After cataract surgery Presciptons

[ioptical72]

I have researched and can not find the answer to my question. I work for an ophthalmologist and on the prescription given to the patient we will write "cataract surgery". The patient, of course, has the option to purchase eyewear from me (and I am a dme for Medicare) or take the prescription. My question is this: I had another optical facility to call me and tell me they needed a prescription for Jane Doe that included her surgery dates, the diagnosis code, and the date written BESIDE the dr signature. Not the date of the exam itself but whenever the actual prescription was signed by the doctor. My issue is this. The patient should have their implant cards telling of the surgery dates, if you're a qualified dme provider you should know the diagnosis code, and why does the date have to put beside the dr signature? Isn't it good enough at the top of the prescription itself. If I am required by Medicare to provide this then so be it. Just want to know once and for all.

[Hayde]

Still slogging my way through the DMEPOS mud, but that seems consistent with what I've read so far. I've seen (unverifed internet chatter) that DMEPOS providers had best verify a prescribing post-op doc is registered on "PECOS" or else the referral is invalid and the eyewear claim is subject to rejection. Have no idea if that's the case or not. But I have it on good authority that the surgery diagnostic code and dates are required for claim submission either way. Not sure if that has to be on the Rx itself, but I bet records from the surgeon's office to that effect ought to suffice.

Will be watching and hoping you get a better answer, io. I fully intend to leech off of it. Thanks for the question.

[CCGREEN]

ioptical72
Great to know I am not the only one that has been down that road lately. I bet you got your call from one of those big box stores and the name begins with a big W and ends with a T. But yes I got the same kind of call about the same stuff. They are just doing as someone above them is asking.
But I must concur with you sir. If they are going to be legit DME providers then they must learn to ask for the Sx implant cards which will give them Sx dates. Probably be good if they can get their hands on a list of the codes if they are going to be filing.
And as far as the date by the signature......put any date you want to down there. We are not the ones filing it, they are. I am yet to see where medicare is requiring that of the Dr.

[ioptical72]

Yes. It was that exact one. And I asked her if she knew the dx code. She did. I told her I would research this because I am not aware of Medicare requiring this on the Rx itself. I do know on the actual claim that is submitted for the eyewear you have to include the surgery dates. It just frustrates me because I do not have time to do their job.

[ioptical72]

Yes. For the CLAIM submission you have to include dx code and dates of surgery. They wanted it written on the actual Rx itself.

[CCGREEN]

codes, dmc numbers and sx dates ON the rx is just a convenience for the one filling the Rx. Nothing else. All that information is transferred onto a claim form. You jack up one letter on that claim for it will be rejected. It seems they look for reasons to reject it. Yes it is information needed to file a claim........but ON the rx? I think not.
Personally a date by the signature, I feel is a bunch of bunk until I see it come from a reliable source. This is the second time in a MD's office. I have spent the last 8 years in this location, we file all the time. I have yet to see any info like the date by the signature.

[CajunOptician]

ioptical72
I bet you got your call from one of those big box stores and the name begins with a big W and ends with a T. But yes I got the same kind of call about the same stuff. They are just doing as someone above them is asking.
But I must concur with you sir. If they are going to be legit DME providers then they must learn to ask for the Sx implant cards which will give them Sx dates. .

Indeed. Plus, Walmart has recently updated its Medicare billing procedure, so there's even more of a circus act we are forced to go through just to file on the patient's behalf. In order for any Medicare claim to be filed on behalf of the patient, the RX must meet certain qualifications. In addition to what is standard to be included on the RX, it must also include: the prescribing doctor's NPI #, diagnosis codes for the procedure (since we don't do the filing ourselves, it is unlikely that many opticians know the correct codes), the date of the procedure, and a date next to the signature of the doctor.

Now a story from the opposite end of the spectrum. I am in consistent conflict with a local Ophthalmologist's office with multiple doctors on staff whose prescriptions they hand off to patients does not have a single doctor's name listed anywhere on the prescriptions. The last two times I have communicated with the office manager about this, I was told that the doctors and technicians simply don't have time to update their prescriptions to be compliant with Medicare. So I am forced to turn away any Medicare patient who attempts to use those prescriptions for post-cataract eye wear.

[rbaker]

Slightly off topic but I am surprised that the taxpayer is still paying for post cataract lenses what all with the advent of interocular lenses.

[Robert Martellaro]

So I am forced to turn away any Medicare patient who attempts to use those prescriptions for post-cataract eye wear.

I'm using this form because I'm no longer enrolled in medicare. Make sure to write on the form "My optician is not enrolled in Medicare".

http://www.cms.gov/Medicare/CMS-Form...CMS012949.html

Slightly off topic but I am surprised that the taxpayer is still paying for post cataract lenses what all with the advent of interocular lenses.

Me too. We should have stopped covering eyeglasses 25 years ago.

IOL recipients usually need eyeglasses part time for distance, and full time for near, essentially the same as pre-op. Before IOLs, most folks went from not wearing a distance correction, to wearing extremely complex and strong eyeglasses full time for both distance and near.

[CME4SPECS]

Robert, I thought that medicare would no longer reimburse the patient.

[CajunOptician]

Also, today I sent a feedback email to one of our regional Walmart Health and Wellness directors regarding these new procedures. He responded that this policy regarding post-cataract prescriptions is originating from Medicare and not Walmart.

[Robert Martellaro]

Robert, I thought that medicare would no longer reimburse the patient.

I let my NPI number lapse because of the low volume of post-op cataract clients, the huge number of hoops I had to jump through to extend it, and the ability to use the cms 1490s for direct client reimbursement.

I had a client earlier this year have a claim rejected, but she was told by her Medicare representative that they or I had to write 'my optician is not enrolled in medicare' on the form. They were going to run it through again, and I heard no more. But just last week a client had a claim rejected, so maybe they changed the direct to client reimbursement policies recently. But this Medicare link still points the patient/client to the 1490s form.

http://www.medicare.gov/claims-and-a...e-a-claim.html

[optical24/7]

Medicare isn't worth fooling with, and I have plenty of post-op catx clients. I let our NPI lapse too. I just give an equevelent discount off their 1st post-op glasses. Win-win.

[Robert Martellaro]

Medicare isn't worth fooling with, and I have plenty of post-op catx clients. I let our NPI lapse too. I just give an equevelent discount off their 1st post-op glasses. Win-win.

I agree. But why does Medicare point to their 1490s form, and then refuse payment? I'm concerned that I've been passing out bad information to my clients. What a mess.

[Java99]

I believe they did change the policy about reimbursing the pt after the fact. I know we tried to help our customers do that a couple times in early 2013 and it was a no go every time even with the 1490s.

[Gizzo]

The last time I even thought about dealing with any aspect of medicare was 1989. I am curious what the gov't would pay (if they did pay)? I have always just 'guessd' at what a reimbursement may involve in time and money and assure the client they will be more than satisfied by my 'medicare discount'. Do any of you use a %? Or do you know what Medicare pays per item? How do ya'll calculate said discounts?