Turning Problems into Profits

Aetna drops prior approval requirement for cataract surgeries

Starting July 1, 2022, Aetna no longer requires precertification for cataract surgeries for any of their commercial or Medicare plans, with the exception of their Medicare Advantage plans in Georgia and Florida.  This is great news for optometrists. Not only are preauthorizations costly and time-consuming for the office, but waiting on the approval causes unnecessary delays in patients’ access to care.

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.