Medicare billing questions

[Dr. B]

"I'm new to Medicare billing so bear with me, please. Is it allowable for me to collect the 20% allowable and refraction fee (92015) up front. In completing my HCFA forms, I don't know how to fill in the 'amount paid' by patient area at the bottom of the form.

A friend had told me to always put in -0- even if the patient had already paid their allowable or for any non-covered services up front. If any figure was entered into that box, Medicare would automatically send the check to the patient. I really want to do things the correct way. Can someone give me some advice? Also, my carrier (Arkansas Blue Cross/Blue Shield) is located down in Baton
Rouge.

I've been unable to reach them since Hurricane Katrina struck. Anyone know
how long I have before I can still file these claims. Is there a time limit?"

[Joann Raytar]

http://www.lamedicare.com/provider/v...articleid=2173

Be assured, all electronic correspondence, including Electronic Funds Transfers (EFT’s) will function as usual, however please touch base with your perspective financial institution regarding their operational status.

[Spexvet]

Disclaimer: this is my understanding, and not necessarily Medicare policy:

Is it allowable for me to collect the 20% allowable

You can for product, but not for service.

and refraction fee (92015) up front.

Yes, as there is no allowable for the refraction fee.

In completing my HCFA forms, I don't know how to fill in the 'amount paid' by patient area at the bottom of the form.

If it is for service, it should be zero - you haven't taken the 20% for an allowable item, and you shouldn't list the refraction fee, as there is no allowable.

A friend had told me to always put in -0- even if the patient had already paid their allowable or for any non-covered services up front. If any figure was entered into that box, Medicare would automatically send the check to the patient.

True.

Anyone know how long I have before I can still file these claims. Is there a time limit?"

Must be recieved by Medicare withing one year of the date of service.

[Stopper]

spexvet,

We always collect the 20% of the allowed amount for services(unless they have a secondaryinsurance) and have never had a problem.It save the trouble of having to bill them later. You should also list the refraction so medicare will deny it and the amount will be listed as the patients responsibility on the EOB or you may get some patients arguing later that they don't have to pay it.

[shellrob]

Yes, you should list the fraction so the patient can see it's their responsibility to pay. Otherwise soem of them question why you didn't bill Medicare because then maybe they would've paid(we all know they won't). Just saves headachees and makes it easier to collect. We collect everything upfront.

[Spexvet]

Thank you. :cheers:

[marlin1015]

I am new to filing for medicare:idea:

hey
Is there a template type form for filing Medicare for post cataract
glasses
For example the filling in the CMS1500 form part c-k
If you can help me great .
I am just learning and could use the help:hammer:
thats all I need
Just a basic on how to file medicare for glasses
if you could provide me with something to follow

[chip anderson]

I'm not sure but I think this has changed. Used to be the surgeon that removed the catarac couldn't be compensated by medicare for the post surgical glasses.

[ilanh]

You can, and should, collect the refraction fee upfront. And you should list 92014 on the billing even though you don't intend to get paid for it by Medicare. It's important for the patient to see on their EOB that this was an "uncovered" benefit. However, we do not collect the 20% co-insurance even if the patient does not have a secondary. We always bill the patient for this after billing medicare. I must admit that it sounds a lot better to be collecting that 20% upfront than waste time billing for it later. We have always been a bit reluctant to do this since we felt that it may annoy some patients.

[drk]

92015 :cheers:

[Echo419]

You should list 92015 and fee, do collect refraction and 20% and if you are accepting assignment leave patient paid area 0.00. Also I'm suprised Medicare is still accepting paper claims. Go electronic they are going to mandate it any way.

[MarcE]

What would the ramifications be if we were to NOT break out the refraction portion of the exam and also not charge the pt. But bill the bundled exam fee plus refraction to Medicare. In my 'example' there is no 92015 being filed. The payments are the same because our fee for bundled exam and refraction are less than the Medicare allowable.

Is it illegal?
Are we asking for trouble if we are audited?

[harry888]

When you bill the refraction (92015), use the modifier "GY".

It shows you know medicare won't cover it, but it still will get sent to the secondary which sometimes pays for the refraction. In my state, medicaid pays for the refraction when it is the secondary.

Anything medicare rejects as not covered will not get sent to the secondary unless you have the gy.

Harry

[k12311997]

What would the ramifications be if we were to NOT break out the refraction portion of the exam and also not charge the pt. But bill the bundled exam fee plus refraction to Medicare. In my 'example' there is no 92015 being filed. The payments are the same because our fee for bundled exam and refraction are less than the Medicare allowable.

Is it illegal?
Are we asking for trouble if we are audited?

I would say there would be trouble, but I'm no lawyer.

imagine the audit... Why does this patient have a Rx no refraction was billed. multiply that times every patient and then get ready to write a big check.

Just like taxes you want to do everything to not get noticed. I think if you suddenly stoped billing refractions but the total amount stayed the same it might send up a flag after awhile.

[chip anderson]

If one does a "complete eye exam" hasn't a refraction been performed in the process of same? Are we not just fussing about how can we get and extra fee for same or fail to give the patient a copy if we can't get paid extra for it? Seems that when I call for Rx's at prescribers offices, they seem to be able to give me one, or have one that the patient "can come by at the office and pick up for a signature and extra fee."
The fact that you don't bill for something doesn't mean that "you could not legally have done one." Some great agency from the thought police isn't going to put you in the place of no darkness if you give the patient, but do not bill for a spectacle Rx.

Chip

[MarcE]

If one does a "complete eye exam" hasn't a refraction been performed in the process of same? Are we not just fussing about how can we get and extra fee for same or fail to give the patient a copy if we can't get paid extra for it? Seems that when I call for Rx's at prescribers offices, they seem to be able to give me one, or have one that the patient "can come by at the office and pick up for a signature and extra fee."
The fact that you don't bill for something doesn't mean that "you could not legally have done one." Some great agency from the thought police isn't going to put you in the place of no darkness if you give the patient, but do not bill for a spectacle Rx.

Chip

It's NOT a way to extract more money. My concern is could we have problems from Medicare (remember that we have to follow their rules if we accept their payments) if we bill Medicare for the "complete eye exam w/refraction" instead of requiring the patient to pay for the refraction portion? In my example we have transferred the refraction portion of the exam from the patients bill to Medicare's bill by bundling it with the "complete eye exam".

K123XXX helped me distill my thoughts. I agree with him/her

[k12311997]

It's NOT a way to extract more money. My concern is could we have problems from Medicare (remember that we have to follow their rules if we accept their payments) if we bill Medicare for the "complete eye exam w/refraction" instead of requiring the patient to pay for the refraction portion? In my example we have transferred the refraction portion of the exam from the patients bill to Medicare's bill by bundling it with the "complete eye exam".

K123XXX helped me distill my thoughts. I agree with him/her

I won't let it go to my head and I'm a him by the way.

[AutumN]

To my understanding, your only going to get what medicare approves regardless of the refraction included or not (if you par). Medicare considers the 92015 as a procedure, albeit, a non-covered procedure and is collectible at time of service. Medicare also requires an ABN (Advance Beneficiary Notice) be signed by the patient indicating that you have informed the patient that it's a non-covered service. Really this should be done prior to the procedure so a patient can refuse if they want. When you bill the 92015 you should use the GY modifier and this tells medicare you have an ABN on file and then the patient's EOB with say it's non-covered and their responsibility. If there's no GY they assume your didn't tell them and then the EOB says non-covered not their responsibility. If a patient sees this and complains to you or god forbid medicare, then you have to reimburse the patient. Then get ready for an audit.
As far as eyeglasses, the same thing applies. ABNs & Modifiers are required for any non-covered items--basically add-ons. If it's a required add-on like poly for a one-eyed patient or prism, then a KX modifier is used to indicate that it's medically necessary.

If you go on-line to your carrier, you'll find all the Vision codes for billing as well as the modifiers and what they're used for. I've had alot of dealing with medicare and know the ins and outs pretty well. If you need any help feel free to PM me.

[chip anderson]

AutumN: Alway Capitalize God!

[AutumN]

Chip: Just because I know my job, (something I'm paid to do), doesn't mean I'm a money monger or that the practice I work for is. I take offense. I simply spewed coding facts. What a practice does with that info is their business. In our practice routine exams with the OD the refraction is included in the cost and in line with any other OD exam. The majority of the MD's exams are medical in nature and a refraction is done for medical purposes The only time they charge for that service is if an Rx is given. Many times a refraction done with a medical exam is covered by their private insurance as well. We only give an Rx when there is a real change (not just +/-.25), or if the patient requests. When getting this Rx the patient is told they are more than welcome to use our optical or take it to an optical of their choice. So, Chip, in the infernal words of my 15 year old "whateverrrrrr"

Dr. B & Marlin1015: I apologize for my capitalistic knowledge. I was only trying to help.