Results 1 to 13 of 13

Thread: Billing Medicare to get a denial to sent on to BCBS for routine eyewear .

  1. #1
    OptiBoard Apprentice
    Join Date
    May 2014
    Location
    up state new york
    Occupation
    Dispensing Optician
    Posts
    15

    Billing Medicare to get a denial to sent on to BCBS for routine eyewear .

    The office manager and myself are having a issue with billing.( BIG SURPRISE ) So the Patient has medicare primary and lets say BCBS secondary and the BCBS has a benefit for routine eye wear. We can't get Medicare to take it because they don't understand the v codes and Dmerc won't pull it from the system. We have sent it point of service office 11 . Should we be changing the point of service to home 12? If any one can help it would be wonderful Thanks

  2. #2
    OptiBoard Novice
    Join Date
    Apr 2015
    Location
    North Carolina
    Occupation
    Ophthalmic Technician
    Posts
    2
    Quote Originally Posted by bwarren View Post
    The office manager and myself are having a issue with billing.( BIG SURPRISE ) So the Patient has medicare primary and lets say BCBS secondary and the BCBS has a benefit for routine eye wear. We can't get Medicare to take it because they don't understand the v codes and Dmerc won't pull it from the system. We have sent it point of service office 11 . Should we be changing the point of service to home 12? If any one can help it would be wonderful Thanks

    Did the patient have cataract surgery?

  3. #3
    My Brain Hurts jpways's Avatar
    Join Date
    Oct 2008
    Location
    NW PA
    Occupation
    Dispensing Optician
    Posts
    603
    Have you tried directly submitting to the BS plan?

    As an aside the question this raises in my head is that the only time I've seen a BS plan with routine eyewear benefits is either a Medicare Advantage plan or an employer sponsored plan. In either case the BS plan would be primary to Medicare, based on Medicare rules (as I understand them) even if the employer sponsored benefit is a spouse's benefit. (And now the actual question) So is this a Medicare Supplement with routine eyewear or one of the other plans I've already mentioned? In any case I'd just submit the BS plan because I'd figure I'd just be banging my head against the wall trying to get Medicare part B to process the claim in the way I wanted.

  4. #4
    OptiBoard Apprentice
    Join Date
    May 2014
    Location
    up state new york
    Occupation
    Dispensing Optician
    Posts
    15
    BCBS will not pay they want primary Insurance to show a denial first .BCBS just kicks it back . These Patient have Medicare primary and BCBS secondary and it is not advantage plan .The benefit is for routine eye wear not after cataract surgery. I do feel like banging my head over and over. When I called BCBS they told me they can't tell me how to bill to them and medicare was no help . Thanks

  5. #5
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
    Join Date
    Dec 2004
    Location
    At a position without dimension...
    Occupation
    Dispensing Optician
    Posts
    5,300
    What codes are you using? Frame V2020 Bifocal V2200 etc?

    Our crackerjack bookkeeper says you must bill medicare first and wait for the denial so something must be wrong with the codes.

  6. #6
    My Brain Hurts jpways's Avatar
    Join Date
    Oct 2008
    Location
    NW PA
    Occupation
    Dispensing Optician
    Posts
    603
    And what diagnosis code are you using, one of the 367s or one of the more esoteric ones like 368.8 (problems with vision)

  7. #7
    OptiBoard Apprentice
    Join Date
    May 2014
    Location
    up state new york
    Occupation
    Dispensing Optician
    Posts
    15
    We are using V2025 for frame and V2200 etc . V72.0 is diagnosis code. My issues is Medicare will not pull from the system does not understand v codes so I can't get an denial so should it go to Dmerc instead?. If so Point of service home or office . SOOOO many Questions I LOVE INSURANCE

  8. #8
    OptiBoard Moron newguyaroundhere's Avatar
    Join Date
    Nov 2014
    Location
    Pittsburgh
    Occupation
    Dispensing Optician
    Posts
    477
    The code may be wrong. I know when I bill for glasses with Dmerc the only code I can use is V43.1 for post cataract glasses
    Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity

  9. #9
    Paper Shuffler GOS_Queen's Avatar
    Join Date
    Dec 2004
    Location
    Portland Metro
    Occupation
    Other Eyecare-Related Field
    Posts
    1,533
    Howdy - I suggest using dx 367.9 (verses the V72.0). Location should be 12 - modifier gy (non medicare covered service) bill to DMERC (not medicare)

    I bill glasses all day long - i'm in jurisdiction D

  10. #10
    Rising Star walleye's Avatar
    Join Date
    Apr 2004
    Location
    Lansdale, PA
    Occupation
    Optometrist
    Posts
    353
    As far as I know Medicare NEVER pays for glasses on a routine basis. They only pay DMERC providers for post cataract glasses under diagnosis code V 43.0
    You have to bill their BC/BS provider or maybe they really have a BC/BS HMO and Davis Vision or another third party is the eyeglass provider.
    We bill Medicare directly and sometimes our billing provider sends it back and says xxx HMO is the primary. The patient may not even know.

  11. #11
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197
    We have to do this too with our medicaid. As GOS_Queen stated, you got to bill DMERC not Medicare for the glasses. There is a difference. They will recognize the codes, then you can get your denial to send in.

    One of the many hoops insurers make you go through to get paid...
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  12. #12
    OptiBoard Apprentice OptiBoard Bronze Supporter
    Join Date
    Aug 2012
    Location
    florida
    Occupation
    Dispensing Optician
    Posts
    48
    We have come across this a few times. What you have to do (what we did to
    get paid) is send an actual copy of the MC denial along with the paper claim to BC/BS together. It's a royal pita but that's what we've done. Hope that helps...

  13. #13
    Bad address email on file
    Join Date
    Dec 2013
    Location
    Bluefield, West Virginia
    Occupation
    Dispensing Optician
    Posts
    14
    I use 367.4 as my diagnosis code. and then v2020 and v2203 etc etc. I haven't as of yet had any issues receiving a denial from medicare to send on to the secondary insurance. And my service office code is 12.

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Billing Routine Exams
    By jdf in forum General Optics and Eyecare Discussion Forum
    Replies: 2
    Last Post: 02-20-2015, 06:49 PM
  2. Medicare and Medicaid billing
    By Dr. B in forum General Optics and Eyecare Discussion Forum
    Replies: 4
    Last Post: 08-05-2014, 08:01 AM
  3. Billing/coding BCBS routine
    By matt2939 in forum General Optics and Eyecare Discussion Forum
    Replies: 1
    Last Post: 02-26-2014, 11:24 AM
  4. Medicare billing
    By RhondaJ in forum General Optics and Eyecare Discussion Forum
    Replies: 5
    Last Post: 05-31-2011, 09:35 AM
  5. Help with Billing After-Cataract Glasses Medical Necessity to BCBS
    By FosterB in forum General Optics and Eyecare Discussion Forum
    Replies: 3
    Last Post: 04-29-2011, 09:47 AM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •