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  • surviving eyemed audit tips

    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

  • #2
    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.

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    • #3
      Originally posted by chronometre View Post
      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!

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      • #4
        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.

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        • #5
          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,

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          • #6
            Originally posted by chronometre View Post
            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!

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            • #7
              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.

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              • #8
                I haven't experienced one of these audits before. What exactly do they request? Exam records, billing records, optical records? EyeMed doesn't strike me as particularly thorough. I suspect online plinko game experience they're mainly interested in trivial matters like: billing for services for a daughter under the mother's plan, billing for an exam but only performing a refraction, or improper billing for frames. It's unlikely to involve state board regulation matters.
                Last edited by Rachael72; 03-06-2024, 09:45 AM.

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                • #9
                  Originally posted by iD View Post
                  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?

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                  • #10
                    Originally posted by chronometre View Post
                    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.

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