Ophthalmology and Optometry medical billing can be challenging if the practice does not take the initiative to gather all necessary information before the visit date. The first step toward providing the best possible care to patients is to understand their needs and establish clear, effective communication. Billers need detailed insurance information in order to submit clean claims and patients need to be aware of the benefits and limitations of their coverage. Knowledge is the key to successful billing.
Well-trained office staff will always ask the right questions in order to understand what type of eye care a patient needs. For eye health issues, patients might have both medical and vision coverage. The office needs to confirm if it will be a yearly vision exam with refraction and/or contact lens fitting or will the visit be for a medical issue such as itchy or infected eyes, flashes or floaters, blurred vision, etc. One thing not to do is to assume that the patient will know which insurance will be billed and what will be billed.
Once the need is established, the next step is to explain to the patient the extent of insurance coverage for the visit and the patient’s options for charges to be billed. A few extra minutes spent on the phone and on the day of the exam with patients will save hours later in following up with both insurance and patient for payments.
Ophthalmology and Optometry Medical Billing: Basic Guide
The following is some basic information that Ophthalmology and Optometry staff needs to know in order to maintain a well-managed practice.
Vision Plans:
Typical vision insurance plans cover an annual eye exam, and prescription check for eyeglasses and/or contact lenses. They will also partially cover the cost of materials, such as frames, lenses, contact lenses, etc. Some plans will have these benefits every 24 months or longer, instead of yearly benefits. To avoid any surprise billing, the office must verify coverage before appointing patients.
Vision plans, such as Blue Vision, Davis Vision, EyeMed, March Vision, Spectra, VSP, etc have different plans for patients to choose from; therefore, it is important not to assume the type of coverage. Many Medicare advantage plans now have vision coverage as well. Tricare and Medicaid plans also might have vision coverage for members. The best policy is always to verify coverage before an appointment. Some vision insurance, such as VSP, might also offer limited medical coverage for patients with certain medical conditions, such as Diabetes.
Medical Plans:
Medical plans mostly cover visits related to medical diagnosis and treatment. Patients coming to an eye doctor might automatically assume the visit will be billed to vision insurance, especially if the patient will be seeing an Optometrist. Vision insurances have little to no co-pays. They also do not have any co-insurance or deductible. Medical insurance might have higher co-pays, co-insurance, and deductible amounts.
If the patient is making an appointment for a medical issue; the provider’s office needs to clearly explain to the patient which insurance will be billed and why. When possible, it is always a good idea to collect any due amount on the day of the visit with a clear explanation to the patient for the reason for the charges.
