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Thread: Medicare, ABN & glasses

  1. #1
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    Medicare, ABN & glasses

    Hi everyone;)...this looks like a great informative site. This is my first time posting on this site, but hopefully someone can help me out.

    We were in the process (end of 2007) of signing up as Medicare non-par providers. So during the application process we were still seeing MC pts, collecting our usual and customary fees and telling them once we get our provider # (which finally arrived 4mo later ) we'll courtesy bill for them and any reimbursements from MC will go directly to them. This actually worked for the exam portion billing...

    But for DMERC and glasses after surgery, they are telling us MC won't pay because dispense/service date was prior to receiving our supplier number. This whole MC stuff is so new to our office that we just found out about this ABN form. So during the applic process we didn't have anyone sign an ABN. Now these claims that we put through with dates prior to getting our supplier # are being denied and we're supposed to refund the pt.

    Is that right? If they're going by disp/service DATES then on those DATES we weren't OFFICALLY providers? Did we still have to get the ABN signed? If we do need to refund their money can/or should we ask for the glasses back?? Or they just got a pair of free glasses from us?

    So sorry this is so long winded but if anyone can help i will be so grateful!
    Thank you:)

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    Master OptiBoarder Ginster's Avatar
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    REF; ABN Form

    The only time they have to sign the ABN form for medicare, is if they purchase an add-on over and above what medicare pay's and for a frame that is over and above the frame fee. That is my understanding. Make sure they sign both sides of the form. I don't know anything about the
    other issue regarding the Id#. Welcome to OPtiboard. :)


    Good Luck Ginny:cheers::cheers:

  3. #3
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    Thanks Ginny! I'm just confused on all this Medicare stuff! So all this stuff is after the fact...We can't have those pts sign and ABN for now because we've already seen them and they've already paid for their glasses? So if we're not a Medicare provider we can't even see Medicare pts?? If we did are we in big trouble? What can we do about the pts we've already seen? HELP!:(

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    Don't Know

    Quote Originally Posted by drxtine View Post
    Thanks Ginny! I'm just confused on all this Medicare stuff! So all this stuff is after the fact...We can't have those pts sign and ABN for now because we've already seen them and they've already paid for their glasses? So if we're not a Medicare provider we can't even see Medicare pts?? If we did are we in big trouble? What can we do about the pts we've already seen? HELP!:(

    I don't think you can re-coupe your losses on past pt's, on the exam or the glasses, but as far as being in troube? I'm not sure about that. I just wanted to let you know about when the Pt. signs the ABN form for in the future when you do get your approval. It sounds like you need to contact them and find out more info about what has happened. Tell them the truth and say you thaught that you could start persueing claims while the paper work was in process. that nobody told you any different. I would think you are just out of alot of money your self, there was no fraud because your claims to Medicare were denied. Remember, I'm not an expert in this by any means, I'm just going off my common sense and education from Coding and Billing School seven years ago, alot has changed since then including laws.

    Good Luck:)

    Ginny

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    Abn

    My understanding is they must sign, and you file a copy of the ABN for any service not covered, i.e. refraction, photos, etc.

  6. #6
    Master OptiBoarder Ginster's Avatar
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    My ABN Form

    Quote Originally Posted by treysdad View Post
    My understanding is they must sign, and you file a copy of the ABN for any service not covered, i.e. refraction, photos, etc.
    I am Looking at mine right now and it say's nothing about services performed during the exam. Medicare does not cover refractions and the Pt. is responsible yes, but the form say's nothing about exam services just the glasses. I just checked with our front desk staff and they told me they no longer deal with ABN forms for any services on Medicare Patients. Medicare stopped that a long time ago. And yes it is for exactly what you stated anything over and above the usual and costomary services that Medicare provides for glasses. To the origional Poster, go to Vision expo West in Vegas this year and take the courses for Medicare Billing and coding for your claims, if you feel you will get alot of referrels and Pt's from being a Medicare Provider it might be in your best interest to hire a billing and coding specailist that is strong in Medicare Claims.

    Ginny;)

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    thanks!

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    Does anyone know if there is a time limit for getting glasses through medicare after cataract surgery? For example if it's been 2 years and the patient is just now getting a pair? For some reason, I thought it was a 1 year after surgery limit, but there has been some discussion about this recently.

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    Mervinek, there has been a long discussion about this on a FB opticians group I am in and based on everyone's responses it looks like it varies state to state. In GA there is a one year limit post most recent DOS. I have seen others say they have filed for and been paid for glasses years later. I would check with your local DMERC provider.

  10. #10
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    Thank you for your help! It is much appreciated.

  11. #11
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    I'm with GAgirl, here in Idaho there is no time limit. The catch is they only pay for it once though. The other thing to watch out for if they only do one eye vs both eyes. In my experience if they have surgery on one eye only they don't as much if it had been two eyes.

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