Medicare Post Cataract Surgery Reimbursement form?

[TEdFitz]

http://www.cms.gov/Medicare/CMS-Form...0s-english.pdf


*Originally posted by Ihavespecialeyes and a long user

[Bev Heishman]

Is this across the board or are there circumstances when they will reimburse the patient directly?

Post operative glasses are provided by a supplier that is not enrolled in DMEPOS, the normally "covered" services and materials will be classified "not covered" and payment is the responsibility of the patient. The same applies if a doctor is not enrolled in Medicare (No NPI).

[Bev Heishman]

Bill using the V43.1 Psuedophakia code alone. Even if only one eye has been done. Also code the correct modifiers and surgery dates.

[Bev Heishman]

Since @fezz has brought up this lovely insurance topic anyway, does anybody know about them covering AR, progressives, and transitions? we have always been told *and told the patients* that medicare will cover the cost of a basic FT-28 and $50ish dollars on their frame, all of the overage (i.e. poly and up, trans, ar, prog upcharge) comes out of their pocket. But then one of our billing people told us this may not be the case anymore? bueller??

/hijackedsorryfezz!

Poly, AR are billed only if the Dr's Rx has medically necessary on it. Proper documentation needs to be maintained.

[ldyflsh]

they also want "non covered" services on a separate claim form. I called Medicare on it and they stated the claims must be "split". My question to them was, why should I submit it, if it's NOT covered...geesh

[Bev Heishman]

If you don't they reject. I agree it is a game.

[becc971]

i believe its called the "insurance tango"

[becc971]

*bump* strange question my boss asked me today. does an optical need to be a certain amount of sq footage to file to NHIC/DMERC after cataract surgery?

[becc971]

oh AND i did track down a nifty sheet that has all of the reimbursement amounts for providers in CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI and VT, also a good simplified version of how to file the claims if anyone wants it i can e-mail it to you :)