We are currently working towards being able to file Medicare glasses after cataract surgury. My question is this....Do you give the patients frames, to a certain amount, that is covered by Medicare, or do you let them choose anything in the store, no matter on cost, and give them an allowance? Just trying to find out what others are doing so I know how to implement in our store. Thank you, the help is much appreciated!!
Bets option I've heard is simply skip the billing process entirely. Offer your Medicare pt's something like a $90-$120 one time discount off their glasses - save all the time and headache of trying to bill Medicare for hardware, and figuring out this co-pay and that, and what they will and won't cover - and you're still more likely to come out in the black than you were going the billing and praying route. :)Originally Posted by gurry04
It's been a while since I was involved in medicare billing, but be carefull. If you are already Medicare providers I don't think you can simply skip the billing. Secondly, if you do not accept Medicare, you may still be required to submit their Medicare form for them in order for them to be reimbursement if they are elligible (that was the case when I was involved in the billing), and remember, you cannot waive their deductibles.
We just give an allowance here.
Medicare can't force you to use them to provide glasses. Give the pt an allowance as described above, and don't bother billing anything is what is being suggested. Or, if you enjoy pain and suffering...bill away! ;)
We do accept Medicare, and give an allowance toward the frame. However, sometimes the say "I want what Medicare will pay for". So we have lower priced frames for this person, and use it as an outlet for older frames we want to move out. The problem with giving an allowance is this person. How is that person able to cover the costs involved in a basic bi/tri and frame if you do not bill Medicare.
I believe you may need to pony up several hundred dollars for a bond to become a provider.
This bond fund was instituted to give the government a chance to get money back from those who commit fraud. Unfortunately it was aimed at those who commit millions of dollars in fraud but didn't take into account little guys like us who can't justify the expense as it costs us anyway way more to acquire the bond than we ever do in medicare business.
At some point Washington will realize that the law needs a tweak, or my guess is Obamacare may take over with basic eyewear coverage at some point in the not too distant future and post cataract glasses will/may* be in that. Until then we just tell them we'll give a discount which is more often than not greater than the programs reimbursement. If they want to use the "benefit" they should call around to see who will do it.
(*Here's an example of a multimillion dollar current annual entitlement benefit that may be given back for those of us 55 and younger in the name of entitlement reform.)
Last edited by Uncle Fester; 01-25-2013 at 03:37 PM. Reason: punctuation tweak and another thought...
DON"T DO IT!!! Medicare wants you to submit separate claims for what is covered and what is not covered. The only reason I can figure for 2 submissions is so that it counts towards the patient's deductible. They don't care if you have all the correct codes..they want 2 submissions. It is an absolute nightmare. We submit the form for the patient. The patient pay us, and Medicare reimburses them. The bond is $505.00 and you have to jump through hoops
I'm surprised post cataract glasses haven't been discontinued. They were originally covered back in the day that there were no IOLs and the patient had a post surgery Rx of +14.00.
Now with the surgery Rx is minimal. DME specs should have been discontinued long ago.
Harry
[QUOTE=Uncle Fester;450605]I .
At some point Washington will realize that the law needs a tweak, or my guess is Obamacare may take over with basic eyewear coverage at some point in the not too distant future and post cataract glasses will/may* be in that. Until then we just tell them we'll give a discount which is more often than not greater than the programs reimbursement. If they want to use the "benefit" they should call around to see who will do it.
QUOTE]
Yes there are hoops and expense to deal with to be a listed provider, however if you are in an environment with Medicare that makes it worthwhile, it can be a help to business. There is a small learning curve to submitting claims, but with a little bit of diligence it becomes easier to deal with. We use a clearinghouse that submits our claims (added expense), but the go through the claim and alert you of an issue to clear up before it is submitted for consideration, then Medicare forwards the claim to the supplemental insurer if they have one listed with them. We find these hoops and expense worthwhile for us. (It keeps them in the store for extra glasses and future needs)
We take it here, and it works out to:
$56.84 on the frame
$110 on lenses. (medicare covering %80 of this amount and coinsurance covering the rest, if no coinsurance they are responsible for the 20%)
we do a LOT of surgeries on site, so its worthwhile for us to offer it. and we're one of the few people in the area who carry it also so we get some walk ins. with the "fees" and stuff if we were a smaller office its not really worth the hassle. and now they're getting so picky and kicking them back for every tiny thing we probably won't take them much longer. you make all of your money on add ons like Trivex, poly, AR, transitions, and progressive upgrades, the things medicare doesn't cover. we have a set of frames that we say are "covered" just our value board frames and lenses, but there isn't a warranty or anything since they're "bulk" stuff.
"what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy
It depends first if they have a supplemental or not. Randall Tibbs is right, if you don't follow the rules it can bite you. The best way is if you do a lot of medicare is to give the dispensary a seperate business entity, it gives you some walk around room with the rules.
We provide post-op cataract glasses through Medicare and we have value frames for the patients to pick from, like others have mentioned already. We allow them a basic lined bifocal or trifocal lens, but anything besides that comes out of their pocket. They have to sign waivers saying they know they're getting non-covered add-ons, but that's pretty much it. It's a pain sometimes. In my first office, we would see them for their visits, but we opted out of providing glasses. Lots of times they would still get glasses from us instead of going through the hassle of finding an office that would provide the glasses.
Same as alot of others, I put my clearance frames and my low low budget frames in the covered catagory and if they want to upgrade, I give a $125 frame allowance. S/V, bifocals and trifocals are covered. Progressives and any other add-ons are regular upcharge.
We for some reason cannot accept here if Medicare is the Primary (partD) ,but we accept if it is the secondary and only the ones we know will pay. It can be a major hassle. A lot of the time we have to bill the "networK' first and get a denial to send to the "main ins" to get paid. I just do what the lady in the billing dept. tells me to do.
I am a post cataract case for the last 5 years...........................
I am a post cataract case for the last 5 years. I have standard implants. Since then my Rx is plano for distance and + 2.50 for close up.
I could fully exist with over the counter $ 2 - 3 Dollar glasses for any working distance. Why use Medicaid ?
So charge them whatever you can get away with .......................
Being a medicare provider is not enough. You have to register with DME and as others have said, there are a bunch of hoops to jump through. And although the AOA has fought the bond requirement for decades, I believe now it is required anyway. If that isn't all hard enough, many patients today have a managed care plan where their glasses are covered through the plan as an ordinary benefit. So, you have to be a member of that plan. And there are at least half a dozen of those to sign up for. Yikes.....
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