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.

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.