April 07, 2016
There is a common perception that optometrists are farsighted (no pun intended) and tend to have their cake and eat it too. This is probably nothing but a reference to the fact that they get paid through two types of plans managed by third-party payers – vision plans and medical insurance plans. However, what most people don't realize is that it is very important in optometry billing to decide which plan is worth billing. It is indeed confusing because most optometrists want to bill the medical carriers for the maximum amount permissible, and still leave the patients a happy lot.
It is probably prudent for an OD to choose the plan that will bring the maximum revenue. An eye care provider is often confused whether the optometry billing should be for a vision plan or a medical plan for the particular visit. While it is illegal to bill vision plan and medical plan for the same eye exam, it is perfectly legal to bill one or the other. For vision plans, it is important that the patient is eligible, and the diagnosis really does not matter. Medical insurance grants approval for claims based only on proper medical diagnosis and a pressing medical need. In case the patient happens to have both vision and medical insurance coverage, any one of the two plans can be billed, provided the medical diagnosis warrants it.
Alternatively, all things being equal, it is prudent to bill the plan that brings in maximum revenue, which would certainly be the medical plan. There are few other things that need to be taken into account in optometry billing like the fact that vision plans warrant lower fees when compared to medical plans. Vision plans normally cover only regular eye exams. It is for the OD or the patient to decide whether it is a routine eye exam or a medical exam. When a patient walks in to verify his or her prescription for eyeglasses, he or she should choose the vision plan. However, a patient walking in with an eye injury, or suspected glaucoma should opt for the medical plan.
It is better to take the opinion of the patient before deciding whether the optometry billing should be under the vision plan or the medical plan. All these plans would probably have terms of their own. However, one cannot discount the possibility that a medical plan will always attract a higher co-payment amount, whereas the vision plan may have not co-payment at all. The medical plan invariably does not offer coverage for refraction tests. In case the OD decides to use the medical plan without the patient's approval or knowledge, it will often leave the patient quite dissatisfied. Such patients may take the issue further with complaints, or worse still, may choose to go to a different practice from next time onwards.
It makes sense to educate the patient with flyers or handouts that explain in detail both types of plans, and what each one entails. Also, keeping the patients informed well in advance saves a lot of unpleasantness on either side. Most successful practices have trained staff handling the front desk who get a brief history of the patient at the time of fixing the appointment. The history itself will indicate whether the patient needs a vision plan or a medical plan. The patient can be informed at that point of time itself, making things a lot easier. With Medical Billers and Coders Optometry billing services ensure timely reimbursement and zero loss of revenue
Revenue Cycle Management