Optometry Staff to check patients’ benefit plans before documentation



It is quite usual for a patient to visit an optometrist’s office with a thorough understanding of the insurance coverage he or she possesses. The optometrist’s staff should also understand and be good at reading the patient’s illnesses while comparing them with the various diagnosis codes. This helps them decide on whether to bill under vision insurance or medical insurance. However, in reality most of the staff employed at an optometrist’s do not realize the importance of checking the patient’s benefits plans before documentation.

This is primarily because most of them do not fully understand which plan is meant for what. Hence, more often than not they are at a loss as to advising the patient on what benefit plan he or she should be using. In such situations not only are the staff frustrated, they leave the poor patients frustrated as well. The staff need to understand:

ü  To ensure error less billing and coding, there needs to be at least one staff member in an optometrist’s office who thoroughly understands the various insurance plans that are acceptable, and how the documentation needs to be done.

ü  In order to check this, the primary step will be to check for the eligibility verification of the patient.

ü  It is better to call up the insurance company or access their website on the Internet to get to understand the particular plan better before documenting it.

ü  Better still if the optometrist were to instruct the staff to have a binder handy, containing all the various insurance plans.

ü  Before documenting a plan in the medical insurance verification of chief complaint and the diagnosis plan are essential.

ü  It is also a good idea for the staff to inform the patient about his or her copay for the particular exam.

Similarly, when a problem is listed without the relevant plan, the healthcare staff may be able to understand the case and decide upon its severity. However, the auditors may give it a cursory glance and may not be able to understand it fully. Unless there is proper and complete documentation, the complexity of the case cannot be inferred at the time of review.  Hence it is important to document an accurate and detailed description of the condition the patient suffers from and an appropriate plan for it. Any plan has to be clearly documented as it indicates the problems that were managed by the optometrist.

Some more points to remember:

  • Staff should realize that patients walking in with eye injuries, infections in the eye, cataract or any other eye ailment related to diabetes, these are covered by medical insurance
  • Vision Service Plan (VSP) offers full coverage for eye care or eye exam. If there is copay, the payment has to be done at the time of service.
  • Medicare also covers eye examination, though refraction is not covered.
  • Medicare also offers coverage for eyeglasses only for the first time after cataract surgery.
  • However, purchase of other eye care aids like contact lenses, eyeglass frames, coatings etc are not covered under Medicare.

Hence, it is important to have an understanding of the benefit plans of every patient that walks in, which will play an important role in ensuring a smooth revenue cycle management for Optometry billing.

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