Benefit Plans for Optometry Billing for Maximum Revenue

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Benefit Plans for Optometry Billing for Maximum
Revenue
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 a 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 the 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.
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Benefit Plans for Optometry Billing for Maximum
Revenue
There are a 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 the 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.
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Benefit Plans for Optometry Billing for Maximum
Revenue
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. To know
more about our Optometry billing and coding
services, contact us at info_at_medicalbillersandcode
rs.com/888-357-3226.