFT payments, which is why they are now being reissued with interest. However, we are also finding that some of our offices that get paper checks have received duplicate payments as well, so it appears Superior is reissuing ALL payments from that time frame. Some offices who get paper checks are truly receiving double payments that will have to be recouped. If you are an OBS clinic, please call your coordinator if you have questions!


1.2.18   2018 MEDICARE REMINDERS:  The Medicare Part B annual deductible will be $183 in 2018, the same as last year. As you start to see Medicare patients in 2018, 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. And finally, remember that Medicare patients will get new cards and ID numbers beginning in April. It will be critical for your staff to scan the new cards and update the new numbers in your software!

Tricare East Just Got More Confusing!

12/30/2017 (Updated 1/3/17).  With less than 48 hours before Tricare North and South transition into the new East region, it now appears that everything we thought we knew about this change may have been wrong.  Why?  Because last minute information coming from new Tricare East Provider Relations Representatives is contradicting what EyeMed has been saying. The only thing that is clear at this point is the principal players aren’t giving out the same reports.

EyeMed has been contacting optometrists in the eastern half of the US over the last six months telling them that they had to sign a new contract with EyeMed in order remain a Tricare provider after January 1, 2018.  According to EyeMed, doctors’ contracts with Tricare North and South would end on December 31, and Humana Military, who was awarded the contract for the new East region, had selected EyeMed to administer all vision claims. Providers also learned that their reimbursement would be reduced to 70% of CHAMPUS allowables.  In fact, this is still the information being given out by EyeMed’s provider relations department if you called this week.

When EyeMed started emailing new contracts to doctors, Tricare North and South didn’t have a lot of information available for providers either since their regions were being phased out.  However, by December the East region was taking shape and provider relations representatives were being assigned.  Because there were so many unanswered questions, Branda starting making calls to Tricare to try to get clarification about such things as out-of-network benefits.  She had long hold times and several transfers, but the real surprise came when Tricare East representatives informed her that nothing in our doctors’ contracts had changed.  If they were Tricare providers for North or South, they would remain Tricare providers for the new East Region. They didn’t have to do anything differently or execute new contracts. To confirm this information, a Tricare representative directed Branda to Tricare East’s website where she could look up contracting providers. A quick search revealed that many of our Tricare doctors who had not signed the EyeMed contract were still listed as Tricare providers in the East Region beginning January 1.

Faced with such opposing information, on Thursday Branda placed a call directly to Dr. Joe Wende, Senior Director of Medical Services at EyeMed.  When Branda reported to Dr. Wende that she had been told by Tricare East, Dr. Wende had no explanation for the contradictory information.  According to Dr. Wende, Humana Military had contracted with EyeMed to use their provider network, and based upon what they had been told by Tricare he was still under the belief that if doctors were not contracted with EyeMed’s Tricare network they would no longer be Tricare providers.   Of course, rather than getting clarification, this conversation left us in an even greater quandry about what to believe and how to advise our clinics.

Today, one of our Virginia doctors forwarded us a letter from their newly appointed Tricare East provider relations representative.  Here is a direct quote:  “The request you have received from EyeMed is not mandatory.  You have no requirement to opt into that agreement.  If you have opted to sign their contract you have to abide by the new contract.  If you opted not to contract with EyeMed it will not change your current agreement with us.  It will remain the same.”

At this point, we can’t be absolutely certain of anything since the information still coming from EyeMed and Tricare East is totally different. There are still many unanswered questions, the most important being these:  Did providers already credentialed with Tricare sign an unnecessary contract with EyeMed agreeing to take a reduced fee, and will doctors who are still contracted directly with Tricare be paid 100% of CHAMPUS allowables, while doctors who signed the EyeMed contract get 70%?  We don’t know the answers to these questions yet, but we will.

The only way to know for certain how claims will process is to file them and track what happens.  We will keep you updated as soon as the first claims start coming back.  In the meantime, we would advise doctors to do nothing more until we have better information.  If you are an OBS practice, be looking for emails from us with updates.  If you are an optometrist just trying to figure out what is your best course of action, continue to monitor our website.


Updated 1/3/17.  The Humana Military website we originally listed to look up provider credentialing status has moved to a new location.  Please select East Locator.  https://www.humanamilitary.com/find-a-provider

If you are not listed on the website, continue to check back.  Humana Military was still updating their provider list as late as this morning.