How many offices (that accept Medicare for doctors' services) collect up-front for eyeglasses? Do you allow the patient to leave without paying, and bill for the balance after Medicare pays (if they ever do)? Do the regulations on that vary from state to state? How often have you heard the magic phrase "I get free glasses, I don't pay a penny"?
p.s. - These are pseudophakics, of course.
I collect up front in full and bill for them. We had been running into alot of patients that we billed for post op specs and the patient got the medicare check....then it's worse than pulling teeth to get the money from the patient, they insist their statement said they don't owe us anything, etc...anyway, now we collect 100% and the patient gets paid directly whatever medicare decides, much easier than letting product walk out the door before it's paid for in my opinion.
Not sure if the contracts differ from state to state.
Yes....It has been a nightmare lately as many Medicare benefits are being crossed with other insurance plans that may not have the same post-op benefits.
We usually end up billing Medicare the first 52.44 for frame, 60.70 for each bifocal lens, and 13.89 for UV on each lens.
Patient pays up front for any lens options not allowed by Medicare such as frame overage, (Progressive cost - Bifocal cost), Transition, scratch warranties, etc.
We had a Medicare audit two years ago and I was shaking at the knees when they announced who they were. After turning over a few stones we were out of compliance on two things:
1. We didn't have instructions for folks to use their eyewear.....DUH:drop:
2. We didn't have a HIPPA statement displayed in our office:hammer:
I should add that these days, "Medicare" sometimes means a replacement HMO; HealthNet Seniority Plus is one we see often. I've asked them if the DMERC schedule is what they use to determine payment, but I never get a straight answer to that question from any of the carriers, or from Medicare itself.
We will bill DMERC for post op eyeglass, any other insurances patient must pay up front and get reimbursed.
For DMERC, patient must sign an ABN and pay out of pocket for the options DMERC does not cover. This has really helped since we are not chasing people for payment anymore:D
Let a Medicare recipient check in here.
I visit your office for an exam. You bill Medicare and BC&BS. if they don't pay the full amount you send me a bill for the unpaid balance. I send you a check. If I get glasses you tell my the cost and I give you a check.
Whats so difficult about that.
Getting long of tooth as my bride and I are we find ourselves spending more and more on the receiving end of the health care spectrum. In addition to our primary care doctors we see a cardiologist, orthopedist, endocrinologist, autolaryngologist and an ophthalmologist with the occasional lab tests and imaging.
I have to say that the ophthalmology encounter is the most tedious of all. These pecker heads all seem to think that we are trying to beat them out of a dollar. The guy we go to has a six page form that he wants filled out before each encounter. The office actually wants us to provide them with information on our savings account, which of course we decline to do. Paranoia. None of our other physicians are so paranoid about their fee.
Whats going on here.
What's going on here is my inability to know what (or if, or when, or how much) Medicare/Medicare Replacement carriers are going to pay for glasses. The third party is unreliable and inscrutable. The medical services aren't my department, thank goodness, because they have their problems too. We have patients from other practices, whom we have never seen before, sent to us by their insurance, to get their free glasses. When we tell them that we require prepayment, they are suspicious of a ripoff, because the glasses are free! Medicare says so! We are crooks! Trying to collect a dime several months later is hopeless most of the time. What's so difficult? All of it!Originally Posted by rbaker
Medicare has a set amount they pay on post IOL patients, ONLY. Contact thier office for reimbursement table and the RULES. Lots has changed this year, and I beleive all states are at same reimbursement rates now. They barely cover costs, but it only will apply ONCE now unless patient gets a pair in between right and left operations.
We assume what will be covered by medicare, charge patient for extras, and file 3rd party insurance for them.
Note: you cannot bill out eyewear untill they are DELIVERED, but costs and completion of the ABN must be done prior to ordering.
Certainly this would not be the case with you ( :o ), but there are a minority of patients who think when a bill is over 45 days old it magically becomes "not their responsibility." And then when it is 60-90 days old it is an irritant that they even had to bother opening an invoice, much less have to pay themselves. Sometimes they are confused by the wording and think we are paid when we have not been. Usually they are $12 or $17 co-pays their insurance would not cover, or an unpaid refraction.
I will say, however, that the vast majority of my medicare patients will pay the first week they receive a bill and are some of the most pleasant patients to deal with in almost all cases.
No doubt they could go a long way to making the process smoother for patient and provider. The amount of money medicare pays in postage alone has to be outstanding.
We take full payment up front and bill it for reimbursement to the patient.
You can find the medicare fee schedule for your area here:
http://www.medicarenhic.com/cpt_agree.shtml
We bill Medicare for exams only. If they choose to get their "free" glasses after surgery then we make them and they pay up front. We then give them a detailed reciept and they send it in themselves. Medicare told us to do just that if we preferred.
Just my humble opinion, but in general, you should be able to collect up front from your patient/customer if you know what their responsibility will be. Therein lies the difficulty.....
For allowable glasses/options my clients like to collect what they can up front:
If there is no secondary coverage, we collect the 20% of the allowable that we know will not be paid.
If there is a secondary, we wait til all is bal billed for the allowable services.
If there are any "deluxe items" that we know probably won't be covered even under a dr order modifier, i.e. progressive, we charge 100% up front for it.
Of course if they have a secondary that for some reason will pay for a deluxe item even if Medicare denies (not likely), we would refund the patient/customer.
Staff is instructed to explain all of this ( I know I know) to the best of their ability. And it really is time consuming and often confusing for everyone. But what can you do except have the patient/customer sign the ABN with explanation of all this and we also warn that we followed the Medicare fee schedule for our region, but we can't guarantee that there will not be more out of pocket due to deductibles, etc. etc.
Post cat glasses really aren't a favorite to deal with but as long as you have followed what's expected and take the time to explain that it's not as cut and dry as a "free pair", then what else can you do?
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