surviving eyemed audit tips

[chronometre]

so stressed. just got my first eyemed audit for my new office that i am in charge of. any tips on claims and patient charts. I am combing through every single patient file and I dont know what to submit or not. its crazy - i cant get anyone on the phone from eyemed that will guide me through submission either. i think one of my claims may have a prescription that expired by ONE day =(

getting skinnier by the minute

[drk]

I've never been through one. They just ask for what? Exam records, billing records, optical records?

EyeMed is not a brainy group. I'm sure they're just looking for stupid stuff, like: I billed for services for the daughter using the mother's plan. I billed for an exam but only did a refraction. I didn't bill EyeMed properly for a frame. That kind of stuff.

It's not going to be state board regulation stuff.

[NAICITPO]

so stressed. just got my first eyemed audit for my new office that i am in charge of. any tips on claims and patient charts. I am combing through every single patient file and I dont know what to submit or not. its crazy - i cant get anyone on the phone from eyemed that will guide me through submission either. i think one of my claims may have a prescription that expired by ONE day =(

getting skinnier by the minute

I wouldn't worry about a prescription being expired by one day. Your doctor can always say they verbally extended that Rx. I think they are looking for insurance fraud issues more than something like that. Are your doc's seeing patients for medical and vision on the same day? Are you billing for refraction/CL Fit when none were done? Did the medically necessary contact meet the parameters? Are you selling plano suns with insurance? I would imagine it is more stuff like that than a Rx being a day off.

The fact that you are new to the office should also help I'd imagine. Just take the tact with them that you are new and looking for any tips you can to improve the office. If you get the chance to ask what they are seeing from your billing practices that made your new office a choice for an audit so you can make sure that everyone in the office knows. And then let us know what they say

It's been several years since my office had an audit, I think they just sent a list of patients and requested all records pertaining to them.

Good luck!

[Uncle Fester]

It's been several years since my office had an audit, I think they just sent a list of patients and requested all records pertaining to them.

This.

My back office says they're just verifying what was billed is what is on the patients record.

[chronometre]

thank you all for your wonderful input. I understand eyemed does audits at least twice a year? our office is all up and up - just one of our staff mis-read a prescription expire date from a patient not from our office. we never do frame onlyfor insurance - raises too many questions. i always feel stressed when it comes to producing documents for audit. like crash studying for finals lol. they ask for charts, valid rx, materials invoices, statements - the works,

[vv0vv]

thank you all for your wonderful input. I understand eyemed does audits at least twice a year? our office is all up and up - just one of our staff mis-read a prescription expire date from a patient not from our office. we never do frame onlyfor insurance - raises too many questions. i always feel stressed when it comes to producing documents for audit. like crash studying for finals lol. they ask for charts, valid rx, materials invoices, statements - the works,

From 10 years of experience with EYEMED it's normally it's about once a year for Eyemed per location (I do audits for two locations).

Usually the Routine Eye Exam result (ie: eyeglass prescription) will suffice, never had an issue; and they're not gonna ride your *** on that. Make sure the dates and billed to insurance pricing matches your receipts (... no extra discounts over insurance etc than what their calculator suggests).

Make sure you or the practice either keep good digital invoices for frames and lenses or you'll have to call for invoices for each frame/Lab invoice/(or Nassau Lab Invoice for States that use that through EYEMED for Stock Lenses) up for Audit.

Always double/triple check everything before you submit as the Auditors only give you one chance to correct any mistakes that they find. So if you mess up twice that particular patient will be on the chopping block.

Post COVID I've seen less 3-4 Year Ago Audits from EYEMED but I have definitely seen them in the past. Keep good Records!

[iD]

we got audited (before I started) because another office snitched saying we would do (sunglass) frames only and leave the demo lenses in there. They didn't fine us but they told us from now on to sell them without the lenses for plano sun eyewear.

[chronometre]

we got audited (before I started) because another office snitched saying we would do (sunglass) frames only and leave the demo lenses in there. They didn't fine us but they told us from now on to sell them without the lenses for plano sun eyewear.

how on earth would they know if you left the sun lenses in or not? is that against the rules to provide them w the plano sun lenses?

[iD]

how on earth would they know if you left the sun lenses in or not? is that against the rules to provide them w the plano sun lenses?

they wouldn't know. but another office called Eyemed saying we are giving patients the demo lenses for sunglasses and that started an audit. This other office was mad that we were taking her patients when she should have worried about her entitled attitude (her dad is a doctor) that was making her lose business.

[Alfredo Alaniz]

Maybe this would help: https://federal-lawyer.com/healthcare/fda/compliance/

[AngeHamm]

how on earth would they know if you left the sun lenses in or not? is that against the rules to provide them w the plano sun lenses?

Yes, it is against the rules to bill a non-prescription sunglass as a prescription device. It's a fairly huge no-no.

[Michael22]

I just have the sunglasses made with a basic cr-39 prescription lens put in, and if the patient wants me to put the demos back in after dispensing, then I'll do that. I don't really see the issue with that because they were originally dispensed as prescription.

[optical24/7]

Just curious, if you have an insurance patient that is diagnosed as an emetrope, is he denied eyewear benefits, (which, UV protective eye wear does have benefits), other than your “ house” or mandated discount?



If not, then that’s a stupid way to run an insurance company….

[Michael22]

Yeah VSP and I believe also Eyemed have cut offs. So if a patient is found to have no prescription at all...they can't use their benefits to get glasses.

[NAICITPO]

I always look at the Rx and quietly curse the doc who writes +0.25 -0.25 x 90 and tells their patient we will help them get blue light lenses. One, blue light am I right? And two, need half a diopter in sphere or cyl for Eyemed or VSP.